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Casey J, Rosenblad A, Agustsson A, Lauge-Pedersen H, Rodby-Bousquet E. Incidence and sequence of scoliosis and windswept hip deformity: which comes first in 4148 children with cerebral palsy? A longitudinal cohort study. BMC Musculoskelet Disord 2024; 25:222. [PMID: 38504256 PMCID: PMC10953287 DOI: 10.1186/s12891-024-07350-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 03/11/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The aim was to analyse whether scoliosis or windswept hip deformity (WSH) occurs first for children with cerebral palsy (CP). METHODS This longitudinal cohort study using data from 1994 - 2020 (26 years) involved 41,600 measurements of 4148 children (2419 [58.3%] boys) with CP born 1990 - 2018 and registered into the Swedish CP follow-up program. Children were followed from a mean age of 2.8 [SD 1.4] years, until they developed either scoliosis or WSH or were removed at surgery. RESULTS WSH developed first in 16.6% of the children (mean age 8.1 [SD 5.0] years), and scoliosis in 8.1% (mean age 8.1 [SD 4.9] years). The incidence of WSH was higher than scoliosis across all levels I-V of the Gross Motor Function Classification System (GMFCS), both sexes, and for those with dyskinetic (20.0%) or spastic (17.0%) CP. The incidence of scoliosis was highest (19.8%) and developed earliest in children with GMFCS level V (mean age 5.5 [SD 3.5] years), and in children with dyskinetic (17.9%) CP (mean age 7.0 [SD 4.7] years). CONCLUSIONS WSH presents earlier than scoliosis in most children with CP. Children with higher GMFCS level or dyskinetic CP are more likely to develop these deformities at a younger age.
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Affiliation(s)
- Jackie Casey
- Department of Clinical Sciences, Orthopaedics, Lund University, Lund, 221 85, Sweden
- Research & Development Office, Southern Health & Social Care Trust, Craigavon, Northern Ireland
- School of Nursing & Paramedic Sciences, Ulster University, Belfast, Northern Ireland
| | - Andreas Rosenblad
- Department of Statistics, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Division of Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Solna, Sweden
| | - Atli Agustsson
- Department of Physiotherapy, Research Centre of Movement Science, University of Iceland, Reykjavik, Iceland
| | - Henrik Lauge-Pedersen
- Department of Clinical Sciences, Orthopaedics, Lund University, Lund, 221 85, Sweden
| | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences, Orthopaedics, Lund University, Lund, 221 85, Sweden.
- Centre for Clinical Research, Uppsala University-Region Västmanland, Västerås, 721 89, Sweden.
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Menozzi GC, Depaoli A, Ramella M, Alessandri G, Frizziero L, Liverani A, Rocca G, Trisolino G. Side-to-Side Flipping Wedge Osteotomy: Virtual Surgical Planning Suggested an Innovative One-Stage Procedure for Aligning Both Knees in "Windswept Deformity". J Pers Med 2023; 13:1538. [PMID: 38003853 PMCID: PMC10671880 DOI: 10.3390/jpm13111538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/11/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: The adoption of Virtual Surgical Planning (VSP) and 3D technologies is rapidly growing within the field of orthopedic surgery, opening the door to highly innovative and individually tailored surgical techniques. We present an innovative correction approach successfully used in a child affected by "windswept deformity" of the knees. (2) Methods: We report a case involving a child diagnosed with "windswept deformity" of the knees. This condition was successfully addressed through a one-stage bilateral osteotomy of the distal femur. Notably, the wedge removed from the valgus side was flipped and employed on the varus side to achieve the correction of both knees simultaneously. The surgical technique was entirely conceptualized, simulated, and planned in a virtual environment. Customized cutting guides and bony models were produced at an in-hospital 3D printing point of care and used during the operation. (3) Results: The surgery was carried out according to the VSP, resulting in favorable outcomes. We achieved good corrections of the angular deformity with an absolute difference from the planned correction of 2° on the right side and 1° on the left side. Moreover, this precision not only improved surgical outcomes but also reduced the procedure's duration and overall cost, highlighting the efficiency of our approach. (4) Conclusions: The integration of VSP and 3D printing into the surgical treatment of rare limb anomalies not only deepens our understanding of these deformities but also opens the door to the development of innovative, personalized, and adaptable approaches for addressing these unique conditions.
