Body Composition and Spasticity in Children with Unilateral Cerebral Palsy—A Case–Control Study
Abstract
:1. Introduction
2. Materials and Methods
- BMI: a weight/height index calculated as weight divided by height squared (kg/m2);
- BMI z-score and BMI percentile: calculated using the AnthroPlus application for age and sex, respectively, according to the World Health Organization (WHO) reference.
Statistical Analysis
3. Results
4. Discussion
5. Conclusions
- Children with unilateral cerebral palsy exhibit greater deficits in general muscle mass than their healthy peers;
- Children with unilateral cerebral palsy are characterized by lower muscle mass in the affected limbs than in the unaffected limbs, as well as by lower muscle mass in affected lower limbs in comparison with the lower limbs of healthy peers;
- The obtained results showed no significant correlation between the mean value of spasticity and particular parameters of mass composition of the affected lower limbs;
- To define the correlations of the level of spasticity in the affected lower limb muscles with skeletal muscle mass in children with unilateral cerebral palsy, further studies are needed in a larger population which includes non-ambulatory children.
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Bax, M.; Goldstein, M.; Rosenbaum, P.; Leviton, A.; Paneth, N.; Dan, B.; Jacobsson, B.; Damiano, D.; Executive Committee for the Definition of Cerebral Palsy. Proposed definition and classification of cerebral palsy, April 2005. Dev. Med. Child Neurol. 2005, 47, 571–576. [Google Scholar] [CrossRef] [PubMed]
- Pandyan, A.D.; Gregoric, M.; Barnes, M.P.; Wood, D.; Van Wijck, F.; Burridge, J.; Hermens, H.; Johnson, G.R. Spasticity: Clinical perceptions, neurological realities and meaningful measurement. Disabil. Rehabil. 2005, 27, 2–6. [Google Scholar] [CrossRef] [PubMed]
- Szkoda, L.; Szopa, A.; Kwiecień-Czerwieniec, I.; Domagalska-Szopa, M. Body composition and spasticity in children with bilateral cerebral palsy. Fizjoterapia Pol. 2022, 22, 174–185. [Google Scholar]
- Więch, P.; Ćwirlej-Sozańska, A.; Wiśniowska-Szurlej, A.; Kilian, J.; Lenart-Domka, E.; Bejer, A.; Domka-Jopek, E.; Sozański, B.; Korczowski, B. The Relationship Between Body Composition and Muscle Tone in Children with Cerebral Palsy: A Case-Control Study. Nutrients 2020, 12, 864. [Google Scholar] [CrossRef] [Green Version]
- Finbråten, A.K.; Martins, C.; Andersen, G.L.; Skranes, J.; Brannsether, B.; Júlíusson, P.B.; Syversen, U.; Stevenson, R.D.; Vik, T. Assessment of body composition in children with cerebral palsy: A cross-sectional study in Norway. Dev. Med. Child Neurol. 2015, 57, 858–864. [Google Scholar] [CrossRef]
- García Íñiguez, J.A.; Vásquez Garibay, E.M.; García Contreras, A.A.; Romero Velarde, E.; Troyo Sanromán, R.; Hernández Rocha, J.; Rea Rosas, A.; Rodríguez León, M.; Uribe Martínez, E. Energy expenditure is associated with age, anthropometric indicators and body composition in children with spastic cerebral palsy. Nutr. Hosp. 2018, 35, 909–913. [Google Scholar] [CrossRef]
