scholarly journals Association between Pelvic Obliquity and Scoliosis, Hip Displacement and Asymmetric Hip Abduction in Children with Cerebral Palsy. A Cross-Sectional Registry Study

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 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.

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

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.

scholarly journals Risk factors for hip dislocation in dyskinetic cerebral palsy

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902110011
Author(s):  
Kyoko Okuno ◽  
Yukihiro Kitai ◽  
Toru Shibata ◽  
Hiroshi Arai
Keyword(s):  
Risk Factors ◽  
Cerebral Palsy ◽  
Birth Weight ◽  
Gestational Age ◽  
Brain Mri ◽  
Brain Lesion ◽  
Brain Lesions ◽  
Lesion Location ◽  
Hip Displacement ◽  
Gmfcs Level

Purpose: To investigate the risk factors for hip displacement in patients with dyskinetic cerebral palsy (DCP). Methods: We evaluated 81 patients with DCP, 45 males and 36 females, aged 10–22 years, risk factors for hip displacement were evaluated using multivariate logistic regression analysis with primary brain lesions, Gross Motor Function Classification System (GMFCS) level, gestational age, birth weight, Cobb’s angle, and complication of epilepsy as independent factors. Hip displacement was defined as migration percentage >30%. Primary brain lesions were classified into globus pallidus (GP), thalamus and putamen (TP), and others using brain magnetic resonance imaging (MRI). Perinatal and clinical features were compared between patients with GP lesions and those with TP lesions. Results: Hip displacement was observed in 53 patients (67%). Higher GMFCS levels (p = 0.013, odds ratio [OR] 2.6) and the presence of GP lesions (p = 0.04, OR 16.5) were independent risk factors for hip displacement. Patients with GP lesions showed significantly higher GMFCS levels, more frequent hip displacement, and lower gestational age and birth weight than those with TP lesions. Conclusion: Primary brain lesion location may be an important factor in predicting hip displacement among patients with DCP. Appropriate risk assessment using brain MRI may contribute to the early detection and intervention of hip displacement because brain lesion location can be assessed during infancy before GMFCS level is decided.

scholarly journals The Level of Children’s Independence with Cerebral Palsy in Several Regions in Java and Sumatra

2020 ◽  
Vol 5 (1) ◽  
pp. 1-12
Author(s):  
Bambang Trisnowiyanto
Keyword(s):  
Cerebral Palsy ◽  
Health Workers ◽  
Brain Lesion ◽  
Clinical Manifestations ◽  
Total Sample ◽  
Body Parts ◽  
Research Subjects ◽  
Cross Sectional ◽  
Children With Cerebral Palsy ◽  
Gmfcs Level

Background:  The most common disorder or disability in childhood is cerebral palsy, obtained during the antenatal, perinatal or early postnatal period. Cerebral palsy is a non-progressive injury or brain lesion with very variable clinical manifestations. children with cerebral palsy have impaired movement, ability levels and functional limitations and affected body parts. Therefore, to find out the level of independence in children with cerebral palsy, it is necessary to have an examination carried out by health workers, especially physiotherapy. In this case, an examination using the Gross Motor Function Classification System (GMFCS). The purpose of this study was to determine the degree of independence of children with cerebral palsy in several regions in Java and Sumatra. Methods: A total of 315 children with cerebral palsy (mean ± SD)  participated in this cross-sectional study design. The research was conducted in March-June 2019. GMFCS data was collected from children with cerebral palsy in the parent community of cerebral palsy in 10 cities. The Kolmogorov-Smirnov test used for data normality test. Result: Overall research subjects from 10 cerebral palsy communities with a total sample of 315 children, most cerebral palsy with GMFCS level 4 as many as 117 children (37.1%), then GMFCS level 3 as many as 84 children (26.7%), GMFCS level 5 is 67 children (21.3%), level 2 GMFCS is 24 children (7.6%), and at least children with level 1 GMFCS are 23 children (7.3%). Conclusion: The conclusion is from a total of 315 children with cerebral palsy, the level of Indonesian children's independence based on GMFCS most of them are less independent.

scholarly journals Ambulatory Physical Activity Performance in Youth With Cerebral Palsy and Youth Who Are Developing Typically

