BACKGROUND Muscle contractures are developing during childhood and may cause extensive problems in gait and every day functioning in children with cerebral palsy (CP). The aim of the present study was to evaluate how the popliteal angle (PA) and hamstrings spasticity change during childhood in walking children with spastic bilateral CP. METHODS The present study was a longitudinal register-based cohort study including 419 children (1-15 years of age) with spastic bilateral CP, gross motor function classification system (GMFCS) level I, II and III included in the Norwegian CP Follow-up Program (CPOP). From 2006 to 2018 a total of 2193 tests were performed. The children were tested by trained physiotherapists yearly or every second year, depending on GMFCS level and age. The PA and the hamstrings spasticity (Modified Ashworth scale (MAS)) were measured at every time point. Both legs were included in the analysis. RESULTS There was an increase in PA with age for all three GMFCS levels with significant differences between the levels from 1 up to 8 years of age. At the age of 10 years there was no significant difference between GMFCS level II and III. At the age of 14 years all three GMFCS levels had a mean PA above 40° and there were no significant differences between the groups. The hamstrings spasticity scores for all the three GMFCS levels were at the lower end of the MAS (mean < 1+), however they were significantly different from each other until 8 years of age. The spasticity increased the first four years in all three GMFCS levels, thereafter the level I and II slightly increased, and level III slightly decreased, until the age of 15 years. CONCLUSION The present study showed an increasing PA during childhood. There were significantly different PAs between GMFCS level I, II and III up to 8 years of age. At the age of 14 years all levels showed a PA above 40°. The spasticity increased up to 4 years of age, but all the spasticity scores were at the lower end of the MAS during childhood.

中文翻译：

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在儿童期出现痉挛性双侧脑性瘫痪的儿童中，pop角和绳肌痉挛的变化。基于注册的队列研究。

背景技术肌肉挛缩症在儿童时期就已发展，并可能在患有脑瘫（CP）的儿童中引起步态和日常工作方面的广泛问题。本研究的目的是评估儿童痉挛性双侧CP患儿的the角（PA）和绳肌痉挛在儿童期的变化。方法本研究是一项基于纵向登记的队列研究，包括419名儿童（1-15岁）患有痉挛性双侧CP，挪威CP随访中包括的I，II和III级大运动功能分类系统（GMFCS）程序（CPOP）。从2006年到2018年，总共进行了2193次测试。根据GMFCS的水平和年龄，每年或每两年由受过训练的物理治疗师对儿童进行测试。在每个时间点测量PA和腿筋痉挛（改良Ashworth量表（MAS））。两条腿都包括在分析中。结果所有三个GMFCS水平的PA均随年龄增加而增加，从1至8岁之间的水平之间存在显着差异。GMFCS II级和III级在10岁时没有显着差异。在14岁时，所有三个GMFCS水平的平均PA均高于40°，两组之间没有显着差异。所有三个GMFCS水平的绳肌痉挛评分均在MAS的较低端（平均<1+），但是在8岁之前，它们之间存在显着差异。在所有三个GMFCS级别中，前四年的痉挛都增加了，此后，I和II级别略有增加，第三级略有下降，直到15岁。结论本研究显示儿童期PA升高。在GMFCS的I，II和III等级（最高8岁）之间存在显着不同的PA。在14岁时，所有水平的PA均高于40°。痉挛程度增加到4岁，但是所有的痉挛评分都在儿童时期处于MAS的低端。