Side-to-side growth discrepancies in children with hemiplegic cerebral palsy: association with function, activity and social participation

Zonta, Marise Bueno; Ramalho-Júnior, Amâncio; Puppi, Marilene; Bruck, Isac; Magdalena, Neiva; Muzzolon, Sandra Regina B.; Carvalho-Neto, Arnolfo de; Santos, Lúcia H Coutinho dos

doi:10.1590/0004-282X20140020

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Articles • Arq. Neuro-Psiquiatr. 72 (5) • May 2014 • https://doi.org/10.1590/0004-282X20140020 copy

Side-to-side growth discrepancies in children with hemiplegic cerebral palsy: association with function, activity and social participation

Discrepâncias no crescimento dos dimídios em crianças com paralisia cerebral hemiplégica: associação com a função, atividades e participação social

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

Evaluate side-to-side discrepancies in children with hemiplegic cerebral palsy (HCP), and investigate associations of these discrepancies with patients’ age at initiation of physical therapy, motor and cognitive function, and degree of activities and social participation.

Method:

We obtained eight side-to-side measurements from 24 HCP children with mean age 49.3±5.2 months.

Results:

Early initiation of physical therapy was associated with lower discrepancy in hand length (p=0.037). Lower foot length discrepancy was associated with lower requirement for caregiver assistance in activities related to mobility. Increased side-to-side discrepancy was associated with reduced wrist extension and increased spasticity. Discrepancy played a larger role in children with hemineglect and in those with right involvement.

Conclusion:

Increased discrepancy in HCP children was associated with reduced degree of activity/social participation. These results suggest an association between functional use of the extremities and limb growth.

children; cerebral palsy; hemiplegia; function; growth

Patient ID	G	Side	Age	Gest age (weeks)	Weight at birth	Adverse events	Epilepsy	GMFCS level	GMFM T score	IQP	VIQ	TIQ	PRS	UPRS	Neuroimage
1	M	L	41	term	AGA	No	Yes	I	81.0%	47	52	45	14	18	1
2	M	L	41	term	AGA	Yes	Yes	I	94.1%	49	63	52	13	18	1
3	M	R	41	term	AGA	Yes	No	II	58.5%	74	91	81	13	6	4
4	M	R	55	term	LGA	Yes	No	I	98.3%	79	84	80	14	16	2
5	F	R	48	preterm (32)	AGA	Yes	No	I	93.8%	51	67	56	14	23	2
6	M	L	53	term	AGA	Yes	No	I	97.0%	65	88	74	10	16	3
7	M	L	45	preterm (34½)	SGA	Yes	No	I	94.7%	77	87	77	10	10	2
8	M	L	55	term	AGA	No	No	I	93.2%	94	105	99	14	26	5
9	M	L	46	term	AGA	Yes	No	I	95.0%	58	81	67	12	17	3
10	F	L	38	term	AGA	Yes	No	I	92.0%	82	95	88	12	21	2
11	F	L	39	preterm (26)	AGA	Yes	Yes	I	93.0%	106	95	101	12	19	1
12	M	L	40	preterm (26)	AGA	Yes	No	I	92.5%	47	50	44	13	22	3
13	M	L	39	term	AGA	No	No	I	92.0%	126	119	126	8	20	2
14	M	L	51	term	AGA	No	No	II	53.0%	47	48	43	9	7	4
15	M	R	41	term	AGA	No	No	I	90.3%	98	99	98	10	17	2
16	F	R	39	term	AGA	No	No	I	93.0%	55	74	61	12	24	1
17	M	R	45	term	LGA	Yes	No	I	86.0%	71	79	72	13	11	2
18	M	R	53	term	AGA	Yes	No	I	96.0%	89	100	94	14	24	2
19	M	R	46	term	AGA	Yes	No	I	72.0%	74	81	76	11	11	3
20	M	R	41	preterm (*)	(*)	Yes	No	I	85.6%	48	61	50	14	23	1
21	M	R	58	term	AGA	No	No	I	95.6%	77	112	94	13	23	1
22	M	L	50	preterm (27)	AGA	Yes	No	I	80.2%	*	*	*	13	18	4
23	F	R	41	term	AGA	No	No	I	95.0%	77	92	83	7	22	1
24	M	L	53	term	AGA	Yes	No	I	96.0%	115	152	141	14	15	2

