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Raftis D, Dance S, Mazudie Ndjonko L, Elabd A, Tabaie S. Beyond words: embracing migration percentage as the universal measurement for hip displacement in children with cerebral palsy by radiologists and orthopedic surgeons. J Pediatr Orthop B 2024; 33:515-517. [PMID: 39087521 DOI: 10.1097/bpb.0000000000001162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Affiliation(s)
- Daniel Raftis
- Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences
| | - Sarah Dance
- Department of Orthopaedic Surgery, Children's National Medical Center, Washington, DC, USA
| | - Laura Mazudie Ndjonko
- Department of Orthopaedic Surgery, Children's National Medical Center, Washington, DC, USA
| | - Ahmed Elabd
- Department of Orthopaedic Surgery, Children's National Medical Center, Washington, DC, USA
| | - Sean Tabaie
- Department of Orthopaedic Surgery, Children's National Medical Center, Washington, DC, USA
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Bakhtiyar M, Iljazi A, Petersen MM, Odgaard A, Wong C. Prevalence and Regional Differences in Migrated Hips in Danish Children with Cerebral Palsy from 2008 to 2021-A Comparison of Ambulant vs. Non-Ambulant Children. CHILDREN (BASEL, SWITZERLAND) 2024; 11:964. [PMID: 39201899 PMCID: PMC11352901 DOI: 10.3390/children11080964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 08/01/2024] [Accepted: 08/09/2024] [Indexed: 09/03/2024]
Abstract
PURPOSE This study aims to assess the incidence of hip displacement and dislocation (denominated as hip migration) among ambulant and non-ambulant Danish children with cerebral palsy (CP) by estimating their cumulative incidence of migrated hips. A secondary objective is to compare the prevalence across different Danish regions. METHODS Data were obtained from the Danish Cerebral Palsy Follow-Up Program (CPOP) from the years 2008 to 2021. This population-based cohort study included 1388 children with CP (58% male; 42% female) as subjects; aged 0-15 years; with an average age of 5.4 years at their last follow-up. The children were categorized according to their Gross Motor Function Classification System (GMFCS) level into ambulators (GMFCS I-III) and non-ambulators (GMFCS IV-V). The Kaplan-Meier estimator was employed to calculate the cumulative incidence of migrated hips from birth until the date of their last radiographic follow-up. Differences between ambulatory and non-ambulatory children and regional differences were assessed with the Log-rank test. RESULTS Median radiological follow-up for ambulators was 51 months and 94 months for non-ambulators. The cumulative incidence of hip dislocation was 0.3% (95% CI: 0-0.8%) and 22.0% (95% CI: 9.2-34.8%) for ambulators and non-ambulators, respectively (p < 0.0001), whereas the incidence of hip displacement was 21.1% (95% CI: 16.3-25.9%) and 76.7% (95% CI: 68.6-84.7%) for ambulators and non-ambulators, respectively (p < 0.0001). There were no significant regional differences in the incidence of hip dislocation among ambulators, but there were significant differences for non-ambulators. Moreover, significant regional differences were detected in hip displacement for both ambulators and non-ambulators. CONCLUSIONS The prevalence of hip migration in Danish children with CP is significantly higher among non-ambulators, who are at an increased risk of hip migration compared to their ambulant counterparts. However, the low frequency of radiographic follow-up for ambulators might cause the incidence of hip migration to be underestimated. This study highlights the necessity of continued targeted surveillance and interventions in Danish non-ambulators.
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Affiliation(s)
- Muhammed Bakhtiyar
- Department of Orthopedic Surgery, Rigshospitalet, 2100 Copenhagen, Denmark
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Lindgren AM, Asma A, Rogers KJ, Miller F, Shrader MW, Howard JJ. Hip Displacement After Triradiate Closure in Ambulatory Cerebral Palsy: Who Needs Continued Surveillance? J Pediatr Orthop 2024:01241398-990000000-00624. [PMID: 39099047 DOI: 10.1097/bpo.0000000000002783] [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] [Indexed: 08/06/2024]
Abstract
BACKGROUND Hip surveillance in cerebral palsy (CP) is an accepted practice with evidence-based guidelines implemented. For the skeletally immature with open triradiate cartilage (TRC), recommendations for radiographic surveillance stemmed from population-based studies. For nonambulatory CP, progression of hip displacement after skeletal maturity has been reported; less is known for ambulatory CP. We aimed to determine the prevalence and risk factors associated with progressive hip displacement after TRC closure, a proxy for skeletal maturity, for ambulatory CP. METHODS This is a retrospective cohort study of patients with ambulatory CP (Gross Motor Function Classification System I-III), with unilateral or bilateral involvement, hypertonic motor type, regular hip surveillance (≥3 radiographs after age 10 yr, 1 before TRC closure, ≥1 after age 16 yr), and 2-year follow-up post-TRC closure. The primary outcome was migration percentage (MP). Other variables included previous preventative/reconstructive surgery, topographic pattern, sex, scoliosis, epilepsy, and ventriculoperitoneal shunt. An "unsuccessful hip" was defined by MP ≥30%, MP progression ≥10%, and/or requiring reconstructive surgery after TRC closure. Statistical analyses included chi-square and multivariate Cox regression. Kaplan-Meier survivorship curves were also determined. Receiver operating characteristic analysis was used to determine the MP threshold for progression to an "unsuccessful hip" after TRC closure. RESULTS Seventy-six patients (39.5% female) met the inclusion criteria, mean follow-up 4.7±2.1 years after TRC closure. Sixteen (21.1%) patients had an unsuccessful hip outcome. By chi-square analysis, diplegia (P=0.002) and epilepsy (P=0.04) were risk factors for an unsuccessful hip. By multivariate analysis, only first MP after TRC closure (P<0.001) was a significant risk factor for progression to an unsuccessful hip; MP ≥28% being the determined threshold (receiver operating characteristic curve analysis, area under curve: 0.845, P<0.02). CONCLUSIONS The risk of MP progression after skeletal maturity is relatively high (21%), similar to nonambulatory CP. Annual hip surveillance radiographs after TRC closure should continue for Gross Motor Function Classification System I-III with an MP ≥28% after TRC closure, especially for bilateral CP and epilepsy. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Amelia M Lindgren
- Department of Orthopedics, Nemours Children's Health, Wilmington, DE
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Saranti A, Dragoumi P, Papavasiliou A, Zafeiriou D. Current approach to cerebral palsy. Eur J Paediatr Neurol 2024; 51:49-57. [PMID: 38824721 DOI: 10.1016/j.ejpn.2024.05.015] [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: 02/23/2024] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/04/2024]
Abstract
This teaching review aims to provide an overview of the current approach to children with cerebral palsy (CP), retrieving the best available evidence and summarizing existing knowledge in the field of CP in children. We also highlight areas where more research is needed and novel strategies for diagnosing and treating cerebral palsy. CP includes a group of permanent disorders of movement and posture that cause activity limitation. Multiple risk factors, occurring preconceptionally, prenatally, perinatally, or postneonatally, are involved in the pathogenesis of CP, with the prenatal ones accounting for 80-90 % of cases. Due to its heterogeneity, CP has various classifications, but usually is classified based on clinical findings and motor impairment. Standardized function classification systems have been developed to address inconsistencies in previous classifications. The combination of clinical assessment and validated predictive tools is recommended for an early diagnosis, which is important for early intervention and prevention of secondary impairments. The therapeutic regimen in CP involves prevention and management of the motor and associated problems. It includes the enhancement of motor performance, the enrichment of cognition and communication skills, the prevention of secondary impairments, and the support of parents and caregivers. The care of CP children demands a multidisciplinary approach focused on improving motor skills, reducing comorbidities, enhancing the quality of life, and prolonging survival.
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Affiliation(s)
- Anna Saranti
- 1th Department of Pediatrics, Aristotle University of Thessaloniki, G. Hippokration Hospital, Thessaloniki, Greece
| | - Pinelopi Dragoumi
- 1th Department of Pediatrics, Aristotle University of Thessaloniki, G. Hippokration Hospital, Thessaloniki, Greece
| | | | - Dimitrios Zafeiriou
- 1th Department of Pediatrics, Aristotle University of Thessaloniki, G. Hippokration Hospital, Thessaloniki, Greece.
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Karkenny AJ, Mackey C, Sharkey MS. What Do We Really Know About the Natural History of Spastic Hip Dysplasia and Pain in Total-involvement Cerebral Palsy? A Systematic Review. J Pediatr Orthop 2024; 44:340-346. [PMID: 38323400 DOI: 10.1097/bpo.0000000000002639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND Hip surveillance protocols and surgery for spastic hip dysplasia have become standard of care for children with cerebral palsy (CP) out of concern for long-term sequelae, including pain. It is unclear if available data support that spastic hip dysplasia/dislocation independently correlates with pain in total-involvement CP. A better understanding of this correlation may help guide decision-making for these medically complex patients. METHODS We undertook a systematic literature review to assess published data on the association of spastic hip dysplasia and pain in total-involvement CP using PubMed (which includes the MedLine databases) and EMBASE databases. A total of 114 English-language articles were identified. Fifteen articles met the inclusion criteria and were evaluated using the PRISMA guidelines for systematic reviews. RESULTS Of 15 articles that specifically assessed the association of spastic hip dysplasia and pain, 5 articles provided strong evidence per our criteria regarding the correlation of pain and spastic hip dysplasia. All 5 articles described the severity of CP in their studied population, radiographically defined hip displacement, included a control group, and described how pain was assessed. Nevertheless, there was no standard classification of dysplasia between studies and the ages of patients and methods of pain determination varied. Four of the articles provided level III evidence and one provided level II evidence. Of these 5 articles with the strongest available evidence, data from 2 did not support a correlation between hip dysplasia and hip pain, 2 supported a correlation, and 1 was equivocal. CONCLUSIONS Even the best available evidence on spastic hip dysplasia and pain reveals no consensus or conclusion on whether spastic hip dysplasia and dislocation in total-involvement CP is independently correlated with pain. LEVEL OF EVIDENCE Level III-Prognostic study.
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Affiliation(s)
- Alexa J Karkenny
- Department of Orthopaedic Surgery, Montefiore Einstein, Bronx, NY
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Chiu AK, Dance S, Ferraro SL, O'Mara A, Thakkar SC, Tabaie S. A National Observational Study From 2010 to 2021 of the Trends in the Timing of Hip Surgery in Children With Cerebral Palsy: Is Surgery Being Performed Earlier? Cureus 2024; 16:e57536. [PMID: 38572177 PMCID: PMC10990000 DOI: 10.7759/cureus.57536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 04/05/2024] Open
Abstract
Background Hip instability is a concern in pediatric cerebral palsy (CP) patients, with approximately one-third developing hip displacement. This may lead to pain, functional limitations, and decreased quality of life. Due to the progressive nature of hip displacement in CP, earlier surgical interventions may be beneficial. However, any shifts in practice to earlier surgical intervention, on a national scale, is not well described. The purpose of this study was to determine the recent trends in the surgical timing of hip interventions in children with CP. Methods A retrospective study was conducted using the PearlDiver Mariner all-payer claims database (PearlDiver Technologies, Colorado Springs, Colorado, United States). CP patients aged 10 years and younger were identified between 2010 and 2021. Hip surgeries including open reduction, adductor tenotomy, and pelvic osteotomy were identified. Patients were stratified by their age on the date of surgery and the year of the procedure. Linear regression analysis was conducted for temporal trends. Further, the compounded annual growth rate (CAGR) was calculated. Results A total of 309,677 CP patients were identified. For those aged one to four years old, the percentage undergoing hip surgery increased from 10.2% in 2010 to 19.4% in 2021. In the five- to 10-year-old age group, the surgery rate peaked at 14.9% in 2016 and steadily declined to 11.5% in 2021. The overall CAGR from 2010 to 2021 was +6.03% for the one- to four-year-old group and +0.88% for the five- to 10-year-old group. Linear regression demonstrated a significant association between year and the percentage of operations for patients ages one to four (R2=0.792, p<0.001), but not ages five-10 (R2=0.019, p=0.704). Conclusions Rates of surgical hip procedures in one- to four-year-old CP patients have been increasing since 2010, whereas the rate in five- to 10-year-old CP patients has been decreasing since 2016. Recently, CP patients may be undergoing hip surgery at younger ages.
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Affiliation(s)
- Anthony K Chiu
- Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Sarah Dance
- Orthopaedic Surgery, Children's National Hospital, Washington DC, USA
| | - Samantha L Ferraro
- Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Alana O'Mara
- Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | | | - Sean Tabaie
- Orthopaedic Surgery, Children's National Hospital, Washington DC, USA
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Sadur A, Martinez C, Dance S, Travers R, Gonzalez A, Tabaie SA. From Hip Screening to Hip Surveillance: Transforming Care for Patients With Cerebral Palsy: An Analysis of a Single Institution. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202312000-00009. [PMID: 38063442 PMCID: PMC10697633 DOI: 10.5435/jaaosglobal-d-23-00236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION Surveillance programs aimed at monitoring hip displacement in patients with cerebral palsy have been demonstrated to decrease the incidence of hip dislocations and properly time surgical intervention, ultimately improving patient outcomes. The objective of this study was to determine whether the implementation of a hip screening to surveillance program at a tertiary academic teaching hospital in 2017 increased the frequency of radiographic evaluations and changed the timing of surgical intervention. METHODS A total of 592 patients with cerebral palsy were identified, and 468 of these patients had initial radiograph date data available. In this analysis, 246 patients with initial radiograph dates after 2012 were included. The study population was divided into two groups based on the initial radiograph date, 2012 to 2016 versus 2017 to 2022. One hundred sixty patients (65%) were in the 2012 to 2016 group, and 86 (35%) were in the 2017 to 2022 group. Statistical analysis was conducted using various techniques, such as two-sample Student t-test, Mann-Whitney U test, chi square/Fisher exact test, and multivariable linear regression analysis. RESULTS The average number of radiographs per year in the 2017 to 2022 group was 0.11 (95% CI: 0.02, 0.20, P = 0.017) higher than the 2012 to 2016 group. After adjusting for confounders using multivariable linear regression analysis, this difference was even larger (difference 0.16, 95% CI: 0.06, 0.25, P = 0.001). The surgical intervention rate was significantly lower in the 2017 to 2022 group compared with the 2012 to 2016 group (12.9% versus 40.6%, P < 0.001). DISCUSSION The results of this study suggest that the implementation of a hip screening to surveillance program results in more frequent radiographic evaluations and possibly a reduced need for surgical intervention from 2017 to 2022. In the 2012 to 2016 group, more surgical interventions were performed likely because of the lack of any hip surveillance or screening program in place.