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Affiliation(s)
- Grazia Chiara Menozzi
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.C.M.); (A.D.); (M.R.); (G.R.)
| | - Alessandro Depaoli
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.C.M.); (A.D.); (M.R.); (G.R.)
| | - Marco Ramella
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.C.M.); (A.D.); (M.R.); (G.R.)
| | - Giulia Alessandri
- Department of Industrial Engineering, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy; (G.A.); (L.F.); (A.L.)
| | - Leonardo Frizziero
- Department of Industrial Engineering, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy; (G.A.); (L.F.); (A.L.)
| | - Alfredo Liverani
- Department of Industrial Engineering, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy; (G.A.); (L.F.); (A.L.)
| | - Gino Rocca
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.C.M.); (A.D.); (M.R.); (G.R.)
| | - Giovanni Trisolino
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.C.M.); (A.D.); (M.R.); (G.R.)
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Casey J, Agustsson A, Rosenblad A, Rodby-Bousquet E. Relationship between scoliosis, windswept hips and contractures with pain and asymmetries in sitting and supine in 2450 children with cerebral palsy. Disabil Rehabil 2022; 44:6738-6743. [PMID: 34487468 DOI: 10.1080/09638288.2021.1971308] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE This cross-sectional study of 2450 children with cerebral palsy aimed to analyse the prevalence and association of scoliosis, windswept hips, hip and knee contractures. METHODS Logistic regression was used to estimate associations with pain, postural asymmetries, and ability to change position for children at Gross Motor Function Classification System (GMFCS) levels I-V, aged 0-18 years. RESULTS Most children with a deformity or contracture had postural asymmetries in both sitting and supine positions; 10.5% had scoliosis, 8.7% windswept hips, 6.6% hip flexion and 19.2% knee contractures. Severe postural asymmetries increased the likelihood for scoliosis 9 times, for windswept hips 6 to 9 times, and for hip and knee flexion contractures 7 and 12 times respectively, adjusted for age, sex and GMFCS level. Hip flexion contractures and windswept hips increased the likelihood for pain by 1.5-1.6 times. CONCLUSION The likelihood of having scoliosis, windswept hips and flexion contractures in the hips and knees increased if the child had postural asymmetries, and for increased age and higher GMFCS levels. Efforts should focus on preventing postural asymmetries from occurring or progressing, and on increasing the child's ability to change position. Reducing postural asymmetries may also reduce the likelihood of pain.Implications for RehabilitationThe risk of having scoliosis, windswept hip deformity and flexion contractures in the hips and knees increased if the child had postural asymmetries in sitting or lying.Efforts should focus on preventing or reducing postural asymmetries, and on increasing the child's ability to change position.Reducing postural asymmetries may also reduce the risk of pain.
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Affiliation(s)
- Jackie Casey
- Department of Clinical Sciences, Orthopaedics, Lund University, Lund, Sweden.,Rehabilitation Engineering Centre, Musgrave Park Hospital, Belfast Health & Social Care Trust, Belfast, Northern Ireland
| | - Atli Agustsson
- Research Centre of Movement Science, Department of Physiotherapy, University of Iceland, Reykjavik, Iceland
| | - Andreas Rosenblad
- Department of Medical Sciences, Division of Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
| | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences, Orthopaedics, Lund University, Lund, Sweden.,Centre for Clinical Research, Uppsala University-Region Västmanland, Västerås, Sweden
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Tenaglia A, Azizi H, Kim H. A pediatric physiatrist's approach to neuromuscular hip dysplasia in cerebral palsy. J Pediatr Rehabil Med 2022; 15:19-24. [PMID: 35311727 DOI: 10.3233/prm-220007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cerebral palsy (CP) encompasses a group of disorders pertaining to abnormalities in movement, tone, and/or posture due to a nonprogressive lesion to an immature brain. Hip dysplasia is the second most common orthopedic deformity seen in CP, and its severity can range from a hip at risk for subluxation to full hip dislocation with degenerative changes. The purpose of this article is to review the hip pathologies that occur in CP focusing on their pathogenesis, physical exam findings, impact on function, and conservative treatment. Through a review of the medical literature, it is demonstrated that early, aggressive, and comprehensive care led by a pediatric physiatrist is essential to mitigate progression to complete hip dislocation and preserve range of motion, prevent contracture, and promote maximum functional ability in all children with CP.
