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Arribart K, Peryoitte V, Kaniewski A, Bonnet X, Pillet H. Is Socket Flexion Alignment Associated With Changes in Gait Parameters in Individuals With an Above-knee Amputation and a Hip Flexion Contracture? Clin Orthop Relat Res 2024:00003086-990000000-01795. [PMID: 39499774 DOI: 10.1097/corr.0000000000003288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 10/03/2024] [Indexed: 11/07/2024]
Abstract
BACKGROUND A hip flexion contracture (HFC) results in an inability to extend the hip by reducing the ROM of the affected hip. The condition affects one in four patients with above-knee amputations on the amputation side. While HFC in other disorders is known to decrease hip ROM and increase pelvic tilt during gait, its impact on the gait of patients with above-knee amputations remains unexplored. Typically, prosthetists design the socket with a flexion angle matching the HFC, potentially leading to compensations during the posterior stance phase of the gait cycle. To our knowledge, little is known about how or whether these compensations relate to the socket's flexion alignment. QUESTIONS/PURPOSES (1) Is the presence of HFC associated with modifications of spatiotemporal and kinematic parameters during gait in patients with an above-knee amputation? (2) Is there a correlation between the socket flexion angle and the spatiotemporal and kinematic parameters during gait in patients with an above-knee amputation with and without HFC? METHODS A comparative observational study was conducted between February 2022 and June 2023. Thirty-two participants with unilateral above-knee amputations who had undergone amputation at least 1 year prior and had a minimum of 1 month of experience with their current prostheses were eligible for consideration and included in the study. After the trial, 1 of 32 participants was excluded due to other impairments affecting gait, and 9% (3 of 32) were excluded because of pain or discomfort during data acquisition on their gait, leaving 88% (28 of 32) of participants included in the analysis. The median (IQR) age of participants in the HFC group (n = 13) was 50 years (26 to 56); 85% (11) were male and 15% (2) were female. The median (IQR) age of participants in the noHFC group (n = 15) was 41 years (32 to 56), and 100% were male. Time since amputation was similar between groups (HFC median 8 years [IQR 3 to 21], noHFC median 6 years [IQR 1 to 9], difference of medians 2; p = 0.31). Thirty-two percent (9 of 28) of patients were classified according to the Medicare Functional Classification Level system as K4 (exceeding basic ambulation skills) and 68% (19 of 28) were classified as K3 (ability to walk with variable cadence and traverse most environmental barriers). Clinical and prosthetic measurements were made, which comprised measurement of the HFC using a hand-held goniometer with the patient in the modified Thomas test position, the socket flexion alignment, and the difference (δ) between the HFC and socket flexion alignment. A gait analysis was performed with an optoelectronic system equipped with six infrared cameras and two force plates to analyze the time-distance and kinematic parameters of gait. To answer our first question, we quantitively compared the gait spatiotemporal and kinematic parameters between groups, and for the second question, we evaluated the correlations between the same parameters and prosthesis alignment for both groups. RESULTS During gait, the HFC group exhibited reduced mean ± SD residual hip ROM in comparison with the noHFC group (35° ± 6° versus 44° ± 6°, mean difference -9° [95% CI -13° to -6°]; p < 0.001), increased pelvic tilt (11° ± 6° versus 7° ± 3°, mean difference 4° [95% CI 1° to 8°]; p = 0.02), increased pelvic rotation (12° ± 3° versus 9° ± 2°, mean difference 3° [95% CI 2° to 6°]; p < 0.001), and increased trunk rotation (15° ± 5° and 12° ± 2°, mean difference 3° [95% CI 0° to 6°]; p = 0.04). Greater δ correlated with decreased ROM in the contralateral hip (r = -0.71; p = 0.006), pelvis (r = -0.77; p = 0.002), and trunk (r = -0.58; p = 0.04) in the sagittal plane and with increased residual hip ROM (r = 0.62; p = 0.02). In terms of spatiotemporal gait parameters, in the HFC group, the δ correlated with an increase in contralateral step width (r = 0.58; p = 0.04) and a decrease in prosthetic step length (r = -0.65; p = 0.02). CONCLUSION Our findings further suggest that physiotherapists should consider the pelvic and trunk compensations associated with HFC in their rehabilitation because of potential long-term effects, such as low back pain or osteoarthritis. In addition, the correlation between the socket flexion angle and the parameters involved may support prosthetists in their choices of prosthetic settings. For now, we cannot consider these compensations as an impaired gait syndrome, and future studies are needed to evaluate their impact on patients' quality of life. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