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Affiliation(s)
- Alana Sadur
- From the Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC (Ms. Sadur and Mr. Martinez), and the Department of Orthopaedic Surgery, Children's National Hospital, Washington, DC (Ms. Dance, Ms. Travers, Ms. Gonzalez, and Dr. Tabaie)
| | - Curt Martinez
- From the Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC (Ms. Sadur and Mr. Martinez), and the Department of Orthopaedic Surgery, Children's National Hospital, Washington, DC (Ms. Dance, Ms. Travers, Ms. Gonzalez, and Dr. Tabaie)
| | - Sarah Dance
- From the Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC (Ms. Sadur and Mr. Martinez), and the Department of Orthopaedic Surgery, Children's National Hospital, Washington, DC (Ms. Dance, Ms. Travers, Ms. Gonzalez, and Dr. Tabaie)
| | - Ryan Travers
- From the Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC (Ms. Sadur and Mr. Martinez), and the Department of Orthopaedic Surgery, Children's National Hospital, Washington, DC (Ms. Dance, Ms. Travers, Ms. Gonzalez, and Dr. Tabaie)
| | - Ariana Gonzalez
- From the Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC (Ms. Sadur and Mr. Martinez), and the Department of Orthopaedic Surgery, Children's National Hospital, Washington, DC (Ms. Dance, Ms. Travers, Ms. Gonzalez, and Dr. Tabaie)
| | - Sean A. Tabaie
- From the Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC (Ms. Sadur and Mr. Martinez), and the Department of Orthopaedic Surgery, Children's National Hospital, Washington, DC (Ms. Dance, Ms. Travers, Ms. Gonzalez, and Dr. Tabaie)
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Battisti N, Cozzaglio M, Faccioli S, Perazza S, Groppi A, Menta L, Motta M, Piovesan R, Digennaro GL, Rodocanachi M, Ronchetti AB, Sarno C, Saviola D, Valagussa G, Cersosimo A. Prevention of hip dislocation in severe cerebral palsy (GMFCS III-IV-V): an interdisciplinary and multi-professional Care Pathway for clinical best practice implementation. Eur J Phys Rehabil Med 2023; 59:714-723. [PMID: 37796120 PMCID: PMC10795071 DOI: 10.23736/s1973-9087.23.07978-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/28/2023] [Accepted: 09/07/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Hip displacement (HD) and dislocation in severe Cerebral Palsy (CP) (GMFCS III, IV, V) are important causes of worsening disability and quality of life. Prevention must be started from the first months of life through screening programs and early treatments, both conservative and surgical. Evidence from Clinical Practice Guidelines also suggests the development of Care Pathways for good clinical practice. At the beginning of 2020 an interdisciplinary, multi-professional working group, composed of 26 members (including Physiatrists, Physiotherapist, Neuro-psychomotor Therapists and Orthopedists representing the respective Italian Scientific Societies) with the involvement of the FightTheStroke Foundation families' association, was set up. AIM The aim of the multi-professional panel was the production of evidence-based recommendations for the Care Pathway "Prevention of Hip Displacement in children and adolescents with severe CP" for best clinical practice implementation in our national context. DESIGN Clinical Care Pathway (Clinical Practice Guideline). SETTING Inpatient and outpatient. POPULATION Children with severe CP (GMFCS III-IV-V). METHODS The recommendations of this Care Pathway were developed using the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) guidelines for Care Pathways development and the Grading of Recommendations Assessment Development and Evaluation (GRADE ADOLOPMENT) working group for adoption or adaption or de novo development of recommendations from high-quality guidelines. In 2020 a multidisciplinary working group (WG) developed four research questions on the prevention of HD on the following topics: screening, botulinum toxin treatment, postural management and preventive soft tissue surgery. A comprehensive review of the biomedical literature was performed on each question. Guidelines, Systematic Reviews and Primary studies were retrieved through a top-down approach. References were screened according to inclusion criteria and quality was assessed by means of specific tools. A list of recommendations was then produced divided by intervention (screening programs, postural management, botulinum toxin, preventive surgery). In a series of meetings, the panel graduated recommendations using the GRADE evidence to decision frameworks. RESULTS Fifteen recommendations were developed: seven on screening programs, four on postural management strategies, one on botulinum toxin, and three on preventive surgery. Evidence quality was variable (from very low to moderate) and only a few strong recommendations were made. CONCLUSIONS In severe CP at high risk of hip dislocation, it is strongly recommended to start early hip surveillance programs. In our national context, there is a need to implement Screening programs and dedicated Network teams. We also strongly recommend a comprehensive approach shared with the families and goal-oriented by integrating the different therapeutic interventions, both conservative and not, within Screening programs. CLINICAL REHABILITATION IMPACT Implementing a comprehensive multi-professional approach for the prevention of hip dislocation in severe CP.
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Affiliation(s)
- Nicoletta Battisti
- Pediatric Physical Medicine and Rehabilitation Unit, IRCCS Institute of Neurological Sciences, Bologna, Italy -
| | - Massimo Cozzaglio
- Pediatric Physical Medicine and Rehabilitation Unit, IRCCS Ca' Granda Ospedale Maggiore Polyclinic Hospital, Milan, Italy
| | - Silvia Faccioli
- Children Rehabilitation Unit of S. M. Nuova Hospital, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Postgraduate Program in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Perazza
- Children Rehabilitation Unit of S. M. Nuova Hospital, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Lorena Menta
- Pediatric Rehabilitation Area, AUSL Parma, Parma, Italy
| | - Matteo Motta
- Child and Adolescent Neurology and Psychiatry Unit, ASST Lecco, Lecco, Italy
| | | | - Giovanni L Digennaro
- Pediatric Orthopedics and Traumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | | | - Claudia Sarno
- UFSMIA Service of Rehabilitation, Azienda Usl Toscana Centro, Florence, Italy
| | - Donatella Saviola
- Cardinal Ferrari Santo Stefano Rehabilitation Center, KOS Care, Fontanellato, Parma, Italy
| | - Giulio Valagussa
- Villa Santa Maria Foundation, Tavernerio, Como, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Antonella Cersosimo
- Pediatric Physical Medicine and Rehabilitation Unit, IRCCS Institute of Neurological Sciences, Bologna, Italy
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Joseph PJS, Khattak M, Masudi ST, Minta L, Perry DC. Radiological assessment of hip disease in children with cerebral palsy: development of a core measurement set. Bone Jt Open 2023; 4:825-831. [PMID: 37909150 PMCID: PMC10618048 DOI: 10.1302/2633-1462.411.bjo-2023-0060.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
Aims Hip disease is common in children with cerebral palsy (CP) and can decrease quality of life and function. Surveillance programmes exist to improve outcomes by treating hip disease at an early stage using radiological surveillance. However, studies and surveillance programmes report different radiological outcomes, making it difficult to compare. We aimed to identify the most important radiological measurements and develop a core measurement set (CMS) for clinical practice, research, and surveillance programmes. Methods A systematic review identified a list of measurements previously used in studies reporting radiological hip outcomes in children with CP. These measurements informed a two-round Delphi study, conducted among orthopaedic surgeons and specialist physiotherapists. Participants rated each measurement on a nine-point Likert scale ('not important' to 'critically important'). A consensus meeting was held to finalize the CMS. Results Overall, 14 distinct measurements were identified in the systematic review, with Reimer's migration percentage being the most frequently reported. These measurements were presented over the two rounds of the Delphi process, along with two additional measurements that were suggested by participants. Ultimately, two measurements, Reimer's migration percentage and femoral head-shaft angle, were included in the CMS. Conclusion This use of a minimum standardized set of measurements has the potential to encourage uniformity across hip surveillance programmes, and may streamline the development of tools, such as artificial intelligence systems to automate the analysis in surveillance programmes. This core set should be the minimum requirement in clinical studies, allowing clinicians to add to this as needed, which will facilitate comparisons to be drawn between studies and future meta-analyses.
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Affiliation(s)
| | - Mohammed Khattak
- University of Liverpool, Liverpool, UK
- Alder Hey Children’s Hospital, Liverpool, UK
| | | | | | - Daniel C. Perry
- University of Liverpool, Liverpool, UK
- Alder Hey Children’s Hospital, Liverpool, UK
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Raftis D, Dance S, Mazudie Ndjonko L, Elabd A, Tabaie S. Beyond Words: Embracing Migration Percentage as the Universal Measurement for Hip Displacement in Children With Cerebral Palsy by Radiologists and Orthopedic Surgeons. Cureus 2023; 15:e48786. [PMID: 38024039 PMCID: PMC10644675 DOI: 10.7759/cureus.48786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Migration percentage (MP) is the standard radiographic measurement to quantify hip displacement in cerebral palsy (CP) hip surveillance programs. We aim to evaluate the use of MP and other descriptors of hip displacement in radiographic impressions by radiologists and orthopedic surgeons before and after the introduction of hip surveillance guidelines at our institution. METHODS CP patients who underwent hip surveillance imaging at our institution in 2016 were retrospectively identified, and their radiographic impressions were collected between 2016 and 2019. Only patients with radiology and orthopedic impressions for the same image were included. The inclusion of MP was documented and compared between the two groups before and after the hip guidelines were implemented in 2018. We also examined the use of other qualitative descriptors for hip displacement within the impressions. Fisher's Exact test was used for statistical significance (p<0.05). Results: Two hundred and fifty-one radiographs were analyzed. One radiology (0.40%) and 33 orthopedic impressions (13.15%) incorporated MP (p<0.001). No statistical significance was found between the inclusion of MP before and after 2018 in the radiology group. In contrast, the orthopedic group showed a significant increase in MP inclusion following guideline implementation, rising from 12 to 21 incidences (p=0.013). Descriptors for hip displacement were more commonly utilized than MP for both orthopedic surgeons and radiologists. Conclusion: MP is underutilized in radiologic and orthopedic impressions in hip surveillance programs. Extensive education for both specialties regarding MP is crucial for the successful management of hip displacement in CP hip surveillance programs.
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Affiliation(s)
- Daniel Raftis
- Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, USA
| | - Sarah Dance
- Orthopaedic Surgery, Children's National Hospital, Washington, USA
| | | | - Ahmed Elabd
- Orthopaedic Surgery, Children's National Hospital, Washington, USA
| | - Sean Tabaie
- Orthopaedic Surgery, Children's National Hospital, Washington, USA
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Doucette SM, Tang S, Kehler H, Creighton D, Lodha A. Utility of the 21-month neurodevelopmental outcome for predicting neurodevelopmental impairment at 36 months for preterm infants <29 weeks gestation. J Perinatol 2023; 43:1406-1412. [PMID: 37714894 DOI: 10.1038/s41372-023-01777-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/25/2023] [Accepted: 09/06/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE To determine the sensitivity and specificity of the 21-month neurodevelopmental outcome for predicting the presence of neurodevelopmental impairment at 36 months corrected age in a population of preterm infants under 29 weeks gestation. STUDY DESIGN This is a retrospective observational cohort study. Preterm infants born under 29 weeks gestation who were followed up at both 18-21 months and 36 months corrected age with outcome data available were enrolled. RESULTS Overall, 713 preterm infants <29 weeks gestation and were included in the final analysis. The specificity of the 21-month assessment for predicting neurodevelopmental impairment at 36 months corrected age was 66% (95% confidence interval[CI] 62-71%) with a positive predictive value of 61% (95% CI 56-66%). CONCLUSION In preterm neonates born <29 weeks gestation, the 18-21 months corrected neurodevelopmental outcome had low specificity and positive predictive value for predicting the presence of neurodevelopmental impairment at 36 months corrected age.
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Affiliation(s)
- Stefani M Doucette
- Division of Neonatology, Department of Pediatrics, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
- Neonatal Follow-Up Clinic, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Selphee Tang
- Alberta Health Services, Calgary, Alberta, Canada
- Neonatal Follow-Up Clinic, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynecology, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Heather Kehler
- Alberta Health Services, Calgary, Alberta, Canada
- Neonatal Follow-Up Clinic, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Dianne Creighton
- Division of Neonatology, Department of Pediatrics, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Abhay Lodha
- Division of Neonatology, Department of Pediatrics, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.
- Alberta Health Services, Calgary, Alberta, Canada.