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Affiliation(s)
- Amy Tenaglia
- Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY, USA
| | - Hana Azizi
- Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY, USA
| | - Heakyung Kim
- Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY, USA
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Yoo N, Arand B, Shi J, Yang J, Noritz G, Whitaker AT. Feeding tube use is associated with severe scoliosis in patients with cerebral palsy and limited ambulatory ability. Spine Deform 2022; 10:1415-1421. [PMID: 35764871 PMCID: PMC9579063 DOI: 10.1007/s43390-022-00540-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 06/05/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Cerebral palsy (CP) is the most common motor disorder in childhood. Scoliosis is a common complication of CP that can reach clinically severe levels, but predictors for scoliosis in CP are not well understood. Some variables identified in the literature involve the severity of the brain injury and the presence of hip deformity. We aimed to identify associations with developing severe scoliosis in a prospective cohort of patients with cerebral palsy at higher risk for severe curve progression. METHODS This study reviewed a prospectively collected database at a tertiary children's hospital. We evaluated a panel of potential associations with severe scoliosis-including age, sex, Gross Motor Function Classification System (GMFCS) class, history of hip surgery, epilepsy, and feeding tube presence-in a population of children with limited ambulatory ability defined as GMFCS level IV or V CP. Univariate analysis and multivariate logistic regression with stepwise selection was used for analysis. RESULTS Descriptive analysis showed that female sex, higher GMFCS class, history of hip surgery, non-upright seating, pelvic obliquity, presence of epilepsy, and presence of a feeding tube were associated with an increased risk for scoliosis. Multivariate logistic regression analysis revealed that the presence of a feeding tube was associated with severe scoliosis even when controlling for GMFCS and age. CONCLUSIONS Feeding tube use may stratify risk for severe scoliosis progression in patients with GMFCS IV or V CP.
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Affiliation(s)
- Nicholas Yoo
- College of Medicine, The Ohio State University, Columbus, OH USA
| | - Brian Arand
- Nationwide Children’s Hospital, Columbus, OH USA
| | - Junxin Shi
- Nationwide Children’s Hospital, Columbus, OH USA
| | | | - Garey Noritz
- Nationwide Children’s Hospital, Columbus, OH USA
| | - Amanda T. Whitaker
- Nationwide Children’s Hospital, Columbus, OH USA ,Shriners Hospital Northern California, University of California Davis, Sacramento, CA USA
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Pargas C, Saisongcroh T, Rogers KJ, Sees JP, Miller F, Shrader MW. The impact of asymmetry on the radiographical outcomes following hip reconstruction in patients with cerebral palsy. J Child Orthop 2021; 15:510-514. [PMID: 34858539 PMCID: PMC8582612 DOI: 10.1302/1863-2548.15.210056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/06/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of this study was to evaluate the impact of asymmetric hip dysplasia on the outcome of hip reconstruction in patients with cerebral palsy according to preoperative migration percentage (MP). METHODS This study was institutional review board-approved for retrospective cohort review. From 2008 to 2018, 65 patients met inclusion criteria: Gross Motor Function Scale Classification (GMFSC) III to V with spastic hips (MP > 30%) who underwent bilateral hip reconstruction, with a follow-up > 24 months. Main exclusion criteria: children with associated syndromes or chromosomal disorders. The cohort was subdivided into three groups according to preoperative MP difference between hips: Group A > 50%, group B 20% to 50% and Group C < 20%. Subsequently, the groups were analyzed individually and then compared. The asymmetry of extended abduction of the hip was also evaluated and separated into three groups: no asymmetry (< 20° difference), mild asymmetry (20° to 50° difference) and severe (> 50° difference). RESULTS In total, 65 patients underwent bilateral bony reconstructive surgery (130 hips). Mean age at surgery was 10.1 years (sd 3.6; 3.6 to 18.4). Mean age at follow-up was 14.7 years (sd 3.8; 8 to 21). Preoperative GMFSC distribution was grade III (four, 6%), IV (15, 23%) and V (46, 71%). In all, 21 symmetric hips (< 20% MP difference) had a preoperative MP difference of 9% and a follow-up MP difference of 18% (p > 0.05); 32 had a preoperative MP difference of 34% and a follow-up MP difference of 16% (p < 0.0001); 12 had a preoperative MP difference of 80% and a follow-up difference of 6% (p < 0.0001). According to pre- and postoperative abduction values, the mean high hip abduction preoperatively was 34° (sd 17°), whereas low hip abduction was 23° (sd 17°). CONCLUSION Hips with asymmetrical dysplasia and/or abduction undergoing bilateral reconstructive surgery focused on symmetric abduction, and corrected dysplasia in patients with cerebral palsy has improved symmetry in hip abduction and MP. Obtaining this goal immediately postoperatively is maintained to medium-term follow-up. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Carlos Pargas
- Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States
| | - Tanyawat Saisongcroh
- Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States,Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kenneth J. Rogers
- Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States
| | - Julieanne P. Sees
- Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States
| | - Freeman Miller
- Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States
| | - M. Wade Shrader
- Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States
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Abstract
PURPOSE The effects of abducted standing on hip migration percentage (MP) and range of hip and knee motion in children with cerebral palsy were studied for more than 7 years in 2 case-control groups. One group had adductor-psoas tenotomy and the other did not. METHODS Case participants performed 15° to 30° of abduction per hip. Controls performed 0° to 10° of abduction and were matched on age, surgery, and follow-up time. RESULTS Median MP decreased 7.0% in the participants without surgery, increased 6.5% in their matched participant, and decreased 3.5% in the participants who had adductor-psoas tenotomy. Migration percentage decreased 18% in participants who after surgery performed abducted standing. Range of motion was greater after surgery in participants who performed standing abduction. CONCLUSIONS Standing abduction at 15° to 30° for 10 h/wk reduces MP and preserves range of motion for up to 7 years. This is a new contribution to research for children with cerebral palsy.
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Affiliation(s)
- Caroline Martinsson
- Habilitation & Health, Children and youth habilitation Borås (Ms Martinsson), Region Västra Götaland, Sweden; Department of Pediatrics (Dr Himmelmann), The Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Sato H. Postural deformity in children with cerebral palsy: Why it occurs and how is it managed. Phys Ther Res 2020; 23:8-14. [PMID: 32850273 DOI: 10.1298/ptr.r0008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/15/2020] [Indexed: 01/04/2023]
Abstract
Despite the fact that children with cerebral palsy may not have any deformities at the time of birth, postural deformities, such as scoliosis, pelvic obliquity, and windswept hip deformity, can appear with increasing age. This may lead to respiratory function deterioration and, in more severe cases, affects survival. To date, postural care is believed to help improve the health and quality of life of children with cerebral palsy. This review provides an overview of the cause and clinical management of postural deformity that is seen in children with cerebral palsy.
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Affiliation(s)
- Haruhiko Sato
- Kitasato University School of Allied Health Sciences
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Hägglund G. Association between pelvic obliquity and scoliosis, hip displacement and asymmetric hip abduction in children with cerebral palsy: a cross-sectional registry study. BMC Musculoskelet Disord 2020; 21:464. [PMID: 32664926 PMCID: PMC7362488 DOI: 10.1186/s12891-020-03484-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pelvic obliquity (PO) is common in individuals with cerebral palsy (CP). The prevalence of PO in a population of children with CP and its associations with scoliosis, hip displacement and asymmetric range of hip abduction were analysed. 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 presence of scoliosis and side difference in hip abduction. Statistical analyses comprised chi-squared and binominal testing. 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 to 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 < 0.001). 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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Affiliation(s)
- Gunnar Hägglund
- Department of Clinical Sciences, Orthopedics, Lund University, Skane University Hospital, 221 85, Lund, Sweden.
