The Influence of Spasticity on Reliability of Range of Movement Measurements for Knee and Ankle in a Pediatric Population With Cerebral Palsy

Scientific question The aim is to investigate the inter-rater reliability of passive range of motion (pROM) measurement with goniometer of knee extension and ankle dorsiflexion for children with unilateral spastic cerebral palsy (USCP) and secondary to explore to what extent spasticity influences the reliability.

Overview of the field Evaluating joint mobility is commonly used and important for physicians and physiotherapists assessing and treating children with cerebral palsy, to early detect occurrence of joint contracture. The primarily used method to measure joint pROM is to use a manual goniometer, even if techniques using a smartphone or other electronic device has been demonstrated (Herrero et al. 2011, Ferriero et al. 2013, Hancock et al. 2018). Previous studies indicate that traditional goniometry is usually reliable both for ankle and knee both in individuals with and without spastic muscles (Brosseau et al. 2001, Allington et al. 2002, McWhirk et al. 2006, Konor et al. 2012) even if some authors indicate that there is a considerable variability among children with spasticity (McDowell et al. 2000).

To our knowledge no earlier study has investigated children with hemiplegic cerebral palsy to evaluate the influence of spasticity on pROM measurements. The idea is to use the child as its own control having both a spastic and a non spastic limb.

Project description

Participants Almost all children with cerebral palsy in Sweden are linked to a local habilitation unit where regular assessments are made by the child's physiotherapist. Information from the national quality registry and follow-up program for individuals with cerebral palsy (CPUP) indicates that there are approximately 140 children with unilateral spastic cerebral palsy (USCP) in Skåne. Families and children (age 2 - 17 years) with USCP linked to habilitation units in Skåne will be asked to participate in the study trough written letter and/or by phone call. When applicable this will be part of the child´s regular and planned assessment. Children with other diagnoses than USCP will be excluded. Children with surgery on the lower extremity within the last year or botox administration to the lower extremity within the last 3 month will also be excluded.