{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T10:58:56Z","timestamp":1790679536923,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Develop Med Child Neuro"],"abstract":"Abstract<\/jats:title>\n \n Aim<\/jats:title>\n To investigate associations between muscle tone measured using the Modified Ashworth Scale (MAS) and pain in children with spastic cerebral palsy (CP).<\/jats:p>\n <\/jats:sec>\n \n Method<\/jats:title>\n \n Children (aged 0\u201317\u2009years; mean age 10\u2009years 2\u2009months) in the Norwegian Quality and Surveillance Registry for Cerebral Palsy with physical therapy assessments between 2018 and 2021 were included (\n n<\/jats:italic>\n \u00a0=\u00a01188; 42.3% female) in this population\u2010based cross\u2010sectional study. Logistic regression analyses were used to examine the association between MAS scores and pain. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Pain was experienced by 41.4% (\n n<\/jats:italic>\n \u00a0=\u00a0492). Risk of pain was highest in children classified in Gross Motor Function Classification System level V (OR\u00a0=\u00a01.81, 95% CI\u00a0=\u00a01.21\u20132.70) and Manual Ability Classification System level V (OR\u00a0=\u00a02.00, 95% CI\u00a0=\u00a01.25\u20133.16), children with bilateral spastic CP (OR\u00a0=\u00a01.34, 95% CI\u00a0=\u00a01.06\u20131.68) and increasing age (OR\u00a0=\u00a01.12, 95% CI\u00a0=\u00a01.09\u20131.15). Pain interfered with sleep in 24.8% (\n n<\/jats:italic>\n \u00a0=\u00a0122) of children and activities of daily living (ADLs) in 53.0% (\n n<\/jats:italic>\n \u00a0=\u00a0261) of children. An MAS\u2009score of 2 or greater was recorded in 42.3% (\n n<\/jats:italic>\n \u00a0=\u00a0502), most often in the ankle plantar flexors. Adjusted analyses showed that the highest MAS score was associated with pain interfering with ADLs (adjusted OR\u00a0=\u00a01.40, 95% CI\u00a0=\u00a01.00\u20131.96), and an MAS score of 2 or greater with higher pain intensity (adjusted OR\u00a0=\u00a01.2, 95% CI\u00a0=\u00a01.01\u20131.42).\n <\/jats:p>\n <\/jats:sec>\n \n Interpretation<\/jats:title>\n Pain is common in children with spastic CP, frequently disrupting sleep and ADLs. Higher MAS scores are modestly associated with increased pain intensity and interference, highlighting the need for targeted pain screening strategies.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/dmcn.70548","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T10:26:27Z","timestamp":1790677587000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Muscle tone and pain in children with spastic cerebral palsy"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-1922-0078","authenticated-orcid":false,"given":"Olav Aga","family":"Kildal","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Telemark Hospital Trust Skien Norway"},{"name":"Faculty of Medicine University of Oslo Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7486-7454","authenticated-orcid":false,"given":"Sandra Julsen","family":"Hollung","sequence":"additional","affiliation":[{"name":"Vestfold Hospital Trust, Norwegian Quality and Surveillance Registry for Cerebral Palsy T\u00f8nsberg Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keson","family":"Jaioun","sequence":"additional","affiliation":[{"name":"Department of Research, Telemark Hospital Trust Skien Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guro L.","family":"Andersen","sequence":"additional","affiliation":[{"name":"Vestfold Hospital Trust, Norwegian Quality and Surveillance Registry for Cerebral Palsy T\u00f8nsberg Norway"},{"name":"Faculty of Medicine and Health Sciences Norwegian University of Science and Technology Trondheim Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"issue":"4","key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1111\/dmcn.70149","article-title":"Updated description of cerebral palsy","volume":"68","author":"Dan B","year":"2026","journal-title":"Dev Med Child Neurol."},{"issue":"5","key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"e1285","DOI":"10.1542\/peds.2012-0924","article-title":"Clinical prognostic messages from a systematic review on cerebral palsy","volume":"130","author":"Novak I","year":"2012","journal-title":"Pediatrics."},{"issue":"3","key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1111\/dmcn.14111","article-title":"Prevalence and characteristics of pain in children and young adults with cerebral palsy: a systematic review","volume":"61","author":"McKinnon CT","year":"2019","journal-title":"Dev Med Child Neurol."},{"issue":"2","key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1080\/16501970310018305","article-title":"Musculoskeletal pain in adults with cerebral palsy compared with the general population","volume":"36","author":"Jahnsen R","year":"2004","journal-title":"J Rehabil Med."},{"issue":"1","key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1111\/apa.15341","article-title":"Pain is frequent in children with cerebral palsy and negatively affects physical activity and participation","volume":"110","author":"Ostergaard CS","year":"2021","journal-title":"Acta Paediatr."},{"issue":"6","key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/j.rehab.2017.03.011","article-title":"Prevalence of pain in 240 non\u2010ambulatory children with severe cerebral palsy","volume":"60","author":"Poirot I","year":"2017","journal-title":"Ann. 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