Association between pelvic obliquity and scoliosis, hip displacement and asymmetric hip abduction in children with cerebral palsy: a cross-sectional registry study

Abstract Background Pelvic obliquity (PO) is common in individuals with cerebral palsy (CP). I analysed the prevalence of PO in a population of children with CP and its associations with scoliosis, hip displacement and asymmetric range of hip abduction.Methods Over a 5-year period all pelvic radiographs from the Swedish surveillance programme for CP and the recorded data for scoliosis and hip abduction in children from southern Sweden at Gross Motor Function Classification System (GMFCS) levels II–V were analysed. PO and hip displacement calculated as migration percentage (MP) were measured on supine pelvic radiographs and compared with side difference in hip abduction. Statistical analyses comprised chi-squared testing and binominal confidence intervals.Results In total, 337 children were analysed, of whom 79 had a PO of ≥5°. The proportion of children with PO increased from 16% in GMFCS level II to 34% in level V. Scoliosis combined with PO was reported in 38 children, of whom 34 (89%, 95% confidence interval [CI] 80–99%) had the convexity opposite the high side of the PO. Asymmetric abduction with PO was reported in 45 children, of whom 40 (89%, CI 79–99%) had reduced abduction on the high side of the PO. Asymmetric MP of ≥5% with PO was seen in 62 children, of whom 50 had higher MP on the high side of the PO (81%, CI 71–90%). Children in GMFCS levels II–IV more often had isolated infra-pelvic association with PO (47% versus 19% in GMFCS V, P = 0.025), while combined supra- and infrapelvic association was more common in GMFCS level V (65% versus 30% in GMFCS II–IV, P = 0.004). Isolated infrapelvic or no association was seen in 74% of children ≤10 years of age while 76% of children ≥11 years old had suprapelvic or combined supra- and infrapelvic association with PO (P = 0.0001).Conclusions There was a strong association between the high side of the PO and the side of scoliosis, highest MP and lowest range of abduction when PO was measured in supine position. PO was more often associated with infrapelvic factors. PO was seen in young children indicating the need for early awareness of this complication.

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Association between pelvic obliquity and scoliosis, hip displacement and asymmetric hip abduction in children with cerebral palsy. A cross-sectional registry study

10.21203/rs.3.rs-24942/v2 ◽

2020 ◽

Author(s):

Gunnar Hägglund

Keyword(s):

Cerebral Palsy ◽

Strong Association ◽

Pelvic Obliquity ◽

Cross Sectional ◽

Hip Displacement ◽

Pelvic Radiographs ◽

High Side ◽

Hip Abduction ◽

Chi Squared ◽

Gmfcs Level

Abstract Background: Pelvic obliquity (PO) is common in individuals with cerebral palsy (CP). I analysed the prevalence of PO in a population of children with CP and its associations with scoliosis, hip displacement and asymmetric hip abduction. Methods: Over a 5-year period all pelvic radiographs from the Swedish surveillance programme for CP and the recorded data for scoliosis and hip abduction in children from southern Sweden at Gross Motor Function Classification System (GMFCS) levels II–V were analysed. PO and hip displacement calculated as migration percentage (MP) were measured on supine pelvic radiographs and compared with side difference in hip abduction. Statistical analyses comprised chi-squared testing and binominal confidence intervals. Results: In total, 337 children were analysed, of whom 79 had a PO of >5°. The proportion of children with PO increased from 16% in GMFCS level II to 34% in level V. Scoliosis combined with PO was reported in 38 children, of whom 34 (89%, 95% confidence interval [CI] 80–99%) had the convexity opposite the high side of the PO. Asymmetric abduction with PO was reported in 45 children, of whom 40 (89%, CI 79–99%) had reduced abduction on the high side of the PO. Asymmetric MP of >5% with PO was seen in 62 children, of whom 50 had higher MP on the high side of the PO (81%, CI 71–90%). Children in GMFCS levels II–IV more often had isolated infra-pelvic association with PO (47% versus 19% in GMFCS V, P=0.025), while combined supra- and infrapelvic association was more common in GMFCS level V (65% versus 30% in GMFCS II–IV, P=0.004). Isolated infrapelvic or no association was seen in 74% of children < 10 years of age while 76% of children >11 years old had suprapelvic or combined supra- and infrapelvic association with PO ( P=0.0001). Conclusions: There was a strong association between the high side of PO and the side of scoliosis, highest MP and lowest range of abduction when PO was measured in supine position. PO was more often associated with infrapelvic factors. PO was seen in young children indicating the need for early awareness of this complication.

