title: Do movement deviations influence self-esteem and sense of coherence in mild unilateral cerebral palsy?
abstract: BACKGROUND
  Individuals with unilateral cerebral palsy (CP) are often physically high functioning. Despite the mildness of the impairment, the movement deviations during walking are often noticeably deviant. In the arm, increased muscle tone causes posturing and decreased motion. In the lower extremity, gait deviations mainly involve the foot and ankle. The deviations often become more apparent with transitions between movements and during rapid movement but also when the person is emotionally affected. Arm posturing and gait deviations may be perceived as cosmetic and social impediments when the individual enters adolescence and becomes more self-conscious. The aim was to study the influence of movement deviations in the upper and lower extremity during walking, on self-esteem, and sense of coherence (SOC) in teenagers and young adults with mild unilateral CP.
  
  
  METHODS
  Three-dimensional gait analysis was performed with an 8-camera system. Movement deviations of the lower extremity, the Gait Profile Score (GPS) and of the upper extremity, and the Arm Posturing Score (APS) were calculated. Self-reported questionnaires "I think I am" measuring self-esteem and SOC were used.
  
  
  RESULTS
  Forty-four patients with a mean age of 17.6 years (range, 13.0 to 24.0 y), 22 females and 22 males, and 15 sex-matched and age-matched controls participated in the study. Forty-two patients were classified as Gross motor function classification scale (GMFCS) I and 2 as GMFCS II. Patients were rated with lower self-esteem than controls (mean, 63.4 vs. 84.7; P=0.025). The SOC assessments revealed no difference. The GPS and APS was higher in patients (6.9 vs. 4.1; P<0.001) and (mean, 10.5 vs. 5.7; P<0.001), respectively. The APS correlated with both self-esteem (coefficient -0.397; P=0.001) and SOC (coefficient -0.375; P=0.05). No correlations were found with the GPS.
  
  
  CONCLUSIONS
  Although physically high functioning, movement deviations in teenagers and young adults with mild unilateral CP are correlated with lower self-esteem. This is more pronounced with increased arm movement deviation and should be considered when evaluating these individuals.
  
  
  METHODS
  Prospective cross-sectional study. Level III.
authors.affiliation: Department of Orthopaedics, Skaraborg Hospital Skövde, Sweden. acques.riad@vgregion.se
authors.forename: Jacques
authors.initials: J
authors.lastname: Riad
authors.forename: Eva
authors.initials: E
authors.lastname: Broström
authors.forename: Ann
authors.initials: A
authors.lastname: Langius-Eklöf
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000503:physiopathology* / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D005684:Gait; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012649:Self Concept; D060685:Sense of Coherence; D012720:Severity of Illness Index; D055815:Young Adult