- Neonatal Follow-Up Clinic, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
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12
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Pruszczyński B, Synder M, Drobniewski M, Borowski A. More than 20 years of experience with Dega transiliac osteotomy in the treatment of dislocated hip joints in children with cerebral palsy. J Pediatr Orthop B 2023; 32:221-226. [PMID: 34028381 DOI: 10.1097/bpb.0000000000000872] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cerebral palsy in children, which is the result of a nonprogressing damage to the central nervous system, causes motor and posture disorders that change with age. The level of child activity correlates with the hip dislocation risk. It most often affects nonwalking patients and those with tetraparesis or oblique pelvis. The aim of the study was to assess the effectiveness and clinical value of Dega pelvic osteotomy with accompanying directional femoral bone osteotomy after minimum of 20 years from surgery of patients with cerebral palsy. The conducted research was retrospective and concerned the children operated at our Hospital. The assessment was carried out in 346 children with spastic hip during the years 1993-2000. The inclusion criteria were applied: unilateral dislocation of the hip, the observation period of at least 20 years, pelvic osteotomy by Dega method and combined with varus derotation femur osteotomy. The analysis involved fifteen patients. The follow-up period was minimum 20 years (20-27 years). The average migration percentage decreased from 88% down to 25%, and an improved range of mobility was observed in the operated joint after surgery. However, the range of mobility was again significantly reduced during the last control examination after a minimum of 20 years. In all hips, the degenerative joint disease was present. Pelvic transiliac osteotomy, according to Dega, with VDRO, ensures very effective correction of the deficit in femoral head coverage by the acetabulum in the upper, lateral and posterior parts. However, it does not prevent the development of the early degenerative disease of the joint.
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Affiliation(s)
- Błażej Pruszczyński
- Clinic of Orthopedics, Pediatric Orthopedics Medical University of Lodz, Lodz, Poland
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13
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Eisman S, Husein N, Fehlings D, Andersen J, Oskoui M, Shevell M. Early Biomarkers in the Prediction of Later Functional Impairment in Term Children with Cerebral Palsy. Pediatr Neurol 2023; 140:59-64. [PMID: 36640520 DOI: 10.1016/j.pediatrneurol.2022.12.004] [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: 05/23/2022] [Revised: 11/09/2022] [Accepted: 12/11/2022] [Indexed: 12/25/2022]
Abstract
AIM To identify possible early biomarkers that could predict later functional capabilities in children at risk for cerebral palsy (CP). METHODS Data from 869 term children with CP were extracted from the Canadian Cerebral Palsy Registry. Univariate analyses were conducted to measure the association between readily available objective early biomarkers (neonatal encephalopathy [NE], cord or first hour of life pH, magnetic resonance imaging [MRI]) and functional outcomes such as mobility and feeding status. Multivariable regressions were then modeled to study whether adding predictors would affect the strength of the observed association. RESULTS Patients with NE have higher odds of having an assigned Gross Motor Function Classification Score level of IV to V (prevalence ratio [PR], 2.87; 95% confidence interval [CI], 2.07 to 3.97) and are more likely to require dependent tube feeding (PR, 2.09; 95% CI, 1.12 to 3.88); this was similarly seen in patients with MRI findings of deep gray matter injury, watershed injury, near-total brain injury, and/or cortical malformation (mobility status [PR, 5.13; 95% CI, 3.73 to 7.11] and feeding status [PR, 4.87; 95% CI, 2.57 to 9.75]). Patients with cord or first hour of life pH <7 were also more likely to predict dependent mobility status (PR, 2.86; 95% CI, 1.76 to 4.69), however, not significantly more likely to predict eventual dependent feeding status (PR, 1.47; 95% CI, 0.58 to 3.32). CONCLUSIONS This retrospective cohort study demonstrates that NE, MRI findings and cord or first hour of life pH can reliably predict later CP related functioning. These associations can be used to inform and clarify early prognosis discussions between caregivers and health professionals.
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Affiliation(s)
- Samantha Eisman
- Faculty of Medicine & Health Sciences, McGill University, Montreal, Quebec, Canada.
| | - Nafisa Husein
- Canadian Cerebral Palsy Registry, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Darcy Fehlings
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - John Andersen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Oskoui
- Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada; Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Michael Shevell
- Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada; Department of Pediatrics, McGill University, Montreal, Quebec, Canada
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14
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Hip Displacement Does Not Change After Pelvic Obliquity Correction During Spinal Fusion in Children With Cerebral Palsy. J Pediatr Orthop 2023; 43:e127-e131. [PMID: 36607919 DOI: 10.1097/bpo.0000000000002292] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Children with cerebral palsy (CP) frequently develop both neuromuscular hip dysplasia and scoliosis, and occasionally, the timing of the worsening of both of these pathologies is concurrent. The question as to whether the hip or spine should be addressed first in CP remains controversial, with the majority of evidence being "expert opinion." The purpose of this project was to determine the impact of posterior spinal fusion (PSF) on the change in hip displacement for children with CP without previous reconstructive hip surgery. METHODS This was an Institutional Review Board-approved study that observed 67 patients from 2004 to 2018. Inclusion criteria included children with CP, 18 years of age and younger, Gross Motor Function Classification System IV and V, undergoing PSF at a single tertiary care children's hospital with a minimum 2-year follow-up. The primary outcome was the change in hip displacement as quantified by the migration percentage (MP). The hip with the highest MP (worst hip) at the spine preoperative analysis were included for analysis. Triradiate cartilage (TRC) status and pelvic obliquity correction were analyzed with multivariate analysis. RESULTS Sixty-seven patients were included for analysis, with a mean age of 12.5±2.3 years. The mean major curve angle of the major curve was 77±23 degrees and the mean preoperative pelvic obliquity was 21±12 degrees. There was no statistically significant change in MP after PSF from a mean preoperative value of 41±27%, to a mean postoperative value of 41±29% at the last follow-up, (P=0.76) The mean follow-up time was 4.1±2.7 years. TRC status (P=0.52) and the severity of pelvic obliquity (P=0.10) did not statistically impact the change in MP after PSF. CONCLUSION PSF did not influence-either negatively or positively-the progression of hip displacement in children with CP, regardless of pelvic obliquity correction or TRC status. The lack of deterioration in hip displacement post-PSF, however, may suggest a protective effect of spine surgery. LEVEL OF EVIDENCE Level III-retrospective cohort study.
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15
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Asma A, Ulusaloglu AC, Shrader MW, Miller F, Rogers KJ, Howard JJ. Hip Displacement After Triradiate Cartilage Closure in Nonambulatory Cerebral Palsy: Who Needs Continued Radiographic Surveillance? J Bone Joint Surg Am 2023; 105:27-34. [PMID: 36575164 DOI: 10.2106/jbjs.22.00648] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Recommendations with regard to the need for continued hip surveillance after skeletal maturity are based on expert opinion rather than evidence. This study aimed to determine the prevalence of and risk factors associated with progressive hip displacement in cerebral palsy (CP) after triradiate cartilage (TRC) closure. METHODS Patients who had spastic nonambulatory CP (Gross Motor Function Classification System IV to V) and hypertonic (spastic or mixed-type) motor type and follow-up of at least 2 years after TRC closure were included. The primary outcome variable was the hip migration percentage (MP). The secondary outcome variables included patient age at the time of TRC closure, prior preventative or reconstructive surgery, a prior intrathecal baclofen pump, history of scoliosis, history of epilepsy, a prior gastrostomy tube, a previous tracheostomy, and gender. An unsuccessful hip outcome was defined as a hip with an MP of ≥40% and/or requiring a reconstructive surgical procedure after TRC closure. RESULTS In this study, 163 patients met the inclusion criteria, with a mean follow-up of 4.8 years (95% confidence interval [CI], 4.4 to 5.1 years) after TRC closure at a mean patient age of 14.0 years (95% CI, 13.7 to 14.3 years). Of these hips, 22.1% (36 of 163) had an unsuccessful hip outcome. In multivariate analysis, the first MP at TRC closure (hazard ratio [HR] per degree, 1.04; p < 0.001) and pelvic obliquity (HR per degree, 1.06; p = 0.003) were independent risk factors for an unsuccessful hip outcome, but gender was not found to be significant (HR for male gender, 1.7 [95% CI, 0.8 to 3.58; p = 0.16]; female gender was the reference). However, the mean survival time for progression to an unsuccessful hip outcome was longer for female patients at 9.2 years [95% CI, 8.1 to 10.2 years]) compared with 6.2 years (95% CI, 5.6 to 6.9 years) for male patients (p = 0.02). There was also a significant improvement in survivorship for prior reconstructive surgical procedures (p = 0.002). The survivorship in patients who underwent reconstructive surgery performed at a patient age of ≥6 years was significantly higher compared with those who underwent surgery performed at <6 years of age (p < 0.05). A first MP at TRC closure of ≥35% was associated with an unsuccessful hip outcome, as determined by receiver operating characteristic (ROC) curve analysis (p < 0.001; area under the ROC curve of 0.891, sensitivity of 81%, and specificity of 94%). CONCLUSIONS The risk factors for the progression of hip displacement after TRC closure in patients with CP included a higher MP and increased pelvic obliquity; there was decreased survivorship for male patients and patients with no prior reconstructive surgery. Patients with these risk factors and/or an MP of ≥35% at TRC closure should have continued radiographic surveillance to detect late hip displacement. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ali Asma
- Nemours Children's Hospital, Wilmington, Delaware
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16
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Faccioli S, Sassi S, Ferrari A, Corradini E, Toni F, Kaleci S, Lombardi F, Benedetti MG. Hip subluxation in Italian cerebral palsy children and its determinants: a retrospective cohort study. Int J Rehabil Res 2022; 45:319-328. [PMID: 36059222 PMCID: PMC9631781 DOI: 10.1097/mrr.0000000000000545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/21/2022] [Indexed: 12/01/2022]
Abstract
The study's aim was two-fold: to describe the trend of hip subluxation in the largest sample of Italian nonambulatory cerebral palsy (CP) children ever published; to investigate its determinants. This single-centre retrospective cohort study included patients with spastic or dyskinetic CP, Gross Motor Function Classification System (GMFCS) level IV or V, age 0-18 years, having been referred to our unit before March 2020. The hip subluxation was measured by means of the migration percentage (MP). Other data were gathered such as sex, CP subtype, GMFCS level, presence of drug-resistant epilepsy, age, use of walkers with weight relief or standing devices, previous botulinum injection or hip surgery, oral or intrathecal baclofen and hip pain. Multiple linear stepwise regression was performed and descriptive statistics are provided. Spastic CP had MP maximum increase in early ages, with GMFCS level V values persistently higher than level IV. The dyskinetic subtype showed a slower increase of the MP, with GMFCS level IV presenting similar or higher values, compared to level V. Age, CP severity and spastic subtype are the main determinants. The stepwise multiple regression analysis demonstrated that weight relief walking and standing assistive devices, combined with botulinum contributed to reduce the MP progression. Dyskinetic CP showed overall lower MP values and a more variable behaviour relative to age and GMFCS level, compared to the spastic subtype. Standing and walking assistive devices, with partial or total weight relief, combined with individually targeted botulinum injections, should be considered in the management of bilateral nonambulatory CP patients, to prevent hip subluxation or its recurrence after surgery.
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Affiliation(s)
- Silvia Faccioli
- Children Rehabilitation Unit of S. M. Nuova Hospital, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia
- PhD Program in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena
| | - Silvia Sassi
- Children Rehabilitation Unit of S. M. Nuova Hospital, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia
| | - Adriano Ferrari
- Children Rehabilitation Unit of S. M. Nuova Hospital, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia
| | - Elena Corradini
- Children Rehabilitation Unit of S. M. Nuova Hospital, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia
| | - Francesca Toni
- Physical Medicine and Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia
| | - Shaniko Kaleci
- Surgical Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena
| | - Francesco Lombardi
- Neurorehabilitation Unit of S. Sebastiano Hospital, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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17
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Chen K, Wu J, Shen C, Zhu J, Chen X, Xia J. Periacetabular osteotomy with or without femoral osteotomy for the treatment of hip subluxation in children and young adults with cerebral palsy. BMC Musculoskelet Disord 2022; 23:809. [PMID: 36002815 PMCID: PMC9404622 DOI: 10.1186/s12891-022-05754-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background This study is aimed to investigate retrospectively the radiographic and clinical outcomes in children and young adults with cerebral palsy (CP) undergoing periacetabular osteotomy (PAO) with or without femoral osteotomy (FO) for hip subluxation. Methods A consecutive cohort of twenty-one patients (23 hips) with symptomatic CP hip subluxation were treated with PAO with or without FO and reviewed retrospectively. Two patients (2 hips) were excluded due to insufficient follow-up and lost to follow-up, respectively. The Reimers migration percentage, lateral center-edge angle (LCEA), Sharp angle, neck-shaft angle (NSA), femoral anteversion (FNA), Gross Motor Function Classification System (GMFCS) and hip pain were assessed. Results Twenty-one hips (19 patients) with CP treated with PAO with or without FO were included. Five hips received PAO. Sixteen hips underwent PAO with FO. Mean age at surgery was 19 ± 6 and 15 ± 4 years for PAO and PAO plus FO, respectively. Mean follow-up was 44.0 ± 28.3 months for PAO and 41.5 ± 17.2 months for PAO + FO. All hips were painful before surgery and painless at final visits. The GMFCS improved by one level in 10 of 19 patients. There was significant increase in LCEA (p < 0.001) and decrease in the Reimer’s MP (p < 0.001), NSA (p < 0.001) and Tonnis angle(p < 0.001) postoperatively. Resubluxation occurred in 7 hips (30%) due to insufficient correction and loosening of fixation. Nervus cutaneus femoris lateralis was impaired in 4 patients after surgery. There was no avascular necrosis of the femoral head, resubluxation or infection. Conclusion PAO with or without FO can be effective for children and young adults with concomitant hip subluxation and CP.
