A pilot study of change in secondary impairments in children with cerebral palsy: Are current preventative measures working?

Research Report
Population: Pediatric

Lynn Marie Jeffries, PT, PhD, PCS, Associate Professor, University of Oklahoma Health Sciences Center lynn-jeffries@ouhsc.edu

Alyssa Fiss, PT, PhD, Associate Professor, Mercer University fiss_al@mercer.edu

Doreen Bartlett, PT, PhD, Professor, Western University djbartle@uwo.ca

Sarah McCoy, PT, PhD, FAPTA, Professor, University of Washington westcs@u.washington.edu

Keywords: Prevention, Pediatrics, Cerebral palsy

Purpose:  Preventing secondary impairments of reductions in strength, range of motion (ROM), and endurance in children with cerebral palsy (CP) is a focus of physical therapists. There is minimal research documenting the change in secondary impairments in this population.  The purposes of this study are to 1) describe strength, ROM, and endurance in children with CP across Gross Motor Function Classification System (GMFCS) levels at two testing sessions and 2) determine if there are differences in strength, ROM, and endurance over time.

Subjects: A sample of 77 children with CP who participated in the Move & PLAY and On Track studies across the USA and Canada.  Mean age at initial testing was 35 months (SD 11 months) and at second testing was 105 months (SD 13 months). Participants were 52% males, 81% white, and GMFCS level 1(N=20), II(N=23), III(N=7), IV(N=10), and V(N=17).

Methods: At time 1 (T1) in the Move & PLAY study, trained reliable assessors completed the Functional Strength Assessment (FSA) with scores of 1 (lowest) to 5 (highest) and the Spinal Alignment and Range of Motion Measure (SAROMM) with scores of 0 (full ROM) to 4 (severe limitation). Parents completed the Early Activity Scale for Endurance (EASE) with scores of 1 (never) to 5 (always, higher equals more endurance). On average, 70 months later, assessors and parents repeated these measures at the first session (T2) in the On Track study. Descriptive and non-parametric comparative analyses were conducted on the median scores for each measure by GMFCS level.

Results: Time 2 FSA scores were significantly higher than time 1 scores for children at GMFCS levels I (T1 3.50,T2 4.56,p<0.001) and II (T1 3.00,T2 4.00,p<0.001). Time 2 SAROMM scores were significantly higher (higher indicates more ROM restriction) than the time 1 scores for children at GMFCS levels IV (T1 1.21,T2 1.63,p=0.028) and V (T1 1.38,T2 2.23,p<0.001).  The EASE median scores were not significantly different at any GMFCS level.

Conclusions: Children with CP present with secondary impairments. In this sample of young children, strength increased significantly for children with relatively higher function (GMFCS levels I and II).  For children with relatively lower function (GMFCS levels III, IV and V), the median strength scores also increased but not to a significant level.  Significant increases in ROM restrictions were noted for children in levels IV and V.  Median endurance scores decreased at all GMFCS levels, except level II, but not to a significant level.

Clinical Relevance: Although limited by the relatively small sample size, this study indicates a renewed focus on preventing ROM restrictions for all children with CP is needed. Therapists should focus on strengthening and improving range of motion for children with CP, especially those with lower motor abilities. Endurance should be encouraged for children at all GMFCS levels. Additional research on change in impairments over time is needed.

Jeffries, Lynn Marie, PT, PhD, PCS; Fiss, Alyssa , PT, PhD; Bartlett, Doreen , PT, PhD; McCoy, Sarah Westcott, PT, PhD, FAPTA. A pilot study of change in secondary impairments in children with cerebral palsy: Are current preventative measures working?. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online. https://u.osu.edu/ivstep/poster/abstracts/108_jeffries-et-al/