| | | | | | - Xavier Bonnet
- Arts et Métiers Sciences et Technologies, Institut de Biomécanique Humaine Georges Charpak, Paris, France
| | - Hélène Pillet
- Arts et Métiers Sciences et Technologies, Institut de Biomécanique Humaine Georges Charpak, Paris, France
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Ramírez-Barragán A, Galán-Olleros M, Egea-Gámez RM, Palazón-Quevedo A, Martínez-Caballero I. Severe rigid hip flexion-abduction contracture in cerebral palsy: a case report and review of the literature. ACTA ORTOPEDICA MEXICANA 2024; 38:197-201. [PMID: 38862151 DOI: 10.35366/115816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
INTRODUCTION severe, rigid hip abduction deformity in individuals with cerebral palsy (CP) is an exceptionally uncommon condition. This posture hinders the positioning in the wheelchair and the completion of basic activities of daily living (ADL). Addressing such severe deformities can be quite challenging. MATERIAL AND METHODS a 14-year-old male, with spastic-dystonic quadriplegic CP, developed rigid and severe flexion-abduction contractures in both hips, characterized by 90 degrees of flexion and 100 degrees of abduction. These contractures severely impeded his ability to comfortably use a wheelchair and even pass through doorways. Performing basic ADLs became a significant challenge for both the patient and his caregivers. RESULTS the treatment approach involved a two-stage surgical procedure, one for each hip, with a two-month interval between them. An extensive release of the fascia latae, gluteus maximus, external rotators, and hip flexors; in combination with a proximal femur osteotomy were performed. To maintain the corrections achieved, long-leg casts connected with two bars were employed, followed by orthotic support and physiotherapy. Following the procedure, lower limb adduction was achieved, and the patient and caregivers were highly satisfied, as ADLs and basic caregiving had been greatly facilitated. CONCLUSIONS while the available literature on the management of severe rigid abduction hip contractures in non-ambulatory CP patients is limited, and treatment options are often complex, the present case underscores the effectiveness of a comprehensive approach involving soft tissue release and bone surgery. Achieving a more favorable wheelchair positioning and facilitating basic ADLs and care represents a significant success for patients and families.
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Affiliation(s)
- A Ramírez-Barragán
- Orthopaedic Surgery and Traumatology Department. Hospital Infantil Universitario Niño Jesús. Madrid, España
| | - M Galán-Olleros
- Orthopaedic Surgery and Traumatology Department. Hospital Infantil Universitario Niño Jesús. Madrid, España
| | - R M Egea-Gámez
- Orthopaedic Surgery and Traumatology Department. Hospital Infantil Universitario Niño Jesús. Madrid, España
| | - A Palazón-Quevedo
- Orthopaedic Surgery and Traumatology Department. Hospital Infantil Universitario Niño Jesús. Madrid, España
| | - I Martínez-Caballero
- Orthopaedic Surgery and Traumatology Department. Hospital Infantil Universitario Niño Jesús. Madrid, España
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Iwasaka-Neder J, Bixby SD, Bedoya MA, Liu E, Jarrett DY, Agahigian D, Tsai A. Virtual 3D femur model to assess femoral version: comparison to the 2D axial slice approach. Pediatr Radiol 2023; 53:2411-2423. [PMID: 37740782 DOI: 10.1007/s00247-023-05758-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Quantifying femoral version is crucial in diagnosing femoral version abnormalities and for accurate pre-surgical planning. There are numerous methods for measuring femoral version, however, reliability studies for most of these methods excluded children with hip deformities. OBJECTIVE To propose a method of measuring femoral version based on a virtual 3D femur