Article

This study examined the causal relation between spasticity, weakness, gross
motor function, and functional outcome (expressed as activity limitation) in
children with cerebral palsy (CP) and tested models of functional outcome
mediated by gross motor function. METHOD: Eighty-one children (50 males, 31
females) with CP were recruited for this cross-sectional study. Their mean age
was 10 years 4 months (SD 1y 9mo). Strength was assessed using the Manual Muscle
Test. Spasticity was assessed by the Modified Ashworth Scale. The Gross Motor
Function Measure assessed gross motor function. The Functional Skills domain of
the Pediatric Evaluation of Disability Inventory assessed functional outcome.
Twenty-eight children (34.6%) had quadriplegia, 44 children (54.3%) had diplegia,
and nine children (11.1%) had hemiplegia. Children were classified using the
Gross Motor Function Classification System with 14 (17.3%) in level I, 9 (11.1%)
in level II, 13 (16.0%) in level III, 5 (6.2%) in level IV, and 40 (49.4%) in
level V. RESULTS: The proposed path model showed good fit indices. The direct
effects were significant between spasticity and gross motor function
(beta=-0.339), between strength and gross motor function (beta=0.447), and
between gross motor function and functional outcome (beta=0.708). Spasticity had
a significant negative indirect effect (beta=-0.240) and strength had a
significant positive indirect effect (beta=0.317) on functional outcome through
effects on gross motor function. INTERPRETATION: Activity-based rather than
impairment-based intervention is more important for reducing activity limitation
in children with CP. The study established a base from which researchers can
further develop a causal model between motor impairments and functional outcome.
CI - (c) The Authors. Journal compilation (c) Mac Keith Press 2010.

Langue : ANGLAIS