Spasticity of the gastrosoleus muscle is related to the development of reduced passive dorsiflexion of the ankle in children with cerebral palsy

Figures & data

Table 1. Distribution of children in relation to CP subtypes based on the Surveillance of Cerebral Palsy in Europe (SCPE) and GMFCS level

CP subtype	GMFCS					Total
	I	II	III	IV	V
Spastic
unilateral	95	13	3	2	0	113
bilateral	45	29	31	31	16	152
Dyskinetic	2	2	3	17	19	43
Ataxic	7	9	1	3	0	20
Mixed	7	3	6	4	7	27
Total	156	56	44	57	42	355

Table 2. Distribution of measurements in relation to CP subtypes based on the Surveillance of Cerebral Palsy in Europe (SCPE) and GMFCS level

CP subtype	GMFCS					Total
	I	II	III	IV	V
Spastic
unilateral	1,476	196	54	20	0	1,746
bilateral	630	522	536	608	240	2,536
Dyskinetic	20	40	42	290	306	698
Ataxic	76	132	16	46	0	270
Mixed	80	36	56	70	100	342
Total	2,282	926	704	1,034	646	5,592

Table 3. The original Ashworth scale and the number of examinations at each level in the present study

Score	Description of the muscle tone	Number of examinations
0	Normal tone, no increase in tone	1,586
1	Slight increase in tone producing a catch when joint is moved in flexion or extension	2,151
2	More marked increase in tone through most of range, but joint easily moved	1,033
3	Considerable increase in tone, passive movement difficult	747
4	Affected parts rigid in flexion or extension	75

Figure 1. Development of dorsiflexion of the ankle joint (mean, 95% CI) up to 18 years of age in the total sample of 355 children with CP. The analysis is based on 2,796 examinations of both legs in all 355 children.

Figure 2. Development of dorsiflexion of the ankle joint (mean, 95% CI) related to level of spasticity according to the Ashworth scale.

Table 4. The predicted mean difference in ROM, between children with normal muscle tone and children with different levels of increased muscle tone, over the entire follow-up interval from 0 to 18 years, related to CP subtype and GMFCS level

CP-subtype Ashworth level	GMFCS level	Mean difference	95% CI
Spastic unilateral	I–III
1		–4.5	(–5.3 to –3.8)
2		–8.1	(–9.4 to –6.8)
3		–15	(–17 to –13)
4		–22	(–30 to –14)
Spastic bilateral	I–III
1		–1.4	(–2.5 to –0.4)
2		–3.6	(–4.9 to –2.4)
3		–7.6	(–9.1 to –6.2)
4		–17	(–21 to –13)
Spastic bilateral	IV–V
1		–1.5	(–4.6 to 1.6)
2		–1.2	(–4.0 to 2.2)
3		–6.0	(–9.4 to –2.7)
4		–14	(–20 to –9.0)
Dyskinetic	I–III
1		–0.3	(–2.4 to 3.0)
2		–2.2	(–6.0 to 1.5)
3		–7.3	(–11 to –3)
4		–29	(–42 to –17)
Dyskinetic	IV–V
1		–4.8	(–7.7 to –1.8)
2		–7.7	(–11 to – 4.5)
3		–11	(–14 to –7.3)
4		–21	(–28 to –14)
Ataxic ^a	I–III
1		–5.8	(–7.9 to –3.6)
2		–7.1	(–10 to –4.2)
3		–18	(–22 to –14)

^a Only one child with ataxic CP and Ashworth level 4.