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Casey J, Rosenblad A, Agustsson A, Lauge-Pedersen H, Rodby-Bousquet E. Incidence and sequence of scoliosis and windswept hip deformity: which comes first in 4148 children with cerebral palsy? A longitudinal cohort study. BMC Musculoskelet Disord 2024; 25:222. [PMID: 38504256 PMCID: PMC10953287 DOI: 10.1186/s12891-024-07350-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 03/11/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The aim was to analyse whether scoliosis or windswept hip deformity (WSH) occurs first for children with cerebral palsy (CP). METHODS This longitudinal cohort study using data from 1994 - 2020 (26 years) involved 41,600 measurements of 4148 children (2419 [58.3%] boys) with CP born 1990 - 2018 and registered into the Swedish CP follow-up program. Children were followed from a mean age of 2.8 [SD 1.4] years, until they developed either scoliosis or WSH or were removed at surgery. RESULTS WSH developed first in 16.6% of the children (mean age 8.1 [SD 5.0] years), and scoliosis in 8.1% (mean age 8.1 [SD 4.9] years). The incidence of WSH was higher than scoliosis across all levels I-V of the Gross Motor Function Classification System (GMFCS), both sexes, and for those with dyskinetic (20.0%) or spastic (17.0%) CP. The incidence of scoliosis was highest (19.8%) and developed earliest in children with GMFCS level V (mean age 5.5 [SD 3.5] years), and in children with dyskinetic (17.9%) CP (mean age 7.0 [SD 4.7] years). CONCLUSIONS WSH presents earlier than scoliosis in most children with CP. Children with higher GMFCS level or dyskinetic CP are more likely to develop these deformities at a younger age.
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Affiliation(s)
- Jackie Casey
- Department of Clinical Sciences, Orthopaedics, Lund University, Lund, 221 85, Sweden
- Research & Development Office, Southern Health & Social Care Trust, Craigavon, Northern Ireland
- School of Nursing & Paramedic Sciences, Ulster University, Belfast, Northern Ireland
| | - Andreas Rosenblad
- Department of Statistics, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Division of Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Solna, Sweden
| | - Atli Agustsson
- Department of Physiotherapy, Research Centre of Movement Science, University of Iceland, Reykjavik, Iceland
| | - Henrik Lauge-Pedersen
- Department of Clinical Sciences, Orthopaedics, Lund University, Lund, 221 85, Sweden
| | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences, Orthopaedics, Lund University, Lund, 221 85, Sweden.
- Centre for Clinical Research, Uppsala University-Region Västmanland, Västerås, 721 89, Sweden.
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Noten S, Pettersson K, Czuba T, Cloodt E, Casey J, Rodby-Bousquet E. Probability of independent walking and wheeled mobility in individuals with cerebral palsy. Dev Med Child Neurol 2024; 66:326-332. [PMID: 37559231 DOI: 10.1111/dmcn.15731] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/11/2023]
Abstract
AIM To estimate the probability of independent walking and wheeled mobility in individuals with cerebral palsy (CP) at home and in the community in relation to age and gross motor function. METHOD This was a longitudinal cohort study using data reported into the combined Swedish CP follow-up programme and national quality registry from October 2000 to October 2022. Walking, walking with aids, wheeled mobility, and assisted mobility defined independent or assisted mobility at home and in the community, based on the Functional Mobility Scale with additional data on wheelchair performance, were assessed. RESULTS There were 52 858 examinations reported for 6647 individuals with CP (age range 0-32 years, follow-up period 0-22 years). Most children and adults in Gross Motor Function Classification System (GMFCS) levels I or II walked without assistive devices. The probability of dependence on others for mobility in the community was high for both children and adults in GMFCS levels III to V. INTERPRETATION Although independent mobility is vital for participation and social inclusion, many children and adults with CP are dependent on others for mobility. We recommend clinicians, together with families and individuals with CP, explore how to increase access to independent mobility from an early age and continuously throughout the life course. WHAT THIS PAPER ADDS • There is a high probability of independent walking in Gross Motor Function Classification System (GMFCS) levels I to II. • Mobility options vary most at home and in the community in GMFCS level III. • Being dependent on others for mobility is likely in GMFCS levels III to V.
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Affiliation(s)
- Suzie Noten
- Centre for Clinical Research, Uppsala University-Region Västmanland, Västerås, Sweden
| | - Katina Pettersson
- Centre for Clinical Research, Uppsala University-Region Västmanland, Västerås, Sweden
- Department of Clinical Sciences, Orthopaedics, Lund University, Lund, Sweden
| | - Tomasz Czuba
- Department of Clinical Sciences, Orthopaedics, Lund University, Lund, Sweden
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Erika Cloodt
- Department of Clinical Sciences, Orthopaedics, Lund University, Lund, Sweden
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - Jackie Casey
- Regional Wheelchair: Training, Research & Service Development (NI), Belfast Health & Social Care Trust, Belfast, UK
| | - Elisabet Rodby-Bousquet
- Centre for Clinical Research, Uppsala University-Region Västmanland, Västerås, Sweden
- Department of Clinical Sciences, Orthopaedics, Lund University, Lund, Sweden
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Asuman D, Gerdtham UG, Alriksson-Schmidt AI, Rodby-Bousquet E, Andersen GL, Jarl J. Pain and labor outcomes: A longitudinal study of adults with cerebral palsy in Sweden. Disabil Health J 2023:101479. [PMID: 37149449 DOI: 10.1016/j.dhjo.2023.101479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Pain is a global health concern with substantial societal costs and limits the activity participation of individuals. The prevalence of pain is estimated to be high among individuals with cerebral palsy (CP). OBJECTIVES To estimate the association between pain and labor outcomes for adults with CP in Sweden. METHODS A longitudinal cohort study based on data from Swedish population-based administrative registers of 6899 individuals (53,657 person-years) with CP aged 20-64 years. Individual fixed effects regression models were used to analyze the association between pain and labor outcomes (employment and earnings from employment), as well as potential pathways through which pain might affect employment and earnings. RESULTS Pain was associated with adverse outcomes varying across severity, corresponding to a reduction of 7-12% in employment and 2-8% in earnings if employed. Pain might affect employment and earnings through increased likelihood of both sickness leave and early retirement. CONCLUSION Pain management could potentially be important to improve labor outcomes for adults with CP, in addition to improving the quality of life.