- Kim, H.J.; Choi, H.N.; Yim, J.E. Food Habits, Dietary Intake, and Body Composition in Children with Cerebral Palsy. Clin. Nutr. Res. 2018, 7, 266–275. [Google Scholar] [CrossRef] [Green Version]
- Johnson, D.L.; Miller, F.; Subramanian, P.; Modlesky, C.M. Adipose tissue infiltration of skeletal muscle in children with cerebral palsy. J. Pediatr. 2009, 154, 715–720. [Google Scholar] [CrossRef] [Green Version]
- Walker, J.L.; Bell, K.L.; Stevenson, R.D.; Weir, K.A.; Boyd, R.N.; Davies, P.S. Differences in body composition according to functional ability in preschool-aged children with cerebral palsy. Clin. Nutr. 2015, 34, 140–145. [Google Scholar] [CrossRef]
- Sung, K.H.; Chung, C.Y.; Lee, K.M.; Cho, B.C.; Moon, S.J.; Kim, J.; Park, M.S. Differences in Body Composition According to Gross Motor Function in Children with Cerebral Palsy. Arch. Phys. Med. Rehabil. 2017, 98, 2295–2300. [Google Scholar] [CrossRef]
- Feeley, B.T.; Gollapudi, K.; Otsuka, N.Y. Body mass index in ambulatory cerebral palsy patients. J. Pediatr. Orthop. B 2007, 16, 165–169. [Google Scholar] [CrossRef] [PubMed]
- Duran, I.; Schulze, J.; Martakis, K.; Stark, C.; Schoenau, E. Diagnostic performance of body mass index to identify excess body fat in children with cerebral palsy. Dev. Med. Child Neurol. 2018, 60, 680–686. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Whitney, D.G.; Miller, F.; Pohlig, R.T.; Modlesky, C.M. BMI does not capture the high fat mass index and low fat-free mass index in children with cerebral palsy and proposed sta-tistical models that improve this accuracy. Int. J. Obes. 2019, 43, 82–90. [Google Scholar] [CrossRef] [PubMed]
- Morgan, P.; McGinley, J.L. Cerebral palsy. Handb. Clin. Neurol. 2018, 159, 323–336. [Google Scholar] [CrossRef] [PubMed]
- Tanner, J.M. Growth and Maturation during Adolescence. Nutr. Rev. 1981, 39, 43–55. [Google Scholar] [CrossRef] [PubMed]
- Crocker, M.K.; Stern, E.A.; Sedaka, N.M.; Shomaker, L.B.; Brady, S.M.; Ali, A.H.; Shawker, T.H.; Hubbard, V.S.; Yanovski, J.A. Sexual dimorphisms in the associations of BMI and body fat with indices of pubertal development in girls and boys. J. Clin. Endocrinol. Metab. 2014, 99, 1519–1529. [Google Scholar] [CrossRef] [Green Version]
- Rusek, W.; Adamczyk, M.; Baran, J.; Leszczak, J.; Inglot, G.; Baran, R.; Pop, T. Is There a Link between Balance and Body Mass Composition in Children and Adolescents? Int. J. Environ. Res. Public Health 2021, 18, 10449. [Google Scholar] [CrossRef]
- Orsso, C.E.; Silva, M.I.B.; Gonzalez, M.C.; Rubin, D.A.; Heymsfield, S.B.; Prado, C.M.; Haqq, A.M. Assessment of body composition in pediatric overweight and obesity: A systematic review of the reliability and validity of common techniques. Obes. Rev. 2020, 21, e13041. [Google Scholar] [CrossRef]
- Kuriyan, R. Body composition techniques. Indian J. Med. Res. 2018, 148, 648–658. [Google Scholar] [CrossRef]