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Affiliation(s)
- Kangming Chen
- Department of Orthopaedics, Huashan Hospital, Fudan University, No.12 Middle Wulumuqi Road, Jing'an District, 200040, Shanghai, China
| | - Jinyan Wu
- Department of Orthopaedics, Xinhua Hospital affiliated to Shanghai Jiao Tong University, School of medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, People's Republic of China
| | - Chao Shen
- Department of Orthopaedics, Xinhua Hospital affiliated to Shanghai Jiao Tong University, School of medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, People's Republic of China
| | - Junfeng Zhu
- Department of Orthopaedics, Xinhua Hospital affiliated to Shanghai Jiao Tong University, School of medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, People's Republic of China
| | - Xiaodong Chen
- Department of Orthopaedics, Xinhua Hospital affiliated to Shanghai Jiao Tong University, School of medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, People's Republic of China.
| | - Jun Xia
- Department of Orthopaedics, Huashan Hospital, Fudan University, No.12 Middle Wulumuqi Road, Jing'an District, 200040, Shanghai, China.
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18
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Wright K, Dehar A, Stott NS, Mackey A, Sorhage A, Tapera R, Williams SA. Prioritizing indigenous health equity in health registers: an environmental scan of strategies for equitable ascertainment and quality data. Glob Health Res Policy 2022; 7:24. [PMID: 35854338 PMCID: PMC9295285 DOI: 10.1186/s41256-022-00250-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 05/31/2022] [Indexed: 11/30/2022] Open
Abstract
Background Cerebral palsy (CP) registers serve as instrumental tools to support development of care pathways, preventative strategies, and health gains. Such health gains, however, are not always universal, with Indigenous health inequities common. To support Indigenous health, health registers need complete, consistent, and high-quality data. The aim of this study was to identify perceived barriers to the ascertainment of Indigenous peoples on health registers and to collate strategies supporting comprehensive ascertainment and achievement of high-quality Indigenous data. Methods Environmental scanning methods were utilized within a Kaupapa Māori theoretical framework, which aims to produce research that is transformational and supportive of Indigenous health gain. Knowledge and insights were obtained from CP registers in countries with Indigenous populations and complemented by information from health registers in Aotearoa New Zealand (NZ). Data collection methods included an online survey and scan of organizational websites. Data extraction focused on general information about the register, barriers to ascertainment, and strategies to support ascertainment and high data quality. Results 52 registers were identified, 20 completed the survey and 19 included in the study (CP registers, n = 10, NZ health registers, n = 9). Web scan data were included for the other 32 registers (CP registers, n = 21, NZ health registers, n = 11). Indigenous health equity was identified in the visions and aims of only two health registers. Ethnicity data collection was identified in nearly three quarters of survey respondents and a limited number of organizational websites. Over half of survey respondents described system, health provider/service, or workforce barriers to ascertainment. Strategies were categorized into collaboration, health provider/service, workforce, and systems-levels. Indigenous-specific strategies were limited and focused on personal behaviour and access to registration. Conclusions CP and other health registers can have a significant role in identifying and addressing Indigenous health inequities. However, this is not currently an overt priority for many registers in this study and few registers describe ascertainment and data quality strategies specific to Indigenous peoples. Significant opportunity exists for health registers to be accountable and to implement approaches to support Indigenous health equity, address structural determinants of inequities, and achieve health gain for all.
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Affiliation(s)
- Karen Wright
- Faculty of Medical and Health Sciences, Te Kupenga Hauora Māori, Auckland, New Zealand.
| | - Aria Dehar
- Faculty of Medical and Health Sciences, Te Kupenga Hauora Māori, Auckland, New Zealand
| | - N Susan Stott
- Department of Surgery, University of Auckland, Auckland, New Zealand.,New Zealand Cerebral Palsy Register, Starship Child Health, Auckland, New Zealand
| | - Anna Mackey
- New Zealand Cerebral Palsy Register, Starship Child Health, Auckland, New Zealand
| | - Alexandra Sorhage
- New Zealand Cerebral Palsy Register, Starship Child Health, Auckland, New Zealand
| | - Rachel Tapera
- Faculty of Medical and Health Sciences, Te Kupenga Hauora Māori, Auckland, New Zealand
| | - Sîan A Williams
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Curtin School of Allied Health, Curtin University, Perth, Australia
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19
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Faccioli S, Sassi S, Corradini E, Toni F, Kaleci S, Lombardi F, Benedetti MG. A retrospective cohort study about hip luxation in non-ambulatory cerebral palsy patients: The point of no return. J Child Orthop 2022; 16:227-232. [PMID: 35800654 PMCID: PMC9254025 DOI: 10.1177/18632521221106361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/28/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The migration percentage is a widely used criterion for surgery in displaced hips. Literature suggests that no hip can spontaneously improve if the migration percentage exceeds 45%, in a mixed population of cerebral palsy children. The aim of the present article was to identify the point of no return of the migration percentage in a selected sample of non-ambulatory cerebral palsy children, being the most exposed to hip luxation. METHODS This single-center retrospective cohort study included patients with spastic or dyskinetic cerebral palsy, Gross Motor Function Classification System level IV or V, age 0-18, having at least three pelvic radiographies, excluding radiographies relative to hips having previously undergone surgery. The following information was collected: sex, cerebral palsy subtype, Gross Motor Function Classification System level, presence of drug-resistant epilepsy, migration percentage, age at assessment, use of walking or standing assistive devices, previous botulinum injection, oral or intrathecal baclofen, and hip pain. Data were analyzed at the level of the individual hips. Descriptive statistics were presented. Receiver operating characteristic curve analysis was conducted to investigate which value of the migration percentage could be adopted as the "point of no return": that is, the cutoff value beyond which no migration percentage reduction, by more than 5%, could be expected. RESULTS The optimal cutoff value was identified as migration percentage ≥50%, with a sensitivity of 84.5% and a specificity of 100% (p-value <0.001). CONCLUSION Based on the present study, migration percentage ≥50% is the "point of no return" for Gross Motor Function Classification System IV-V cerebral palsy patients, representing the cutoff value beyond which no spontaneous cerebral palsy reduction may be expected, unless addressing surgery. LEVEL OF EVIDENCE level II-retrospective study.
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Affiliation(s)
- Silvia Faccioli
- Children Rehabilitation Unit of S. M.
Nuova Hospital, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio
Emilia, Italy,Clinical and Experimental Medicine,
Department of Biomedical, Metabolic and Neural Sciences, University of Modena and
Reggio Emilia, Modena, Italy,Silvia Faccioli, Children Rehabilitation
Unit of S. M. Nuova Hospital, Azienda Unità Sanitaria Locale IRCCS di Reggio
Emilia, 42122 Reggio Emilia, Italy. Emails:
;
| | - Silvia Sassi
- Children Rehabilitation Unit of S. M.
Nuova Hospital, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio
Emilia, Italy,Silvia Faccioli, Children Rehabilitation
Unit of S. M. Nuova Hospital, Azienda Unità Sanitaria Locale IRCCS di Reggio
Emilia, 42122 Reggio Emilia, Italy. Emails:
;
| | - Elena Corradini
- Children Rehabilitation Unit of S. M.
Nuova Hospital, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio
Emilia, Italy
| | - Francesca Toni
- Physical Medicine and Rehabilitation
Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia,
Italy
| | - Shaniko Kaleci
- Surgical Medical and Dental Department
of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine,
University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Lombardi
- Neurorehabilitation Unit of S.
Sebastiano Hospital, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio
Emilia, Italy
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation
Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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20
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Jeglinsky I, Alriksson-Schmidt AI, Hägglund G, Ahonen M. Prevalence and treatment of hip displacement in children with cerebral palsy in Finland. J Child Orthop 2022; 16:128-135. [PMID: 35620122 PMCID: PMC9127885 DOI: 10.1177/18632521221089439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/01/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The aim was to study the prevalence of hip displacements, dislocations, and the hip surgeries performed in a Finnish cohort of children with cerebral palsy not followed up in a hip surveillance program and to compare these with previous studies performed in Northern European countries before and after the implementation of hip surveillance programs. METHODS A cross-sectional study. A cohort including 480 children with cerebral palsy, born during the period 2000-2018, not enrolled in a hip surveillance program. Migration percentages were recorded from hip radiographs, age at first hip surgery and type of surgery was extracted from medical records. In a separate analysis, the inclusion criteria were adapted to fit two studies analyzing hip dislocation and hip surgery in Sweden, Norway, and Scotland before and after the implementation of a hip surveillance program. Chi-square tests were used to assess differences in proportions between the groups. RESULTS In total, 286 children (60%) have had at least one hip radiograph. Of these, 10 (3.5%) developed hip dislocation, which is more than in children of countries with hip surveillance programs (Sweden 0.7%, Scotland 1.3%, p < 0.001). Initial surgery to prevent hip dislocation was performed at an older age (p < 0.001). CONCLUSION Children with cerebral palsy in Finland not participating in a surveillance hip program were more likely to undergo hip surgery at an older age and to develop hip displacements and dislocations. The results support the effectiveness of surveillance programs to prevent hip dislocation in children with cerebral palsy. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ira Jeglinsky
- Department of Health and Welfare, Arcada University of Applied Sciences, Helsinki, Finland,Ira Jeglinsky, Department of Health and Welfare, Arcada University of Applied Sciences, Jan-Magnus Janssonin aukio 1, 00560 Helsinki, Finland.
| | - Ann I Alriksson-Schmidt
- Orthopedics, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Gunnar Hägglund
- Orthopedics, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Matti Ahonen
- Department of Pediatric Surgery, Helsinki Children’s Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
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21
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Pham TT, Le MB, Le LH, Andersen J, Lou E. Assessment of hip displacement in children with cerebral palsy using machine learning approach. Med Biol Eng Comput 2021; 59:1877-1887. [PMID: 34357510 DOI: 10.1007/s11517-021-02416-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
Manual measurements of migration percentage (MP) on pelvis radiographs for assessing hip displacement are subjective and time consuming. A deep learning approach using convolution neural networks (CNNs) to automatically measure the MP was proposed. The pre-trained Inception ResNet v2 was fine tuned to detect locations of the eight reference landmarks used for MP measurements. A second network, fine-tuned MobileNetV2, was trained on the regions of interest to obtain more precise landmarks' coordinates. The MP was calculated from the final estimated landmarks' locations. A total of 122 radiographs were divided into 57 for training, 10 for validation, and 55 for testing. The mean absolute difference (MAD) and intra-class correlation coefficient (ICC [2,1]) of the comparison for the MP on 110 measurements (left and right hips) were 4.5 [Formula: see text] 4.3% (95% CI, 3.7-5.3%) and 0.91, respectively. Sensitivity and specificity were 87.8% and 93.4% for the classification of hip displacement (MP-threshold of 30%), and 63.2% and 94.5% for the classification of surgery-needed hips (MP-threshold of 40%). The prediction results were returned within 5 s. The developed fine-tuned CNNs detected the landmarks and provided automatic MP measurements with high accuracy and excellent reliability, which can assist clinicians to diagnose hip displacement in children with CP.
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Affiliation(s)
- Thanh-Tu Pham
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Minh-Binh Le
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada.,Department of Computer Science, Ho Chi Minh City University of Science, Ho Chi Minh City, Vietnam
| | - Lawrence H Le
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - John Andersen
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Edmond Lou
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada. .,Department of Electrical and Computer Engineering, 11-263 Donadeo Innovation Centre for Engineering, University of Alberta, 9211-116 Street, Edmonton, AB, T6G 1H9, Canada.
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Miller S, Bone J, Mulpuri K. Suspension of Hip Surveillance for Children with Cerebral Palsy During the COVID-19 Outbreak: The Benefit of Hip Surveillance Does Not Outweigh the Risk of Infection. Indian J Orthop 2021; 55:20-22. [PMID: 32873988 PMCID: PMC7453848 DOI: 10.1007/s43465-020-00236-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/13/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Stacey Miller
- Department of Physical Therapy, BC Children’s Hospital, University of British Columbia, Vancouver, Canada
| | - Jeffrey Bone
- Department of Obstetrics and Gynecology, BC Children’s Hospital, Vancouver, Canada
| | - Kishore Mulpuri
- Department of Orthopaedic Surgery, BC Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
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Aroojis A, Mantri N, Johari AN. Hip Displacement in Cerebral Palsy: The Role of Surveillance. Indian J Orthop 2021; 55:5-19. [PMID: 33569095 PMCID: PMC7851306 DOI: 10.1007/s43465-020-00162-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/29/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Hip displacement is common in cerebral palsy (CP) and is related to the severity of neurological and functional impairment. It is a silent, but progressive disease, and can result in significant morbidity and decreased quality of life, if left untreated. The pathophysiology of hip displacement in CP is a combination of hip flexor-adductor muscle spasticity, abductor muscle weakness, and delayed weight-bearing, resulting in proximal femoral deformities and progressive acetabular dysplasia. Due to a lack of symptoms in the early stages of hip displacement, the diagnosis is easily missed. Awareness of this condition and regular surveillance by clinical examination and serial radiographs of the hips are the key to early diagnosis and treatment. HIP SURVEILLANCE PROGRAMMES Several population-based studies from around the world have demonstrated that universal hip surveillance in children with CP allows early detection of hip displacement and appropriate early intervention, with a resultant decrease in painful dislocations. Global hip surveillance models are based upon the patients' age, functional level determined by the Gross Motor Function Classification system (GMFCS), gait classification, standardized clinical exam, and radiographic indices such as the migration percentage (MP), as critical indicators of progressive hip displacement. CONCLUSION Despite 25 years of evidence showing the efficacy of established hip surveillance programmes, there is poor awareness among healthcare professionals in India about the importance of regular hip surveillance in children with CP. There is a need for professional organizations to develop evidence-based guidelines for hip surveillance which are relevant to the Indian context.
