Gait & posture · 2026
Physical and neuromuscular impairment profiles across GMFCS Levels I-III in children with spastic cerebral palsy.
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Brodt Guilherme Auler, Machado Neto Lauro
Аннотация
BACKGROUND: Spastic cerebral palsy (CP) is a non-progressive neurological condition resulting from early brain injury or maldevelopment, leading to heterogeneous motor impairments that affect functional abilities and daily activities. Describing how physical and neuromuscular impairments vary across functional severity levels may improve characterization of functional impairment profiles relevant to clinical assessment.
OBJECTIVES: To describe between-group differences in joint range of motion (ROM), muscle strength, spasticity, and selective motor control (SMC) across Gross Motor Function Classification System (GMFCS) levels I to III in individuals with spastic CP.
METHODS: A retrospective cross-sectional analysis was conducted using clinical records of 251 participants with CP (GMFCS I-III). Standardized physical examinations included passive joint ROM, manual muscle testing, the Modified Ashworth Scale for spasticity, and an ordinal SMC scale. Physical examination outcomes were analysed by muscle group using general linear models, with GMFCS level as a fixed factor and age as a covariate. Partial eta squared was used to estimate effect sizes.
RESULTS: ROM measures demonstrating the largest effect were passive knee extension, slow hip abduction, and the Modified Thomas test, with more restricted values observed in GMFCS III. Muscle strength exhibited large effect sizes across all muscle groups, with the greatest discrimination observed for plantar flexors and knee flexors. Spasticity showed predominantly large effect sizes, particularly in knee flexors, knee extensors, hip adductors, and hip flexors. SMC demonstrated large effect sizes for plantar flexors, knee flexors, and dorsiflexors, with lower scores observed in higher GMFCS levels. Age contributed minimally to between-group differences for most outcomes.
CONCLUSIONS: Across GMFCS levels I to III, impairments in plantar flexor strength and SMC, followed by knee flexor spasticity, strength, and SMC, demonstrated the greatest discriminatory capacity between functional levels. These findings describe consistent impairment patterns associated with GMFCS classification in participants with spastic CP.
OBJECTIVES: To describe between-group differences in joint range of motion (ROM), muscle strength, spasticity, and selective motor control (SMC) across Gross Motor Function Classification System (GMFCS) levels I to III in individuals with spastic CP.
METHODS: A retrospective cross-sectional analysis was conducted using clinical records of 251 participants with CP (GMFCS I-III). Standardized physical examinations included passive joint ROM, manual muscle testing, the Modified Ashworth Scale for spasticity, and an ordinal SMC scale. Physical examination outcomes were analysed by muscle group using general linear models, with GMFCS level as a fixed factor and age as a covariate. Partial eta squared was used to estimate effect sizes.
RESULTS: ROM measures demonstrating the largest effect were passive knee extension, slow hip abduction, and the Modified Thomas test, with more restricted values observed in GMFCS III. Muscle strength exhibited large effect sizes across all muscle groups, with the greatest discrimination observed for plantar flexors and knee flexors. Spasticity showed predominantly large effect sizes, particularly in knee flexors, knee extensors, hip adductors, and hip flexors. SMC demonstrated large effect sizes for plantar flexors, knee flexors, and dorsiflexors, with lower scores observed in higher GMFCS levels. Age contributed minimally to between-group differences for most outcomes.
CONCLUSIONS: Across GMFCS levels I to III, impairments in plantar flexor strength and SMC, followed by knee flexor spasticity, strength, and SMC, demonstrated the greatest discriminatory capacity between functional levels. These findings describe consistent impairment patterns associated with GMFCS classification in participants with spastic CP.