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Schmidt SM, Hägglund G, Alriksson‐Schmidt AI. Bone and joint complications and reduced mobility are associated with pain in children with cerebral palsy. Acta Paediatr 2020; 109:541-549. [PMID: 31506983 PMCID: PMC7028048 DOI: 10.1111/apa.15006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/23/2019] [Accepted: 09/06/2019] [Indexed: 12/26/2022]
Abstract
AIM To investigate the relationships between pain in the lower extremities and back, and spasticity, bone/joint complications and mobility. METHODS Retrospective population-based registry study. Participants (N = 3256) with cerebral palsy (CP), 2.5-16 years of age, participating in the Swedish Cerebral Palsy Follow-up Program were included. Spasticity was measured using scissoring and the Modified Ashworth Scale. Bone/joint complications consisted of hip displacement, range of motion, windswept posture and scoliosis. Mobility was measured using the Functional Mobility Scale (5-, 50- and 500-metres), wheelchair use (outdoors) and the ability to stand/get up from sitting/use stairs, respectively. Pain was measured as presence of pain in hips, knees, feet and back. Data were analysed using structural equation modelling. RESULTS Bone/joint complications had the strongest direct pathway with pain in the lower extremities (standardised regression coefficient = 0.48), followed by reduced mobility (standardised regression coefficient = -0.24). The pathways between spasticity and pain, and age and pain were not significant. The R2 of the model was 0.15. CONCLUSION Bone/joint complications and reduced mobility were associated with pain in the lower extremities when controlling for sex. Considering the R2 of the model, other factors not included in the model are also associated with pain in the lower extremities in children with CP.
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Affiliation(s)
| | - Gunnar Hägglund
- Department of Clinical Sciences, Orthopedics Skåne University Hospital Lund University Lund Sweden
| | - Ann I. Alriksson‐Schmidt
- Department of Clinical Sciences, Orthopedics Skåne University Hospital Lund University Lund Sweden
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Holmes C, Fredrickson E, Brock K, Morgan P. The intra- and inter-rater reliability of the Goldsmith indices of body symmetry in non-ambulant adults with cerebral palsy. Disabil Rehabil 2020; 43:2640-2646. [DOI: 10.1080/09638288.2019.1708979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Carlee Holmes
- St. Vincent’s Hospital, Melbourne, Australia
- Physiotherapy Department, Monash University, Frankston, Australia
| | | | - Kim Brock
- St. Vincent’s Hospital, Melbourne, Australia
| | - Prue Morgan
- Physiotherapy Department, Monash University, Frankston, Australia
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12
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Johnson E, Nilsson S, Adolfsson M. How pain management for children with cerebral palsy in South African schools complies with up-to-date knowledge. Afr J Disabil 2019; 8:575. [PMID: 31824834 PMCID: PMC6890561 DOI: 10.4102/ajod.v8i0.575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 09/19/2019] [Indexed: 01/18/2023] Open
Abstract
Background Pain in children with cerebral palsy (CP) has its sources in musculoskeletal problems that can influence learning in a school setting. Best pain management is essential for these children, but school staff may not keep up to date with the latest developments and interventions. Therefore, staff's perceptions of beneficial strategies may not comply with contemporary scientific knowledge about effective evidence-based interventions. Objectives This study investigated how pain management intervention for children with CP in South African schools complied with international scientific knowledge about evidence-based interventions. The intention was to provide support for an update of knowledge on both individual level (i.e. professionals) and system level (i.e. decision makers). Method Five focus groups were conducted with staff members at five schools for children with special educational needs in South Africa. Manifest and latent content analyses of professional statements identified interventions reported as beneficial and related them to higher and lower levels of intervention evidence as reported at the time of data collection. Results Most treatment strategies concerned motor functioning that fell within the framework of physiotherapists and occupational therapists. Access to orthopaedic expertise was limited, waiting times were long and medication for spasticity treatment was not offered. Conclusion A discrepancy between published evidence and clinical practice for pain management in children with CP in South African school settings was noted. Suggestions for improved early intervention to identify children's hips at risk through surveillance programmes; and orthopaedic management are proposed to prevent deformities and unnecessary suffering in South African children with CP.
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Affiliation(s)
- Ensa Johnson
- Centre for Augmentative and Alternative Communication, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Stefan Nilsson
- Children, Health, Intervention, Learning and Development (CHILD), Jönköping University, Jönköping, Sweden.,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Margareta Adolfsson
- Centre for Augmentative and Alternative Communication, Faculty of Humanities, University of Pretoria, Pretoria, South Africa.,School of Education and Communication, Jönköping University, Jönköping, Sweden.,Swedish Institute of Disability Research, Jönköping University, Jönköping, Sweden
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Abstract
Background and purpose - Surveillance of scoliosis in individuals with cerebral palsy (CP) is important for ensuring timely diagnosis and identification of curve progression. We analyzed the incidence of scoliosis in relation to age, sex, and gross motor function in a population-based cohort of individuals with CP. Patients and methods - This was a prospective register study of all 1,025 individuals born 1990-2012 in southern Sweden (1.4 million inhabitants) in the Swedish surveillance program for CP, which included >95% of the total population of people with CP in the area. Annual clinical examinations and radiographic measurement of the Cobb angle of those with a moderate or severe scoliosis were registered. We determined the incidence of scoliosis related to age, sex, and the Gross Motor Function Classification System (GMFCS) level. Results - The inclusion criteria were fulfilled by 962 individuals. The number of people (140/962) with scoliosis increased up to 20-25 years of age. The incidence of scoliosis was related to age and GMFCS level. In individuals at the lowest level of gross motor function (GMFCS V) scoliosis was seen in 10/131 before 5 years of age and at the age of 20 years 75% of these individuals had a Cobb angle ≥40°. No one in the highest level of motor function (GMFCS I) developed a Cobb angle ≥40° Interpretation - Surveillance programs for scoliosis in CP should be based on age and GMFCS level and should be initiated at a young age and continued into adulthood.