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Pelvic obliquity and measurement of hip displacement in children with cerebral palsy

Acta Orthopaedica ◽

10.1080/17453674.2018.1519104 ◽

2018 ◽

Vol 89 (6) ◽

pp. 652-655 ◽

Cited By ~ 2

Author(s):

Gunnar Hägglund ◽

Mikael Goldring ◽

Maria Hermanson ◽

Elisabet Rodby-Bousquet

Keyword(s):

Cerebral Palsy ◽

Pelvic Obliquity ◽

Hip Displacement ◽

Children With Cerebral Palsy

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A Cross-sectional Study of the Clinical Profile of Children With Cerebral Palsy in Benin, a West African Low-Income Country

Journal of Child Neurology ◽

10.1177/0883073819864516 ◽

2019 ◽

Vol 34 (13) ◽

pp. 842-850

Author(s):

Emmanuel Segnon Sogbossi ◽

Damienne Houekpetodji ◽

Toussaint G. Kpadonou ◽

Yannick Bleyenheuft

Keyword(s):

Risk Factors ◽

Cerebral Palsy ◽

Low Income ◽

Classification System ◽

West African ◽

Low Income Countries ◽

Cross Sectional ◽

Common Cause ◽

Low Income Country ◽

Children With Cerebral Palsy

Cerebral palsy is a common cause of pediatric motor disability. Although there are increasing amounts of data on the clinical profile of children with cerebral palsy in high-income countries, corresponding information about low-income countries and developing countries is lacking. Therefore, we aimed to describe the clinical spectrum of cerebral palsy in children in Benin, a representative West African low-income country. Our cross-sectional observational study included 114 children with cerebral palsy recruited from community-based rehabilitation centers and teaching hospitals (median age: 7 years, range 2-17; sex: 66% male). Data were collected through review of medical records and interviews with children’s mothers. Assessment included risk factors, clinical subtypes according to the Surveillance of CP in Europe criteria, severity of motor outcome scored by the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System, comorbidities, and school attendance. We recorded a high prevalence of intrapartum adverse events. Seventeen percent of children had postneonatal cerebral palsy, with cerebral malaria being the most common cause. Most children were severely affected (67.5% as bilateral spastic; 54.4% as GMFCS IV or V), but severity declined substantially with age. Only 23% of the children with cerebral palsy had attended school. Poor motor outcomes and comorbidities were associated with school nonattendance. These results suggest that intrapartum risk factors and postnatal cerebral malaria in infants are opportune targets for prevention of cerebral palsy in Sub-Saharan low-income countries.

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Hip surgery and radiology reporting for children with cerebral palsy prior to initiation of a hip surveillance program

Journal of Pediatric Rehabilitation Medicine ◽

10.3233/prm-201506 ◽

2021 ◽

pp. 1-7

Author(s):

Kyra Kane ◽

Marshall Siemens ◽

Shane Wunder ◽

Jacqueline Kraushaar ◽

J. Alexandra Mortimer ◽

...