model, and systematically compare its reliability to the widely used Murphy's 2D axial slice technique. MATERIALS AND METHODS We searched our imaging database to identify hip/femur CTs performed on children (<18 years old) with a clinical indication of femoral version measurement (September 2021-August 2022). Exclusion criteria were prior hip surgery, and inadequate image quality or field-of-view. Two blinded radiologists independently measured femoral version using the virtual 3D femur model and Murphy's 2D axial slice method. To assess intrareader variability, we randomly selected 20% of the study sample for re-measurements by the two radiologists >2 weeks later. We analyzed the reliability and correlation of these techniques via intraclass correlation coefficient (ICC), Bland-Altman analysis, and deformity subgroup analysis. RESULTS Our study sample consisted of 142 femurs from 71 patients (10.6±4.4 years, male=31). Intra- and inter-reader correlations for both techniques were excellent (ICC≥0.91). However, Bland-Altman analysis revealed that the standard deviation (SD) of the absolute difference between the two radiologists for the Murphy method (mean 13.7°) was larger than that of the 3D femur model technique (mean 4.8°), indicating higher reader variability. In femurs with hip flexion deformity, the SD of the absolute difference for the Murphy technique was 17°, compared to 6.5° for the 3D femur model technique. In femurs with apparent coxa valga deformity, the SD of the absolute difference for the Murphy technique was 10.4°, compared to 5.2° for the 3D femur model technique. CONCLUSION The 3D femur model technique is more reliable than the Murphy's 2D axial slice technique in measuring femoral version, especially in children with hip flexion and apparent coxa valga deformities.
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Affiliation(s)
- Jade Iwasaka-Neder
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
| | - Sarah D Bixby
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - M Alejandra Bedoya
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Enju Liu
- Department of Pediatrics, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Delma Y Jarrett
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
- Department of Radiology, New York Presbyterian Hospital-Weill Cornell, 525 East 68th Street, New York, NY, 10065, USA
| | - Donna Agahigian
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Andy Tsai
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
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Cloodt E, Lindgren A, Lauge-Pedersen H, Rodby-Bousquet E. Sequence of flexion contracture development in the lower limb: a longitudinal analysis of 1,071 children with cerebral palsy. BMC Musculoskelet Disord 2022; 23:629. [PMID: 35780097 PMCID: PMC9250270 DOI: 10.1186/s12891-022-05548-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background To prevent severe contractures and their impact on adjacent joints in children with cerebral palsy (CP), it is crucial to treat the reduced range of motion early and to understand the order by which contractures appear. The aim of this study was to determine how a hip–knee or ankle contracture are associated with the time to and sequence of contracture development in adjacent joints. Methods This was a longitudinal cohort study of 1,071 children (636 boys, 435 girls) with CP born 1990 to 2018 who were registered before 5 years of age in the Swedish surveillance program for CP and had a hip, knee or ankle flexion contracture of ≥ 10°. The results were based on 1,636 legs followed for an average of 4.6 years (range 0–17 years). The Cox proportional-hazards model adjusted for Gross Motor Function Classification System (GMFCS) levels I–V was used to compare the percentage of legs with and without more than one contracture. Results A second contracture developed in 44% of the legs. The frequency of multiple contractures increased with higher GMFCS level. Children with a primary hip or foot contracture were more likely to develop a second knee contracture. Children with a primary knee contracture developed either a hip or ankle contracture as a second contracture. Conclusions Multiple contractures were associated with higher GMFCS level. Lower limb contractures appeared in specific patterns where the location of the primary contracture and GMFCS level were associated with contracture development in adjacent joints.