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Affiliation(s)
- Alaric Aroojis
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai, Maharashtra 400012 India
| | - Nihit Mantri
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai, Maharashtra 400012 India
| | - Ashok N. Johari
- Paediatric Orthopaedics, Balabhai Nanavati Super Speciality Hospital, Mumbai, India
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Siemens M, Wunder S, Kraushaar J, Mortimer JA, Siddiqui M, Kane K. Hip surgery and radiology reporting for children with cerebral palsy prior to initiation of a hip surveillance program. J Pediatr Rehabil Med 2021; 14:257-263. [PMID: 34092658 DOI: 10.3233/prm-201506] [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] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Hip displacement impacts quality of life for many children with cerebral palsy (CP). While early detection can help avoid dislocation and late-stage surgery, formalized surveillance programs are not ubiquitous. This study aimed to examine: 1) surgical practices around pediatric hip displacement for children with CP in a region without formalized hip surveillance; and 2) utility of MP compared to traditional radiology reporting for quantifying displacement. METHODS A retrospective chart review examined hip displacement surgeries performed on children with CP between 2007-2016. Surgeries were classified as preventative, reconstructive, or salvage. Pre- and post-operative migration percentage (MP) was calculated for available radiographs using a mobile application and compared using Wilcoxon Signed Ranks test. MPs were also compared with descriptions in the corresponding radiology reports using directed and conventional content analyses. RESULTS Data from 67 children (115 surgical hips) were included. Primary surgery types included preventative (63.5% hips), reconstructive (36.5%), or salvage (0%). For the 92 hips with both radiology reports and radiographs available, reports contained a range of descriptors that inconsistently reflected the retrospectively-calculated MPs. CONCLUSION Current radiology reporting practices do not appear to effectively describe hip displacement for children with CP. Therefore, standardized reporting of MP is recommended.
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Affiliation(s)
| | - Shane Wunder
- University of Saskatchewan, Saskatoon, SK, Canada.,Wascana Rehabilitation Centre, Saskatchewan Health Authority, Regina, SK, Canada
| | - Jacqueline Kraushaar
- University of Saskatchewan, Saskatoon, SK, Canada.,Wascana Rehabilitation Centre, Saskatchewan Health Authority, Regina, SK, Canada
| | - J Alexandra Mortimer
- University of Saskatchewan, Saskatoon, SK, Canada.,Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, SK, Canada
| | | | - Kyra Kane
- University of Saskatchewan, Saskatoon, SK, Canada.,Wascana Rehabilitation Centre, Saskatchewan Health Authority, Regina, SK, Canada
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Cobanoglu M, Chen BPJ, Perotti L, Rogers K, Miller F. The Impact of Spinal Fusion on Hip Displacement in Cerebral Palsy. Indian J Orthop 2020; 55:176-182. [PMID: 33569112 PMCID: PMC7851297 DOI: 10.1007/s43465-020-00271-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/23/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND STUDY AIMS The aims of this study were to determine the risk of progressive hip subluxation in children with CP after spinal fusion for scoliosis and how frequent the hips follow-up should be scheduled. PATIENTS AND METHODS Pelvis radiography [migration index (MI) and pelvic obliquity (PO)] of Gross Motor Function Classification System (GMFCS) levels IV and V children with CP who received spinal fusion and pelvic fixation were reviewed retrospectively. This population was categorized into three groups based on the MI at spinal fusion: G1 = 0-29%; G2 = 30-59%; and G3 = 60-100%. RESULTS Fifty children (age 7.5-15.0 years) and categorized into 3 groups (G1 = 19, G2 = 23, G3 = 8; 100 hips in total). Preoperative and last follow-up MI were 22 ± 7% and 30 ± 20% (G1), 41 ± 9% and 43 ± 22% (G2), 92 ± 15% and 97 ± 10% (G3). The MIs at spinal fusion between groups were statistically different (p < 0.001). In G1, the mean MI progression was 5% and 25% at 12 months and 62 months, respectively. In G2, the mean MI progression was 9% and 25% at 12 months and 32 months, respectively. The progression more than 10% occurred within 2 years in G1 and within 1 year in G2. There was no difference between groups based on preoperative degree of PO (p = 0.653) and correction rate in PO (p = 0.421). CONCLUSIONS In GMFCS IV and V children with the highest risk for progression occurred with increasing preoperative MI, especially over 50%. Hips should be monitored continuously after spinal fusion until hip stability is documented.
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Affiliation(s)
- Mutlu Cobanoglu
- Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE USA ,Department of Orthopedics and Traumatology, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Brian Po-Jung Chen
- Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE USA ,Department of Pediatric Orthopedics and Traumatology, Poznań University of Medical Sciences, Poznan, Poland
| | - Lucio Perotti
- Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE USA ,Hospital Pequeno Principe, Curitiba, Brazil
| | - Kenneth Rogers
- Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE USA
| | - Freeman Miller
- Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE USA
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Cost-effectiveness analysis of a surveillance program to prevent hip dislocation in children with cerebral palsy. GACETA SANITARIA 2020; 34:377-384. [DOI: 10.1016/j.gaceta.2019.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 04/25/2019] [Accepted: 05/03/2019] [Indexed: 01/08/2023]
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Rehbein I, Teske V, Pagano I, Cúneo A, Pérez ME, von Heideken J. Analysis of orthopedic surgical procedures in children with cerebral palsy. World J Orthop 2020; 11:222-231. [PMID: 32405471 PMCID: PMC7206198 DOI: 10.5312/wjo.v11.i4.222] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/21/2020] [Accepted: 03/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Orthopedic surgery in children with cerebral palsy (CP) aims to improve function and prevent deformities. Each child’s condition in CP is unique and many co-variables influence surgical decision-making including a patient's age and their functional level. Little is known about the frequency of different types of orthopedic surgery in children with CP who have varied functional levels, particularly in countries from Latin America.
AIM To assess the type of orthopedic surgical procedures in relation to age and gross motor function in children with CP.
METHODS This retrospective study included all children with CP (n = 245) treated with elective orthopedic surgery at a Uruguayan university hospital between October 2010 and May 2016 identified from a surgical database. Eighteen children (7%) were lost to follow-up due to missing medical charts. Demographics, gross motor function classification (GMFCS), and orthopedic surgeries were obtained from the medical records of 227 children. Chi-squared tests and analysis of variance were used to assess the frequency of surgery, accounting for GMFCS levels. Mean age for soft tissue vs bone surgery was compared with the independent samples t-test.
RESULTS A total of 711 surgical procedures were performed between 1998 and 2016. On average, children had 3.1 surgical procedures and the mean age at first surgery was 8.0 years. There were no significant differences in age at first surgery among GMFCS levels (P = 0.47). The most common procedures were lower leg soft tissue surgery (n = 189, 27%), hip tenotomy (n = 135, 19%), and hamstring tenotomy (n = 104, 14%). For children with GMFCS level I, the mean number of surgeries per child [1.8 (range 1-9)] differed significantly at P < 0.05 in children with GMFCS levels II [3.2 (1-12)], III [3.2 (1-8)], IV [3.3 (1-13)], and V [3.6 (1-11)]. Within II, III, IV, and V, there was no significant difference in mean number of surgeries per child when comparing across the groups. The proportion of soft tissue surgery vs bone surgery was higher in GMFCS levels I-III (80%-85%) compared to levels IV (68%) and V (55%) (P < 0.05).
CONCLUSION The frequency of surgical procedures per child did not increase with higher GMFCS level after level I. However, the proportion of bone surgery was higher in GMFCS levels IV-V compared to I-III.
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Affiliation(s)
- Ignacio Rehbein
- Clínica de Traumatología y Ortopedia Pediátrica, Facultad de Medicina, Universidad de la República, Montevideo 11200, Uruguay
| | - Viviana Teske
- Clínica de Traumatología y Ortopedia Pediátrica, Facultad de Medicina, Universidad de la República, Montevideo 11200, Uruguay
| | - Ignacio Pagano
- Clínica de Traumatología y Ortopedia Pediátrica, Facultad de Medicina, Universidad de la República, Montevideo 11200, Uruguay
| | - Alejandro Cúneo
- Clínica de Traumatología y Ortopedia Pediátrica, Facultad de Medicina, Universidad de la República, Montevideo 11200, Uruguay
| | - María Elena Pérez
- Clínica de Traumatología y Ortopedia Pediátrica, Facultad de Medicina, Universidad de la República, Montevideo 11200, Uruguay
| | - Johan von Heideken
- Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, Stockholm 17177, Sweden
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Kerstens HCJW, Satink T, Nijkrake MJ, De Swart BJM, Nijhuis-van der Sanden MWG, Van der Wees PJ, Geurts ACH. Experienced consequences of spasticity and effects of botulinum toxin injections: a qualitative study amongst patients with disabling spasticity after stroke. Disabil Rehabil 2020; 43:3688-3695. [PMID: 32255361 DOI: 10.1080/09638288.2020.1746843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: Chronic spasticity poses a major burden on patients after stroke. Intramuscular botulinum toxin injections constitute an important part of the treatment for patients suffering from troublesome focal spasticity. This study explores the experienced consequences of chronic spasticity amongst patients after stroke regarding physical impairments and activities, the experienced effects of botulinum toxin treatment on these domains, and whether current spasticity management addresses patients' needs.Materials and methods: Fourteen participants with chronic spasticity after stroke who were treated with cyclical botulinum toxin injections in the upper and/or lower extremity muscles were interviewed. Inductive thematic analysis generated representative themes.Results: Analyses of the interviews revealed three themes: (1) spasticity-related impairments and activity limitations; (2) fluctuations in spasticity related to botulinum toxin; (3) need for professional support and feedback. Besides motor impairments, participants experienced activity limitations in many domains of everyday life, with considerable day-to-day fluctuations. Moreover, treatment with botulinum toxin led to cyclical fluctuations in spasticity-related symptoms, which differed across participants. The participants called for shared responsibility for treatment, particularly regarding optimising the timing of injections.Conclusion: Incorporating patient-relevant outcomes into the current assessment of spasticity and monitoring these outcomes may improve spasticity management, particularly regarding the timing of botulinum toxin injections.Implications for rehabilitationBecause chronic spasticity after stroke impacts on almost all domains of everyday life, professionals should identify and target the most relevant problems in each individual patient.Monitoring patient-reported outcomes may help patients and professionals to get insight in the fluctuations of spasticity-related symptoms and may help to evaluate the effects of botulinum toxin injections from the patient's perspective.Patient education and providing insight in the fluctuations of spasticity-related symptoms may support self-management and shared decision-making in spasticity management.
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Affiliation(s)
- Hans C J W Kerstens
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, Netherlands.,HAN University of Applied Sciences, Nijmegen, Netherlands
| | - Ton Satink
- HAN University of Applied Sciences, Nijmegen, Netherlands
| | - Maarten J Nijkrake
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Bert J M De Swart
- HAN University of Applied Sciences, Nijmegen, Netherlands.,Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, Netherlands.,Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Philip J Van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, Netherlands
| | - Alexander C H Geurts
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
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DORNER REBECCAA, BOSS RENEED, BURTON VERAJOANNA, RAJA KATHERINE, LEMMON MONICAE. Parent preferences for neurodevelopmental screening in the neonatal intensive care unit. Dev Med Child Neurol 2020; 62:500-505. [PMID: 31909496 PMCID: PMC7056590 DOI: 10.1111/dmcn.14457] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2019] [Indexed: 12/24/2022]
Abstract
AIM To determine whether, and how, neonatal intensive care unit (NICU) parents want to receive early neurodevelopmental screening information about their child's future risk of cerebral palsy and other disabilities. METHOD This was a qualitative interview study. Parents of hospitalized infants born preterm completed semi-structured interviews. Data were analysed using a directed content analysis approach. RESULTS Thematic saturation was achieved after 19 interviews. Four themes characterized parent perceptions of early neurodevelopmental screening: (1) acceptability: most parents were in favour of neurodevelopmental screening if parents could refuse; (2) disclosure of results: parents want emotional preparation for results, especially false positives; (3) emotional burden of uncertainty: parents of children in the NICU balance taking their infant's illness 'day by day' and preparing for an uncertain future. Parents expressed distress with screening that increased uncertainty about the future; and (4) disability: prior experience with disability informs parent concerns. INTERPRETATION Parents interpret the risks and benefits of NICU developmental screening through the lens of prior experiences with disability. Most expressed interest in screening and emphasized a desire for autonomy, pretest counselling, and emotional preparation. WHAT THIS PAPER ADDS Most parents with infants in the neonatal intensive care unit expressed interest in early screening for developmental disability. Prior experience with disability informed concerns about specific deficits. Parents emphasized a desire for autonomy, pretest counselling, and emotional preparation.