Measurements (in cm)	Unaffected side mean (SD)	Affected side mean (SD)	Mean difference	Mean % difference	p value
Upper limb total length	44.29 (±2.79)	43.06 (±2.68)	1.22 (±0.94)	2.65	<0.001
Hand length	11.76 (±0.72)	10.89 (±0.76)	0.88 (±0.54)	6.1	<0.001
Hand width	6.06 (±0.26)	5.70 (±0.45)	0.36 (±0.34)	5.99	<0.001
Lower limb total length	45.17(±2.17)	44.52 (±2.19)	0.65 (±0.65)	1.5	<0.001
Foot length	16.33 (±0.81)	15.59 (±0.89)	0.73 (±0.56)	4.41	<0.001
Arm circumference	18.04 (±1.16)	16.88 (±1.06)	1.12 (±0.57)	5.75	<0.001
Thigh circumference	32.19 (±2.30)	31.23 (±2.45)	0.88 (±0.63)	2.68	<0.001
Calf circumference	21.81 (±1.32)	20.93 (±1.35)	0.88 (±0.53)	2.65	<0.001

PT	ULTL		HL		HW		LLTL		FL		AC		TC		CC
	DIF	%	DIF	%	DIF	%	DIF	%	DIF	%	DIF	%	DIF	%	DIF	%
1	1	2.1	1	8	0	0	1.5	3.1	1	6	0.5	2.4	0	0	1	4.2
2	0	0	0.5	4.1	0.5	7.6	0	0	1	5.7	2	10.2	1	3	0.5	2.1
3	3	6.5	1.2	10.2	0.5	8.3	0	0	0	0	2	10.5	1.5	4.1	2	8.6
4	3	6.3	1.5	12	0.5	7.6	0.5	1	0	0	1	5.7	1	3	1	4.6
5	0	0	1	8	0	0	1	2.2	0	0	1	5.8	1.5	4.9	2	8.6
6	1.5	3.1	0.5	4	0.5	8.3	0.5	1	1.5	8.5	1.5	7.8	2	6.2	0.5	2.2
7	1.5	3.7	0.9	8.2	0.5	8.3	1	2.4	1	6.2	1	5.2	0.5	1.4	0.5	2.2
8	0.2	0.4	0.5	4.3	0	0	0	0	0	0	0	0	0	0	0	0
9	1.8	3.9	0.7	5.7	0.7	11.2	1	2.1	1.7	9.6	1	5.8	2	6.6	1	4.7
10	0.5	1.1	1.5	12.5	0.5	8.3	1	2.1	1.1	6.5	1.2	6	1.5	4.1	0.5	2
11	1	2.3	1	9	0	0	0	0	1.1	6.9	1.2	7.8	1.5	5	0.9	4.5
12	0.5	1.1	0.2	1.7	0	0	0	0	1	6.2	1	5.2	1	2.9	1	4.5
13	1	2.1	0	0	0	0	1	2	0	0	0.5	2.7	0	0	0.5	2.2
14	2.5	5.2	2	15.3	1	16.6	1	2.1	1.5	8.8	0.5	3	1	3.4	0.5	2.5
15	1.5	3.6	1	8.6	0.5	8.3	1	2.3	1.5	9.6	1	5.5	0.5	1.6	1	4.7
16	0.5	1.1	0.5	4.5	0.5	9	0	0	0.5	3.2	0.5	2.8	0.5	1.4	1	4.7
17	2	4.7	1.7	15.45	1.2	20	1	2.3	1	6.6	1.5	8.3	1	3.2	1.5	6.9
18	0.5	1.2	0.5	4.7	0.3	5.4	2	4.4	0.5	3.2	2	11.1	1	3.3	1.5	7.5
19	3	6.6	2	16.66	0.5	8.3	1	2.1	0.2	1.1	2	10.5	1	3.1	1	4.3
20	1	2.6	0.3	2.8	0.5	8.3	0	0	1	6.4	1	5.7	0.5	1.6	0.8	3.8
21	1	2.1	0.8	6.2	0	0	0	0	0.5	2.7	2	11.1	0.5	1.5	1.5	6.6
22	0.5	1.1	0.7	6	0.5	8.3	0	0	0.9	5.8	0.5	2.9	0	0	0.5	2.5
23	0	0	0.5	4.3	0	0	2	4.3	0.5	2.9	1	5.5	1.5	4.2	0.5	2.1
24	1.5	3	0.5	4	0	0	0	0	0	0	1	5.8	0	0	0	0

