Upper‐limb contracture development in children with cerebral palsy: a population‐based study

• Published in: Developmental medicine and child neurology 2019-02, Vol.61 (2), p.204-211
• Main Authors: Hedberg‐Graff, Jenny, Granström, Fredrik, Arner, Marianne, Krumlinde‐Sundholm, Lena
• Format: Article
• Language: English
• ISSN: 0012-1622; 1469-8749; 1469-8749
• DOI: 10.1111/dmcn.14006

Aim The aim of this study was to investigate the longitudinal development of passive range of motion (ROM) in the upper limbs in a population‐based sample of children with cerebral palsy (CP), and to investigate which children are more likely to develop contractures related to functional level, CP subtype, and age. Method Registry data of annual passive ROM measurements of the upper limbs from 771 children with CP (417 males, 354 females; mean age 11y 8mo, [SD 5mo] range 1–18y) were analysed. Mixed models were used to investigate at what age decreased passive ROM occurs. Odds ratios were calculated to compare risks and logistic regression analysis was used to predict contracture development. Results Thirty‐four per cent of the children had developed contractures. Among these children, decreased passive ROM was significant at a mean age of 4 years for wrist extension and 7 years for shoulder flexion, elbow extension, and supination. Children at Manual Ability Classification System (MACS) level V had a 17‐times greater risk of contractures than children at MACS level I. Interpretation One‐third of the children in the total population developed upper‐limb contractures while passive ROM decreased with age. MACS level was the strongest predictor of contracture development. What this paper adds In a population‐based sample of 771 children with cerebral palsy, 34% developed an upper‐limb contracture. Contracture development started at preschool age. The first affected movements were wrist extension and supination. Passive range of motion decreased with age. High Manual Ability Classification System level was the most important predictor of contractures. Resumen Desarrollo de contracturas en los miembros superiores en niños con parálisis cerebral: un estudio de población Objetivo El objetivo de este estudio fue investigar el desarrollo longitudinal del rango de movimiento pasivo (ROM) de las extremidades superiores en una muestra poblacional de niños con parálisis cerebral (PC) e investigar qué niños tienen más probabilidades de desarrollar contracturas relacionadas a. el nivel funcional, subtipo PC y edad. Método Se analizaron los registros anuales de los datos de las mediciones de ROM de los miembros superiores de 771 niños con PC (417 varones, 354 mujeres, edad media 11 años 8meses, [DS 5 meses] en un grupo etario de 1‐18 años). Se usaron modelos mixtos para investigar a qué edad disminuyó la movilidad pasiva. Los Odds ratios se calcularon para comparar los rie