Relación entre las curvaturas sagitales de raquis y el nivel de función motora gruesa

Abstract

ABSTRACT Goals: To study the criterion-related validity and reliability of the "Locomotor Stages" as classification system of the gross motor function. This would allow us to compare locomotor function of children with typical development and those with cerebral palsy. To study the relation between the sagittal curves of the spine and the reduced level of gross motor function in subjects with cerebral palsy; and to study the relation between the sagittal curves of the spine and the increased level of gross motor function in subjects training locomotor skills beyond the ontogenic development. Method. Sagittal lumbar spine kinematics from 97 children with cerebral palsy from Three-Dimensional Gait Analysis were plotted relative to their gross motor level. Also, sagittal spinal morphotype was studied in 48 artistic gymnasts. Results: High values for interrater and intrarater reliability was found for Locomotor Stages (0.987, P value < 0.568), as well as high correlation with Gross Motor Classification System (-0.925, P value < 0.001). Significant correlations were found between all average and minimum values of the lumbar spine and locomotor stage in children with cerebral palsy Maximal values did not correlate with gross motor function, but only with age at Loading Response. Significant regressions were found in all average and minimum values when taking age in combination with Gross Motor Function Classification System. Correlation values of the sagittal plane spine measurements showed significantly increased thoracic kyphosis in male gymnasts (-0.445, p<0.001). No significant correlations have been found between training hours per year or training volume and any measurements of the spine on the sagittal plane. When data from the two sitting tests were integrated, 62.5% of gymnasts had a functional thoracic kyphosis and 39.6% had lumbar kyphotic attitude. Conclusions. Locomotor Stages is a reliably classification system, sensitive and specific for gross motor function, that also allows plotting typical development children and those with cerebral palsy. Basal and maintenance values of the sagittal lumbar curve are specific to each gross motor level in children with cerebral palsy. Higher classifications of gross motor skills correlate with more extended lumbar spine. In Children with cerebral palsy who cannot walk independently, the effect of development is reversed, flexing the lumbar spine. Functional training of skills beyond the ontogenetic locomotor function, like walking ability on the upper limbs, seems to required specific adaptations in postural hypolordosis, functional thoracic kyphosis and lumbar kyphotic attitude during sitting and trunk flexion.