- Harries, N.; Kassirer, M.; Amichai, T.; Lahat, E. Changes over years in gross motor function of 3-8 year old children with cerebral palsy: Using the Gross Motor Function Measure (GMFM-88). Isr. Med. Assoc. J. 2004, 6, 408–411. [Google Scholar]
- Kułaga, Z.; Różdżyńska-Świątkowska, A.; Grajda, A.; Gurzkowska, B.; Wojtyło, M.; Góźdź, M.; Świąder-Leśniak, A.; Litwin, M. Siatki centylowe dla oceny wzrastania i stanu odżywienia polskich dzieci i młodzieży od urodzenia do 18 roku życia. Stand. Med. 2015, 12, 119–135. [Google Scholar]
- de Onis, M.; Garza, C.; Victora, C.G.; Onyango, A.W.; Frongillo, E.A.; Martines, J. The WHO Multicentre Growth Reference Study: Planning, study design, and methodology. Food Nutr. Bull. 2004, 25 (Suppl. 1), S15–S26. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Pascoe, J.; Thomason, P.; Graham, H.K.; Reddihough, D.; Sabin, M.A. Body mass index in ambulatory children with cerebral palsy: A cohort study. J. Paediatr. Child Health 2016, 52, 417–421. [Google Scholar] [CrossRef] [PubMed]
- Bohannon, R.W.; Smith, M.B. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys. Ther. 1987, 67, 2067. [Google Scholar] [CrossRef]
- Macedo, O.G.; Carazzato, J.G.; de Souza Meirelles , E.; de Paula, A.; dos Santos , C.A.; Neto, R.B.; Júnior, R.M. Comparative study of skin folding of dominant and nondominant hemibodies in spastic hemiplegic cerebral palsy. Clinics 2008, 63, 601–606. [Google Scholar] [CrossRef] [Green Version]
- Domagalska-Szopa, M.; Szopa, A. Gait pattern differences between children with mild scoliosis and children with unilateral cerebral palsy. PLoS ONE 2014, 9, e10309. [Google Scholar] [CrossRef]
Muscle | Patient Position | Testing Procedure |
---|---|---|
Iliopsoas | Supine, lower limb in flexion | Affected lower limb moved through the range of available hip extension |
Anterior thigh muscles | Prone, lower limb in extension | Distal limb moved through the range of available knee flexion |
Medial thigh muscles | Supine, lower limb in midline | Extended lower limb moved through the range of available hip adduction |
Posterior thigh muscles | Supine, lower limb distal to the knee was suspended over the plinth edge | Distal limb moved through the range of available knee extension |
Posterior shin muscles | Supine, leg in midline | Foot moved through the range of available ankle dorsiflexors |
Parameter | Tested Group (N = 31) | Control Group (N = 31) | Statistical Test | ||
---|---|---|---|---|---|
p-Values | |||||
Age (years); M ± SD, range | 11.74 ± 2.73 | 8–16 | 11.74 ± 2.73 | 8–16 | t = 0.00; 1.00 |
Height (cm); M ± SD, range | 145.02 ± 13.71 | 119.50–170.00 | 155.50 ± 14.51 | 128.00–182.50 | t = −2.92; 0.00 |
Weight (kg); M ± SD, range | 36.53 ± 10.51 | 22.40–60.00 | 54.20 ± 9.58 | 40.00–75.70 | t = −6.92; 0.00 |
BMI; M ± SD, range | 17.08 ± 2.67 | 12.45–24.10 | 22.34 ± 1.42 | 18.60–24.40 | t = −9.70; 0.00 |
BMI z-score; M ± SD, range | −0.72 ± 1.19 | −3.58–0.86 | 0.53 ± 1.08 | −1.46–2.65 | t = −4.32; 0.00 |
BMI percentile; M ± SD, range | 39.78 ± 34.12 | 0.10–97.90 | 62.61 ± 27.90 | 7.20–99.60 | t = −2.88; 0.01 |
