Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan.
College of Medicine and School of Public Health, Drexel University, Philadelphia, PA, USA.
Child Care Health Dev. 2022 May;48(3):396-405. doi: 10.1111/cch.12938. Epub 2021 Dec 13.
Although children with spastic cerebral palsy (CP) commonly present with restricted passive range of motion (PROM) and contractures, knowledge about the child's characteristics that increase the risk of development of restricted PROM is limited. Identifying children who are more likely to develop contractures is important for early detection and the provision of appropriate medical management. This study aims to identify the most commonly restricted PROM of children with spastic CP and (2) to examine the combined effect of a child's age, gender, gross motor functional classification level and CP subtype on the development of restricted PROM in children with spastic CP.
The PROM of 233 children diagnosed with CP was extracted from the national registry of CP in Jordan (CPUP-Jordan) in addition to information about children's age, gender, level of Gross Motor Function Classification System-Expanded and Revised (GMFCS-E&R) and subtype of CP. The mean age of the participants was 3.73 years (SD = 3.14), 57.5% were males and 80.3% had bilateral spastic CP. Point biserial correlations were calculated between the PROM and the child's variables. Multiple binary logistic regressions were conducted to identify the predictors of PROM.
Hip abduction was the most common restricted PROM (57.9%), whereas the hip extension was the least (2.1%). Children with older ages demonstrated more restrictions in knee extension and ankle dorsiflexion; males demonstrated more restriction in hip abduction than females; children with lower GMFCS-E&R levels had more restrictions in hip internal rotation but fewer restrictions in hip abduction and ankle dorsiflexion; and children with bilateral spastic CP had more restrictions in hip abduction than children with unilateral spastic CP.
PROM of the hip, knee and ankle joints of children with spastic CP was predicted by different sets of child characteristics. Implications for health professionals and follow-up registries of children with CP are provided.
患有痉挛型脑瘫（CP）的儿童通常存在受限的被动活动范围（PROM）和挛缩，但对于增加受限 PROM 发展风险的儿童特征知之甚少。识别更有可能发生挛缩的儿童对于早期发现和提供适当的医疗管理很重要。本研究旨在确定痉挛型 CP 儿童最常见的受限 PROM，并（2）检查儿童年龄、性别、粗大运动功能分类水平和 CP 亚型对痉挛型 CP 儿童受限 PROM 发展的综合影响。
从约旦脑瘫注册处（CPUP-Jordan）中提取了 233 名被诊断为 CP 的儿童的 PROM，此外还包括儿童年龄、性别、粗大运动功能分类系统扩展和修订版（GMFCS-E&R）和 CP 亚型的信息。参与者的平均年龄为 3.73 岁（SD=3.14），57.5%为男性，80.3%为双侧痉挛型 CP。计算了 PROM 与儿童变量之间的点二项式相关。进行了多个二元逻辑回归，以确定 PROM 的预测因素。
髋关节外展是最常见的受限 PROM（57.9%），而髋关节伸展是最不常见的受限 PROM（2.1%）。年龄较大的儿童在膝关节伸展和踝关节背屈方面表现出更多的限制；男性髋关节外展的限制比女性多；GMFCS-E&R 水平较低的儿童髋关节内旋受限较多，但髋关节外展和踝关节背屈受限较少；双侧痉挛型 CP 的儿童髋关节外展的限制比单侧痉挛型 CP 的儿童多。
不同的儿童特征预测了痉挛型 CP 儿童髋关节、膝关节和踝关节的 PROM。为 CP 儿童的健康专业人员和随访登记处提供了启示。
