Muscle Contractures in Children with Spastic Cerebral Palsy

Aim: The aim of this study is to analyze the prevalence of muscle contractures in lower limbs in patients with spastic CP and the influence of age, gender, limb distribution, and functional level.

Methods: We performed a retrospective study. Data were collected from chart reports. Inclusion criteria were as follows: Patients with spastic CP (unilateral and bilateral spastic CP, gross motor function level I–V) younger than 18 years. The presence of muscle contracture in psoas, adductors, hamstrigns, and gastrocnemius was classified according to the Spinal Alignment and Range of Motion Measure. Parametric or nonparametric tests were used depending on the normality of the data.

Results: A total of 102 patients were included, 36 with unilateral spastic CP. The mean age was 9.2 (± 4.2 years) years. Overall, 368 total contractures were observed: 65 in psoas, 64 in adductors, 115 in hamstrings, and 124 in gastrocnemius. The group with contractures was significantly older than the group without contractures. The risk of contractures increased 16% (p < 0.001) per year (CI 95%, 1.064–1.264) in the psoas, 0.7% (p < 0.052) per year (CI 95%, 0.999–1.161 in the adductors), and 31% (p < 0.001) per year (CI 95%, 1.170–1.473) in the hamstrings. Males are globally more likely to present muscle contractures, but a statistical significant difference was shown only in hamstrings (p < 0.05). Psoas (p < 0.05), adductors (p < 0.05), and hamstrings (p < 0.05) contractures were more frequent in bilateral CP. Patients in GMFCS III–V had contractures in the psoas (p < 0.05), adductors (p < 0.05), and hamstrings (p < 0.05) more often.

Conclusion: The most prevalent muscle contracture was in gastrocnemius. The group of patient without contractures is younger that the one with contractures. Males are globally more likely to present contractures. In those patients with bilateral CP or worst functional level, there is a higher prevalence of psoas, adductors, and hamstrings contractures, and gastrocnemius. The analysis of the factors that could influence muscle contractions will allow a better planification of medical resources and will help to educate families about the importance of preventive treatment strategies.

Keywords: cerebral palsy, muscle contracture, contracture, spastic CP.