Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117 (USA).
Department of Physical Therapy, Mercer University, Atlanta, Georgia.
Phys Ther. 2019 Mar 1;99(3):329-338. doi: 10.1093/ptj/pzy160.
Children with cerebral palsy (CP) frequently present with secondary impairments in spinal alignment and extremity range of motion, endurance for activity, and muscle strength. Creation of developmental trajectories for these impairments will help guide clinical decision-making.
For children in each level of the Gross Motor Function Classification System (GMFCS) this study aimed to: (1) create longitudinal developmental trajectories for range of motion (Spinal Alignment and Range of Motion Measures [SAROMM]), endurance (Early Activity Scale for Endurance [EASE]), and functional strength (Functional Strength Assessment [FSA]); and (2) develop age-specific reference percentiles and amount of change typical over 1 year for these outcomes.
This study used a longitudinal cohort design.
Participants comprised 708 children with CP across GMFCS levels, aged 18 months up to the 12th birthday, and their families. In 2 to 5 assessments every 6 months over 2 years, trained therapists performed the SAROMM and FSA, and parents completed the EASE questionnaire. For children in each GMFCS level, longitudinal trajectories using linear and nonlinear mixed-effects models from all visits, and reference percentiles using quantile regression from the first, 12-month, and 24-month visits were created for each measure.
Longitudinal trajectories and percentile graphs for SAROMM, FSA, and EASE were primarily linear, with different performance scores among GMFCS levels. There was much variability in both longitudinal trajectories and percentiles within GMFCS levels.
Limitations included a convenience sample and varying numbers of participants assessed at each visit.
The longitudinal trajectories and percentile graphs have application for monitoring how children with CP are performing and changing over time compared with other children with CP. The resources presented allow therapists and families to collaboratively make decisions about intervention activities targeted to children's unique needs.
脑瘫儿童常伴有脊柱排列和肢体活动范围、活动耐力和肌肉力量等继发性损伤。这些损伤的发展轨迹的建立将有助于指导临床决策。
对于每个粗大运动功能分级系统（GMFCS）水平的儿童，本研究旨在：（1）为运动范围（脊柱排列和运动范围测量 [SAROMM]）、耐力（早期耐力活动量表 [EASE]）和功能力量（功能力量评估 [FSA]）创建纵向发展轨迹；（2）为这些结果制定特定年龄的参考百分位数和典型 1 年内的变化量。
本研究采用纵向队列设计。
参与者包括 708 名 GMFCS 各级脑瘫儿童，年龄从 18 个月到 12 岁生日，及其家属。在 2 至 5 次评估中，每 6 个月进行一次，为期 2 年，经过培训的治疗师进行 SAROMM 和 FSA 评估，家长完成 EASE 问卷。对于每个 GMFCS 水平的儿童，从所有就诊中使用线性和非线性混合效应模型以及从首次就诊、12 个月就诊和 24 个月就诊中使用分位数回归为每个测量值创建纵向轨迹和参考百分位数。
SAROMM、FSA 和 EASE 的纵向轨迹和百分位数图主要是线性的，GMFCS 水平之间的表现评分不同。GMFCS 水平内的纵向轨迹和百分位数都存在很大的变异性。
局限性包括方便样本和每个就诊时评估的参与者数量不同。
纵向轨迹和百分位数图可用于监测脑瘫儿童随时间推移的表现和变化，与其他脑瘫儿童进行比较。提供的资源允许治疗师和家属共同决定针对儿童独特需求的干预活动。
