Association Between Extremity Muscle Strength and Functional Outcomes in Children With Cerebral Palsy

The Effect of Upper and Lower Extremity Muscle Strength on Activity Level, Participation and Quality of Life in School-Age Children With Cerebral Palsy

The aim of this study was to evaluate whether upper and lower extremity muscle strength is a factor in activity, participation and quality of life parameters in school-age children with CP and to reveal the difference in upper and lower extremity muscle strength compared to typically developing peers.

Study Overview

• Status: Completed
• Conditions: Cerebral Palsy (CP)

Detailed Description

Upper motor neuron lesion causing Cerebral Palsy (CP) leads to various problems including muscle tone, coactivation of agonist-antagonist muscles, coordination, balance, muscle strength, loss of selective motor control, bone deformities and muscle contractures by negatively affecting motor control and these problems have been shown to affect the level of activity and participation in social life.

Studies demonstrate that increased muscle strength, especially with muscle strengthening programmes, improves functional outcomes in children with CP. Although studies exist on causal relationships between motor affectivity, GMFCS level, muscle strength and quality of life in children with CP, studies directly examining the relationship between muscle strength and activity level, participation in social life and quality of life are limited. Determining the relationship between lower and upper extremity muscle strength and participation and quality of life in children with CP is important for rehabilitation approaches. This will help focus on strengthening specific muscle groups in rehabilitation to increase participation in social life and quality of life in children with CP.

• Study Type: Observational
• Enrollment (Actual): 140

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • İzmir
    • Ankara, İzmir, Turkey (Türkiye), 35410
      • Hacettepe University, Faculty of Physical Therapy and Rehabilitation

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Children with cerebral palsy who applied to the Paediatric Physiotherapy and Cerebral Palsy Unit of the Department of Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, and children of the same age group with typical development were included in the study.

Description

Inclusion Criteria:

• Having been diagnosed with cerebral palsy,
• Being classified as Level I-II-III on the Gross Motor Classification System,
• Being classified as Level I-II on the Communication Function Classification System (IFSS) for Individuals with Cerebral Palsy,
• Having turned 6 years old by the start of the study and not having turned 12 years old by the end of the study.

Inclusion criteria for typically developing children:

• Not having been diagnosed with any neurological disorder,
• Having turned 6 years old by the start of the study and not having turned 12 years old by the end of the study.

Exclusion Criteria:

• Have a Gross Motor Classification System Level IV-V,
• Have a Communication Function Classification System (IFSS) Level III, IV, and V for individuals with cerebral palsy,
• Having undergone Botulinum Toxin-A (BTX-A) injection in the last 6 months,
• Having undergone orthopaedic surgery in the last 6 months,
• Using medication that may affect muscle strength,
• Having cardiovascular problems.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Upper and Lower Extremity Isometric Muscle Strength Measured by Hand-Held Dynamometer (ActivForce 2, Activbody, San Diego, CA, USA).	Isometric muscle strength of the following muscle groups was assessed using the "Make Test" with a portable hand-held dynamometer (ActivForce 2; Activbody, San Diego, CA, USA): Shoulder abductors, Shoulder extensors, Elbow flexors, Elbow extensors, Hip abductors, Hip extensors, Knee flexors, Knee extensors. Muscle strength values were recorded in kilograms (kg). Higher values indicate greater muscle strength.	1 day (single assessment session)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pediatric Evaluation of Disability Inventory - Computer Adaptive Test (PEDI-CAT) Domain Scores	The PEDI-CAT assesses functional performance in four domains: Daily Activities, Mobility, Social/Cognitive, Responsibility. Each domain is scored on a standardized scale (norm-based score; mean 50, SD 10). Higher scores indicate better functional performance.	1 day
Cerebral Palsy Quality of Life Questionnaire (CP QOL) Total Score	The CP QOL assesses quality of life across multiple domains including: Social well-being and acceptance, Feelings about functioning, Participation and physical health, Emotional well-being and self-esteem, Pain and impact of disability. Domain scores range from 0 to 100. Higher scores indicate better quality of life.	1 day
Assessment of Life Habits (LIFE-H) Total Score	The LIFE-H (5-13 years version) evaluates social participation across 12 domains. Items are scored from 0 to 9: 0 = Complete restriction in participation 9 = Optimal participation Higher scores indicate better participation.	1 day
Pediatric Outcomes Data Collection Instrument (PODCI) Global Function Score	The PODCI evaluates health-related quality of life and functional performance across five domains: Upper Extremity Function, Transfers and Basic Mobility, Physical Function and Sports, Comfort and Pain, Happiness Scores range from 0 to 100. Higher scores indicate better function and quality of life.	1 day

Collaborators and Investigators

• Sponsor: Hacettepe University
• Investigators: Principal Investigator: Mintaze Kerem Günel, PT, Prof. Dr., Hacettepe University, Faculty of Physical Therapy and Rehabilitation

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2022
• Primary Completion (Actual): June 1, 2023
• Study Completion (Actual): June 15, 2023

Study Registration Dates

• First Submitted: February 26, 2026
• First Submitted That Met QC Criteria: March 3, 2026
• First Posted (Actual): March 4, 2026

Study Record Updates

• Last Update Posted (Actual): March 4, 2026
• Last Update Submitted That Met QC Criteria: March 3, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Cerebral Palsy; Quality of Life; Muscle Strength; Participation
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Brain Damage, Chronic; Cerebral Palsy
• Other Study ID Numbers: HU-FTR-AS-01

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No