Correlation		n	R	p
Muscle Strength	Discrepancy
Proximal Upper limb
	DIF HW	23	-0.43	0.042
	% HW	23	-0.48	0.022
Distal lower limb
	% FL	23	-0.39	0.066
	% TC	23	-0.79	0.000
Total lower limb
	% FL	23	-0.38	0.074
	% TC	23	-0.80	0.000
Total upper and lower limbs
	% FL	23	-0.49	0.017
	% TC	23	-0.62	0.002
UPRS
	DIF ULTL	24	-0.80	<0.001
	% ULTL	24	-0.78	<0.001
	DIF HL	24	-0.56	0.004
	% HL	24	-0.50	0.012
	DIF HW	24	-0.55	0.005
GMFM
Dimension A
	DIF_ULTL	24	-0.53	0.007
	%_ULTL	24	-0.54	0.006
	DIF_HL	24	-0.62	0.001
	%_HL	24	-0.61	0.001
	DIF_HW	24	-0.39	0.061
	%_HW	24	-0.41	0.048
Dimension B
	DIF_ULTL	24	-0.44	0.030
	%_ULTL	24	-0.45	0.027
Dimension C
	DIF_ULTL	24	-0.39	0.061
	%_ULTL	24	-0.39	0.060
	DIF_HL	24	-0.41	0.048
	DIF_HW	24	-0.40	0.054
	%_HW	24	-0.39	0.059
Dimension D
	DIF_HL	24	-0.40	0.049
	%_HL	24	-0.39	0.057
	%_FL	24	-0.41	0.048
PEDI - Mobility
Caregiver Assistance	DIF FL	24	-0.47	0.019
Caregiver Assistance	% FL	24	-0.45	0.028
GAIT ANALYSIS
% IDSupport	DIF LLTL	24	-0.037	0.074

Hemineglect	Discrepancy	n	Mean	Median	Minimum	Maximum	SD	p
Yes	DIF_HL	14	0.65	0.50	0.00	1.50	0.39
No	DIF_HL	8	1.15	1.10	0.50	2.00	0.55	0.042
Yes	DIF_AC	14	0.98	1.00	0.00	2.00	0.54
No	DIF_AC	8	1.53	1.50	1.00	2.00	0.44	0.020
Yes	DIF_TC	14	0.68	0.50	0.00	2.00	0.61
No	DIF_TC	8	1.31	1.50	0.50	2.00	0.46	0.020
Yes	%_HL	14	5.54	4.60	0.00	12.00	3.25
No	%_HL	8	9.66	9.10	4.00	16.66	4.88	0.070
Yes	%_AC	14	5.42	5.60	0.00	11.10	2.96
No	%_AC	8	8.19	8.05	5.50	11.10	2.30	0.016
Yes	%_TC	14	2.13	1.60	0.00	6.60	1.99

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[1] Correspondence: Marise Bueno Zonta; Centro de Neuropediatria, Hospital de Clínicas, Universidade Federal do Paraná; Rua Floriano Essenfelder, 81; 80060-270 Curitiba PR, Brasil; E-mail: marisebzonta@gmail.com