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Affiliation(s)
- REBECCA A DORNER
- Division of Perinatal-Neonatal Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - RENEE D BOSS
- Division of Perinatal-Neonatal Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD;,Johns Hopkins Berman Institute of Bioethics, Baltimore, MD
| | - VERA JOANNA BURTON
- Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD;,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - MONICA E LEMMON
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD;,Department of Pediatrics, Division of Pediatric Neurology, Duke University School of Medicine, Durham, NC;,Duke-Margolis Center for Health Policy, Durham, NC, USA
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Abstract
Background and purpose - Children and young adults with cerebral palsy (CP) have an increased risk of developing scoliosis, with a prevalence ranging from 11% to 29%. Information on risk factors for the emergence and progression of scoliosis is inconclusive. This study aimed to develop a risk score based on 5-year-old children with CP to predict the risk of scoliosis before the age of 16.Patients and methods - This prospective registry study included 654 children with CP in Sweden born in 2000 to 2003 and registered with the Swedish CP follow-up program (CPUP) at the age of 5 years, including all Gross Motor Function Classification System (GMFCS) levels. 92 children developed a scoliosis before the age of 16 years. Univariable and multivariable logistic regressions were used to analyze 8 potential predictors for scoliosis: GMFCS, sex, spastic subtype, epilepsy, hip surgery, migration percentage, and limited hip or knee extension.Results - 4 predictors for scoliosis remained significant after analyses: female sex, GMFCS levels IV and V, epilepsy, and limited knee extension, and a risk score was constructed based on these factors. The predictive ability of the risk score was high, with an area under the receiver operating characteristics curve of 0.87 (95% CI 0.84-0.91).Interpretation - The risk score shows high discriminatory ability for differentiating between individuals at high and low risk for development of scoliosis before the age of 16. It may be useful when considering interventions to prevent or predict severe scoliosis in young children with CP.
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Affiliation(s)
- Katina Pettersson
- Department of Clinical Sciences, Lund University, Orthopedics, Lund, Sweden; ,Centre for Clinical Research, Region Västmanland—Uppsala University, Västerås, Sweden,Correspondence: Katina PETTERSSON, Department of Clinical Sciences, Lund University, Orthopedics, Lund, Sweden,
| | - Philippe Wagner
- Centre for Clinical Research, Region Västmanland—Uppsala University, Västerås, Sweden
| | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences, Lund University, Orthopedics, Lund, Sweden; ,Centre for Clinical Research, Region Västmanland—Uppsala University, Västerås, Sweden
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Karim T, Al Imam MH, Golland P, Khan AI, Hossain I, Smithers-Sheedy H, Badawi N, Muhit M, Khandaker G. Hip dysplasia among children with spastic cerebral palsy in rural Bangladesh. BMC Musculoskelet Disord 2019; 20:494. [PMID: 31656186 PMCID: PMC6815374 DOI: 10.1186/s12891-019-2805-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/30/2019] [Indexed: 12/05/2022] Open
Abstract
Background Hip dysplasia is common among children with cerebral palsy (CP), particularly in spastic CP. It can result in pain, reduced function and quality of life. However, the burden of hip dysplasia among children with CP in llow-and middle-income countries (LMICs) like Bangladesh is unknown. We aimed to define the burden of hip dysplasia among children with spastic CP in Bangladesh. Methods This study includes a subset of the Bangladesh CP Register (BCPR) study cohort who were registered between January and March 2015. The BCPR is a population-based surveillance of children with CP (aged < 18 years) operating in a northern sub-district (Shahjadpur; child population ~ 226,114) of Bangladesh. Community-based key informant’s method (KIM) survey conducted to identify children with CP in the surveillance area. A diagnosis of CP was made based on clinical history and examination by the study physicians and physiotherapist. Study participants had an antero-posterior (AP) X-ray of their pelvis. The degree of subluxation was assessed by calculating the migration percentage (MP). Results During the study period, 196 children with CP were registered, 144 had spastic CP. 40 children with spastic CP (80 hips) had pelvic X-Rays (mean age 9.4 years, range 4.0–18.0 years) and 32.5% were female. Gross Motor Function Classification System (GMFCS) showed 37.5% (n = 15) with GMFCS level I-II and 62.5% (n = 25) with GMFCS level III-V. Twenty percent (n = 8) of the children had hip subluxation (MP: 33–80%). Osteopenic changes were found in 42.5% (n = 17) children. Conclusions To the best of our knowledge this is one of the first studies exploring hip dysplasia among children with spastic CP in Bangladesh. Our findings reflect that hip dysplasia is common among children with spastic CP. Introduction of hip surveillance programmes is imperative for prevention of secondary complications, reduced function and poor quality of life among these children.
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Affiliation(s)
- Tasneem Karim
- CSF Global, Dhaka, Bangladesh. .,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh. .,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia. .,Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, Australia.
| | - Mahmudul Hassan Al Imam
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Prue Golland
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, Australia
| | - Aynul Islam Khan
- CSF Global, Dhaka, Bangladesh.,Singair Upazilla Health Complex, Singair, Manikganj, Bangladesh
| | - Iqbal Hossain
- Radiology and Imaging Department, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | | | - Nadia Badawi
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, Australia
| | - Mohammad Muhit
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Gulam Khandaker
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
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Abstract
This laboratory study evaluates head shaft angle (HSA) reliability using ranges of simulated femoral orientation often seen in children with cerebral palsy. A dry femur was mounted in a jig that enabled the bone to be positioned in a range of internal and external rotation (-40° to + 40°) and flexion (0°-60°), alone or in combination. A metal wire was placed as a surrogate physis to give two HSA angles of 140° and 160°. Radiographs were taken of the femur in differing combinations of rotation, flexion and the two HSA angles. The HSA was measured by four independent observers on two separate occasions. Intraclass correlation coefficients (ICCs) were used to assess interobserver and intraobserver reliability. The HSA was accurately measured within ± 5° when the femur was positioned between 20° internal rotation and 40° external rotation. Flexion up to 60° did not affect the accuracy of the measurement. The interobserver reliability for the HSA was excellent with an ICC of 0.9970 [95% confidence interval (CI): 0.9995-0.9983] for the first measurement and 0.9988 for the second (95% CI: 0.9979-0.9993, all P < 0.01). The intraobserver reliability was also excellent with an ICC of not less than 0.990 for all four observers (95% CI: 0.9806-0.9986, all P < 0.01). There was excellent interobserver and intraobserver reliability when measuring the HSA in an experimental model provided femoral rotation lay within 20° internal and 40° external rotation and less than 60° of flexion.
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Poirot I, Laudy V, Rabilloud M, Roche S, Iwaz J, Kassaï B, Vuillerot C. Patterns of hip migration in non-ambulant children with cerebral palsy: A prospective cohort study. Ann Phys Rehabil Med 2019; 63:400-407. [PMID: 31121332 DOI: 10.1016/j.rehab.2019.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 03/18/2019] [Accepted: 04/10/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND In children with cerebral palsy (CP), we have little information on when hip migration (HM) starts, what causes hip displacement, how HM changes over time, and how to halt this migration to avoid surgery. OBJECTIVES We aimed to estimate the prevalence of HM percentage (HMP)>40% in a homogeneous population of non-ambulant children with CP and model the changes in HMP over a 2.6-year mean follow-up. METHODS From September 2009 to September 2015, this observational, prospective, multicenter cohort study recruited 235 children from 51 centers who were 3 to 10 years old and had levels IV and V of the Gross Motor Function Classification System for CP. The outcomes were yearly HMP measurements by the Reimers index. Only children with at least one hip with HMP≤40% at baseline were included in trajectory modeling. Comparisons of chidren's characteristics between trajectory groups were adjusted by the false discovery rate method. RESULTS The prevalence of children with at least one hip with HMP>40% was estimated at 24.3% (95% confidence interval 18.6-30.0). Pelvic obliquity was observed in 51.4% and 24.4% of children with asymmetric and symmetric HMP (P=0.002). The trajectory modelling identified 3 types of MP changes over time. Many children (67.4% and 79.3% for the right and left hip) could be assigned to the "stable" trajectory group. CONCLUSIONS In non-ambulant children with CP, the prevalence of HM requiring surgery is low and most hips remain practically stable over time.
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Affiliation(s)
- Isabelle Poirot
- Service de médecine physique et réadaptation pédiatrique, hospices civils de Lyon, 69677 Bron, France.
| | - Valérie Laudy
- Inserm, EPICIME-CIC 1407 de Lyon, service de pharmacologie clinique, hospices civils de Lyon, Bron, France
| | - Muriel Rabilloud
- Service de biostatistique-bioinformatique, pôle santé publique, université de Lyon, hospices civils de Lyon, Lyon, France; CNRS UMR 5558, laboratoire de biométrie et biologie évolutive, équipe biostatistique-santé, Villeurbanne, France
| | - Sylvain Roche
- Service de biostatistique-bioinformatique, pôle santé publique, université de Lyon, hospices civils de Lyon, Lyon, France; CNRS UMR 5558, laboratoire de biométrie et biologie évolutive, équipe biostatistique-santé, Villeurbanne, France
| | - Jean Iwaz
- Service de biostatistique-bioinformatique, pôle santé publique, université de Lyon, hospices civils de Lyon, Lyon, France; CNRS UMR 5558, laboratoire de biométrie et biologie évolutive, équipe biostatistique-santé, Villeurbanne, France
| | - Behrouz Kassaï
- Inserm, EPICIME-CIC 1407 de Lyon, Department of Clinical Epidemiology, hospices civils de lyon, Bron, France; CNRS UMR 5558, laboratoire de biométrie et biologie évolutive, Villeurbanne, France
| | - Carole Vuillerot
- Service de médecine physique et réadaptation pédiatrique, hospices civils de Lyon, 69677 Bron, France; CNRS UMR 5558, laboratoire de biométrie et biologie évolutive, Villeurbanne, France; Université de Lyon, Université Lyon 1, Villeurbanne, France
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Kerstens HCJW, Satink T, Nijkrake MJ, De Swart BJM, Van Lith BJH, Geurts ACH, Nijhuis-van der Sanden MWG. Stumbling, struggling, and shame due to spasticity: a qualitative study of adult persons with hereditary spastic paraplegia. Disabil Rehabil 2019; 42:3744-3751. [PMID: 31079503 DOI: 10.1080/09638288.2019.1610084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Purpose: Little is known concerning the impact of chronic spasticity on physical activities, social participation, and well-being, and whether patients' needs are addressed by current treatments. This study aims to investigate these lacunas in persons with a pure form of hereditary spastic paraplegia (HSP), in whom spasticity is a prominent symptom.Methods: Fourteen patients with a pure form of HSP were interviewed. These interviews were recorded, verbally transcribed, and thematically analyzed.Results: Four themes were identified which can be reflected by the phrases: (1) 'I stumble', (2) 'I struggle', (3) 'I feel ashamed', and (4) 'I need support'. Balance and gait problems led to limitations in domestic activities, employment, and recreation. 'Stumbling' also occurred due to pain, stiffness, and fatigue. Struggling was related to the continuous need for adaptation strategies, including the abandonment of some activities. Participants further reported feelings of shame, fear, and frustration. Lastly, they needed more support in daily activities than currently provided.Conclusion: Besides treating spasticity-related motor impairments, patients with HSP need practical support for optimizing their physical activities and social participation. They also seek attention for the non-motor consequences of their chronic spasticity to improve their well-being. Patient-reported outcomes might help to address these needs.Implications for rehabilitationAccording to patients with hereditary spastic paraplegia, interventions for spasticity should not only be aimed at reducing motor impairments, but also on reducing pain and fatigue, improving nighttime rest and general well-being, and optimizing the performance of relevant personal activities.Medical, role and emotional management in patients with hereditary spastic paraplegia can be improved only when individual needs are identified and monitored over the course of the disease.Besides assessment of bodily functions and physical capacities, systematic evaluation of patient-reported outcomes will help both patients and professionals to monitor the functional impact of disease progression and to evaluate the effects of interventions aimed at retarding this progression.
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Affiliation(s)
- Hans C J W Kerstens
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Ton Satink
- HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Maarten J Nijkrake
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Bert J M De Swart
- HAN University of Applied Sciences, Nijmegen, The Netherlands.,Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Bas J H Van Lith
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Alexander C H Geurts
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
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Marcström A, Hägglund G, Alriksson-Schmidt AI. Hip pain in children with cerebral palsy: a population-based registry study of risk factors. BMC Musculoskelet Disord 2019; 20:62. [PMID: 30736784 PMCID: PMC6368700 DOI: 10.1186/s12891-019-2449-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 02/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background Hip pain is prevalent in children with cerebral palsy (CP). Hip displacement is a known risk factor for hip pain. However, many children do not have displaced hips but still have hip pain and the aetiologies are poorly understood. The aims of this study were to investigate: 1. the prevalence of hip pain related to age, gender, gross motor function, degree of hip displacement and 2. the associations between hip pain and age, gender, gross motor function, degree of hip displacement, ranges of hip and knee motion (ROM) and degree of spasticity in the muscles around the hip. Methods This was a cross-sectional retrospective register study based on data from the Swedish follow-up programme and national healthcare registry CPUP, which includes > 95% of children with CP in Sweden. The participants were born in 2000 or later and 4–16 years of age. Data from the latest examination were used. In Aim 1, the prevalence of hip pain was calculated using frequencies and crosstabs. Differences between groups were calculated using chi-square tests and independent samples t-tests. In Aim 2, associations between hip pain and the variables were analysed using logistic regression. Results The overall prevalence of hip pain was 7%. No significant gender difference was found. Hip pain prevalence increased with age, lower gross motor function and higher degree of hip displacement. The median migration percentage (MP) in painful hips was 26%, compared to 21% in hips where pain was not reported. In the multivariable analysis, significant associations with hip pain were found for MP > 30% and decreased ROM in abduction, flexion and inwards rotation of the hip (p < 0.05). Conclusion Hip displacement was associated with hip pain. However, hip displacement was not present in the majority of painful hips. In addition to hip displacement, decreased ROM was also associated with hip pain. Electronic supplementary material The online version of this article (10.1186/s12891-019-2449-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexander Marcström
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Orthopedics, Lund, Sweden.
| | - Gunnar Hägglund
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Orthopedics, Lund, Sweden
| | - Ann I Alriksson-Schmidt
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Orthopedics, Lund, Sweden
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Bugler KE, Gaston MS, Robb JE. Hip displacement in children with cerebral palsy in Scotland: a total population study. J Child Orthop 2018; 12:635-639. [PMID: 30607212 PMCID: PMC6293334 DOI: 10.1302/1863-2548.12.180106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
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.
