La force musculaire et son évaluation chez l'enfant infirme moteur cérébral

The muscular weakness is a determining factor in the cerebral palsy symptoms. Muscle strength should be evaluated as objectively as possible to improve the quality of diagnosis and treatment. To measure the muscle strength, we have at the present time a wide choice of tools. The most common and easy method is manual muscle testing, but its main inconvenience is its subjectivity. The manual muscle testing seems to be more appropriate for assigning grades 0 to 3 over 5. Hand held dynamometers give objective and quantifiable values. They are easy to use however the procedures, the positioning of the limb segment without or with the influence of the gravity, the stabilization or not of the joint, the experience of the clinician are responsible for a important errors of measurement which it is necessary to take into account in the follow-up of the programs of muscular training. The isokinetic testing machines are considered as golden standard, they offer a good stabilization of the patient, accurate end repeatable measurement and no examiner bias. Their clinical uses are limited due the lack of portability and the time required doing the measurements. All of these methods need an optimal level of the child participation and a good motor control. The spasticity and the contractures may interfere in the quality of the measurement. In the rehabilitation filed even if the strength improvement is important to reduce the disability, activity-based intervention are also necessary for reducing activity limitation in children with cerebral palsy.