Abstract: Background：Abnormal muscle tone is a major factor contributing to movement and postural abnormalities in children and adolescents with cerebral palsy. It significantly affects multiple aspects of body function and structure, activity and participation, and quality of life. However, a systematic review on how abnormal muscle tone systematically interacts with other health-related factors is currently lacking. Objective：To explore the current status of the interaction between muscle tone and other health-related factors in the children and adolescents with cerebral palsy. Design：Systematic review. Methods：A systematic search and screening process was conducted to identify studies examining the interaction between muscle tone and other health-related factors in children and adolescents with cerebral palsy. Characteristics of the studies were extracted including participant age, gender, Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), CP subtype, muscle tone assessment metrics, and associated health indicators. Statistical Methods： used to analyze interactions were also extracted. The associated health indicators were categorized based on the International Classification of Functioning, Disability, and Health for Children and Youth (ICF-CY). A constructed methodological framework was applied to determine the interactions between muscle tone and other health-related factors. Main outcome measures：The current status of the interaction between muscle tone and other health-related factors. Results：A total of 19,831 studies were retrieved from Chinese and English databases, and 106 studies were included in the final analysis (92 in English, 14 in Chinese), comprising 14,021 children and adolescents with CP. Of these studies, 6 did not report CP subtype, 12 did not restrict CP subtype, 80 focused solely on spastic CP, and 8 focused on dyskinetic CP. The assessment included 120 pyramidal system indicators (92.3%) and 10 extrapyramidal system indicators. A total of 648 health-related factors with 2,327 interaction data items were included. The top three most frequently reported associated factors were upper limb motor function (172 items, 26.5%), gait (118 items, 18.2%), and secondary musculoskeletal disorders (72 items, 11.1%). The top three interaction data categories were gait (630 entries, 27.1%), upper limb motor ability (288 entries, 12.4%), and muscle strength and endurance (264 entries, 11.3%). Among the included studies, 1,668 entries reported correlation analysis, 444 entries used regression analysis, 17 entries employed structural equation modeling, 13 entries conducted confirmatory factor analysis, and 179 entries applied other and unspecified analytical Methods：. The methodological framework was used to determine interactions between muscle tone and other health-related dimensions. Conclusion：The factors that may interact with muscle tone in children and adolescents with cerebral palsy include gross motor skills, muscle strength and endurance, quality of life, and secondary musculoskeletal disorders. Uncertain interactive factors include gait, participation, activities of daily living, and upper limb function. The factor of physical activity may not interact with muscle tone.

Key words: Cerebral palsy, Muscle tone, Interaction, Systematic review