Flexibility in Children and Youth with Cerebral Palsy

Abstract

Spasticity, increased passive muscle stiffness, and contracture contribute to decreased flexibility in children and youth with cerebral palsy (CP). Three fourths (75%) of children with CP present with spasticity, and four fifths (80%) develop contractures. Clinically, spasticity is best evaluated using the Modified Tardieu Scale (MTS). The MTS compares range of motion of a joint at two velocities of movement to determine the impact of spasticity on flexibility. Contractures are best assessed with goniometry or visual observation when a detailed individual joint assessment is needed. When a more global assessment of flexibility is required, the Spinal Alignment and Range of Motion Measure (SAROMM) can be used. No clinical measure of passive muscle stiffness is currently available. Botulinum toxin A, diazepam, and selective dorsal rhizotomy are effective interventions used to reduce spasticity in children with CP. Serial casting can reduce plantarflexor contractures. Ideal interventions to reduce passive muscle stiffness have not been identified. While improving flexibility does not consistently lead to improvements in activity level of function, combining interventions to enhance flexibility with physical or occupational therapy may improve activity level outcomes more than each in isolation. Further investigation into measurement and treatment tools for flexibility in children and youth with CP is required.