Muscle strength does not explain standing ability in children with bilateral spastic cerebral palsy: a cross sectional descriptive study

Cecilia Lidbeck,Kristina Tedroff,Åsa Bartonek

doi:10.1186/s12883-015-0441-y

Abstract

BackgroundIn bilateral cerebral palsy (CP) muscle strength is considered important for development of gross motor functions, but its influence on standing ability has not been explored. Our aims were to examine muscle strength with respect to the ability to stand with (SwS) or without (SwoS) hand support, asymmetrical weight bearing (WB), and whether the ability to produce strength was influenced by different seated conditions.MethodsIn this cross sectional descriptive study standing posture was recorded with 3D motion analysis, and muscle strength was measured with a hand-held dynamometer, in 25 children with bilateral CP, GMFCS levels II-III, SwS (n = 14, median age 11.4 years), or SwoS, (n = 11, median age 11.4 years). Strength measurements were taken in the hip flexors, knee extensors, dorsiflexors and plantarflexors, in two seated conditions; a chair with arm- and backrests, and a stool.ResultsCompared to SwoS, children SwS stood with a more flexed posture, but presented with equal strength in the hip flexors, dorsiflexors and plantarflexors, and with somewhat more strength in the knee extensors. Despite asymmetric WB during standing, both limbs were equally strong in the two groups. No differences in strength were measured between the two seated conditions.ConclusionsDespite challenges measuring muscle strength in CP, the lower limb muscle strength cannot be considered an explanatory factor for variations in standing in this group of children with bilateral CP. The findings rather strengthen our hypothesis that deficits in the sensory systems could be as determinant for standing as muscle weakness in children with bilateral spastic CP.

Highlights

In bilateral cerebral palsy (CP) muscle strength is considered important for development of gross motor functions, but its influence on standing ability has not been explored
Participants Of the 27 children who were enrolled in the study, two did not complete the examinations; 25 children (12 females and 13 males), median age 11.4, years participated
According to standing ability 14 children required hand support during standing (SwS), and 11 were able to stand without hand support (SwoS) (Table 1)

Summary

Introduction

In bilateral cerebral palsy (CP) muscle strength is considered important for development of gross motor functions, but its influence on standing ability has not been explored. In bilateral CP muscle strength is considered important for development of gross motor functions, but its influence on standing ability has not been explored. Muscle strength is clearly important for achieving gross motor functions. In another study by Ferrari et al, an impaired motor control strategy with ineffective anticipatory postural adjustments during a seated reaching task in children with bilateral CP, was explained by disturbances in the perceptual system [10]. The above mentioned findings indicate that disorders in the sensory and perceptual systems affect gross motor function in CP even if they are not fully understood

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