Normative Values of Physical Examinations Commonly Used for Cerebral Palsy

Abstract

Purpose: The aim of this study was to establish normative values and to identify age-related change in physical examinations that are commonly used while evaluating patients with cerebral palsy (CP).

Materials and methods: One hundred four healthy volunteers (mean age 36 years, standard deviation 15 years) were enrolled and divided into four age groups: 13-20, 21-35, 36-50, and 51 years and older. The eighteen physical examination tests for CP were selected by five orthopedic surgeons in consensus-building session. The measurements were taken by three orthopedic surgeons.

Results: There was no significant difference in the measures of physical examination among all the age groups, except for the Staheli test (p=0.002). The post hoc test revealed that the mean hip extension was 2.7° higher in the 13-20-year-old group than in the other age groups. The bilateral popliteal angle had a tendency to increase in those over 36-years-old. There were 31 participants (30%) with a unilateral popliteal angle greater than 40°.

Conclusion: We documented normative values that can be widely used for evaluating CP in patients 13 years and older.

Keywords: Physical examination; cerebral palsy; normative values; range of motion.

Fig. 1. The Staheli test is performed with the participant in the prone position on the edge of the examination table. The examiner places one hand on the pelvis and gradually extends the thigh with the other. The point at which the pelvis begins to rise indicates the end of hip motion. At this point, the horizontal-thigh angle is measured. The psoas muscle (arrow) is primarily responsible for hip flexion contracture.

Fig. 2. The Silfverskiöld test. (A) The participant is placed in the supine position with the knee extended. (B) The hip and knee flexed at 90°. The angle is measured between parallel to long axis of fibula and parallel to long axis of 5th metatarsal. Arrows indicate gastrocnemius muscle.

Fig. 3. (A) Unilateral popliteal angle: the participant is in the supine position with the contralateral hip and knee in extension. The pelvis is tilted anteriorly accentuating lumbar lordosis. The tested limb is flexed to 90° at the hip and the knee is extended passively. The angle between the longitudinal axis of the leg and vertical line passing through the thigh is defined as the unilateral popliteal angle. (B) Bilateral popliteal angle: the same test is performed with the contralateral and knee flexed to neutroalize the anterior pelvic tilt, which decreases lumbar lordosis. Black arrows indicate hamstring muscle.