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Affiliation(s)
- Erika Cloodt
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden. .,Department of Research and Development, Region Kronoberg, Växjö, Sweden.
| | - Anna Lindgren
- Centre for Mathematical Sciences, Lund University, Lund, Sweden
| | | | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden.,Centre for Clinical Research Västerås, Uppsala University-Region Västmanland, Västerås, Sweden
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Mechlenburg I, Østergaard MTF, Menzel CB, Nordbye‐Nielsen K. Hip contractures were associated with low gross motor function in children with cerebral palsy. Acta Paediatr 2021; 110:1562-1568. [PMID: 33305389 DOI: 10.1111/apa.15717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 11/30/2020] [Accepted: 12/08/2020] [Indexed: 12/12/2022]
Abstract
AIM The aim was to identify the prevalence of hip contractures and their association with gross motor function and pain in the lower extremities among Danish children with cerebral palsy (CP). METHODS This cross-sectional study was based on data collected during regular clinical examinations in 2018-2019 and registered in the National Danish Clinical Quality Database of children with CP. The study population was 688 children (59% boys) aged five to 12 years across all Gross Motor Function Classification System (GMFCS) levels. Any associations between hip contracture and gross motor function and pain were investigated with logistic regression analysis and presented as odds ratios (OR) with 95% confidence intervals (95% CI). RESULTS The prevalence of hip contracture was 22% across all five GMFCS levels, and the incidence varied across the five Danish regions. The odds ratios for hip contracture were significantly higher at GMFCS level IV (OR 1.99, 95% CI 1.10-3.62) and V (OR 5.49, 95% CI 3.33-9.07) compared with level I. Hip contractures were not significantly associated with pain in the lower extremities (OR 1.43, 95% CI 0.95-2.15). CONCLUSION Hip contractures were frequent and associated with low gross motor function, but not lower extremity pain, in children with CP.
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Affiliation(s)
- Inger Mechlenburg
- Department of Orthopaedic Surgery Aarhus University Hospital Aarhus N Denmark
- Department of Clinical Medicine Aarhus University Aarhus N Denmark
- Department of Public Health Aarhus University Aarhus N Denmark
| | | | | | - Kirsten Nordbye‐Nielsen
- Department of Orthopaedic Surgery Aarhus University Hospital Aarhus N Denmark
- CPNorth: Living life with cerebral palsy in the Nordic countries Aarhus N Denmark
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Holmes SJ, Mudge AJ, Wojciechowski EA, Axt MW, Burns J. Impact of multilevel joint contractures of the hips, knees and ankles on the Gait Profile score in children with cerebral palsy. Clin Biomech (Bristol, Avon) 2018; 59:8-14. [PMID: 30099242 DOI: 10.1016/j.clinbiomech.2018.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 03/31/2018] [Accepted: 08/06/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Children with cerebral palsy are at risk of developing muscle contractures, often contributing to pain, structural deformities and mobility limitations. With the increasing use of gait indices to summarise the findings of three dimensional gait analysis (3DGA), the purpose of this study is to determine whether there is a relationship between multilevel joint contractures and the Gait Profile Score in children with cerebral palsy. METHODS The Gait Profile Score, calculated from 3D gait analysis, and passive range of motion, strength and spasticity of the hips, knees and ankles in the sagittal plane were measured in 145 children with cerebral palsy (mean age:11 years,4 months; SD:2 years,10 months) (83 males) enrolled in the NSW Paediatric Gait Analysis Service Research Registry from 2011 to 2016. The relationships between these physical measures and the Gait Profile Score were explored using bivariate and multivariate correlations. FINDINGS Reduced hip extension, knee extension and ankle dorsiflexion (knee extended) range of motion were correlated with a higher (worse) Gait Profile Score (r = -0.348 to -0.466, p < .001). Children with all joints contracted had a significantly higher Gait Profile Score (mean 17.5°, SD 6.2°) than those with no contractures (mean 11.0°, SD 2.3°) or ankle contractures only (mean 12.8°, SD 5.1°) (p < .05). Knee flexion weakness, reduced hip extension and ankle dorsiflexion (knee extended) range of motion predicted 47% of the Gait Profile Score. INTERPRETATION The Gait Profile Score is a sensitive measure for demonstrating the relationship between multilevel sagittal plane joint contractures and kinematic gait. Clinically, this supports the use of the Gait Profile Score as a simplified measure to understand the contribution of contractures to functional gait limitations. Monitoring knee flexion strength, and hip extension and ankle dorsiflexion (knee extended) range of motion may assist clinicians in prioritising interventions to improve gait in this population.