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Affiliation(s)
- Gunnar Hägglund
- Lund University, Department of Clinical Sciences, Lund, Orthopedics; ,Department of Orthopaedics, Skane University Hospital, Lund; ,Correspondence:
| | - Katina Pettersson
- Lund University, Department of Clinical Sciences, Lund, Orthopedics; ,Centre for Clinical Research, Uppsala University, Region Västmanland, Västerås;
| | - Tomasz Czuba
- National Competence Center for Quality Registers, University Hospital, Lund, Sweden
| | - Måns Persson-Bunke
- Lund University, Department of Clinical Sciences, Lund, Orthopedics; ,Department of Orthopaedics, Skane University Hospital, Lund;
| | - Elisabet Rodby-Bousquet
- Lund University, Department of Clinical Sciences, Lund, Orthopedics; ,Centre for Clinical Research, Uppsala University, Region Västmanland, Västerås;
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14
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Ágústsson A, Sveinsson T, Pope P, Rodby-Bousquet E. Preferred posture in lying and its association with scoliosis and windswept hips in adults with cerebral palsy. Disabil Rehabil 2018; 41:3198-3202. [DOI: 10.1080/09638288.2018.1492032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Atli Ágústsson
- School of Health Sciences, Research Centre of Movement Science, University of Iceland, Reykjavík, Iceland
- Endurhaefing þekkingarsetur, Kópavogur, Iceland
| | - Thorarinn Sveinsson
- School of Health Sciences, Research Centre of Movement Science, University of Iceland, Reykjavík, Iceland
| | | | - Elisabet Rodby-Bousquet
- Centre for Clinical Research, Uppsala University, Region Västmanland, Västerås, Sweden
- Department of Clinical Sciences Lund, Division of Orthopaedics, Lund University, Lund, Sweden
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15
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Ágústsson A, Sveinsson Þ, Rodby-Bousquet E. The effect of asymmetrical limited hip flexion on seating posture, scoliosis and windswept hip distortion. Res Dev Disabil 2017; 71:18-23. [PMID: 28987968 DOI: 10.1016/j.ridd.2017.09.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/19/2017] [Accepted: 09/27/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Postural asymmetries with seating problems are common in adults with cerebral palsy. AIMS To analyse the prevalence of asymmetrical limited hip flexion (<90°) in adults with CP, and to evaluate the association between asymmetrical limited hip flexion and postural asymmetries in the sitting position. METHODS AND PROCEDURES Cross-sectional data of 714 adults with CP, 16-73 years, GMFCS level I-V, reported to CPUP, the Swedish cerebral palsy national surveillance program and quality registry, from 2013 to 2015. Hip range of motion was analysed in relation to pelvic obliquity, trunk asymmetry, weight distribution, scoliosis and windswept hip distortion. OUTCOMES AND RESULTS The prevalence of asymmetrical limited hip flexion increased as GMFCS level decreased. Of adults at GMFCS level V, 22% had asymmetrical limited hip flexion (<90°). The odds of having an oblique pelvis (OR 2.6, 95% CI:1.6-2.1), an asymmetrical trunk (OR 2.1, 95% CI:1.1-4.2), scoliosis (OR 3.7, 95% CI:1.3-9.7), and windswept hip distortion (OR 2.6, 95% CI:1.2-5.4) were higher for adults with asymmetrical limited hip flexion compared with those with bilateral hip flexion>90°. CONCLUSIONS AND IMPLICATIONS Asymmetrical limited hip flexion affects the seating posture and is associated with scoliosis and windswept hip distortion.