2007 ◽  
Vol 87 (3) ◽  
pp. 248-257 ◽  
Author(s):  
Kristie F Bjornson ◽  
Basia Belza ◽  
Deborah Kartin ◽  
Rebecca Logsdon ◽  
John F McLaughlin
Keyword(s):  
Cerebral Palsy ◽  
Activity Levels ◽  
Ambulatory Activity ◽  
Cross Sectional ◽  
Walking Activity ◽  
Activity Performance ◽  
Cross Sectional Design ◽  
Low Activity ◽  
Gmfcs Level ◽  
Daily Total

Background and Purpose Assessment of walking activity in youth with cerebral palsy (CP) has traditionally been “capacity-based.” The purpose of this study was to describe the day-to-day ambulatory activity “performance” of youth with CP compared with youth who were developing typically. Subjects Eighty-one youth with CP, aged 10 to 13 years, who were categorized as being in Gross Motor Function Classification System (GMFCS) levels I to III and 30 age-matched youth who were developing typically were recruited. Methods Using a cross-sectional design, participants wore the StepWatch monitor for 7 days while documenting average daily total step counts, percentage of time they were active, ratio of medium to low activity levels, and percentage of time at high activity levels. Results The youth with CP demonstrated significantly lower levels of all outcomes than the comparison group. Discussion and Conclusion Daily walking activity and variability decreased as functional walking level (GMFCS level) decreased. Ambulatory activity performance within the context of the daily life for youth with CP appears valid and feasible as an outcome for mobility interventions in CP.

scholarly journals Reference Values for Aerobic Fitness in Children, Adolescents, and Young Adults Who Have Cerebral Palsy and Are Ambulatory

2010 ◽  
Vol 90 (8) ◽  
pp. 1148-1156 ◽  
Author(s):  
Olaf Verschuren ◽  
Manon Bloemen ◽  
Cas Kruitwagen ◽  
Tim Takken
Keyword(s):  
Young Adults ◽  
Cerebral Palsy ◽  
Young People ◽  
Reference Values ◽  
Aerobic Fitness ◽  
Adolescents And Young Adults ◽  
Cross Sectional ◽  
Level I ◽  
Shuttle Run ◽  
Gmfcs Level

BackgroundVery few objective data exist regarding aerobic performance in young people with cerebral palsy (CP). The characterization of aerobic fitness could provide baseline and outcome measures for the rehabilitation of young people with CP.ObjectiveThe objective of this study was to provide reference values for aerobic fitness in a group of children, adolescents, and young adults who had CP and who were classified at Gross Motor Function Classification System (GMFCS) level I or II. Data were collected with 10-m shuttle run tests.DesignThis investigation was a cross-sectional observational study conducted between August 2008 and June 2009.MethodsReference values were established using data from a total of 306 children, adolescents, and young adults who had CP, who were 6 to 20 years old, and who were recruited from 26 rehabilitation centers in the Netherlands, Switzerland, Australia, Canada, and the United States. A total of 211 participants were classified at GMFCS level I (mean age=12.2 years, SD=3.0), and 95 were classified at GMFCS level II (mean age=12.4 years, SD=3.2); 181 were male, and 125 were female. Aerobic fitness was reflected by the level achieved on the 10-m shuttle run tests.ResultsOn the basis of a total of 306 assessments from the 10-m shuttle run tests, 4 reference curves were created.LimitationsThe limitation of this study is the cross-sectional nature of the design.ConclusionsThis study provided height-related reference values for aerobic fitness in children, adolescents, and young adults who had CP, who were 6 to 20 years old, and who were classified at GMFCS level I or II. Generalized additive models for location, scale, and shape were used to construct centile curves. These curves are clinically relevant and provide a user-friendly method for the prediction of aerobic fitness in young people with CP.

scholarly journals Hip displacement in children with cerebral palsy in Scotland: a total population study

2018 ◽  
Vol 12 (6) ◽  
pp. 635-639 ◽  
Author(s):  
K. E. Bugler ◽  
M. S. Gaston ◽  
J. E. Robb
Keyword(s):  
Cerebral Palsy ◽  
Total Population ◽  
Hip Dislocation ◽  
Level Of Evidence ◽  
Surveillance Programme ◽  
Hip Displacement ◽  
Number Of Children ◽  
Children With Cerebral Palsy ◽  
Migration Percentage ◽  
Gmfcs Level

