RESEARCH REPORT POSTER DISPLAY

LOWER EXTREMITY ISOMETRIC STRENGTH IN CHILDREN WITH CEREBRAL PALSY OR JUVENILE IDIOPATHIC ARTHRITIS. Saarinen J¹, Lehtonen K¹, Lahdenne P¹, Autti-Rämö I², Mälkiä E³; ¹Helsinki University Central Hospital for Children and Adolescent. ²Stakes National Research and Development for Welfare and Health. ³University of Jyväskylä, Finland

PURPOSE: There are few reports published on muscle strength in children with a chronical disease. It has been studied at least in children with acute lymphoblastic leukemia, children with cystic fibrosis and in children and adolescents with Down Syndrome. Muscle weakness was found in these diagnostic groups when compared to healthy controls. Muscle strength in children has been studied more in children with juvenile idiopathic arthritis (JIA) and cerebral palsy (CP). Muscle strength in JIA has been assessed in a few studies with different methods, e.g. an isokinetic dynamometry, a hand-held dynamometry and a computerized dynamo-meter. These studies have suggested that children with JIA have reduced muscle strength. On the other hand one study reported no difference in muscle strength between children with JIA and healthy controls. Also in children with CP different methods has been used and muscle weakness has been reported in hip, knee and ankle in children with diplegia. In hemiplegia group weakness has been found on the involved side with some changes on the uninvolved side. The purpose of this study was to compare muscle strength in children with various degrees of physical disorder. RELEVANCE: Muscle strengthening is often used in physiotherapy. It is important to spesify the treatment plan for different kind of patients. PARTICIPANTS: The participants were patients with JIA (n=25) or CP (n=47) of Hospital for Children and Adolescents, Helsinki University Central Hospital (HUCH). All patients with JIA had lower extremity articular involment with no active arthritis in lower extremities at the time of testing. All children were on anti-rheumatic medication. All children with CP could walk independently without a gait aid. The Gross Motor Classification System (GMFCS) was used to classify the severity of the disability, Level I and II were identified. A control group (n=25) of age-, height- and gender-matched healthy children, most of them children of HUCH hospital staff. METHODS: A dynamometer chair (Good Strength, Mtitur Ltd., Finland) was used and maximal isometric strength in knee and ankle was measured from both sides in a sitting position. ANALYSIS: All analysis were done with SPSS 11.5 for Windows. One-way ANOVA procedure and t-test were used in the group comparisons and post hoc analyses were performed using Tukey test. Force values normalized by body weigth (N/kg) were used in all group comparisons. Zero values were not in analyzes. RESULTS: Significantly different values were found in knee extension and knee flexion between GMFCS Level II and all other groups and in ankle dorsiflexio/plantarflexion between both CP groups and other groups. In JIA knee extension was near tosignificantly different (p = 0.52) compared to controls. CONCLUSIONS: The Level of muscle strength is connected to the degree of the physical disorder. In this study the muscle strength in JIA group was near to normal but in GMFCS Level II significantly lower compared to other groups. IMPLICATIONS: Adynamometer chair is well suited to measuring pediatric patients and a good tool in assessment and planning of treatment in physioterapy KEYWORDS: Children, mucsle strength, fixed dynamometer. FUNDING ACKNOWLEDGEMENTS: This study was supported by Children’s castle Foundation and HUCH, Hospital for children and adolescent donation fund and McDonalds.

ETHICS COMMITTEE: The Research Ethics Committee at the HUCH Hospital for Children and Adolescent approved this study