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Affiliation(s)
| | | | - J. E. Robb
- School of Medicine, University of St Andrews, St Andrews, UK, Correspondence should be sent to J. E. Robb, MD FRCS, School of Medicine, University of St Andrews, St Andrews, UK. E-mail:
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Almasri NA, Saleh M, Abu-Dahab S, Malkawi SH, Nordmark E. Development of a Cerebral Palsy Follow-up Registry in Jordan (CPUP-Jordan). Child Care Health Dev 2018; 44:131-139. [PMID: 28983951 DOI: 10.1111/cch.12527] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 08/27/2017] [Accepted: 09/18/2017] [Indexed: 11/27/2022]
Abstract
AIMS This study aims to describe the development of a Cerebral Palsy Follow-up Registry in Jordan (CPUP-Jordan) and to provide a baseline child and parent demographic information, birth history of the child participants, and distribution of the participants based on topographical distribution of cerebral palsy (CP) and functional classification systems. METHODS The CPUP-Jordan was developed using a similar framework of a follow-up surveillance programme for persons with CP in Sweden (CPUP). Standard assessment forms were utilized to collect data related to child and family demographics, child birth history, and functional classifications and physiotherapy and occupational therapy assessments and interventions. Research assistants were trained to conduct the assessments. A secured web-based system was developed to store data and disseminate knowledge maintained in the registry. Children with CP were included in the registry if they have confirmed diagnosis of CP. The ascertainment age of inclusion and the minimum age of survival required are 4 years. RESULTS One hundred sixty-seven children were registered between 2013 and 2015 (mean age is 3.6 ± 3.0 years). Forty-two percent were born premature, and 48% were less than the normal birthweight. Perinatal causes were reported for 54% of the participants. The most common type of CP based on tone disturbance was spastic type, and the most common topographical distributions of motor dysfunction were quadriplegia followed by diplegia. Fifty-six percent of the participants had severe limitation in ambulation; 48% had restricted manual abilities, and 47% had limited communication abilities even with familiar family members and partners. CONCLUSIONS The development of CPUP-Jordan registry for children with CP proved to be both feasible and informative. The registry baseline descriptive data were similar to those reported in previous research in Jordan supporting validity of the data. The implementation of CPUP-Jordan at national level is expected to have a positive impact on children with CP, clinicians, policymakers, and researchers.
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Affiliation(s)
- N A Almasri
- Department of Physiotherapy, Faculty of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - M Saleh
- Department of Physiotherapy, Faculty of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - S Abu-Dahab
- Department of Occupational Therapy, Faculty of Rehabilitation Sciences The University of Jordan, Queen Rania Al Abdallah St., Amman, Jordan
| | - S H Malkawi
- Department of Occupational Therapy, Faculty of Rehabilitation Sciences The University of Jordan, Queen Rania Al Abdallah St., Amman, Jordan
| | - E Nordmark
- Paediatric Physiotherapy, Senior lecturer in Disability Research, Excellent Teaching Practitioner (ETP), Faculty of Medicine, Lund University, Lund, Sweden
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Novak I, Morgan C, Adde L, Blackman J, Boyd RN, Brunstrom-Hernandez J, Cioni G, Damiano D, Darrah J, Eliasson AC, de Vries LS, Einspieler C, Fahey M, Fehlings D, Ferriero DM, Fetters L, Fiori S, Forssberg H, Gordon AM, Greaves S, Guzzetta A, Hadders-Algra M, Harbourne R, Kakooza-Mwesige A, Karlsson P, Krumlinde-Sundholm L, Latal B, Loughran-Fowlds A, Maitre N, McIntyre S, Noritz G, Pennington L, Romeo DM, Shepherd R, Spittle AJ, Thornton M, Valentine J, Walker K, White R, Badawi N. Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment. JAMA Pediatr 2017; 171:897-907. [PMID: 28715518 PMCID: PMC9641643 DOI: 10.1001/jamapediatrics.2017.1689] [Citation(s) in RCA: 825] [Impact Index Per Article: 117.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Cerebral palsy describes the most common physical disability in childhood and occurs in 1 in 500 live births. Historically, the diagnosis has been made between age 12 and 24 months but now can be made before 6 months' corrected age. Objectives To systematically review best available evidence for early, accurate diagnosis of cerebral palsy and to summarize best available evidence about cerebral palsy-specific early intervention that should follow early diagnosis to optimize neuroplasticity and function. Evidence Review This study systematically searched the literature about early diagnosis of cerebral palsy in MEDLINE (1956-2016), EMBASE (1980-2016), CINAHL (1983-2016), and the Cochrane Library (1988-2016) and by hand searching. Search terms included cerebral palsy, diagnosis, detection, prediction, identification, predictive validity, accuracy, sensitivity, and specificity. The study included systematic reviews with or without meta-analyses, criteria of diagnostic accuracy, and evidence-based clinical guidelines. Findings are reported according to the PRISMA statement, and recommendations are reported according to the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument. Findings Six systematic reviews and 2 evidence-based clinical guidelines met inclusion criteria. All included articles had high methodological Quality Assessment of Diagnostic Accuracy Studies (QUADAS) ratings. In infants, clinical signs and symptoms of cerebral palsy emerge and evolve before age 2 years; therefore, a combination of standardized tools should be used to predict risk in conjunction with clinical history. Before 5 months' corrected age, the most predictive tools for detecting risk are term-age magnetic resonance imaging (86%-89% sensitivity), the Prechtl Qualitative Assessment of General Movements (98% sensitivity), and the Hammersmith Infant Neurological Examination (90% sensitivity). After 5 months' corrected age, the most predictive tools for detecting risk are magnetic resonance imaging (86%-89% sensitivity) (where safe and feasible), the Hammersmith Infant Neurological Examination (90% sensitivity), and the Developmental Assessment of Young Children (83% C index). Topography and severity of cerebral palsy are more difficult to ascertain in infancy, and magnetic resonance imaging and the Hammersmith Infant Neurological Examination may be helpful in assisting clinical decisions. In high-income countries, 2 in 3 individuals with cerebral palsy will walk, 3 in 4 will talk, and 1 in 2 will have normal intelligence. Conclusions and Relevance Early diagnosis begins with a medical history and involves using neuroimaging, standardized neurological, and standardized motor assessments that indicate congruent abnormal findings indicative of cerebral palsy. Clinicians should understand the importance of prompt referral to diagnostic-specific early intervention to optimize infant motor and cognitive plasticity, prevent secondary complications, and enhance caregiver well-being.
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Affiliation(s)
- Iona Novak
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | - Cathy Morgan
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | - Lars Adde
- Norwegian University of Science and Technology, St Olavs University Hospital, Trondheim
| | - James Blackman
- Cerebral Palsy Alliance Research Foundation, New York, New York
| | | | | | - Giovanni Cioni
- Stella Maris Scientific Institute, University of Pisa, Pisa, Italy
| | | | - Johanna Darrah
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | | | | | | | | | - Darcy Fehlings
- Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Simona Fiori
- Stella Maris Scientific Institute, University of Pisa, Pisa, Italy
| | | | | | | | - Andrea Guzzetta
- Stella Maris Scientific Institute, University of Pisa, Pisa, Italy
| | - Mijna Hadders-Algra
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | - Petra Karlsson
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | | | - Beatrice Latal
- University Children's Hospital Zurich, Zurich, Switzerland
| | | | - Nathalie Maitre
- Nationwide Children's Hospital, The Ohio State University, Columbus
| | - Sarah McIntyre
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | - Garey Noritz
- Nationwide Children's Hospital, The Ohio State University, Columbus
| | | | - Domenico M Romeo
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Alicia J Spittle
- Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
| | - Marelle Thornton
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | - Jane Valentine
- Princess Margaret Hospital, University of Western Australia, Perth
| | - Karen Walker
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
- Children's Hospital Westmead, The University of Sydney, Sydney, Australia
| | - Robert White
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
- Children's Hospital Westmead, The University of Sydney, Sydney, Australia
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Seliner B, Latal B, Spirig R. Effectiveness of a nurse-led preadmission intervention for parents of children with profound multiple disabilities undergoing hip-joint surgery: A quasi-experimental pilot study. J SPEC PEDIATR NURS 2017; 22. [PMID: 28497613 DOI: 10.1111/jspn.12184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/10/2017] [Accepted: 03/26/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of this study was to assess the effectiveness of a family-centered care (FCC) intervention provided by an advanced practice nurse (APN) for parents of children with profound disabilities undergoing surgery. DESIGN AND METHODS In a quasi-experimental design, we used the MPOC-20 to assess satisfaction with FCC and interviews to identify potential mechanisms for improving satisfaction. RESULTS There was a positive effect on the MPOC-20 domain "general information," albeit with a small effect size (Cohen's d = 0.35). The interviewed parents expected additional support. PRACTICE IMPLICATIONS Emphasis should be placed on providing comprehensive care coordination by an experienced APN. Shared care management is crucial in improving FCC.
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Affiliation(s)
- Brigitte Seliner
- University Children's Hospital Zurich, Zurich, Switzerland.,Department of Nursing Studies, University of Witten/Herdecke, Witten, Germany
| | - Beatrice Latal
- University Children's Hospital Zurich, Zurich, Switzerland
| | - Rebecca Spirig
- University Children's Hospital Zurich, Zurich, Switzerland.,Department of Nursing Studies, University of Witten/Herdecke, Witten, Germany.,Institute of Nursing Science, University of Basel, Basel, Switzerland
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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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Abstract
Orthopedic surgery (OS) plays an important role in the management of cerebral palsy (CP). The objectives of OS are to optimize functions and prevent deformity. Newer developments in OS for CP include emphasis on hip surveillance, minimally invasive procedures, use of external fixators instead of plates and screws, better understanding of lever arm dysfunctions (that can only be corrected by bony OS), orthopedic selective spasticity-control surgery, and single-event multilevel lever arm restoration and anti spasticity surgery, which have led to significant improvements in gross motor function and ambulation, especially in spastic quadriplegia, athetosis, and dystonia. The results of OS can be dramatic and life altering for the person with CP and their caregivers if it is performed meticulously by a specialized surgical team, at the appropriate age, for the correct indications, employing sound biomechanical principles and is followed by physician-led, protocol based, intensive, multidisciplinary, institutional rehabilitation, and long term followup. However, OS can be a double-edged sword, and if performed less than optimally, and without the supporting multidisciplinary medical and rehabilitation team, expertise and infrastructure, it often leads to significant functional worsening of the person with CP, including irretrievable loss of previous ambulatory capacity. OS must be integrated into the long term management of the person with CP and should be anticipated and planned at the optimal time and not viewed as a "last resort" intervention or failure of rehabilitation. This instructional course lecture reviews the relevant contemporary principles and techniques of OS in CP.
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Affiliation(s)
- Deepak Sharan
- Department of Pediatric Orthopedics and Rehabilitation, RECOUP Neuromusculoskeletal Rehabilitation Centre, Bengaluru, Karnataka, India,Address for correspondence: Dr. Deepak Sharan, Department of Pediatric Orthopedics and Rehabilitation, RECOUP Neuromusculoskeletal Rehabilitation Centre, 312, Further Extension of Anjanapura Layout, 10th Block, Bengaluru - 560 108, Karnataka, India. E-mail:
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Abstract
BACKGROUND When hip displacement in children with cerebral palsy (CP) is identified early, treatment is more successful. The standard test is a radiograph of the pelvis measuring the migration index (MI). Our study aims to review published literature of the natural history of hip dislocation among children with CP and to define related risk factors to develop screening criteria for early recognition. METHODS The review included 10 studies with sample sizes greater than 20 children with CP below18 years who had hips with no surgical intervention or dislocation at initial presentation, minimum 2-year follow-up, and recorded MI, pattern, and Gross Motor Function Classification System (GMFCS) level. RESULTS On the basis of this review, we suggest screening with 1 radiograph for GMFCS I and II, or, if MI>30%, an annual radiograph between ages 2 and 8 years, followed by a radiograph every 2 years until the age of 18 years. For GMFCS III, IV, and V, we recommend an annual radiograph if MI<30% or 1 every 6 months if MI>30% between ages 2 and 8 years, followed by radiograph every 2 years until the age of 18 years. CONCLUSIONS Applying a practical surveillance program for children with CP can prevent hip dislocation, provide early treatment, and ultimately lead to consistently better outcomes than those of neglected hip dislocations. The GMFCS level has a strong impact on subluxation risk and that the risk continues to the end of growth. LEVEL OF EVIDENCE Level III-systematic review.