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Affiliation(s)
- Derek Asuman
- Health Economics, Department of Clinical Sciences (Malmö), Lund University, Lund, Sweden.
| | - Ulf-G Gerdtham
- Health Economics, Department of Clinical Sciences (Malmö), Lund University, Lund, Sweden; Department of Economics, Lund University, Lund, Sweden; Centre for Economic Demography, Lund University, Lund, Sweden
| | | | - Elisabet Rodby-Bousquet
- Orthopaedics, Department of Clinical Sciences (Lund), Lund University, Lund, Sweden; Centre for Clinical Research, Uppsala University-Region Västmanland, Västeräs, Sweden
| | - Guro L Andersen
- Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP), Vestfold Hospital Trust, Tønsberg, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Johan Jarl
- Health Economics, Department of Clinical Sciences (Malmö), Lund University, Lund, Sweden
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Krasny J, Jozwiak M, Rodby-Bousquet E. Comparison of the six-minute walk test performed over a 15 and 30 m course by children with cerebral palsy. BMC Musculoskelet Disord 2023; 24:34. [PMID: 36650438 PMCID: PMC9843890 DOI: 10.1186/s12891-022-05944-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 11/02/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The aim of this study was to compare performance on the six-minute walk test (6MWT) performed over 15 m and 30 m courses by children and youths with cerebral palsy (CP). METHODS Children and youths with CP at Gross Motor Function Classification System levels I-IV performed the 6MWT in a straight 15 m-long corridor (first trial) and 30 m-long corridor (second trial). The intraclass correlation coefficient (ICC) and Bland-Altman plots were used to evaluate the agreement between the 6MWT results for the two corridor lengths. RESULTS We included 82 children and youths with CP (36 girls, 46 boys), with a mean age of 11.7 years (SD 4.2, range 5-22 years). There was high agreement between the results of the two 6MWTs: ICC 0.93 (95% confidence interval 0.76-0.97). The total walking distance was longer for the 30 m course (median 399 m, range 44-687 m) than the 15 m course (median 357 m, range 24-583 m). CONCLUSIONS We observed good agreement for the performance of the 6MWT in the 15 m and 30 m courses, although the total walking distance was greater for the 30 m course. We recommend that the same distance is used when evaluating changes in walking ability for an individual child. Both distances are appropriate when measuring endurance in children and youths with CP.
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Affiliation(s)
- Joanna Krasny
- grid.22254.330000 0001 2205 0971Department of Pediatric Orthopedics and Traumatology, Poznan University of Medical Sciences, Poznań, Poland
| | - Marek Jozwiak
- grid.22254.330000 0001 2205 0971Department of Pediatric Orthopedics and Traumatology, Poznan University of Medical Sciences, Poznań, Poland
| | - Elisabet Rodby-Bousquet
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden ,grid.8993.b0000 0004 1936 9457Centre for Clinical Research, Uppsala University-Region Västmanland, Västerås, Sweden
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Rodby-Bousquet E, Peterson MD. Editorial: Adults with childhood onset disabilities: A lifespan approach. Front Neurol 2023; 13:1115869. [PMID: 36686513 PMCID: PMC9846257 DOI: 10.3389/fneur.2022.1115869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Affiliation(s)
- Elisabet Rodby-Bousquet
- Faculty of Medicine, Lund University, Lund, Sweden,Centre for Clinical Research, Uppsala University, Uppsala, Sweden,*Correspondence: Elisabet Rodby-Bousquet ✉
| | - Mark D. Peterson
- Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
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Casey J, Agustsson A, Rosenblad A, Rodby-Bousquet E. Relationship between scoliosis, windswept hips and contractures with pain and asymmetries in sitting and supine in 2450 children with cerebral palsy. Disabil Rehabil 2022; 44:6738-6743. [PMID: 34487468 DOI: 10.1080/09638288.2021.1971308] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE This cross-sectional study of 2450 children with cerebral palsy aimed to analyse the prevalence and association of scoliosis, windswept hips, hip and knee contractures. METHODS Logistic regression was used to estimate associations with pain, postural asymmetries, and ability to change position for children at Gross Motor Function Classification System (GMFCS) levels I-V, aged 0-18 years. RESULTS Most children with a deformity or contracture had postural asymmetries in both sitting and supine positions; 10.5% had scoliosis, 8.7% windswept hips, 6.6% hip flexion and 19.2% knee contractures. Severe postural asymmetries increased the likelihood for scoliosis 9 times, for windswept hips 6 to 9 times, and for hip and knee flexion contractures 7 and 12 times respectively, adjusted for age, sex and GMFCS level. Hip flexion contractures and windswept hips increased the likelihood for pain by 1.5-1.6 times. CONCLUSION The likelihood of having scoliosis, windswept hips and flexion contractures in the hips and knees increased if the child had postural asymmetries, and for increased age and higher GMFCS levels. Efforts should focus on preventing postural asymmetries from occurring or progressing, and on increasing the child's ability to change position. Reducing postural asymmetries may also reduce the likelihood of pain.Implications for RehabilitationThe risk of having scoliosis, windswept hip deformity and flexion contractures in the hips and knees increased if the child had postural asymmetries in sitting or lying.Efforts should focus on preventing or reducing postural asymmetries, and on increasing the child's ability to change position.Reducing postural asymmetries may also reduce the risk of pain.
