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. 2008 Nov 6:9:150.
doi: 10.1186/1471-2474-9-150.

Development of spasticity with age in a total population of children with cerebral palsy

Gunnar Hägglund  1 , Philippe Wagner
Affiliations

Development of spasticity with age in a total population of children with cerebral palsy

Gunnar Hägglund et al. BMC Musculoskelet Disord. .

Abstract

Background: The development of spasticity with age in children with cerebral palsy (CP) has, to our knowledge, not been studied before. In 1994, a register and a health care program for children with CP in southern Sweden were initiated. In the programme the child's muscle tone according to the modified Ashworth scale is measured twice a year until six years of age, then once a year. We have used this data to analyse the development of spasticity with age in a total population of children with cerebral palsy.

Methods: All measurements of muscle tone in the gastrocnemius-soleus muscle in all children with CP from 0 to 15 years during the period 1995-2006 were analysed. The CP subtypes were classified according to the Surveillance of Cerebral Palsy in Europe network system. Using these criteria, the study was based on 6218 examinations in 547 children. For the statistical analysis the Ashworth scale was dichotomized. The levels 0-1 were gathered in one category and levels 2-4 in the other. The pattern of development with age was evaluated using piecewise logistic regression in combination with Akaike's An Information Criterion.

Results: In the total sample the degree of muscle tone increased up to 4 years of age. After 4 years of age the muscle tone decreased each year up to 12 years of age. A similar development was seen when excluding the children operated with selective dorsal rhizotomy, intrathecal baclofen pump or tendo Achilles lengthening. At 4 years of age about 47% of the children had spasticity in their gastro-soleus muscle graded as Ashworth 2-4. After 12 years of age 23% of the children had that level of spasticity. The CP subtypes spastic bilateral and spastic unilateral CP showed the same pattern as the total sample. Children with dyskinetic type of CP showed an increasing muscle tone up to age 6, followed by a decreasing pattern up to age 15.

Conclusion: In children with CP, the muscle tone as measured with the Ashworth scale increases up to 4 years of age and then decreases up to 12 years of age. The same tendency is seen in all spastic subtypes. The findings may have implications both for clinical judgement and for research studies on spasticity treatment.

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Figures

Figure 1
Figure 1
Number of treatments with BxA related to age at time of treatment in the total sample of children with CP.
Figure 2
Figure 2
Degree of spasticity in the gastrocnemius-soleus muscle according to the modified Ashworth scale related to age in the total sample of children with CP (547 children, 6218 measurements). Number of measurements presented as a percentage of the total number of measurements in each age group.
Figure 3
Figure 3
Degree of spasticity in the total sample according to Figure 2. Children treated with SDR, ITB or TAL excluded.
Figure 4
Figure 4
Degree of spasticity in the gastrocnemius-soleus muscle according to the modified Ashworth scale related to age in the total sample of children with unilateral CP (186 children, 1269 measurements). Number of measurements presented as a percentage of the total number of measurements in each age group.
Figure 5
Figure 5
Degree of spasticity children with unilateral CP according to Figure 4. Children treated with TAL excluded.
Figure 6
Figure 6
Degree of spasticity in the gastrocnemius-soleus muscle according to the modified Ashworth scale related to age in the total sample of children with bilateral CP (266 children, 3521 measurements). Number of measurements presented as a percentage of the total number of measurements in each age group.
Figure 7
Figure 7
Degree of spasticity in the children with bilateral CP according to Figure 5. Children treated with SDR, ITB or TAL excluded.
Figure 8
Figure 8
Degree of spasticity in the gastrocnemius-soleus muscle according to the modified Ashworth scale related to age in the total sample of children with dyskinetic CP (72 children, 882 measurements). Number of measurements presented as a percentage of the total number of measurements in each age group.
Figure 9
Figure 9
Degree of spasticity in the gastrocnemius-soleus muscle according to the modified Ashworth scale related to age in the total sample of children with ataxic CP (53 children, 546 measurements). Number of measurements presented as a percentage of the total number of measurements in each age group.
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