The Mechanism of Hip Dislocation Related to the Use of Abduction Bar and Hip Compression Bandage in Patients With Spastic Cerebral Palsy

Hip adductor spasticity is a contributing factor to hip dislocation in patients with cerebral palsy (CP). We hypothesized that botulinum toxin injected into the hip adductor muscles would reduce spasticity and help prevent hip dislocation. Twenty patients with bilateral spastic CP aged 2 to 10 years with gross motor function classification system level IV or V were included. Botulinum toxin was injected into the hip adductor muscles at baseline and at 6-month follow-up. Muscle tone was measured with an eight-channel surface electromyography (EMG) recorder. A hip X-ray was performed, and Reimer’s hip migration index (MI) was measured. The Wilcoxon signed-rank test was used to compare the surface EMG values of the hip muscles at baseline and follow-up. The mean root mean square surface EMG value of the hip adductor muscles was significantly reduced at 1, 2, 3, and 7 months after the first injection, up to approximately 53% of the baseline. The 1-year progression of the hip MI was −0.04%. Repeated sessions of botulinum toxin injections at the hip adductor muscles significantly reduced muscle tone and hip displacement. A botulinum toxin injection may be used as an adjunctive treatment in the prevention of hip dislocation.

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Correlation of Postural Asymmetries with Gross Motor Functional Classification among Cerebral Palsy Children

Pakistan Journal of Medicine and Dentistry ◽

10.36283/pjmd10-3/005 ◽

2021 ◽

Keyword(s):

Cerebral Palsy ◽

High Frequency ◽

Sagittal Plane ◽

Functional Limitation ◽

Hip Dislocation ◽

Standing Position ◽

Spastic Cerebral Palsy ◽

Special School ◽

Gross Motor

Background: Motor control and posture disorders are responsible in the development of cerebral palsy (CP). Spastic CP, the most common type of CP is associated with postural asymmetries resulting in functional limitation among children and compromising their quality of life. Therefore, the study aimed to describe the severity of postural asymmetries among special school going children with spastic cerebral palsy in correlation with Gross Motor Function Classification System levels (GMFCS). Methods: Thirty-four subjects from Lahore who were special school going children diagnosed with spastic CP for more than 6 months and less than 1 year were recruited. Children with uncontrolled seizures, hearing and visual impairment, surgery scheduled and other types of cerebral palsy were excluded. The scale used for the assessment of postural asymmetries was Posture and Postural Ability Scale with the reliability of 0.99. ANOVA test was applied with p<0.05 considered as statistically significant. Results: Severe asymmetries were found in standing position with 5.9% (n=2) in frontal and 20.6% (n=7) in sagittal plane. There were mild asymmetries in supine position, 55.9% (n=19) in frontal and 50% (n=17) in sagittal plane. In prone position, reported asymmetries were 55.9% (n=19) in frontal and 44.1% (n=15) in sagittal plane. In sitting position 76.5% (n=26) accounted for both frontal and sagittal plane asymmetries. p<0.05 showed significant distribution of postural asymmetries. Conclusion: Severe postural asymmetries were found in standing position (p<0.05). However, high frequency of pain, scoliosis and hip dislocation were observed at level III of GMFCS among special school going children diagnosed with spastic cerebral palsy. Keywords: Cerebral Palsy; Children; Spastic; Muscle Spasticity.

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