Sitting and standing performance in a total population of children with cerebral palsy: a cross-sectional study

Elisabet Rodby-Bousquet, Gunnar Hägglund, Elisabet Rodby-Bousquet, Gunnar Hägglund

Abstract

Background: Knowledge of sitting and standing performance in a total population of children with cerebral palsy (CP) is of interest for health care planning and for prediction of future ability in the individual child. In 1994, a register and a health care programme for children with CP in southern Sweden was initiated. In the programme information on how the child usually sits, stands, stands up and sits down, together with use of support or assistive devices, is recorded annually.

Methods: A cross-sectional study was performed, analysing the most recent report of all children with CP born 1990-2005 and living in southern Sweden during 2008. All 562 children (326 boys, 236 girls) aged 3-18 years were included in the study. The degree of independence, use of support or assistive devices to sit, stand, stand up and sit down was analysed in relation to the Gross Motor Function Classification System (GMFCS), CP subtype and age.

Result: A majority of the children used standard chairs (57%), could stand independently (62%) and could stand up (62%) and sit down (63%) without external support. Adaptive seating was used by 42%, external support to stand was used by 31%, to stand up by 19%, and to sit down by 18%. The use of adaptive seating and assistive devices increased with GMFCS levels (p < 0.001) and there was a difference between CP subtypes (p < 0.001). The use of support was more frequent in preschool children aged 3-6 (p < 0.001).

Conclusion: About 60% of children with CP, aged 3-18, use standard chairs, stand, stand up, and sit down without external support. Adding those using adaptive seating and external support, 99% of the children could sit, 96% could stand and 81% could stand up from a sitting position and 81% could sit down from a standing position. The GMFCS classification system is a good predictor of sitting and standing performance.

Figures

Figure 1
Figure 1
Type of chair used for sitting related to GMFCS level. Information missing in 3 of the 562 children aged 3-18 years. The use of adaptive seating increased with GMFCS-levels (p < 0.001), linear by linear association test.
Figure 2
Figure 2
Type of chair used for sitting related to CP subtype. Information missing in 3 of the 562 children aged 3-18 years. Kruskal-Wallis test showed a significant difference in use of standard chairs between CP-subtypes (p < 0.001) Post hoc analyses with Mann-Whitney showed a significant difference between all subtypes (p < 0.001) except for ataxic/spastic bilateral, ataxic/unclassified and spastic bilateral/unclassified.
Figure 3
Figure 3
The use of support to stand (A), stand up (B) and sit down (C) related to GMFCS level. Information missing in one of the 562 children aged 3-18 years. The use of support increased with GMFCS level (p < 0.001), linear by linear association test.
Figure 4
Figure 4
The use of support to stand (A), stand up (B) and sit down (C) related to CP subtype. Information missing in one of the 562 children aged 3-18 years. Kruskal-Wallis test showed a significant difference between CP subtypes (p < 0.001) to stand, stand up and sit down. Post hoc analyses with Mann-Whitney revealed a difference between all subtypes (p < 0.05) except for spastic bilateral vs. unclassified.

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