Association of Nutritional Status with Gross Motor Function in Cerebral Palsy

Main Article Content

Maryam Shams
Danish Hassan
Mehwish Boota
Ali Asad Naeem
Osama Khalil


Background: Cerebral palsy is a prevalent disorder characterized by severe disability in body structures, impacting physical activities and daily living. This condition is often accompanied by poor nutritional status due to its complex interaction with movement and posture disorders.

Objective: The study aimed to determine the association between nutritional status and gross motor function in children with cerebral palsy.

Methods: A cross-sectional analytical study was conducted at Khawaja Arshad Hospital, Sargodha from July to December 2020. Children aged 4-12 years diagnosed with cerebral palsy were included, excluding those with genetic, metabolic, or neurodegenerative diseases affecting growth. Nutritional status was assessed using the WHO ANTHRO PLUS calculator, and children were categorized into five levels of gross motor function based on the Gross Motor Function Classification System.

Results: The study consisted of 55% males and 45% females. Gross motor function assessments revealed that 25% of participants were in level I, 60% in levels II and III, and 15% in levels IV and V. Nutritional assessments indicated that 17% of the children were malnourished, 70% had normal nutrition, and 12% were overweight. Height for age percentile showed 30% malnutrition and 70% normal nutritional status.

Conclusion: There was a significant correlation between the severity of gross motor dysfunction and nutritional status in children with cerebral palsy, with higher levels of motor impairment associated with greater nutritional deficits.

Article Details

How to Cite
Shams, M., Hassan, D., Boota, M., Naeem, A. A., & Khalil, O. (2024). Association of Nutritional Status with Gross Motor Function in Cerebral Palsy. Journal of Health and Rehabilitation Research, 4(2), 1265–1273.
Author Biographies

Maryam Shams, Riphah International Institute Lahore Pakistan.

Student in physical therapy department, Riphah International Institute Lahore, Pakistan.

Danish Hassan, Riphah International Institute Lahore Pakistan.

Assistant Professor, physical therapy department, Riphah International Institute Lahore, Pakistan.

Mehwish Boota, The University of Lahore-Lahore Pakistan.

Student at University Institute of Physical Therapy, The University of Lahore-Lahore Pakistan.

Ali Asad Naeem, The University of Lahore-Lahore Pakistan.

Student in University Institute of Physical Therapy department, The University of Lahore-Lahore Pakistan.

Osama Khalil, The University of Lahore-Lahore Pakistan.

Student in University Institute of Physical Therapy department, The University of Lahore-Lahore Pakistan.


Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109(suppl 109):8-14.

Del Giudice E, Staiano A, Capano G, Romano A, Florimonte L, Miele E, et al. Gastrointestinal manifestations in children with cerebral palsy. Brain and Development. 1999;21(5):307-11.

Stallings VA, Cronk CE, Zemel BS, Charney EB. Body composition in children with spastic quadriplegic cerebral palsy. The Journal of pediatrics. 1995;126(5):833-9.

Polack S, Adams M, O'banion D, Baltussen M, Asante S, Kerac M, et al. Children with cerebral palsy in Ghana: malnutrition, feeding challenges, and caregiver quality of life. Developmental Medicine & Child Neurology. 2018;60(9):914-21.

Isakova T, Xie H, Yang W, Xie D, Anderson AH, Scialla J, et al. Fibroblast growth factor 23 and risks of mortality and end-stage renal disease in patients with chronic kidney disease. Jama. 2011;305(23):2432-9.

Kakooza‐Mwesige A, Tumwine JK, Eliasson AC, Namusoke HK, Forssberg

H. Malnutrition is common in Ugandan children with cerebral palsy, particularly those over the age of five and those who had neonatal complications. Acta Paediatrica. 2015;104(12):1259-68.

Jelliffe DB, Organization WH. The assessment of the nutritional status of the community (with special reference to field surveys in developing regions of the world: World Health Organization; 1966.

Papadopoulos AJ, Foskett M, Seckl MJ, McNeish I, Paradinas FJ, Rees H, et al. Twenty-five years' clinical experience with placental site trophoblastic tumors. The Journal of reproductive medicine. 2002;47(6):460-4.

Secker DJ, Jeejeebhoy KN. Subjective global nutritional assessment for children. The American journal of clinical nutrition. 2007;85(4):1083-9.

Dahlseng MO, Finbråten AK, Júlíusson PB, Skranes J, Andersen G, Vik T. Feeding problems, growth and nutritional status in children with cerebral palsy. Acta paediatrica. 2012;101(1):92-8.

Bansal A, Diwan S, Diwan J, Vyas N. Prevalance of obesity in children with cerebral palsy. Journal of clinical and diagnostic research: JCDR. 2014;8(8):BC08.

Sullivan P. Measurement of body composition should become routine in nutritional assessment of children with cerebral palsy. Developmental Medicine & Child Neurology. 2015;57(9):793-4.

Oeffinger DJ, Gurka MJ, Kuperminc M, Hassani S, Buhr N, Tylkowski C. Accuracy of skinfold and bioelectrical impedance assessments of body fat percentage in ambulatory individuals with cerebral palsy. Developmental Medicine & Child Neurology. 2014;56(5):475-81.

Finbråten AK, Martins C, Andersen GL, Skranes J, Brannsether B, Júlíusson PB, et al. Assessment of body composition in children with cerebral palsy: a cross‐sectional study in N orway. Developmental Medicine & Child Neurology. 2015;57(9):858-64.

Delalić A, Kapidžić-Bašić N, Glinac A. Body mass index in cerebral palsy patients with various motor severities. Paediatrics Today. 2014;10(2):95-103.