OLAF BMI; M ± SD, range | 21.13 ± 33.13 | 0.10–97.00 | 59.29 ± 24.85 | 7.00–89.00 | t = −5.13; 0.00 |
OLAF height; M ± SD, range | 25.03 ± 32.48 | 0.10–99.90 | 53.51 ± 32.17 | 1.00–99.90 | t = −3.47; 0.00 |
OLAF weight; M ± SD, range | 29.11 ± 29.22 | 0.10–96.00 | 59.19 ± 27.43 | 4.00–97.00 | t = −4.18; 0.00 |
Girls; N (%) | 21 (68) | 20 (65) | χ2 = 0.07; 0.79 | ||
Boys; N (%) | 10 (32) | 11 (35) | |||
GMFCS level I; N (%) | 5 (16.00) | ||||
GMFCS level II; N (%) | 26 (84.00) | − | |||
BMI classification: | − | ||||
1; N (%) | 22 (71.00) | 0 (0.00) | |||
2; N (%) | 9 (29.00) | 31 (100.00) |
Parameter | Tested Group (N = 31) | Control Group (N = 31) | t | p | ||
---|---|---|---|---|---|---|
M ± SD | Min–Max | M ± SD | Min–Max | |||
BMR (kJ) | 4769.64 ± 481.19 | 4006.80–5400.20 | 6045.78 ± 551.17 | 5534.08–7900.00 | −9.88 | 0.00 |
FM (kg) | 7.51 ± 4.36 | 1.30–18.60 | 12.81 ± 3.70 | 7.30–19.00 | −5.16 | 0.00 |
FM% | 19.31 ± 7.08 | 3.00–28.10 | 23.02 ± 5.36 | 12.10–32.30 | −2.33 | 0.02 |
FFM (kg) | 29.32 ± 8.64 | 15.00–45.00 | 36.85 ± 6.96 | 23.30–50.00 | −3.78 | 0.00 |
FFM% | 80.69 ± 7.08 | 71.90–97.00 | 76.98 ± 5.36 | 67.70–87.90 | 2.33 | 0.02 |
FFMI (kg/m2) | 13.60 ± 2.13 | 8.88–18.22 | 15.14 ± 1.19 | 13.18–17.75 | −3.51 | 0.00 |
TBW (kg) | 21.17 ± 7.32 | 3.50–37.60 | 27.45 ± 5.15 | 20.10–40.00 | −3.90 | 0.00 |
TBW% | 0.59 ± 0.08 | 0.20–0.70 | 0.51 ± 0.04 | 0.43–0.64 | 4.62 | 0.00 |
PMM (kg) | 27.92 ± 8.89 | 15.00–45.30 | 35.39 ± 7.50 | 22.10–52.00 | −3.58 | 0.00 |
PMM% | 65.26 ± 7.86 | 55.22–93.19 | 75.98 ± 8.18 | 58.37–92.84 | 5.26 | 0.00 |
SMM (kg) | 14.77 ± 4.09 | 7.10–29.00 | 21.73 ± 2.96 | 17.00–25.90 | −7.68 | 0.00 |
SMM% | 40.79 ± 7.71 | 22.90–59.20 | 46.32 ± 9.26 | 24.80–70.20 | −2.55 | 0.00 |
IMP (Ohm) | 723.98 ± 59.47 | 600.00–797.00 | 694.35 ± 66.12 | 606.63–870.58 | 1.85 | 0.07 |
SMI (kg/m2) | 4.81 ± 0.69 | 3.60–6.00 | 5.71 ± 0.46 | 5.00–6.94 | −6.19 | 0.00 |
BONEM (kg) | 1.57 ± 0.41 | 1.00–2.80 | 1.93 ± 0.28 | 1.40–2.50 | −4.12 | 0.00 |
Phase angle (°) | 4.94 ± 0.26 | 4.50–5.60 | 5.48 ± 0.49 | 4.60–6.84 | −5.42 | 0.00 |
Parameter | Unaffected Lower Limb (N = 31) | Affected Lower Limb (N = 31) | t | p | 95% CI | d Cohena | |
---|---|---|---|---|---|---|---|
M ± SD | M ± SD | LL | UL | ||||
LFM (kg) | 1.77 ± 0.83 | 1.92 ± 0.96 | 0.66 | 0.51 | −0.31 | 0.61 | 1.33 |
LFM% | 30.92 ± 5.18 | 32.92 ± 5.51 | 0.89 | 0.38 | −1.51 | 3.93 | 1.13 |
LFFM (kg) | 3.96 ± 1.50 | 3.87 ± 1.50 | −0.25 | 0.81 | −0.85 | 0.67 | 1.00 |
LFFM% | 69.08 ± 5.18 | 67.87 ± 5.51 | −0.89 | 0.38 | −3.93 | 1.51 | 1.13 |
LPMM (kg) | 3.81 ± 1.53 | 3.55 ± 1.30 | −0.72 | 0.47 | −0.98 | 0.46 | 1.38 |
LPMM% | 66.99 ± 5.79 | 62.70 ± 6.06 | −2.85 | 0.01 | −7.30 | −1.28 | 1.10 |
LIMP (Ohm) | 331.76 ± 47.11 | 345.14 ± 40.88 | 1.19 | 0.24 | −9.03 | 35.79 | 1.33 |
Parameter | Tested Group (N = 31) | Control Group (N = 31) | Mean Square | F | p | ||||
---|---|---|---|---|---|---|---|---|---|
Unaffected Lower Limb (N = 31) | Affected Lower Limb (N = 31) | Lower Limbs (N = 62) | |||||||
M ± SD | Min–Max | M ± SD | Min–Max | M ± SD | Min-Max | ||||