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Affiliation(s)
- Jackie Casey
- Department of Clinical Sciences, Orthopaedics, Lund University, Lund, Sweden.,Rehabilitation Engineering Centre, Musgrave Park Hospital, Belfast Health & Social Care Trust, Belfast, Northern Ireland
| | - Atli Agustsson
- Research Centre of Movement Science, Department of Physiotherapy, University of Iceland, Reykjavik, Iceland
| | - Andreas Rosenblad
- Department of Medical Sciences, Division of Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
| | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences, Orthopaedics, Lund University, Lund, Sweden.,Centre for Clinical Research, Uppsala University-Region Västmanland, Västerås, Sweden
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Cloodt E, Lindgren A, Lauge-Pedersen H, Rodby-Bousquet E. Sequence of flexion contracture development in the lower limb: a longitudinal analysis of 1,071 children with cerebral palsy. BMC Musculoskelet Disord 2022; 23:629. [PMID: 35780097 PMCID: PMC9250270 DOI: 10.1186/s12891-022-05548-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background To prevent severe contractures and their impact on adjacent joints in children with cerebral palsy (CP), it is crucial to treat the reduced range of motion early and to understand the order by which contractures appear. The aim of this study was to determine how a hip–knee or ankle contracture are associated with the time to and sequence of contracture development in adjacent joints. Methods This was a longitudinal cohort study of 1,071 children (636 boys, 435 girls) with CP born 1990 to 2018 who were registered before 5 years of age in the Swedish surveillance program for CP and had a hip, knee or ankle flexion contracture of ≥ 10°. The results were based on 1,636 legs followed for an average of 4.6 years (range 0–17 years). The Cox proportional-hazards model adjusted for Gross Motor Function Classification System (GMFCS) levels I–V was used to compare the percentage of legs with and without more than one contracture. Results A second contracture developed in 44% of the legs. The frequency of multiple contractures increased with higher GMFCS level. Children with a primary hip or foot contracture were more likely to develop a second knee contracture. Children with a primary knee contracture developed either a hip or ankle contracture as a second contracture. Conclusions Multiple contractures were associated with higher GMFCS level. Lower limb contractures appeared in specific patterns where the location of the primary contracture and GMFCS level were associated with contracture development in adjacent joints.
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Affiliation(s)
- Erika Cloodt
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden. .,Department of Research and Development, Region Kronoberg, Växjö, Sweden.
| | - Anna Lindgren
- Centre for Mathematical Sciences, Lund University, Lund, Sweden
| | | | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden.,Centre for Clinical Research Västerås, Uppsala University-Region Västmanland, Västerås, Sweden
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Noten S, Rodby-Bousquet E, Limsakul C, Tipchatyotin S, Visser F, Grootoonk A, Thorpe DE, van der Slot WMA, Selb M, Roebroeck ME, Roebroeck ME, Noten S, van den Berg-Emons RJG, van der Slot WMA, Hilberink SR, Limsakul C, Konijnenbelt M, van den Borne K, de Groot V, Grootoonk A, Selb M. An international clinical perspective on functioning and disability in adults with cerebral palsy. Disabil Health J 2022; 15:101318. [DOI: 10.1016/j.dhjo.2022.101318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022]
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Rodby-Bousquet E, Agustsson A. Postural Asymmetries and Assistive Devices Used by Adults With Cerebral Palsy in Lying, Sitting, and Standing. Front Neurol 2021; 12:758706. [PMID: 34938261 PMCID: PMC8685523 DOI: 10.3389/fneur.2021.758706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To describe the use of assistive devices and postural asymmetries in lying, sitting and standing positions in adults with cerebral palsy, and to analyze postural asymmetries and any associations with their ability to maintain or change position and time in these positions. Methods: A cross-sectional study based on data from the Swedish Cerebral Palsy follow-up program of 1,547 adults aged 16-76 years, at Gross Motor Function Classification System (GMFCS) levels I (n = 330), II (n = 323), III (n = 235), IV (n = 298), and V (n = 361). Assistive devices such as wheelchairs, seating systems, adjustable beds, standing equipment and time in each position were reported. The Posture and Postural Ability Scale was used to identify asymmetries and rate the ability to maintain or change position. Binary logistic regression models were used to estimate odds ratios (OR) for postural asymmetries in supine, sitting and standing. Results: Assistive devices were used by 63% in sitting (range 5-100% GMFCS levels I-V), 42% in lying (4-92% levels I-V), and 32% in standing (2-70% levels II-V). Wheelchairs were used as seating systems by 57%. Most adults had postural asymmetries in supine (75%; range 35-100% levels I-V), sitting (81%; 50-99% levels I-V) and standing (88%; 65-100% levels I-V). Men were more likely than women to have postural asymmetries, and the likelihood of postural asymmetries increased with age, GMFCS levels and inability to change position. Inability to maintain position increased the probability of postural asymmetries in all positions from OR 2.6 in standing to OR 8.2 in lying and OR 13.1 in sitting. Conclusions: Almost twice as many adults used assistive devices in sitting than in lying or standing. Two thirds of the adults who used standing devices used it for <1 h per day, indicating that they might spend the remaining 23 out of 24 h per day either sitting or lying. Asymmetric postures were frequent across all ages and were highly associated with inability to change or maintain position.
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Affiliation(s)
- Elisabet Rodby-Bousquet
- Centre for Clinical Research, Uppsala University-Region Västmanland, Västerås, Sweden.,Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Atli Agustsson
- Research Centre of Movement Science, School of Health Sciences, University of Iceland, Reykjavík, Iceland
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Abstract
Objectives: To analyse the living conditions and social outcomes (housing, engagement in employment or higher education, access to personal assistance and having a partner) in adults with cerebral palsy (CP) relative to their age, sex, communication ability, and motor skills. Methods: Cross-sectional registry-based study of 1,888 adults (1,030 males/858 females) with CP in the Swedish CP follow-up programme, median age 25 years (range 16–78 y). Type of housing, occupation, access to personal assistance and having a partner were analysed relative to their age, sex, and the classification systems for Gross Motor Function (GMFCS) and Communication Function (CFCS). Binary logistic regression models were used to calculate odds ratios (OR) for independent living, competitive employment, and having a partner. Results: Most of the 25- to 29-year olds (55.6%) lived independently, increasing to 72.4% in 40- to 49-year olds, while the majority (91.3%) of those under 20 years lived with their parents. Independent living was almost equal in adults at GMFCS levels I (40.2%) and V (38.6%). This parity was explained by access to personal assistance, which increased with higher GMFCS and CFCS levels. Personal assistance of >160 hours/week was associated with a high probability of independent living (OR 57). In the age span 20–64 years, 17.5% had competitive employment and 45.2% attended activity centres for people with intellectual disabilities. In the younger age group up to 24 years old, 36.9% went to mainstream/higher education and 20.5% went to special schools. In total, 13.4% had a partner and 7.8% lived together. Slightly more women than men had a partner, and most individuals were classified at CFCS level I. Conclusion: Only one in eight adults with CP has a partner, and one in six has competitive employment. Access to personal assistance is the single most important factor for independent living. It is vital to support adults with CP throughout their lifespan to achieve the best possible outcomes in all aspects of life.