Dahl M, Thommessen M, Rasmussen M, Selberg T. Feeding and nutritional characteristics in children with moderate or severe cerebral palsy. Acta paediatrica. 1996;85(6):697-701.

Lewis D, Khoshoo V, Pencharz PB, Golladay ES. Impact of nutritional rehabilitation on gastroesophageal reflux in neurologically impaired children. Journal of pediatric surgery. 1994;29(2):167-70.

Bandini LG, Schoeller DA, Fukagawa NK, Wykes LJ, Dietz WH. Body composition and energy expenditure in adolescents with cerebral palsy or myelodysplasia. Pediatric research. 1991;29(1):70-7.

Durnin J, Rahaman MM. The assessment of the amount of fat in the human body from measurements of skinfold thickness. British journal of Nutrition. 1967;21(3):681-9.

Waterlow J. Note on the assessment and classification of protein-energy malnutrition in children. The Lancet. 1973;302(7820):87-9.

Hoare B, Ditchfield M, Thorley M, Wallen M, Bracken J, Harvey A, et al. Cognition and bimanual performance in children with unilateral cerebral palsy: protocol for a multicentre, cross-sectional study. BMC neurology. 2018;18(1):1-12.

Sulaeman E, Udall Jr JN, Brown RF, Mannick EE, Loe WA, Hill CB, et al. Gastroesophageal reflux and Nissen fundoplication following percutaneous endoscopic gastrostomy in children. Journal of pediatric gastroenterology and nutrition. 1998;26(3):269-73.

Mokhy MS, Jamaluddin R, Abd Rasyid Ismail WYS, Sulaiman N, Adznam SNA, Ismail IH. Anthropometry Measurements to Determine Nutritional Status Among Cerebral Palsy Children: A Scoping Review. Malays J Med Health Sci. 2020;16:210-5.

Baker JP, Detsky AS, Wesson DE, Wolman SL, Stewart S, Whitewell J, et al. Nutritional assessment: a comparison of clinical judgment and objective measurements. New England Journal of Medicine. 1982;306(16):969-72.

Detsky AS, Baker JP, O'Rourke K, Johnston N, Whitwell J, Mendelson RA, et al. Predicting nutrition‐associated complications for patients undergoing gastrointestinal surgery. Journal of Parenteral and Enteral Nutrition. 1987;11(5):440- 6.

Haapala H, Peterson MD, Daunter A, Hurvitz EA. Agreement between actual height and estimated height using segmental limb lengths for individuals with cerebral palsy. American journal of physical medicine & rehabilitation/Association of Academic Physiatrists. 2015;94(7):539.

Detsky AS, Baker J, Johnston N, Whittaker S, Mendelson R, Jeejeebhoy K. What is subjective global assessment of nutritional status? Journal of parenteral and enteral nutrition. 1987;11(1):8-13.

Detsky AS, Smalley PS, Chang J. Is this patient malnourished? Jama. 1994;271(1):54-8.

Samson-Fang L, Bell K. Assessment of growth and nutrition in children with cerebral palsy. European journal of clinical nutrition. 2013;67(2):S5-S8.

SINGH DK, LAISRAM N, MALIK A, KANAUJIA V, BADHAL S, JAIN S. Association of Motor Function and Neuroimaging in Cerebral Palsy: A Cross- sectional Study. Journal of Clinical & Diagnostic Research. 2021;15(10).

Carniel MP, Santetti D, Andrade JS, Favero BP, Moschen T, Campos PA, et al. Validation of a subjective global assessment questionnaire. Jornal de Pediatria (Versão em Português). 2015;91(6):596-602.

Mahdavi AM, Safaiyan A, Ostadrahimi A. Subjective vs objective nutritional assessment study in children: a cross-sectional study in the northwest of Iran. Nutrition research. 2009;29(4):269-74.

Guindos-Sanchez LD, Lucena-Anton D, Moral-Munoz JA, Salazar A, Carmona-Barrientos I. The Effectiveness of Hippotherapy to Recover Gross Motor Function in Children with Cerebral Palsy: A Systematic Review and Meta-Analysis. Children. 2020;7(9):106.

Duran I, Schulze J, Martakis K, Stark C, Schoenau E. Diagnostic performance of body mass index to identify excess body fat in children with cerebral palsy. Developmental Medicine & Child Neurology. 2018;60(7):680-6.

Control CfD, Prevention, Statistics NCfH. CDC growth charts. United States; May 30, 2000. Set; 2019.

García-Contreras AA, Vásquez-Garibay EM, Romero-Velarde E, Ibarra- Gutiérrez AI, Troyo-Sanromán R, Sandoval-Montes IE. El apoyo nutricio intensivo mejora el estado nutricio y la composición corporal en niños gravemente desnutridos con parálisis cerebral. Nutrición Hospitalaria. 2014;29(4):838-43.

Rakhmaeva R, Kamalova A, Ayupova V. Evaluation of anthropometric parameters and body composition in children with cerebral palsy. Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics). 2019;64(5):204-8.

Aggarwal S, Chadha R, Pathak R. Nutritional status and growth in children with cerebral palsy: a review. International Journal of Medical Science and Public Health. 2015;4(6):737-44.

Tüzün EH, Güven DK, Eker L, Elbasan B, Bülbül SF. Nutritional status of children with cerebral palsy in Turkey. Disability and rehabilitation. 2013;35(5):413- 7.

Glinac A, Matović L, Delalić A, Mešalić L. Quality of life in mothers of children with cerebral palsy. Acta clinica Croatica. 2017;56(2.):299-307.

Rajikan R, Zakaria N, Manaf Z, Yusoff N, Shahar S. The effect of feeding problems on the growth of children and adolescents with cerebral palsy. Journal of Fundamental and Applied Sciences. 2017;9(6S):787-804.