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Affiliation(s)
- Atli Ágústsson
- University of Iceland, School of Health Sciences, Research Centre of Movement Science, Reykjavík, Iceland.
| | - Þórarinn Sveinsson
- University of Iceland, School of Health Sciences, Research Centre of Movement Science, Reykjavík, Iceland.
| | - Elisabet Rodby-Bousquet
- Centre for Clinical Research, Uppsala University, Vestmanland County Hospital, Västerås, Sweden; Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden.
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16
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Adang LA, Sherbini O, Ball L, Bloom M, Darbari A, Amartino H, DiVito D, Eichler F, Escolar M, Evans SH, Fatemi A, Fraser J, Hollowell L, Jaffe N, Joseph C, Karpinski M, Keller S, Maddock R, Mancilla E, McClary B, Mertz J, Morgart K, Langan T, Leventer R, Parikh S, Pizzino A, Prange E, Renaud DL, Rizzo W, Shapiro J, Suhr D, Suhr T, Tonduti D, Waggoner J, Waldman A, Wolf NI, Zerem A, Bonkowsky JL, Bernard G, van Haren K, Vanderver A. Revised consensus statement on the preventive and symptomatic care of patients with leukodystrophies. Mol Genet Metab 2017; 122:18-32. [PMID: 28863857 PMCID: PMC8018711 DOI: 10.1016/j.ymgme.2017.08.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/18/2017] [Accepted: 08/19/2017] [Indexed: 12/21/2022]
Abstract
Leukodystrophies are a broad class of genetic disorders that result in disruption or destruction of central myelination. Although the mechanisms underlying these disorders are heterogeneous, there are many common symptoms that affect patients irrespective of the genetic diagnosis. The comfort and quality of life of these children is a primary goal that can complement efforts directed at curative therapies. Contained within this report is a systems-based approach to management of complications that result from leukodystrophies. We discuss the initial evaluation, identification of common medical issues, and management options to establish a comprehensive, standardized care approach. We will also address clinical topics relevant to select leukodystrophies, such as gallbladder pathology and adrenal insufficiency. The recommendations within this review rely on existing studies and consensus opinions and underscore the need for future research on evidence-based outcomes to better treat the manifestations of this unique set of genetic disorders.
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Affiliation(s)
- Laura A Adang
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Omar Sherbini
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Laura Ball
- Center for Translational Science, Children's National Medical Center, Washington, DC, USA; Department of Physical Medicine and Rehabilitation, Children's National Medical Center, Washington, DC, USA
| | - Miriam Bloom
- Department of Pediatrics, Children's National Medical Center, Washington, DC, USA; Complex Care Program, Children's National Medical Center, Washington, DC, USA
| | - Anil Darbari
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's National Medical Center, Washington, DC, USA
| | - Hernan Amartino
- Servicio de Neurología Infantil, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Donna DiVito
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Florian Eichler
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Maria Escolar
- Department of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sarah H Evans
- Center for Translational Science, Children's National Medical Center, Washington, DC, USA; Department of Physical Medicine and Rehabilitation, Children's National Medical Center, Washington, DC, USA
| | - Ali Fatemi
- The Hugo W. Moser Research Institute, The Kennedy Krieger Institute, Baltimore, MD, USA
| | - Jamie Fraser
- Rare Disease Institute, Children's National Medical Center, Washington, DC, USA
| | - Leslie Hollowell
- Complex Care Program, Children's National Medical Center, Washington, DC, USA
| | - Nicole Jaffe
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christopher Joseph
- The Hugo W. Moser Research Institute, The Kennedy Krieger Institute, Baltimore, MD, USA
| | - Mary Karpinski
- Pediatric Multiple Sclerosis Center, Women and Children's Hospital, Buffalo, NY, USA
| | - Stephanie Keller
- Division of Pediatric Neurology, Emory University, Atlanta, GA, USA
| | - Ryan Maddock
- Department of Pediatrics, Children's National Medical Center, Washington, DC, USA
| | - Edna Mancilla
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Bruce McClary
- The Hugo W. Moser Research Institute, The Kennedy Krieger Institute, Baltimore, MD, USA
| | - Jana Mertz
- Autism Spectrum Disorders Center, Women and Children's Hospital, Buffalo, NY, USA
| | - Kiley Morgart
- Psychiatric Social Work Program, The Kennedy Krieger Institute, Baltimore, MD, USA
| | - Thomas Langan
- Hunter James Kelly Research Institute, Buffalo, NY, USA
| | - Richard Leventer
- Department of Paediatrics, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
| | - Sumit Parikh
