Range of Motion in Children with Spastic Diplegia, GMFCS I-II Compared to Age and Gender Matched Controls

Abstract

Measurements of passive range of motion are often used to define the degree of muscle shortening in children with spastic diplegic cerebral palsy. However, little is known about the expected values of passive range of motion measurements in children with spastic diplegia and how these might differ from age and gender matched norms taken from the same population. Therefore, the purpose of this study was to compare eight lower limb measurements of sagittal plane passive range of motion in 22 children with spastic diplegia, GMFCS I to II, with 22 matched controls. Children with spastic diplegia had minimal hip extension loss, but reduced hamstring length, with popliteal angle averaging −59.2 ± 10.6 degrees (control −38.8 ± 13.4 degrees, p < 0.001) and SLR averaging 52.7 ± 10.2 degrees (control 75.8 ± 11.1 degrees, p < 0.001). Ankle dorsiflexion with knee extension averaged −2.5 ± 8.4 degrees in children with spastic diplegia (control 8.6 ± 6.8 degrees, p < 0.001). These data confirmed that children with mild spastic diplegia had some restriction in passive range of motion compared to controls but that there was considerable variability between individuals.

Key Words:

• Cerebral palsy
• GMFCS
• goniometry
• range of motion
• spastic diplegia

Additional information

Notes on contributors

Gaela M. Kilgour

Michael Lepp, PT, is in private practice, Associate Instructor of the Upledger Institute, and Clinical Instructor, Case Western Reserve University School of Dentistry, Cleveland, OH.

Marie McKenzie, MS, OTR, is in private practice. She was Coordinator of Occupational Therapy at Scottish Rite Hospital at the time of this study.

Heather Miller, MS, OTR/L, is currently employed by Madison County Educational Service Center, providing therapy services to the county's pre-schools. This research was completed in partial fulfillment of the requirements of an MS degree at Ohio State University.

Linda Viscardis, BA, is Team Leader and Community Development Worker, Peterborough Family Enrichment Centre. She is Co-Founder of P.R.O.S.P.E.C.T.S., a support and advocacy group for families who have children with special needs.

Debra Stewart, BSc, OT(C), is Occupational Therapist, Erinoak, Serving Young People with Physical Disabilities, Mississauga, ON, and Clinical Lecturer, School of Rehabilitation Science, McMaster University.

Janette McDougall, MA, was Project Coordinator

Kip Husted, BEd, was a parent representative on the study team.

Aviva Yochman, MA, OTR, was a student in the School of Occupational Therapy, Faculty of Medicine, The Hebrew University of Jerusalem, Israel at the time of this study.

Imelda Burgman, MA OTR/L BCP, completed her MA in Movement Sciences at Teachers College, Columbia University, and was an Occupational Therapist at The Shield Institute, Bronx, NY. She is currently Lecturer, Habilitation, School of Community Health, Faculty of Health Studies, Charles Sturt University, Albury, N.S.W., Australia.

Barbara J. Steva, OTWL, BCP, is Occupational Therapist, University of New England Community Occupational Therapy Clinic, Saco, ME. She was Director of Occupational Therapy and Therapeutic Recreation, Franciscan Children's Hospital and Rehabilitation Center, Boston, MA, when this work was completed.

Mary-Ann L. Fulks, MSc, OT(C), is Occupational Therapist, Vancouver Community Mental Health Service and Clinical Assistant Professor, School of Rehabilitation Sciences, University of British Columbia. This study was completed in partial fulfillment of a Master of Science degree.

Laura Zawacki, MS, PT, PCS, currently practices Pediatric Physical Therapy in the Chicago metropolitan area.

Judy T. Jennings holds a Certificate in PT and an MA in Special Education and has 25 years of experience as a PT working with children from infancy to high school.

Barbara G. Sarbaugh, BS and MA in OT, has worked with children for 20 years and is on the faculty, occupational therapy program at Xavier University, Cincinnati, OH.

At the time of this study, Marianne Kratochvil, MA, was a social worker at the Glenrose Rehabilitation Hospital, Edmonton, Alberta. She has since retired.