BILATERAL SYMMETRY IN LOWER LIMBS IN CHILDREN WITH HEMIPLEGIC CEREBRAL PALSY: AN OBSERVATIONAL STUDY

H.-C. Chiu¹, L. Ada², R.-J. Cherng³, C. Chen⁴

¹I-Shou University, Physical Therapy, Kaohsiung, Taiwan, ²The University of Sydney, Physiotherapy, Sydney, Australia, ³National Chung Kung University, Physical Therapy, Tainan, Taiwan, ⁴Taipei Medical University, Public Health, Taipei, Taiwan

Background: Cerebral palsy is a non-progressive neurological condition resulting in motor impairments, the severity of which can interfere with mobility over the lifespan. Children with hemiplegic cerebral palsy undergo therapy mainly focused on the affected leg throughout their childhood to achieve their maximum capacity of mobility because it is often assumed that the other leg is unaffected. However, even children with hemiplegic cerebral palsy within Gross Motor Function Classification System (GMFCS) Level I have reached the point with no visible impairments, they still feel behind in the physical education class and hope to be more engaged in the physical activity. Limited studies have compared the impairments between legs in children with hemiplegic cerebral palsy. Therefore, a measure of both legs may be useful for assessing the effect on overall mobility in a clinical setting.

Purpose: Our purpose for pre-adolescent children with hemiplegic cerebral palsy was to examine whether there were any difference in sensory-motor impairments (i.e., balance, coordination, strength, spasticity, contracture and proprioception) between legs.

Methods: An observational study was carried out in participants who were children with spastic hemiplegic cerebral palsy. Both lower limbs of participants were measure in one session. Six sensory-impairments (balance, coordination, strength, spasticity, contracture and proprioception) were measured. The between-leg differences in children with hemiplegia were analyzed using paired t-tests and presented as mean differences (95% CI) to ascertain the clinical significance.

Results: Twenty-four children with hemiplegic cerebral palsy aged 10.3 years (SD 1.3 years) participated, of which 13 (54%) were male and children were classified as GMFCS Level I (88%) or II (12%). Compared with the less affected leg, balance (MD -12.9 s, 95% CI -19.4 to -6.5, p < 0.001), strength of dorsiflexors (MD -2.8 Nm, 95% CI -4.2 to -1.4, p < 0.001), plantarflexors (MD -2.6 Nm, 95% CI -4.1 to -1.0, p = 0.002), knee extensors (MD -5.3 Nm, 95% CI -10.2 to -0.5, p = 0.03), and range of ankle dorsiflexion (MD -8 deg, 95% CI -13 to -3, p = 0.001) were decreased in the affected leg. There was no difference between legs in coordination (MD -0.20 taps/s, 95% CI -0.42 to -0.01, p = 0.06), strength of hip extensors (MD 0.3 Nm, 95% CI -4.7 to 5.3, p = 0.91) and hip abductors (MD -2.6 Nm, 95% CI -5.3 to 0.1, p = 0.06), spasticity (MD 0.4, 95% CI -0.2 to 1.0, p = 0.18) and proprioception (MD 1 deg, 95% CI 0 to 2, p = 0.10).

Conclusions: The differences between legs were balance, strength of dorsiflexors, plantarflexors and knee extensor of strength and contracture, while the similarities between legs were coordination, strength of hip extensors and abductors, spasticity and proprioception in children with hemiplegic cerebral palsy.

Implications: The current results suggest that therapeutic planning and intervention for children with hemiplegic cerebral palsy should consider focusing on strength of knee and ankle muscles.

Funding acknowledgements: This research was, in part, supported by National Science and Technology Council, under Grant no. MOST107-2320-B-214 -002 -MY3.

Keywords:
Cerebral Palsy
Hemiplegia
Impairments

Topics:
Paediatrics: cerebral palsy
Paediatrics
Neurology

Did this work require ethics approval? Yes

Institution: National Cheng Kung University

Committee: Human Research Ethics Committee

Ethics number: 105-311