- Neurogenetics, Neurologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amy Pizzino
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erin Prange
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Deborah L Renaud
- Division of Child and Adolescent Neurology, Departments of Neurology and Pediatrics, Mayo Clinic, Rochester, MN, USA
| | - William Rizzo
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jay Shapiro
- The Hugo W. Moser Research Institute, The Kennedy Krieger Institute, Baltimore, MD, USA
| | | | | | - Davide Tonduti
- Department of Child Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Amy Waldman
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nicole I Wolf
- Department of Child Neurology, VU University Medical Centre and Amsterdam Neuroscience, Amsterdam, The Netherlands
| | | | - Joshua L Bonkowsky
- Department of Pediatrics, Division of Pediatric Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Genevieve Bernard
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada; Department of Pediatrics, McGill University, Montreal, Canada; Department of Medical Genetics, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada; Child Health and Human Development Program, Research Institute of the McGill University Health Center, Montreal, Canada
| | - Keith van Haren
- Department of Neurology, Lucile Packard Children's Hospital and Stanford University School of Medicine, Stanford, CA, USA
| | - Adeline Vanderver
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Center for Translational Science, Children's National Medical Center, Washington, DC, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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17
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Abstract
PURPOSE Children with cerebral palsy (CP) are at increased risk for hip dislocation. This can be prevented in most cases using surveillance programmes that include radiographic examinations. Known risk factors for hip dislocation include young age, high Gross Motor Function Classification System (GMFCS) level and high migration percentage (MP). The head-shaft angle (HSA) has recently been described as an additional risk factor. The study aim was to determine inter- and intra-rater reliability of the HSA in a surveillance programme for children with CP. METHODS We included hip radiographs from the CP surveillance programme CPUP in southern Sweden during the first half of 2016. Fifty radiographs were included from children at GMFCS levels II-V, with a mean age of 6.6 (SD 3.2) years. Three raters measured the HSA of one hip (left or right) at baseline and four weeks later; intraclass correlation coefficient (ICC) was used to estimate inter- and intra-rater reliability. RESULTS Inter- and intra-rater reliability were excellent for the HSA, with ICC 0.92 (95% CI 0.87-0.96) and ICC 0.99 (95% CI 0.98-0.99), respectively. CONCLUSION The HSA showed excellent inter- and intra-rater reliability for children with CP, providing further evidence for use of the HSA as an additional factor for identifying risk for further hip displacement or dislocation.
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Affiliation(s)
- M. Hermanson
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Skåne University Hospital, Lund, Sweden,Dr M. Hermanson, Sahlgrenska University Hospital/Östra. S-416 85 Göteborg, Sweden. E-mail:
| | - G. Hägglund
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Skåne University Hospital, Lund, Sweden
| | - J. Riad
- Department of Clinical Sciences, Skaraborgs Hospital/Skövde, Sweden
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18
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Abstract
PURPOSE OF REVIEW Spastic hip dysplasia (SHD) is a common finding in patients with cerebral palsy, with a higher incidence in more involved patients, causing disability and reducing quality of life in these patients. SHD is the most serious orthopedic problem seen in cerebral palsy patients, and requires special attention and tenacious evaluation of the patients. The aim of this article is to review the new developments in the treatment of SHD. RECENT FINDINGS Patients with cerebral palsy were shown to have better hip joint morphology when they had access to hip surveillance programmes, with proactive search of patients with progressing hip subluxation and early intervention. Prediction of progression of SHD is now available based on the experience of these programmes.Patients who underwent hip joint reconstruction showed that incongruent joints remodeled following a Dega osteotomy. Patients who underwent a varus osteotomy of the femoral neck without pelvic reconstruction had a higher rate of recurrence when they were older and the SHD was more severe. Health-related quality of life measures improved following hip joint reconstructions and salvage procedures. CONCLUSION Patients with cerebral palsy should be monitored with a well-defined hip surveillance programme, with early identification and timely intervention for SHD.
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