RELATIVE CONTRIBUTION OF SENSORY-MOTOR IMPAIRMENTS TO MOBILITY LIMITATIONS IN CHILDREN WITH 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, but the condition is not unchanging; and various impairments of the neuromuscular, musculoskeletal, and sensory systems become features of infancy and early childhood. Children with cerebral palsy undergo therapy throughout their childhood in order to achieve maximum mobility which reaches a plateau approaching the 6th birthday. However, mobility can gradually decline after the 9th birthday. A better understanding of what impairments contribute to mobility in ambulatory children with cerebral palsy could enhance intervention by targeting specific impairments.

Purpose: The purpose of this study was to determine the relative contribution of sensory and motor impairments to mobility limitations in pre-adolescent children with cerebral palsy.

Methods: An observational study was carried out in 83 children with all types of cerebral palsy within Gross Motor Function Classification System Level I to IV with a mean age of 10.8 years (SD 1.2). Five impairments (coordination, strength, spasticity, contracture, proprioception) and three aspects of mobility (standing up from a chair, short and long distance walking) were measured. For analysis, the average of mobility was used as a single measure that reflected mobility. Standard multiple regression was used to determine the relative contribution of impairments to mobility as well as the relative contribution of strength of individual muscle groups (dorsiflexors, plantarflexors, knee extensors, hip abductors and hip extensors) to mobility.

Results: Five impairments accounted for 48% of the variance in overall mobility (p < 0.001): coordination independently accounted for 9%, contracture for 4% and strength for 3% of the variance. Five muscle groups accounted for 53% of the variance in overall mobility (p < 0.001): hip extensors independently accounted for 9%, knee extensors for 4%, dorsiflexors for 4% and plantarflexors for 3% of the variance.

Conclusions: Our findings demonstrate that the impairments making a significant independent contribution to mobility in pre-adolescent cerebral palsy were loss of coordination, contracture and strength.

Implications: With increasing severity of cerebral palsy, mobility declined and impairments increased. Main impairments contributing to mobility limitations were loss of coordination and strength in children with cerebral palsy. Intervention aimed at strength and coordination may benefit those with severe impairments.

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
Mobility
Impairments

Topics:
Paediatrics: cerebral palsy
Neurology
Paediatrics

Did this work require ethics approval? Yes

Institution: National Cheng Kung University

Committee: Human Research Ethics Committee

Ethics number: 105-311