Ethics code: IR.MAZUMS.REC.1403.18178
Hamed Hamed Rouhani Zadeh1, Masoud Shayesteh Azar2, Khadijeh Kazemi3, Mahla Motaharinik2, Masoud Gharib *4
1- Department of Pediatrics, School of Medicine, Pediatric Infectious Diseases Research Center, Research Institute for Infectious Diseases, Bu-Ali Sina Hospital, Sari, Mazandaran University of Medical Sciences, Mazandaran, Sari, Iran., Pediatric Neurology Department of Pediatrics, School of Medicine Pediatric Infectious Diseases Research Center Communicable Diseases Institute Sari Bu Ali Sina Hospital Mazandaran University of Medical Sciences
2- Orthopedic Research Center, Mazandaran University of Medical Science, Sari, Iran., Orthopedic Research Center, Mazandaran University of Medical Science, Sari, Iran.
3- Orthopedic Research Center, Mazandaran University of Medical Science, Sari, Iran.
4- Orthopedic Research Center, Mazandaran University of Medical Science, Sari, Iran. ,gharib_masoud@yahoo.com
2- Orthopedic Research Center, Mazandaran University of Medical Science, Sari, Iran., Orthopedic Research Center, Mazandaran University of Medical Science, Sari, Iran.
3- Orthopedic Research Center, Mazandaran University of Medical Science, Sari, Iran.
4- Orthopedic Research Center, Mazandaran University of Medical Science, Sari, Iran. ,
Abstract: (12 Views)
Objective: Rehabilitation planning for children with cerebral palsy (CP) depends on identifying which factors most strongly shape daily function. Musculoskeletal impairments are common in CP, but their separate contributions to gross motor performance and social participation are not fully known. This study investigated the independent predictive value of joint range of motion, spasticity, muscle strength, and pain for motor performance and participation in children with spastic CP.
Methods: In this cross-sectional study, 117 children with spastic CP (mean age 10.4 ± 3.6 years; GMFCS levels I–IV) were recruited by convenience sampling from pediatric outpatient rehabilitation clinics. Lower-extremity joint range of motion, spasticity (Modified Ashworth Scale), isometric muscle strength (hand-held dynamometry), and pain intensity (numeric rating scale or Faces Pain Scale–Revised) were measured. The GMFM-66 assessed motor function, and the LIFE-H for children assessed participation. Hierarchical multiple regression and unique variance analyses determined each predictor’s independent contribution.
Results: The final models accounted for 71.3% and 71.7% of variance in motor function and participation, respectively. Muscle strength was the strongest independent predictor of motor function (β = 0.41, sr² = 12%, p < 0.001) and was independently associated with participation (β = 0.19, sr² = 3%, p = 0.018). Pain independently predicted motor function (β = -0.19, sr² = 4%, p = 0.003) and participation (β = -0.18, sr² = 3%, p = 0.004). Range of motion uniquely predicted motor function (β = 0.22, sr² = 5%, p = 0.004) but not participation. After adjustment for other musculoskeletal variables, spasticity was no longer a significant independent predictor. Motor function partially mediated the associations of muscle strength and pain with participation.
Conclusion: In children with spastic CP, lower-limb strength and pain are the most important modifiable predictors of motor performance and social participation. Rehabilitation should prioritize targeted strengthening and comprehensive pain management to improve function and real-world participation.
Methods: In this cross-sectional study, 117 children with spastic CP (mean age 10.4 ± 3.6 years; GMFCS levels I–IV) were recruited by convenience sampling from pediatric outpatient rehabilitation clinics. Lower-extremity joint range of motion, spasticity (Modified Ashworth Scale), isometric muscle strength (hand-held dynamometry), and pain intensity (numeric rating scale or Faces Pain Scale–Revised) were measured. The GMFM-66 assessed motor function, and the LIFE-H for children assessed participation. Hierarchical multiple regression and unique variance analyses determined each predictor’s independent contribution.
Results: The final models accounted for 71.3% and 71.7% of variance in motor function and participation, respectively. Muscle strength was the strongest independent predictor of motor function (β = 0.41, sr² = 12%, p < 0.001) and was independently associated with participation (β = 0.19, sr² = 3%, p = 0.018). Pain independently predicted motor function (β = -0.19, sr² = 4%, p = 0.003) and participation (β = -0.18, sr² = 3%, p = 0.004). Range of motion uniquely predicted motor function (β = 0.22, sr² = 5%, p = 0.004) but not participation. After adjustment for other musculoskeletal variables, spasticity was no longer a significant independent predictor. Motor function partially mediated the associations of muscle strength and pain with participation.
Conclusion: In children with spastic CP, lower-limb strength and pain are the most important modifiable predictors of motor performance and social participation. Rehabilitation should prioritize targeted strengthening and comprehensive pain management to improve function and real-world participation.
Keywords: Cerebral Palsy, Muscle Strength, Pain, Motor Performance, Participation, Range of Motion, Spasticity
Type of Study: Original |
Subject:
Occupational Therapy
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This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 (CC-By-NC 4.0), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
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