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Affiliation(s)
- Sarah J Holmes
- The University of Sydney, Faculty of Health Sciences, 75 East Street, Lidcombe 2141, New South Wales, Australia..
| | - Anita J Mudge
- Paediatric Gait Analysis Service of New South Wales, Sydney Children's Hospitals Network (Randwick and Westmead), 178 Hawkesbury Road, Westmead 2145, New South Wales, Australia
| | - Elizabeth A Wojciechowski
- The University of Sydney, Faculty of Health Sciences, 75 East Street, Lidcombe 2141, New South Wales, Australia.; Paediatric Gait Analysis Service of New South Wales, Sydney Children's Hospitals Network (Randwick and Westmead), 178 Hawkesbury Road, Westmead 2145, New South Wales, Australia
| | - Matthias W Axt
- Orthopaedic Department, The Children's Hospital at Westmead, 170 Hawkesbury Road, Westmead 2145, New South Wales, Australia; Paediatric Gait Analysis Service of New South Wales, Sydney Children's Hospitals Network (Randwick and Westmead), 178 Hawkesbury Road, Westmead 2145, New South Wales, Australia
| | - Joshua Burns
- The University of Sydney, Faculty of Health Sciences, 75 East Street, Lidcombe 2141, New South Wales, Australia.; Paediatric Gait Analysis Service of New South Wales, Sydney Children's Hospitals Network (Randwick and Westmead), 178 Hawkesbury Road, Westmead 2145, New South Wales, Australia
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Abstract
BACKGROUND The orthopaedic treatment of the patient with cerebral palsy (CP) is complex and must take into account the heterogeneity and natural history of the condition. Although the goals of management are for the most part universal, the specific interventions and outcome measures used to reach these goals are wide ranging. This update serves to summarize some of the recent publications in the field of pediatric orthopaedics that have made important contributions to our understanding and care of the patient with CP. METHODS We searched the PubMed database using the following terms: "cerebral palsy" AND "orthopedic." The results were then filtered to include only review papers or clinical trials published in English from 2010 to 2014. The obtained list of references was then reviewed for publications in the fields of lower extremity muscle imbalance, foot and ankle deformities, hip and acetabular dysplasia, and advances in orthopaedic-related technology. RESULTS Updates in the field of pediatric orthopaedics are constant and the current level of evidence for the effectiveness of specific treatment modalities in patients with CP was reviewed. The search method yielded 153 publications, of which 31 papers were identified as having contributed important new findings. CONCLUSIONS Our understanding of orthopaedic treatments for children with CP continues to grow and expand. The studies reviewed illustrate just some of the strides we have taken in utilizing evidence-based surgical decision making in practice. Nevertheless, there remains a paucity of randomized controlled trials and higher evidence research, which may contribute to the variability in current practices among providers. By elucidating these gaps we can more purposefully delegate our time and resources into targeted areas of research. LEVEL OF EVIDENCE Level 4-literature review.
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Ruiz-Cortes X, Ortiz-Corredor F, Mendoza-Pulido C. Reliability of home-based, motor function measure in hereditary neuromuscular diseases. J Int Med Res 2017; 45:261-271. [PMID: 28222643 PMCID: PMC5536597 DOI: 10.1177/0300060516674608] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate the reliability of the motor function measure (MFM) scale in the assessment of disease severity and progression when administered at home and clinic and assess its correlation with the Paediatric Outcomes Data Collection Instrument (PODCI). Methods In this prospective study, two assessors rated children with hereditary neuromuscular diseases (HNMDs) using the MFM at the clinic and then 2 weeks later at the patients’ home. Intraclass correlation coefficient (ICC) was calculated for the reliability of the MFM and its domains. The reliability of each item was assessed and the correlation between MFM and three domains of PODCI was evaluated. Results A total of 48 children (5–17 years of age) were assessed in both locations and the MFM scale demonstrated excellent inter-rater reliability (ICC, 0.98). Weighted kappa ranged from excellent to poor. Correlation of the home-based MFM with the PODCI domain ‘basic mobility and transfers’ was excellent, with the ‘upper extremity’ domain was moderate, but there was no correlation with the ‘happiness’ domain. Conclusion The MFM is a reliable tool for assessing patients with HNMD when used in a home-based setting.