Keyword(s):

Cerebral Palsy ◽

Retrospective Chart Review ◽

Surveillance Program ◽

Radiology Reporting ◽

Reporting Practices ◽

Hip Displacement ◽

Primary Surgery ◽

Radiology Reports ◽

Children With Cerebral Palsy ◽

Surveillance Programs

PURPOSE: Hip displacement impacts quality of life for many children with cerebral palsy (CP). While early detection can help avoid dislocation and late-stage surgery, formalized surveillance programs are not ubiquitous. This study aimed to examine: 1) surgical practices around pediatric hip displacement for children with CP in a region without formalized hip surveillance; and 2) utility of MP compared to traditional radiology reporting for quantifying displacement. METHODS: A retrospective chart review examined hip displacement surgeries performed on children with CP between 2007–2016. Surgeries were classified as preventative, reconstructive, or salvage. Pre- and post-operative migration percentage (MP) was calculated for available radiographs using a mobile application and compared using Wilcoxon Signed Ranks test. MPs were also compared with descriptions in the corresponding radiology reports using directed and conventional content analyses. RESULTS: Data from 67 children (115 surgical hips) was included. Primary surgery types included preventative (63.5% hips), reconstructive (36.5%), or salvage (0%). For the 92 hips with both radiology reports and radiographs available, reports contained a range of descriptors that inconsistently reflected the retrospectively-calculated MPs. CONCLUSION: Current radiology reporting practices do not appear to effectively describe hip displacement for children with CP. Therefore, standardized reporting of MP is recommended.

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Unequal physical activity among children with cerebral palsy in Sweden—A national registry study

Health Science Reports ◽

10.1002/hsr2.342 ◽

2021 ◽

Vol 4 (3) ◽

Author(s):

Frida Degerstedt ◽

Martin Björklund ◽

Britt‐Inger Keisu ◽

Birgit Enberg

Keyword(s):

Physical Activity ◽

Cerebral Palsy ◽

National Registry ◽

Registry Study ◽

Children With Cerebral Palsy

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Effect of an interval rehabilitation program with home-based, vibration-assisted training on the development of muscle and bone in children with cerebral palsy – an observational study

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2020-0080 ◽

2020 ◽

Vol 33 (8) ◽

pp. 1083-1092 ◽

Cited By ~ 1

Author(s):

Ibrahim Duran ◽

Kyriakos Martakis ◽

Christina Stark ◽

Leonie Schafmeyer ◽

Mirko Rehberg ◽

...

Keyword(s):

Cerebral Palsy ◽

Bone Growth ◽

Muscle Growth ◽

Rehabilitation Program ◽

Whole Body ◽

Cross Sectional ◽

Home Based ◽

Children With Cerebral Palsy ◽

One Year ◽

Intensive Rehabilitation

AbstractObjectivesIn children with cerebral palsy (CP), the most common cause of physical impairment in childhood, less muscle and bone growth has been reported, when compared with typically developing children. The aim of this study was to evaluate the effect of an intensive rehabilitation program including physiotherapy in combination with 6 months of home-based, vibration-assisted training on muscle and bone growth in children with CP.MethodsWe included children with CP, who participated in a rehabilitation program utilizing whole-body vibration (WBV). Muscle mass was quantified by appendicular lean mass index (App-LMI) and bone mass by total-body-less-head bone mineral content (TBLH-BMC) assessed by Dual-energy X-ray absorptiometry (DXA) at the beginning of rehabilitation and one year later. To assess the functional muscle-bone unit, the relation of TBLH-BMC to TBLH lean body mass (TBLH-LBM) was used.ResultsThe study population included 128 children (52 females, mean age 11.9 ± 2.7). App-LMI assessed in kg/m2 increased significantly after rehabilitation. The age-adjusted Z-score for App-LMI showed no significant change. TBLH-BMC assessed in gram increased significantly. The Z-scores for TBLH-BMC decreased lesser than expected by the evaluation of the cross-sectional data at the beginning of rehabilitation. The parameter $\frac{TBLH-BMC}{TBLH-LBM}$ did not change relevantly after 12 months.ConclusionsMuscle growth and to a lesser extent bone growth could be increased in children with CP. The intensive rehabilitation program including WBV seemed to have no direct effect on the bone, but the observed anabolic effect on the bone, may only been mediated through the muscle.

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