Use of Segmental Lengths for the Assessment of Growth in Children with Cerebral Palsy

  • Kristie L. Bell
  • Peter S. W. Davies
  • Roslyn N. Boyd
  • Richard D. Stevenson


Measurement of height or recumbent length is essential for the assessment of linear growth in children. Children with cerebral palsy (CP) often grow poorly and assessment of growth in this population is further complicated by two main difficulties. Firstly, children may have joint contractures, muscular weakness, scoliosis, and/or involuntary movements that make standing or lying straight difficult, if not impossible. Hence, accurate and reliable measures of height or recumbent length are not always attainable in this population. Secondly, as a result of atypical growth patterns, generally accepted reference charts for typically developing children may not be appropriate for use in children with CP. Due to these difficulties segmental lengths such as knee height, tibial length or upper arm length are frequently used as alternatives. These measures are all reliable and valid alternative measures for height in children with CP. They have been recommended for inclusion in the routine growth assessment of this group when accurate or reliable direct measurements of height or recumbent length are difficult or not possible (Spender et al. 1989; White and Ekvall 1993; Chumlea 1994; Stevenson 1995; Gauld et al. 2004). Segmental lengths can be compared directly with growth charts developed from data collected from children with normal growth or children with CP (Spender et al. 1989; White and Ekvall 1993; Stevenson et al. 2006). Alternatively, they may be used to estimate height using published equations, thus enabling comparison with height-for-age reference charts developed from typically developing children or children with CP (CDC 2000; Stevenson et al. 2006; WHO 2006; Day et al. 2007).


Cerebral Palsy Segmental Length Duchenne Muscular Dystrophy Growth Chart Gross Motor Function Classification System 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.





Body Mass Index


Center for Disease Control and Prevention


Cerebral Palsy


Coefficient of Variation


Gross Motor Function Classification System


North American Growth in Cerebral Palsy Project


Root Mean Square of the Error


Standard Error of the Estimate


Technical Error


World Health Organisation



We thank the School of Medicine, University of Queensland and the Royal Children’s Hospital Foundation, Brisbane, Australia for financial support; the National Health and Medical Research Council (NHMRC) for the Project Grant “Growth, Nutrition and Physical Activity of Young Children with Cerebral Palsy” (NHMRC 569605) and Career Development Award for A/Professor Boyd (NHMRC 473860). The North American Growth in Cerebral Palsy Project (NAGCPP; Prof. Stevenson) was supported by the Kluge Research Fund and the Children’s Hospital Committee of the University of Virginia (UVA), the Genetech Foundation for Growth and Development, the National Center for Medical Rehabilitation Research (Grants # 5 R01 HD35739–04, 1 F32 HD08615–01A1, 1 R24 HD39631–01, K24-HD041504–01) and the UVA General Clinical Research Center (GCRC, #M01RR00847). In addition, NAGCPP was supported by: the University of North Carolina GCRC (#M01RR00046) and the National Institute of Arthritis, Musculoskeletal and Skin Diseases (#K24AR02132); the GCRC (M01RR00240) and the Nutrition Center at the Children’s Hospital of Philadelphia; the Jones-Guerrero Fund at Duke University, the Children’s Hospital Fund at the University of British Columbia, and the GCRC at the University of Rochester (#M01 RR00044). The authors acknowledge Mark Conaway, PhD, who created the growth chart figures.


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Kristie L. Bell
    • 1
  • Peter S. W. Davies
  • Roslyn N. Boyd
  • Richard D. Stevenson
  1. 1.Queensland Cerebral Palsy and Rehabilitation Research CentreUniversity of Queensland, Discipline of Paediatrics and Child HealthHerstonAustralia

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