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Affiliation(s)
- Katina Pettersson
- Centre for Clinical Research, Uppsala University/Region Västmanland, Västerås, Sweden
| | - Elisabet Rodby-Bousquet
- Centre for Clinical Research, Uppsala University/Region Västmanland, Västerås, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
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Stadskleiv K, van Walsem MR, Andersen GL, Bergqvist L, Bøttcher L, Christensen K, Heyerdahl D, Hollung SJ, Høye H, Jahnsen R, Klevberg GL, Lindquist B, Passmark H, Rike PO, Rodby-Bousquet E, Alriksson-Schmidt AI. Systematic Monitoring of Cognition for Adults With Cerebral Palsy-The Rationale Behind the Development of the CP Cog-Adult Follow-Up Protocol. Front Neurol 2021; 12:710440. [PMID: 34630285 PMCID: PMC8492925 DOI: 10.3389/fneur.2021.710440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/19/2021] [Indexed: 11/13/2022] Open
Abstract
Cerebral palsy (CP) comprises a heterogeneous group of conditions recognized by disturbances of movement and posture and is caused by a non-progressive injury to the developing brain. Birth prevalence of CP is about 2-2.5 per 1,000 live births. Although the motor impairment is the hallmark of the diagnosis, individuals with CP often have other impairments, including cognitive ones. Cognitive impairments may affect communication, education, vocational opportunities, participation, and mental health. For many years, CP has been considered a "childhood disability," but the challenges continue through the life course, and health issues may worsen and new challenges may arise with age. This is particularly true for cognitive impairments, which may become more pronounced as the demands of life increase. For individuals with CP, there is no one-to-one correlation between cognition and functioning in other areas, and therefore, cognition must be individually assessed to determine what targeted interventions might be beneficial. To facilitate this for children with CP, a systematic follow-up protocol of cognition, the CPCog, has been implemented in Norway and Sweden. However, no such protocol currently exists for adults with CP. Such discontinuity in healthcare services that results from lack of follow-up of cognitive functioning and subsequent needs for adjustments and interventions makes transition from pediatric to adult healthcare services challenging. As a result, a protocol for the surveillance of cognition in adults with CP, the CPCog-Adult, has been developed. It includes assessment of verbal skills, non-verbal reasoning, visual-spatial perception, and executive functioning. It is recommended to perform these assessments at least once in young adulthood and once in the mid-fifties. This report describes the process of developing the CPCog-Adult, which has a three-fold purpose: (1) to provide equal access to healthcare services to enable the detection of cognitive impairments; (2) to provide interventions that increase educational and vocational participation, enhance quality of life, and prevent secondary impairments; and (3) to collect systematic data for research purposes. The consent-based registration of data in the well-established Swedish and Norwegian national CP registries will secure longitudinal data from childhood into adulthood.
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Affiliation(s)
- Kristine Stadskleiv
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | - Marleen R. van Walsem
- Department of Neurohabilitation, Oslo University Hospital, Oslo, Norway
- Center for Habilitation and Rehabilitation Models and Services, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Guro L. Andersen
- Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP), Vestfold Hospital Trust, Tønsberg, Norway
| | - Lena Bergqvist
- Unit of Occupational Therapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Louise Bøttcher
- Danish School of Education, Aarhus University, Copenhagen, Denmark
| | | | | | - Sandra Julsen Hollung
- Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP), Vestfold Hospital Trust, Tønsberg, Norway
| | | | - Reidun Jahnsen
- Center for Habilitation and Rehabilitation Models and Services, Institute of Health and Society, University of Oslo, Oslo, Norway
- Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP), Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | - Gunvor L. Klevberg
- Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP), Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | | | - Henrik Passmark
- The Cerebral Palsy Surveillance Programme (CPUP), User board, Lund, Sweden
| | - Per-Ola Rike
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Elisabet Rodby-Bousquet
- Center for Clinical Research, Uppsala University-Region Västmanland, Västerås, Sweden
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
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Cloodt E, Wagner P, Lauge-Pedersen H, Rodby-Bousquet E. Knee and foot contracture occur earliest in children with cerebral palsy: a longitudinal analysis of 2,693 children. Acta Orthop 2021; 92:222-227. [PMID: 33228441 PMCID: PMC8158222 DOI: 10.1080/17453674.2020.1848154] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Joint contracture is a common problem among children with cerebral palsy (CP). To prevent severe contracture and its effects on adjacent joints, it is crucial to identify children with a reduced range of motion (ROM) early. We examined whether significant hip, knee, or foot contracture occurs earliest in children with CP.Patients and methods - This was a longitudinal study involving 27,230 measurements obtained for 2,693 children (59% boys, 41% girls) with CP born 1990 to 2018 and registered before 5 years of age in the Swedish surveillance program for CP. The analysis was based on 4,751 legs followed up for an average of 5.0 years. Separate Kaplan-Meier (KM) curves were drawn for each ROM to illustrate the proportions of contracture-free legs at a given time during the follow-up. Using a clustered bootstrap method and considering the child as the unit of clustering, 95% pointwise confidence intervals were generated for equally spaced time points every 2.5 years for each KM curve.Results - Contracture developed in 34% of all legs, and the median time to the first contracture was 10 years from the first examination. Contracture was most common in children with a higher Gross Motor Function Classification System (GMFCS) level. The first contracture was a flexion contracture preventing dorsiflexion in children with GMFCS level I or II and preventing knee extension in children with GMFCS level III to V.Interpretation - Early interventions to prevent knee and foot contractures in children with CP should be considered.