Purpose The purpose of this study is to report the number of children from a total population of children with cerebral palsy (CP) in Scotland who had a displaced or dislocated hip at first registration in a national surveillance programme. Methods Migration percentage (MP), laterality, Gross Motor Function Classification System (GMFCS) level, CP subtype, distribution of CP and age were analyzed in 1171 children. Relative risk was calculated with 95% confidence intervals. Hip displacement and dislocation were defined as a MP of 40 to 99 and > 100 respectively. Results Radiographs were available from the first assessment of 1171 children out of 1933 children registered on the system. In all, 2.5% of children had either one or both hips dislocated (29/1171) and dislocation only occurred in children of GMFCS levels IV and V. A total of 10% of children had a MP 40 to 99 in one or both hips (117/1171). An increasing GMFCS level was strongly associated with an abnormal MP. Hip dislocation was unusual in patients under the age of seven years. A MP of 40 to 99 was not seen in children with isolated dystonia. Displacement was more frequent in children with bilateral involvement and dislocation was only seen in spastic and mixed tone groups. Conclusion This data gives an overview of the number of CP children who have hip displacement/dislocation in Scotland and who will possibly require surgery. Level of Evidence I

scholarly journals Self-versus Proxy-Reported Pain in Children with Cerebral Palsy: A Population-Based Registry Study of 3783 Children

2020 ◽  
Vol 11 ◽  
pp. 215013272091152 ◽  
Author(s):  
Gunnar Hägglund ◽  
Amanda Burman-Rimstedt ◽  
Tomasz Czuba ◽  
Ann I. Alriksson-Schmidt
Keyword(s):  
Logistic Regression ◽  
Cerebral Palsy ◽  
Classification System ◽  
Population Based ◽  
Registry Study ◽  
Cross Sectional ◽  
Marginal Effects ◽  
Level I ◽  
Average Marginal Effects ◽  
Gmfcs Level

Objective: To assess how the prevalence of pain in a population-based sample of children and adolescents with cerebral palsy (CP) differ based on self- or proxy reporting. Methods: This cross-sectional registry study included 3783 children (58% boys), 1 to 18 years old, enrolled in the Swedish follow-up program for CP. Logistic regression was used to regress source of reporting (self or proxy) on the presence of general pain adjusted for age, sex, Gross Motor Function Classification System (GMFCS), and Communication Function Classification System (CFCS) levels, including marginal effects between source of reporting and adjusted covariates. Results: The pain item was self-reported in 45%, proxy-reported in 51%, and information was missing in 3%. Pain was reported in 44% of those who self-reported and in 41% of those who proxy-reported ( P = .04). The logistic regression showed that the average marginal effects of proxy versus self-reported pain were lower among children at GMFCS level IV (−0.14, 95% CI −0.17 to −0.03) and CFCS level I (−0.09, CI −0.16 to −0.01) and higher at CFCS level III (0.11, CI 0.00-0.22). There were no statistically significant differences in average marginal effects related to age, sex, or the other GMFCS and CFCS levels between proxy and self-reporting. Conclusions: Pain was more often reported by those who self-reported. However, after adjusting for age, sex, CFCS level, and GMFCS level, the proportion of reported pain was almost equal between self and proxy-reporting. Assuming that the self- and proxy-reported groups were not significantly different on relevant factors not controlled for the results indicate that presence of pain is equally reported by children and parents.

scholarly journals Sales-Orientation and Customer-Orientation on Performance of Direct Sales Executives of Fidelity Bank, Ghana

2020 ◽  
Vol 9 (4) ◽  
pp. 70-86
Author(s):  
Charles Adusei ◽  
Isaac Tweneboah-Koduah ◽  
Gloria K.Q. Agyapong
Keyword(s):  
Customer Orientation ◽  
Strong Association ◽  
Sales Performance ◽  
Cross Sectional Study ◽  
Study Data ◽  
Listening Skills ◽  
Cross Sectional ◽  
Direct Sales ◽  
Customer Information ◽  
Chi Squared

This study focused on sales-orientation and customer-orientation of Direct Sales Executives (DSEs) on sales performance at Fidelity Bank, Ghana; which was a cross-sectional study. Data were analysed using descriptive statistics, Kendall’s coefficient of concordance, cross tabulation and chi-squared test of independence. The result showed a strong association between prior sales experience and employment status. DSEs customer orientation was influenced by customer information while the sales orientation was on convincing customers to buy. The customer-oriented culture was based on reliable market and customer information. DSEs sales performance were influenced by complete knowledge of the bank’s products and services, listening skills and empathy. The study suggests that Fidelity Bank must sensitize its DSEs on the bank philosophy on its customer orientation culture. This study appears to be the first of its kind to explore the connection between sales orientation and customer orientation on performance in the Banking Industry in Ghana, thus providing empirical evidence for academics and practitioners.

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