LFM (kg) | 1.77 ± 0.83 | 0.60–3.30 | 1.92 ± 0.96 | 0.60–3.70 | 2.54 ± 0.87 | 1.40–4.10 | 7.70 | 9.88 | 0.00 b,c |
LFM% | 30.92 ± 5.18 | 20.20–41.30 | 32.13 ± 5.51 | 20.00–41.90 | 30.32 ± 6.16 | 20.20–39.60 | 33.96 | 1.02 | 0.36 |
LFFM (kg) | 3.96 ± 1.50 | 1.50–6.60 | 3.87 ± 1.50 | 1.60–7.00 | 5.80 ± 1.10 | 3.30–8.00 | 54.89 | 31.96 | 0.00 b,c |
LFFM% | 69.08 ± 5.18 | 58.70–79.80 | 67.87 ± 5.51 | 58.10–80.00 | 69.68 ± 6.16 | 60.40–79.80 | 33.96 | 1.02 | 0.36 |
LPMM (kg) | 3.81 ± 1.53 | 1.50–7.00 | 3.55 ± 1.30 | 1.50–6.00 | 5.50 ± 0.95 | 3.10–7.30 | 51.74 | 35.45 | 0.00 b,c |
LPMM% | 66.99 ± 5.79 | 47.50–80.46 | 62.70 ± 6.06 | 45.00–68.42 | 66.55 ± 6.61 | 57.14–78.43 | 188.00 | 4.77 | 0.01 a,b |
LIMP (Ohm) | 331.76 ± 47.11 | 224.70–399.10 | 345.14 ± 40.88 | 257.10–431.00 | 296.95 ± 32.30 | 235.00–365.90 | 28073.48 | 18.83 | 0.00 b,c |
Parameter | Affected Lower Limb (n = 31) | |
---|---|---|
M ± SD | Min–Max | |
Iliopsoas | 2.15 ± 0.45 | 1.50–3.00 |
Anterior thigh muscles | 2.05 ± 0.52 | 1.50–3.00 |
Medial thigh muscles | 1.37 ± 0.74 | 0.00–3.00 |
Posterior thigh muscles | 1.18 ± 0.33 | 1.00–2.00 |
Posterior shin muscles | 2.81 ± 0.40 | 2.00–3.00 |
All | 1.91 ± 0.30 | 1.50–2.50 |
Parameter | r | p |
---|---|---|
LFM (kg) | −0.26 | 0.16 |
LFM% | −0.18 | 0.32 |
LFFM (kg) | −0.33 | 0.07 |
LFFM% | 0.18 | 0.32 |
LPMM (kg) | −0.34 | 0.06 |
LPMM% | 0.23 | 0.22 |
LIMP (Ohm) | 0.19 | 0.32 |
Muscle Group | LFM (kg) | LFM% | LFFM (kg) | LFFM% | LPMM (kg) | LPMM% | LIMP (Ohm) | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
r | p | r | p | r | p | r | p | r | p | r | p | r | p | |
Iliopsoas | −0.34 | 0.06 | −0.11 | 0.56 | −0.36 | 0.04 | 0.11 | 0.56 | −0.40 | 0.02 | 0.02 | 0.92 | 0.35 | 0.06 |
Anterior thigh muscles | 0.01 | 0.95 | 0.13 | 0.49 | −0.07 | 0.69 | −0.13 | 0.49 | −0.10 | 0.61 | −0.16 | 0.39 | −0.16 | 0.39 |
Medial thigh muscles | −0.14 | 0.45 | −0.09 | 0.63 | −0.26 | 0.15 | 0.09 | 0.63 | 0.25 | 0.17 | 0.21 | 0.26 | 0.05 | 0.77 |
Posterior thigh muscles | −0.15 | 0.44 | −0.05 | 0.81 | −0.21 | 0.26 | 0.05 | 0.81 | −0.21 | 0.25 | −0.01 | 0.95 | 0.18 | 0.35 |
Posterior shin muscles | −0.08 | 0.68 | −0.20 | 0.28 | −0.04 | 0.84 | 0.20 | 0.28 | −0.05 | 0.81 | 0.23 | 0.21 | 0.07 | 0.71 |
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Szkoda, L.; Szopa, A.; Siwiec, A.; Kwiecień-Czerwieniec, I.; Domagalska-Szopa, M. Body Composition and Spasticity in Children with Unilateral Cerebral Palsy—A Case–Control Study. Children 2022, 9, 1904. https://doi.org/10.3390/children9121904
Szkoda L, Szopa A, Siwiec A, Kwiecień-Czerwieniec I, Domagalska-Szopa M. Body Composition and Spasticity in Children with Unilateral Cerebral Palsy—A Case–Control Study. Children. 2022; 9(12):1904. https://doi.org/10.3390/children9121904
Chicago/Turabian StyleSzkoda, Lawia, Andrzej Szopa, Andrzej Siwiec, Ilona Kwiecień-Czerwieniec, and Małgorzata Domagalska-Szopa. 2022. "Body Composition and Spasticity in Children with Unilateral Cerebral Palsy—A Case–Control Study" Children 9, no. 12: 1904. https://doi.org/10.3390/children9121904