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Affiliation(s)
- Erika Cloodt
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund; ,Department of Research and Development, Region Kronoberg, Växjö;; ,Correspondence:
| | - Philippe Wagner
- Centre for Clinical Research Västerås, Uppsala University-Region Västmanland, Västerås, Sweden
| | | | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund; ,Centre for Clinical Research Västerås, Uppsala University-Region Västmanland, Västerås, Sweden
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13
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Cloodt E, Krasny J, Jozwiak M, Rodby-Bousquet E. Interrater reliability for unilateral and bilateral tests to measure the popliteal angle in children and youth with cerebral palsy. BMC Musculoskelet Disord 2021; 22:275. [PMID: 33714264 PMCID: PMC7956112 DOI: 10.1186/s12891-021-04135-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/02/2021] [Indexed: 11/18/2022] Open
Abstract
Background Short hamstring muscles can cause several problems for children with cerebral palsy. The results of the clinical measurement of hamstring length are often used in decision-making about treatment of children with cerebral palsy. There are different ways of performing this measurement. The aim of this study was to evaluate the interrater reliability of the unilateral and bilateral measurement of the popliteal angle in children and youth with cerebral palsy. Methods Two methods for estimating hamstring length using unilateral and bilateral measurements of the popliteal angle were applied in children with cerebral palsy. Both tests were applied bilaterally by two independent examiners on the same day for each child. The intraclass correlation coefficient (ICC) was calculated to evaluate the interrater reliability of both measurements. Seventy young people with cerebral palsy (32 females, 38 males, mean age 10 years 8 months, range 5–22 years) at Gross Motor Function Classification System levels I (n = 17), II (n = 31), III (n = 12) and IV (n = 10) were included. Results The interrater reliability was good for both measurements. The ICC values were 0.80 on the right and 0.86 on the left for the unilateral popliteal angle, and 0.82 on the right and 0.83 on the left for the bilateral popliteal angle. Conclusions Both unilateral and bilateral measurement of the popliteal angle is a reliable method for estimating hamstring length in children and youth with cerebral palsy.
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Affiliation(s)
- Erika Cloodt
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden. .,Department of Research and Development, Region Kronoberg, Växjö, Sweden.
| | - Joanna Krasny
- Department of Pediatric Orthopedics and Traumatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Jozwiak
- Department of Pediatric Orthopedics and Traumatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden.,Centre for Clinical Research, Uppsala University-Region Västmanland, Västerås, Sweden
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14
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Casey J, Rosenblad A, Rodby-Bousquet E. Postural asymmetries, pain, and ability to change position of children with cerebral palsy in sitting and supine: a cross-sectional study. Disabil Rehabil 2020; 44:2363-2371. [PMID: 33142069 DOI: 10.1080/09638288.2020.1834628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To examine any associations between postural asymmetries, postural ability, and pain for children with cerebral palsy in sitting and supine positions. METHODS A cross-sectional study of 2,735 children with cerebral palsy, 0-18 years old, reported into the Swedish CPUP registry. Postural asymmetries, postural ability, the gross motor function classification system levels I-V, sex, age and report of pain were used to determine any relationship between these variables. RESULTS Over half the children had postural asymmetries in sitting (n = 1,646; 60.2%) or supine (n = 1,467; 53.6%). These increased with age and as motor function decreased. Children were twice as likely to have pain if they had an asymmetric posture (OR 2.1-2.7), regardless of age, sex and motor function. Children unable to maintain or change position independently were at higher risk for postural asymmetries in both supine (OR 2.6-7.8) and sitting positions (OR 1.5-4.2). CONCLUSIONS An association was found between having an asymmetric posture and ability to change position in sitting and/or lying; and with pain. The results indicate the need to assess posture and provide interventions to address asymmetric posture and pain.Implications for rehabilitationPostural asymmetries are present in children with cerebral palsy at all levels of gross motor function.Postural asymmetries increase with age and are associated with pain.Assessment of posture should be included in surveillance programs to enable early detection and treatment.
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Affiliation(s)
- Jackie Casey
- Department of Clinical Sciences, Orthopedics, Lund University, Lund, Sweden.,Regional Rehabilitation Engineering Centre, Musgrave Park Hospital, Belfast Health & Social Care Trust, Belfast, Northern Ireland
| | - Andreas Rosenblad
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
| | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences, Orthopedics, Lund University, Lund, Sweden.,Centre for Clinical Research, Uppsala University-Region Västmanland, Västerås, Sweden
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15
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van der Slot WMA, Benner JL, Brunton L, Engel JM, Gallien P, Hilberink SR, Månum G, Morgan P, Opheim A, Riquelme I, Rodby-Bousquet E, Şimşek TT, Thorpe DE, van den Berg-Emons RJG, Vogtle LK, Papageorgiou G, Roebroeck ME. Pain in adults with cerebral palsy: A systematic review and meta-analysis of individual participant data. Ann Phys Rehabil Med 2020; 64:101359. [PMID: 32061920 DOI: 10.1016/j.rehab.2019.12.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 12/29/2019] [Accepted: 12/31/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is little focus on adults with cerebral palsy (CP) in research and health care and insufficient knowledge on how to identify and manage pain in this population. OBJECTIVES This systematic review and meta-analysis aimed to determine whether pain prevalence in adults with CP is high and to explore variations in pain prevalence of subgroups, pain locations, pain severity and pain interference. METHODS Potential datasets were identified by experts in the field and literature searches in Embase, MEDLINE, and Cochrane, from January 2000 to October 2016. Included studies had a representative sample of ≥25 adults with CP and ≥1 pain outcomes. Methodological quality assessment, pain prevalence estimates and logistic regression models for subgroup effects on pain prevalence were conducted. RESULTS In total, 17 eligible studies were identified from 4584 publications. A meta-analysis was performed with individual participant data from 15 studies totalling 1243 participants (mean [SD] age 34.3 [12.6] years). Overall mean pain prevalence was 70% (95% CI 62-78). Women were more likely to have pain than men (P<0.001). The odds of pain was increased in adults with gross motor function level II (odds ratio [OR] 1.92, 95% CI 1.22-3.12) and IV (OR 1.77, 95% CI 1.03-4.29). Participants with pain reported pain predominantly in the legs (76%, 95% CI 66-84), and mean pain severity was 3.7/10 (95% CI 2.7-4.7) and pain interference 3.5/10 (95% CI 2.5-4.5). CONCLUSIONS This meta-analysis provides the first reliable pain prevalence estimate in a large international sample of adults with CP. The high prevalence of pain, 70%, suggests that adults with CP should be routinely screened for pain and treated accordingly. The range of measurement instruments used by the included studies emphasizes using common outcome measures specific to pain internationally.
