Alemdaroğlu-Gürbüz, Ipek

Calders, Patrick

De Jonghe, Lenka

Desloovere, Kaat

Feys, Hilde

Hanssen, Britta

Heyrman, Lieve

Plasschaert, Frank

Van den Broeck, Christine

Van Tittelboom, Vanessa

English

Ghent University Academic Bibliography

Contents lists available at ScienceDirectGait & Posturejournal homepage: www.elsevier.com/locate/gaitpostReliability and validity of lower limb functional strength tests in children with bilateral cerebralpalsyB. Hanssena,b,*, V. Van Tittelbooma,b, I. Alemdaroğlu-Gürbüzc, L. De Jonghea, L. Heyrmana,b,F. Plasschaertd,e, P. Caldersb, H. Feysa, K. Deslooverea,f, C. Van den Broeckba KU Leuven, Department of Rehabilitation Sciences, Leuven, BelgiumbGhent University, Department of Rehabilitation Sciences, Ghent, BelgiumcHacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, TurkeydGhent University, Department of Human Structure and Repair, Ghent, BelgiumeGhent University Hospitals, Department of Orthopaedics and Traumatology, Ghent, BelgiumfUniversity Hospitals Leuven, Clinical Motion Analysis Laboratory, Pellenberg, Belgium1. IntroductionLower limb functional strength tests (FSTs) are clinically applicableevaluations of dynamic muscle strength [1]. Although they have beenoften applied in functional children and adults with cerebral palsy (CP)[1–4], their reliability and validity have only been tested in CP patientswith rather high functional capacity.2. Research QuestionWhat are the reliability and validity of lower limbs FSTs in childrenwith CP, GMFCS levels II and III?3. MethodsTwenty-four children with bilateral CP (11.4±2.5 yrs, GMFCS II/III:13/11) were recruited. Commonly described FSTs were adapted withupper limb support to the children’s abilities where needed to ensurequality of execution. FSTs were repeated within one week to define thereliability. Total averaged scores were created separately for endurancestrength and explosiveness. Composite lower limb isometric strengthscores for the dominant and non-dominant limb were obtained fromhand-held dynamometer assessments in a custom-designed chair [5].Gait capacity (GC) was evaluated by Timed Up and Go (TUG) and 1-minute walking test (1MWT) and a composite score for selective motorcontrol (SMC) combining multiple lower limb joint measures [6]. As-sociations of FST with isometric strength, GC and SMC were evaluatedby means of Spearman’s rank correlation coefficient to determineconvergent validity. Known group validity was examined by comparingscores between GMFCS levels with the Mann Whitney U test (p< 0.01).4. ResultsFSTs' reliability ranged from good to excellent for all tests(Table 1A). There were no significant associations of FSTs with com-posite lower limb isometric strength scores. Both total FST enduranceand explosive associated moderately with SMC (r=0.48/p=0.017 andr=0.64/p=0.019 respectively) and GC (TUG: r=-0.65/p< 0.001 andr=-0.59/p=0.035, 1MWT: r=0.50/p=0.013 and r=0.63/p=0.020respectively). Only averaged FST endurance showed a tendency todiscriminate between GMFCS II and III (p=0.047) (Table 1B).5. DiscussionStrength endurance tests were feasible for most children, whether ornot with upper limb support, but explosive strength tests were notfeasible for children GMFCS level III. The reliability indices were si-milar to values obtained in more functional children [1–3], but pre-viously reported moderate associations with isometric strength couldnot be confirmed by this investigation [2]. Functional and isometrictests evaluate different strength modalities. It is likely that upper limbsupport further confounded their relationship. The upper limb supportmay have influenced the scores to such extent that the endurance testscould not distinguish between two known groups. Yet, the ability toperform the explosive tests distinguished them almost perfectly.Nevertheless, associations with lower limb SMC and GC confirm part ofits convergent validity. The associations with SMC represent the po-tential importance of inter- and intramuscular coordination duringfunction, whilst the associations with GC indicate the importance offunctional strength in mobility [7]. Concluding, FSTs are reliable andpartially valid, but attention is required to changes in upper limb sup-https://doi.org/10.1016/j.gaitpost.2019.07.022⁎ Corresponding author.Gait & Posture 73 (2019) 42–430966-6362/ © 2019 Published by Elsevier B.V.Tport when evaluating intervention effects.References[1] O. Verschuren, M. Ketelaar, T. Takken, M. Van Brussel, J. Paul, M. Helders,J.W. Gorter, Reliability of hand-held dynamometry and functional strength tests forthe lower extremity in children with Cerebral Palsy 8288 (2009), https://doi.org/10.1080/09638280701639873 .[2] W. Aertssen, E. Smulders, B. Smits-Engelsman, E. Rameckers, Functional strengthmeasurement in cerebral palsy: feasibility, test–retest reliability, and construct va-lidity, Dev. Neurorehabil. (2018) 1–9, https://doi.org/10.1080/17518423.2018.1518963 .[3] L. van Vulpen, S. de Groot, J.G. Becher, G.S. De wolf, Feasibility and test-retestreliability of measuring lower-limb strength in young children with cerebral palsy,Eur. J. Phys. Rehabil. Med. (2012).[4] J.G. Gillett, G.A. Lichtwark, R.N. Boyd, L.A. Barber, Functional capacity in adultswith cerebral palsy: Lower limb muscle strength matters, Arch. Phys. Med. Rehabil.(2018), https://doi.org/10.1016/j.apmr.2018.01.020 .[5] M. Goudriaan, A. Nieuwenhuys, S.H. Schless, N. Goemans, G. Molenaers, K.Desloovere, A new strength assessment to evaluate the association between muscleweakness and gait pathology in children with cerebral palsy, in: PLoS One, PublicLibrary of Science, 2018: p. e0191097. doi:10.1371/journal.pone.0191097.[6] J.R. Gage, M. Schwartz, S. Koop, T. Novacheck, The identification and treatment ofgait problems in cerebral palsy (2009).[7] D.M. Begnoche, L.A. Chiarello, R.J. Palisano, E.J. Gracely, S.W. McCoy, M.N. Orlin,Predictors of Independent Walking in Young Children With Cerebral Palsy, Phys.Ther. 96 (2016) 183–192, https://doi.org/10.2522/ptj.20140315 .Table 1Reliability (A) and known-group validity (B) of functional strength tests.B. Hanssen, et al. Gait & Posture 73 (2019) 42–4343

Reliability and validity of lower limb functional strength tests in children with bilateral cerebral palsy

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Reliability and validity of lower limb functional strength tests in children with bilateral cerebral palsy

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