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Affiliation(s)
- Xiomara Ruiz-Cortes
- 1 Division of Rehabilitation Medicine, Instituto de Ortopedia Infantil Roosevelt, Bogota, Colombia
| | - Fernando Ortiz-Corredor
- 1 Division of Rehabilitation Medicine, Instituto de Ortopedia Infantil Roosevelt, Bogota, Colombia.,2 Department of Physical Medicine and Rehabilitation, Universidad Nacional de Colombia, Sede Bogota, Colombia
| | - Camilo Mendoza-Pulido
- 1 Division of Rehabilitation Medicine, Instituto de Ortopedia Infantil Roosevelt, Bogota, Colombia
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Progression to musculoskeletal deformity in childhood dystonia. Eur J Paediatr Neurol 2016; 20:339-45. [PMID: 26943984 DOI: 10.1016/j.ejpn.2016.02.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 02/07/2016] [Indexed: 11/27/2022]
Abstract
AIM Dystonia is a movement disorder characterized by involuntary muscle contractions, resulting in abnormalities of posture and movement. Children with dystonia are at risk of developing fixed musculoskeletal deformities (FMDs). FMDs cause pain, limit function and participation and interfere with care. We aimed to explore factors relating to the development of FMD in a large cohort of children with dystonia. METHOD The case notes of all children referred to our Complex Motor Disorder service between July 2005 and December 2011 were reviewed. Data from 279 children (median age 9 years 10 months, Standard Deviation 4 years 2 months) with motor disorders including a prominent dystonic element were analyzed. Parametric accelerated failure time regression was used to identify the factors related to development of contractures. RESULTS FMDs were present at referral in more than half (n = 163, 58%) of cases. Three quarters (n = 120, 74%) of children with FMD had deformities around the hip, and 42% had spinal deformity (n = 68). Compared to pure primary dystonia, FMD onset was earlier with a diagnosis of secondary or heredodegenerative dystonia, and a mixed spastic-dystonic phenotype (all p < 0.001). FMD onset was also earlier with increasing Gross Motor Function Classification System (GMFCS) level (p < 0.001). The effect of aetiological classification was lost when controlling for GMFCS level and motor phenotype. INTERPRETATION Children with secondary or heredodegenerative dystonia are at greater risk of progression to FMD compared to primary dystonia, likely due to more severe dystonia within these groups. Children with additional spasticity are at particular risk, requiring close monitoring.
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Jianjun L, Shurong J, Weihong W, Yan Z, Fanyong Z, Nanling L. Botulinum toxin-A with and without rehabilitation for the treatment of spastic cerebral palsy. J Int Med Res 2013; 41:636-41. [PMID: 23696596 DOI: 10.1177/0300060513488515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To determine the efficacy of botulinum toxin-A (BTX-A) nerve block, with and without rehabilitation, in the treatment of spastic cerebral palsy. METHODS Patients (aged 1-23 years) with spastic cerebral palsy underwent nerve block with BTX-A, followed by ≥ 2 h/day rehabilitation (experimental group) or <2 h/day rehabilitation (control group). Muscle tension and motor function were evaluated pre-block using the Modified Ashworth Scale (MAS) and gross motor function measure (GMFM), respectively. MAS was assessed weekly to determine duration of action of BTX-A; GMFM was assessed at 1 year post-block. RESULTS There were no significant differences between the experimental group (n = 120) and the control group (n = 124) in age, body weight, pre-block MAS or GMFM, or BTX-A duration of action. MAS was significantly improved in both groups at 1 month post-block. At 1 year post-block, GMFM was significantly improved in both groups, with a significantly greater improvement seen in the experimental group compared with the control group. CONCLUSION BTX-A block improved muscle tension and motor function. Rehabilitation training, following the block, resulted in greater improvements to motor function than block alone.
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Affiliation(s)
- Liu Jianjun
- Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Centre, Beijing, China.
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