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Affiliation(s)
- Wilma M A van der Slot
- Rijndam Rehabilitation and Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Joyce L Benner
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Laura Brunton
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Joyce M Engel
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, Milwaukee, Wi, USA
| | - Philippe Gallien
- Breizh Paralysie Cérébrale Health Network, Pôle MPR Saint-Hélier, Rennes, France
| | - Sander R Hilberink
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Grethe Månum
- Department of Research, Sunnaas Rehabilitation Hospital and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Prue Morgan
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - Arve Opheim
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway; Department of Research and Development, Habilitation & Health, Region Västra Götaland and Department of Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Region Västra Götaland, Gothenburg, Sweden
| | - Inmaculada Riquelme
- Department of Nursing and Physiotherapy, University Institute of Health Sciences, University of the Balearic Islands, Palma de Mallorca, Mallorca, Spain
| | - Elisabet Rodby-Bousquet
- Center for Clinical Research, Uppsala University, Region Västmanland, Västerås and Department of Clinical Sciences, Orthopaedics, Lund University, Lund, Sweden
| | - Tülay Tarsuslu Şimşek
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, İzmir, Turkey
| | - Deborah E Thorpe
- Division of Physical Therapy, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rita J G van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Laura K Vogtle
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Grigorios Papageorgiou
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marij E Roebroeck
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, Rotterdam, The Netherlands
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16
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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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17
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Alriksson-Schmidt A, Jarl J, Rodby-Bousquet E, Lundkvist Josenby A, Westbom L, Himmelmann K, Stadskleiv K, Ödman P, Svensson I, Antfolk C, Malesevic N, Jeglinsky I, Saha S, Hägglund G. Improving the Health of Individuals With Cerebral Palsy: Protocol for the Multidisciplinary Research Program MOVING ON WITH CP. JMIR Res Protoc 2019; 8:e13883. [PMID: 31599737 PMCID: PMC6811769 DOI: 10.2196/13883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/10/2019] [Accepted: 07/07/2019] [Indexed: 11/25/2022] Open
Abstract
Background Cerebral palsy (CP) is one of the most common early onset disabilities globally. The causative brain damage in CP is nonprogressive, yet secondary conditions develop and worsen over time. Individuals with CP in Sweden and most of the Nordic countries are systematically followed in the national registry and follow-up program entitled the Cerebral Palsy Follow-Up Program (CPUP). CPUP has improved certain aspects of health care for individuals with CP and strengthened collaboration among professionals. However, there are still issues to resolve regarding health care for this specific population. Objective The overall objectives of the research program MOVING ON WITH CP are to (1) improve the health care processes and delivery models; (2) develop, implement, and evaluate real-life solutions for Swedish health care provision; and (3) evaluate existing health care and social insurance benefit programs and processes in the context of CP. Methods MOVING ON WITH CP comprises 9 projects within 3 themes. Evaluation of Existing Health Care (Theme A) consists of registry studies where data from CPUP will be merged with national official health databases, complemented by survey and interview data. In Equality in Health Care and Social Insurance (Theme B), mixed methods studies and registry studies will be complemented with focus group interviews to inform the development of new processes to apply for benefits. In New Solutions and Processes in Health Care Provision (Theme C), an eHealth (electronic health) procedure will be developed and tested to facilitate access to specialized health care, and equipment that improves the assessment of movement activity in individuals with CP will be developed. Results The individual projects are currently being planned and will begin shortly. Feedback from users has been integrated. Ethics board approvals have been obtained. Conclusions In this 6-year multidisciplinary program, professionals from the fields of medicine, social sciences, health sciences, and engineering, in collaboration with individuals with CP and their families, will evaluate existing health care, create conditions for a more equal health care, and develop new technologies to improve the health care management of people with CP. International Registered Report Identifier (IRRID) DERR1-10.2196/13883
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Affiliation(s)
| | - Johan Jarl
- Department of Health Economics, Faculty of Medicine, Lund University, Lund, Sweden
| | - Elisabet Rodby-Bousquet
- Department of Orthopedics, Faculty of Medicine, Lund University, Lund, Sweden.,Centre for Clinical Research, Västmanland-Uppsala University, Västerås, Sweden
| | - Annika Lundkvist Josenby
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.,Children's Hospital, Skåne University Hospital, Lund, Sweden
| | - Lena Westbom
- Children's Hospital, Skåne University Hospital, Lund, Sweden.,Department of Paediatrics, Faculty of Medicine, Lund University, Lund, Sweden
| | - Kate Himmelmann
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Kristine Stadskleiv
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Sweden
| | - Pia Ödman
- Department of Medical and Health Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden
| | - Ingrid Svensson
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | | | | | - Ira Jeglinsky
- Department of Health and Welfare, Arcada University of Applied Sciences, Helsinki, Finland
| | - Sanjib Saha
- Department of Health Economics, Faculty of Medicine, Lund University, Lund, Sweden
| | - Gunnar Hägglund
- Department of Orthopedics, Faculty of Medicine, Lund University, Lund, Sweden
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18
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Lindén O, Hägglund G, Rodby-Bousquet E, Wagner P. The development of spasticity with age in 4,162 children with cerebral palsy: a register-based prospective cohort study. Acta Orthop 2019; 90:286-291. [PMID: 30907682 PMCID: PMC6534199 DOI: 10.1080/17453674.2019.1590769] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Spasticity is often regarded as a major cause of functional limitation in children with cerebral palsy (CP). We analyzed the spasticity development with age in the gastrosoleus muscle in children with CP. Children and methods - This is a longitudinal cohort study of 4,162 children (57% boys) with CP born in 1990-2015, monitored using standardized follow-up examinations in the Swedish surveillance program for CP. The study is based on 57,953 measurements of spasticity of the gastrosoleus muscle assessed using the Ashworth scale (AS) in participants between 0 and 15 years of age. The spasticity was analyzed in relation to age, sex, and Gross Motor Function Classification System (GMFCS) levels using a linear mixed model. Development of spasticity with age was modeled as a linear spline. Results - The degree of spasticity increased in most children over the first 5 years of life. At 5 years of age, 38% had an AS level of ≥ 2. The spasticity then decreased for 65% of the children during the remaining study period. At 15 years of age only 22% had AS ≥ 2. The level of spasticity and the rate of increase and decrease before and after 5.5 years of age were higher in children at GMFCS IV-V. Interpretation - The degree of spasticity of the gastrosoleus muscle often decreases after 5 years of age, which is important for long-term treatment planning and should be considered in spasticity management.
