Archives of Physical Medicine and Rehabilitation
Volume 88, Issue 9 , Pages 1114-1120, September 2007

Relationships Between Spasticity, Strength, Gait, and the GMFM-66 in Persons With Spastic Diplegia Cerebral Palsy

  • Sandy A. Ross, PT, DPT, MHS, PCS

      Affiliations

    • Department of Physical Therapy, Maryville University, St. Louis, MO
    • Corresponding Author InformationReprint requests to Sandy A. Ross, PT, DPT, MHS, PCS, Physical Therapy Program, Maryville University, 650 Maryville University Dr, St. Louis, MO 63141-7299
    • ,
  • Jack R. Engsberg, PhD

      Affiliations

    • Department of Physical Therapy, Saint Louis University, St. Louis, MO.

Abstract 

Ross SA, Engsberg JR. Relationships between spasticity, strength, gait, and the GMFM-66 in persons with spastic diplegia cerebral palsy.

Objective

To determine the relationships between spasticity, strength, and the functional measures of gait and gross motor function in persons with spastic diplegia cerebral palsy (CP).

Design

Retrospective, cross-sectional study.

Setting

Hospital clinic.

Participants

Ninety-seven participants (49 boys, 48 girls; mean age ± standard deviation, 9.11±4.8y) with spastic diplegia CP were tested once.

Interventions

Not applicable.

Main Outcome Measures

A KinCom dynamometer was used to objectively measure spasticity (ankle plantarflexors, knee flexors, hip adductors) and maximum strength (ankle dorsiflexors and plantarflexors, knee flexors and extensors, hip abductors and adductors). A gait analysis was conducted to evaluate linear variables (gait speed, stride length, cadence) and kinematic variables (ankle dorsiflexion, foot progression, knee and hip flexion, pelvic tilt at initial contact and ankle dorsiflexion, knee and hip flexion, pelvic tilt, trunk rotation range of motion) during gait. Gross motor function was measured using the Gross Motor Function Measure (GMFM-66) and separately, the GMFM walking, running & jumping dimension. Multiple linear regression analysis was used to determine the relationships between spasticity, strength, gait, and the GMFM (P<.05).

Results

Spasticity did not account for a substantial amount of explained variance in gait and gross motor function (up to 8% for the GMFM walking, running & jumping dimension). Moderate to high correlations existed between strength and gait linear data and function, accounting for up to 69% of the explained variance (strength and GMFM-66, r2=.69).

Conclusions

For this cohort of participants with spastic diplegia CP who ambulated with or without an assistive device, strength was highly related to function and explained far more of the variance than spasticity. The results may not be generalized to those with more severe forms of CP.

Key Words: Cerebral palsy, Gait, Muscle spasticity, Rehabilitation

 

 Supported by the National Institute of Neurological Disorders and Stroke, National Institutes of Health (grant no. R01 NS35830).

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

PII: S0003-9993(07)00428-5

doi:10.1016/j.apmr.2007.06.011

Archives of Physical Medicine and Rehabilitation
Volume 88, Issue 9 , Pages 1114-1120, September 2007

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