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Development of lower limb range of motion from early childhood to adolescence in cerebral palsy: a population-based study

Eva Nordmark12*, Gunnar Hägglund3, Henrik Lauge-Pedersen3, Philippe Wagner4 and Lena Westbom25

Author Affiliations

1 Department of Health Sciences, Division of Physiotherapy, Lund University, SE-221 00 Lund, Sweden

2 Hospital for Children and Adolescents, Lund University Hospital, SE-221 85 Lund Sweden

3 Department of Orthopaedics, Lund University Hospital SE-221 85 Lund, Sweden

4 National Competence Centre for Musculoskeletal Disorders, Lund University Hospital, SE-221 85 Lund, Sweden

5 Department of Clinical Sciences, Division of Paediatrics, Lund University, Lund, Sweden

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BMC Medicine 2009, 7:65  doi:10.1186/1741-7015-7-65

Published: 28 October 2009



The decreasing range of joint motion caused by insufficient muscle length is a common problem in children with cerebral palsy (CP), often worsening with age. In 1994 a CP register and health care programme for children with CP was initiated in southern Sweden. The aim of this study was to analyse the development of the passive range of motion (ROM) in the lower limbs during all the growth periods in relation to gross motor function and CP subtype in the total population of children with CP.


In total, 359 children with CP born during 1990-1999, living in the southernmost part of Sweden in the year during which they reached their third birthday and still living in the area in the year of their seventh birthday were analysed. The programme includes a continuous standardized follow-up with goniometric measurements of ROM in the lower limbs. The assessments are made by each child's local physiotherapist twice a year until 6 years of age, then once a year. In total, 5075 assessments from the CPUP database from 1994 to 1 January 2007 were analysed.


The study showed a decreasing mean range of motion over the period 2-14 years of age in all joints or muscles measured. The development of ROM varied according to GMFCS level and CP subtype.


We found a decreasing ROM in children with CP from 2-14 years of age. This information is important for both the treatment and follow-up planning of the individual child as well as for the planning of health care programmes for all children with CP.