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Affiliation(s)
- Olof Lindén
- Department of Clinical Sciences, Lund, Orthopedics, Lund University, Sweden;; ,Correspondence:
| | - Gunnar Hägglund
- Department of Clinical Sciences, Lund, Orthopedics, Lund University, Sweden;;
| | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences, Lund, Orthopedics, Lund University, Sweden;; ,Centre for Clinical Research, Uppsala University, Region Västmanland, Västerås, Sweden
| | - Philippe Wagner
- Centre for Clinical Research, Uppsala University, Region Västmanland, Västerås, Sweden
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19
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Jarl J, Alriksson-Schmidt A, Rodby-Bousquet E. Health-related quality of life in adults with cerebral palsy living in Sweden and relation to demographic and disability-specific factors. Disabil Health J 2019; 12:460-466. [PMID: 30837198 DOI: 10.1016/j.dhjo.2019.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 01/24/2019] [Accepted: 02/17/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The knowledge base on health-related quality of life (HRQoL) in adults with cerebral palsy (CP) is small and inconsistent. OBJECTIVE The aim was to study HRQoL in adults with CP stratified on demographic and disability-specific factors using both experience- and hypothetical-based value-sets. METHODS Cross-sectional study based on registry data from the Swedish follow-up program CPUP. The EQ-5D-3L (5 domains; self-care, usual activities, mobility, pain/discomfort, anxiety/depression) was used to measure HRQoL. The Swedish experience-based and the United Kingdom hypothetical-based value-sets were used to calculate the quality-adjusted life-years (QALY), and associations to demographic and disability-specific factors were studied in univariate and multivariate analyses. RESULTS The sample consisted of 408 adults with CP (189 women, 219 men), 18-73 years (mean age = 27, SD = 10). Approximately half reported no problems on self-care, usual activities, anxiety/depression, and some problems on mobility and pain/discomfort. Using the value-set based on experienced health states resulted in substantially higher HRQoL scores (0.77) compared to the hypothetical-based values (0.54) (when the health state is described to someone not personally experiencing it). Level of functioning and pain were strongly related to HRQoL, with gross motor functioning being a dominating factor. Sex and CP-subtype were not associated with HRQoL in the multivariate analysis. CONCLUSIONS HRQoL was found to be high in this Swedish population of adults with CP although severe pain and reduced functioning was associated with lower HRQoL. The choice of value-set have strong influence on the HRQoL estimations, especially for lower levels of functioning.
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Affiliation(s)
- Johan Jarl
- Lund University, Department of Clinical Sciences Malmö, Health Economics Unit, 221 00, Lund, Sweden.
| | - Ann Alriksson-Schmidt
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Orthopedics, 221 00, Lund, Sweden
| | - Elisabet Rodby-Bousquet
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Orthopedics, 221 00, Lund, Sweden; Uppsala University, Region Västmanland, Centre for Clinical Research, Västerås, Sweden
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20
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Agustsson A, Gislason MK, Ingvarsson P, Rodby-Bousquet E, Sveinsson T. Validity and reliability of an iPad with a three-dimensional camera for posture imaging. Gait Posture 2019; 68:357-362. [PMID: 30580201 DOI: 10.1016/j.gaitpost.2018.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 11/19/2018] [Accepted: 12/13/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND It is important to quantify a static posture to evaluate the need for and effectiveness of interventions such as physical management, physiotherapy, spinal orthosis or surgical treatment on the alignment of body segments. Motion analysis systems can be used for this purpose, but they are expensive, require a high degree of technical experience and are not easily accessible. A simpler method is needed to quantify static posture. RESEARCH OBJECTIVE Assess validity and inter and intra rater reliability using an iPad with a 3-D camera to evaluate posture and postural deformity. METHOD A 3-D model of a lying posture, created using an iPad with a 3-D camera, was compared to a Qualisys motion analysis system of the same lying posture, the latter used as the gold standard. Markers on the trunk and the leg were captured by both systems, and results from distance and angle measurements were compared. RESULTS All intra-class correlation coefficient values were above 0.98, the highest systematic error was 4.3 mm for length measurements and 0.2° for angle measurements. SIGNIFICANCE A 3-D model of a person, with markers on anatomical landmarks, created with an iPad with a 3-D camera, is a valid and reliable method of quantifying static posture. CONCLUSION An iPad with a 3-D camera is a relatively inexpensive, valid and reliable method to quantify static posture in a clinical environment.
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Affiliation(s)
- A Agustsson
- School of Health Sciences, Research Centre of Movement Science, University of Iceland, Reykjavík, Iceland.
| | - M K Gislason
- School of Science and Engineering, Biomedical Engineering, Reykjavik University, Reykjavík, Iceland.
| | - P Ingvarsson
- Department of Rehabilitation Medicine, Landspitali - The National University Hospital of Iceland, Reykjavík, Iceland; Medical Faculty, The University of Iceland, Reykjavík, Iceland.
| | - E Rodby-Bousquet
- Centre for Clinical Research, Uppsala University, Region Västmanland, Västerås, Sweden; Department of Clinical Sciences Lund, Division of Orthopaedics, Lund University, Lund, Sweden.
| | - Th Sveinsson
- School of Health Sciences, Research Centre of Movement Science, University of Iceland, Reykjavík, Iceland.