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Alriksson-Schmidt AI, Arner M, Westbom L, Krumlinde-Sundholm L, Nordmark E, Rodby-Bousquet E, Hägglund G. A combined surveillance program and quality register improves management of childhood disability. Disabil Rehabil 2016; 39:830-836. [DOI: 10.3109/09638288.2016.1161843] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Marianne Arner
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Hand Surgery, Södersjukhuset, Stockholm, Sweden
| | - Lena Westbom
- Department of Clinical Sciences, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
| | - Lena Krumlinde-Sundholm
- Department of Women's and Children's Health, Astrid Lindgren Children's Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Eva Nordmark
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences, Division of Orthopaedics, Lund University, Lund, Sweden
- Centre for Clinical Research, Uppsala University, Västerås, Sweden
| | - Gunnar Hägglund
- Department of Clinical Sciences, Division of Orthopaedics, Lund University, Lund, Sweden
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O'Connor B, Kerr C, Shields N, Imms C. A systematic review of evidence-based assessment practices by allied health practitioners for children with cerebral palsy. Dev Med Child Neurol 2016; 58:332-47. [PMID: 26645152 DOI: 10.1111/dmcn.12973] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 12/16/2022]
Abstract
AIM The routine use of psychometrically robust assessment tools is integral to best practice. This systematic review aims to determine the extent to which evidence-based assessment tools were used by allied health practitioners for children with cerebral palsy (CP). METHOD The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocols 2015 was employed. A search strategy applied the free text terms: 'allied health practitioner', 'assessment', and 'cerebral palsy', and related subject headings to seven databases. Included articles reported assessment practices of occupational therapists, physiotherapists, or speech pathologists working with children with CP aged 0 to 18 years, published from the year 2000. RESULTS Fourteen articles met the inclusion criteria. Eighty-eight assessment tools were reported, of which 23 were in high use. Of these, three tools focused on gross motor function and had acceptable validity for use with children with CP: Gross Motor Function Measure, Gross Motor Function Classification System, and goniometry. Validated tools to assess other activity components, participation, quality of life, and pain were used infrequently or not at all. INTERPRETATION Allied health practitioners used only a few of the available evidence-based assessment tools. Assessment findings in many areas considered important by children and families were rarely documented using validated assessment tools.
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Affiliation(s)
- Bridget O'Connor
- School of Allied Health, Australian Catholic University, Fitzroy, Vic., Australia
| | - Claire Kerr
- Centre for Disability and Development Research, Australian Catholic University, Fitzroy, Vic., Australia.,School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Nora Shields
- School of Allied Health, La Trobe University, Bundoora, Vic., Australia.,Northern Centre for Health Education and Research, Epping, Vic., Australia
| | - Christine Imms
- Centre for Disability and Development Research, Australian Catholic University, Fitzroy, Vic., Australia
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Hurley DS, Sukal-Moulton T, Gaebler-Spira D, Krosschell KJ, Pavone L, Mutlu A, Dewald JPA, Msall ME. Systematic Review of Cerebral Palsy Registries/Surveillance Groups: Relationships between Registry Characteristics and Knowledge Dissemination. INTERNATIONAL JOURNAL OF PHYSICAL MEDICINE & REHABILITATION 2015; 3:266. [PMID: 27790626 PMCID: PMC5079705 DOI: 10.4172/2329-9096.1000266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The aims of this study were to provide a comprehensive summary of the body of research disseminated by Cerebral Palsy (CP) registries and surveillance programs from January 2009 through May 2014 in order to describe the influence their results have on our overall understanding of CP. Secondly, registries/surveillance programs and the work they produced were evaluated and grouped using standardized definitions and classification systems. METHOD A systematic review search in PubMed, CINAH and Embase for original articles published from 1 January 2009 to 20 May 2014 originating from or supported by population based CP registries and surveillance programs or population based national registries including CP were included. Articles were grouped by 2009 World CP Registry Congress aim, registry/surveillance program classification, geographical region, and the International Classification of Function, Disability and Health (ICF) domain. Registry variables were assessed using the ICF-CY classification. RESULTS Literature searches returned 177 articles meeting inclusion criteria. The majority (69%) of registry/surveillance program productivity was related to contributions as a Resource for CP Research. Prevention (23%) and Surveillance (22%) articles were other areas of achievement, but fewer articles were published in the areas of Planning (17%) and Raising the Profile of CP (2%). There was a range of registry/surveillance program classifications contributing to this productivity, and representation from multiple areas of the globe, although most of the articles originated in Europe, Australia, and Canada. The domains of the ICF that were primarily covered included body structures and function at the early stages of life. Encouragingly, a variety of CP registry/surveillance program initiatives included additional ICF domains of participation and environmental and personal factors. INTERPRETATION CP registries and surveillance programs, including novel non-traditional ones, have significantly contributed to the understanding of how CP affects individuals, families and society. Moving forward, the global CP registry/surveillance program community should continue to strive for uniformity in CP definitions, variables collected and consistency with international initiatives like the ICF so that databases can be consolidated for research use. Adaptation to new technologies can improve access, reduce cost and facilitate information transfer between registrants, researchers and registries/surveillance programs. Finally, increased efforts in documenting variables of individuals with CP into adulthood should be made in order to expand our understanding of CP across the lifespan.
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Affiliation(s)
- Donna S Hurley
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Theresa Sukal-Moulton
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | | | - Kristin J Krosschell
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | | | - Akmer Mutlu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Julius PA Dewald
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Michael E Msall
- University of Chicago Comer Children’s Hospital and Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, Chicago, IL, USA
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Hedström L, Brogren Carlberg E. Missing data in physiotherapists’ assessments of children with cerebral palsy. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2015. [DOI: 10.3109/21679169.2015.1009162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hägglund G, Alriksson-Schmidt A, Lauge-Pedersen H, Rodby-Bousquet E, Wagner P, Westbom L. Prevention of dislocation of the hip in children with cerebral palsy. Bone Joint J 2014; 96-B:1546-52. [DOI: 10.1302/0301-620x.96b11.34385] [Citation(s) in RCA: 162] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In 1994 a cerebral palsy (CP) register and healthcare programme was established in southern Sweden with the primary aim of preventing dislocation of the hip in these children. The results from the first ten years were published in 2005 and showed a decrease in the incidence of dislocation of the hip, from 8% in a historical control group of 103 children born between 1990 and 1991 to 0.5% in a group of 258 children born between 1992 and 1997. These two cohorts have now been re-evaluated and an additional group of 431 children born between 1998 and 2007 has been added. By 1 January 2014, nine children in the control group, two in the first study group and none in the second study group had developed a dislocated hip (p < 0.001). The two children in the first study group who developed a dislocated hip were too unwell to undergo preventive surgery. Every child with a dislocated hip reported severe pain, at least periodically, and four underwent salvage surgery. Of the 689 children in the study groups, 91 (13%) underwent preventive surgery. A population-based hip surveillance programme enables the early identification and preventive treatment, which can result in a significantly lower incidence of dislocation of the hip in children with CP. Cite this article: Bone Joint J 2014; 96-B:1546–52.
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Affiliation(s)
- G. Hägglund
- Lund University, Department
of Clinical Sciences, Lund, 22185, Sweden
| | | | - H. Lauge-Pedersen
- Lund University, Department
of Clinical Sciences, Lund, 22185, Sweden
| | | | - P. Wagner
- Uppsala University, Centre
for Clinical Research Västerås, Sweden
| | - L. Westbom
- Lund University, Department
of Clinical Sciences, Lund, 22185, Sweden
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Šmigovec I, Ðapić T, Trkulja V. Ultrasound screening for decentered hips in children with severe cerebral palsy: a preliminary evaluation. Pediatr Radiol 2014; 44:1101-9. [PMID: 24710864 DOI: 10.1007/s00247-014-2956-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 02/09/2014] [Accepted: 02/26/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ultrasound (US) is routinely used for hip screening in children with developmental hip disorders, whereas standard hip surveillance in children with cerebral palsy is based on repeated X-ray assessments. OBJECTIVE To evaluate US as a diagnostic tool in screening for decentered hips in children with cerebral palsy. MATERIALS AND METHODS We conducted a prospective, diagnostic single-center assessor-blind study that included consecutive children (age 2-8 years) with cerebral palsy and severe motor disability who underwent US and X-ray hip assessment. US lateral longitudinal scans were used to determine lateral head distance. X-ray assessment was used to determine migration percentage. Diagnostic properties of lateral head distance in detecting hips with a migration percentage ≥0.33 (which requires preventive treatment) were evaluated overall (n = 100) and for hips assessed at the age 24-60 months (n = 38) or >60 to ≤96 months (n = 62). Fifty hips underwent US assessment by two investigators to evaluate inter-rater reliability and agreement. RESULTS Prevalence of migration percentage ≥0.33 was 22.0% overall and 26.2% and 19.4% in the younger and older age-based subsets, respectively. Lateral head distance well discriminated hips with a migration percentage ≥0.33 (areas under the receiver operating characteristics [ROC] curves 94%, 99% and 92%, respectively). At the optimum cut-off values of lateral head distance (5.0, 5.0 and 4.8 mm, respectively), sensitivity was 95.5%, 100% and 100% overall and in the two age-based subsets, respectively, whereas specificity was 85.9%, 96.4% and 72.0%, respectively. Consequently, positive predictive value was relatively low, but negative predictive value was 98.5% (95% CI 92.1-100) overall and 100% (97.5% one-sided CI 87.2-100) and 100% (97.5 one-sided CI 90.2-100) in the two age-based subsets, respectively. Inter-rater reliability was high (intraclass correlation coefficient = 0.98, 95% CI 0.97-0.99) and 95% limits of agreement were reasonably narrow (-1.203 mm to 0.995 mm). CONCLUSION In children with cerebral palsy, US can be reliably used in screening for decentered hips and can greatly reduce the need for repeated radiographic assessments, thus reducing radiation burden in these children.
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Affiliation(s)
- Igor Šmigovec
- Department of Orthopedic Surgery, University Hospital Center Zagreb, Zagreb University School of Medicine, Šalata 6, 10000, Zagreb, Croatia,
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Robb JE, Hägglund G. Hip surveillance and management of the displaced hip in cerebral palsy. J Child Orthop 2013; 7:407-13. [PMID: 24432103 PMCID: PMC3838516 DOI: 10.1007/s11832-013-0515-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 06/17/2013] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION This article provides an overview of the management of a displaced hip in children with cerebral palsy and considers surveillance programmes, principles of surgical reconstruction and options for the salvage of an unreconstructable hip in these children. CONCLUSION Hip dislocation in CP is potentially preventable if children are included from an early age in a surveillance programme that includes repeat radiographic and clinical examinations, and preventive treatment for hips that are displacing. A surveillance programme should be based on the child's age, GMFCS level and migration percentage (MP), and surgical prevention may be considered in children with a MP exceeding 33 %.
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Affiliation(s)
- J. E. Robb
- />School of Medicine, University of St Andrews, St Andrews, KY16 9TF Scotland, UK
| | - G. Hägglund
- />Department of Orthopaedics, University Hospital, SE-221 85 Lund, Sweden
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Rodby-Bousquet E, Czuba T, Hägglund G, Westbom L. Postural asymmetries in young adults with cerebral palsy. Dev Med Child Neurol 2013; 55:1009-15. [PMID: 23834239 PMCID: PMC3906840 DOI: 10.1111/dmcn.12199] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2013] [Indexed: 11/30/2022]
Abstract
AIM The purpose was to describe posture, ability to change position, and association between posture and contractures, hip dislocation, scoliosis, and pain in young adults with cerebral palsy (CP). METHODS Cross-sectional data of 102 people (63 males, 39 females; age range 19-23 y, median 21 y) out of a total population with CP was analysed in relation to Gross Motor Function Classification System (GMFCS) levels I (n=38), II (n=21), III (n=13), IV (n=10), and V (n=20). The CP subtypes were unilateral spastic (n=26), bilateral spastic (n=45), ataxic (n=12), and dyskinetic CP (n=19). The Postural Ability Scale was used to assess posture. The relationship between posture and joint range of motion, hip dislocation, scoliosis, and pain was analysed using logistic regression and Spearman's correlation. RESULTS At GMFCS levels I to II, head and trunk asymmetries were most common; at GMFCS levels III to V postural asymmetries varied with position. The odds ratios (OR) for severe postural asymmetries were significantly higher for those with scoliosis (OR=33 sitting), limited hip extension (OR=39 supine), or limited knee extension (OR=37 standing). Postural asymmetries correlated to hip dislocations: supine (r(s) =0.48), sitting (r(s) =0.40), standing (r(s) =0.41), and inability to change position: supine (r(s) =0.60), sitting (r(s) =0.73), and standing (r(s) =0.64). CONCLUSIONS Postural asymmetries were associated with scoliosis, hip dislocations, hip and knee contractures, and inability to change position.
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Affiliation(s)
- Elisabet Rodby-Bousquet
- Centre for Clinical Research, Uppsala University, Central HospitalVästerås, Sweden,Department of Orthopaedics, Lund University, Skåne University HospitalLund, Sweden
| | - Tomasz Czuba
- RC Syd, National Centre for Quality Registers, Lund University, Skåne University HospitalLund, Sweden
| | - Gunnar Hägglund
- Department of Orthopaedics, Lund University, Skåne University HospitalLund, Sweden
| | - Lena Westbom
- Department of Paediatrics, Lund University, Skåne University HospitalLund, Sweden,Correspondence to Elisabet Rodby-Bousquet, Department of Orthopaedics, Lund University, Skåne University Hospital, SE-221 85 Lund, Sweden. E-mail:
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