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21
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Abstract
PURPOSE Analyze the goals for treatment and attained goals for spinal orthoses in children with cerebral palsy (CP), and describe the use of spinal orthoses in relation to age, sex, gross motor function, and scoliosis. METHODS Cross-sectional data for all children born between 2000 and 2014 and registered in the Swedish CP registry were analyzed in relation to age, sex, Gross Motor Function Classification System (GMFCS), and scoliosis. Treatment goals were to 1) prevent deformity; 2) improve stability/positioning; 3) improve head control; and 4) improve arm/hand function. RESULTS Overall, 251 of the 2800 children (9%) used spinal orthoses, and the frequency increased significantly with age and GMFCS level; 147 of the 251 children had scoliosis. Several treatment goals were reported for most children. The most common goal was improved stability/positioning (96%), followed by head control (51%) and arm/hand function (38%). Only one third of the children used spinal orthoses to prevent deformities. The rate of goal attainment was 78-87% for the functional outcomes and 57% for the prevention of deformities. CONCLUSION Although the goal of using spinal orthosis to prevent curvature progression remains important, we found that its functional benefits (stability, head control, arm/hand function) were of greater importance.
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Affiliation(s)
- Katina Pettersson
- Department of Clinical Sciences Lund, Lund University, Orthopaedics, Lund, Sweden
- Centre for Clinical Research Västerås, Uppsala University, Västerås, Sweden
| | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences Lund, Lund University, Orthopaedics, Lund, Sweden
- Centre for Clinical Research Västerås, Uppsala University, Västerås, Sweden
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22
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Abstract
Background and purpose - Pelvic obliquity, common in individuals with cerebral palsy (CP), changes the muscle force vector on the hip joint and probably affects the risk of hip dislocation. We evaluated a new method for measurement of hip displacement in CP that takes the pelvic obliquity into account: the pelvic adjusted migration percentage (PAMP). Children and methods - From the Swedish surveillance program for cerebral palsy (CPUP), the first pelvic radiograph of 268 children <18 years in southern Sweden during a 3-year period were evaluated. Pelvic obliquity, PAMP, and the migration percentage (MP) were measured. 50 radiographs were randomly selected for analysis of interrater reliability by three raters using the intraclass correlation coefficient (ICC). The correlations between PAMP/MP and pelvic obliquity were analyzed with Pearson correlation coefficients. Results - The interrater reliability for all 3 measurements was high (ICCs 0.88-0.97). The correlation between the high side of the pelvic obliquity and the difference between right and left hip displacement was higher for PAMP (r = 0.70) than for MP (r = 0.41). Interpretation - The new PAMP measurement showed high interrater reliability and a higher correlation with pelvic obliquity than MP. We suggest the use of PAMP at least in hips with a pelvic obliquity exceeding 5°.
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Affiliation(s)
- Gunnar Hägglund
- Department of Clinical Sciences, Lund University, Lund; ,Department of Orthopaedics, Skane University Hospital, Lund; ,Correspondence:
| | | | - Maria Hermanson
- Department of Surgery, Sahlgrenska University Hospital/Östra, Göteborg;
| | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences, Lund University, Lund; ,Centre for Clinical Research, Uppsala University, Region Västmanland, Västerås, Sweden
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Rodby-Bousquet E. The gap between current knowledge and clinical practice in childhood disability. Dev Med Child Neurol 2018; 60:969-970. [PMID: 29998559 DOI: 10.1111/dmcn.13971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Background and purpose - Surveillance of scoliosis in individuals with cerebral palsy (CP) is important for ensuring timely diagnosis and identification of curve progression. We analyzed the incidence of scoliosis in relation to age, sex, and gross motor function in a population-based cohort of individuals with CP. Patients and methods - This was a prospective register study of all 1,025 individuals born 1990-2012 in southern Sweden (1.4 million inhabitants) in the Swedish surveillance program for CP, which included >95% of the total population of people with CP in the area. Annual clinical examinations and radiographic measurement of the Cobb angle of those with a moderate or severe scoliosis were registered. We determined the incidence of scoliosis related to age, sex, and the Gross Motor Function Classification System (GMFCS) level. Results - The inclusion criteria were fulfilled by 962 individuals. The number of people (140/962) with scoliosis increased up to 20-25 years of age. The incidence of scoliosis was related to age and GMFCS level. In individuals at the lowest level of gross motor function (GMFCS V) scoliosis was seen in 10/131 before 5 years of age and at the age of 20 years 75% of these individuals had a Cobb angle ≥40°. No one in the highest level of motor function (GMFCS I) developed a Cobb angle ≥40° Interpretation - Surveillance programs for scoliosis in CP should be based on age and GMFCS level and should be initiated at a young age and continued into adulthood.
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Affiliation(s)
- Gunnar Hägglund
- Lund University, Department of Clinical Sciences, Lund, Orthopedics; ,Department of Orthopaedics, Skane University Hospital, Lund; ,Correspondence:
| | - Katina Pettersson
- Lund University, Department of Clinical Sciences, Lund, Orthopedics; ,Centre for Clinical Research, Uppsala University, Region Västmanland, Västerås;
| | - Tomasz Czuba
- National Competence Center for Quality Registers, University Hospital, Lund, Sweden
| | - Måns Persson-Bunke
- Lund University, Department of Clinical Sciences, Lund, Orthopedics; ,Department of Orthopaedics, Skane University Hospital, Lund;
| | - Elisabet Rodby-Bousquet
- Lund University, Department of Clinical Sciences, Lund, Orthopedics; ,Centre for Clinical Research, Uppsala University, Region Västmanland, Västerås;
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Ágústsson A, Sveinsson T, Pope P, Rodby-Bousquet E. Preferred posture in lying and its association with scoliosis and windswept hips in adults with cerebral palsy. Disabil Rehabil 2018; 41:3198-3202. [DOI: 10.1080/09638288.2018.1492032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Atli Ágústsson
- School of Health Sciences, Research Centre of Movement Science, University of Iceland, Reykjavík, Iceland
- Endurhaefing þekkingarsetur, Kópavogur, Iceland
| | - Thorarinn Sveinsson
- School of Health Sciences, Research Centre of Movement Science, University of Iceland, Reykjavík, Iceland
| | | | - Elisabet Rodby-Bousquet
- Centre for Clinical Research, Uppsala University, Region Västmanland, Västerås, Sweden
- Department of Clinical Sciences Lund, Division of Orthopaedics, Lund University, Lund, Sweden
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Cloodt E, Rosenblad A, Rodby-Bousquet E. Demographic and modifiable factors associated with knee contracture in children with cerebral palsy. Dev Med Child Neurol 2018; 60:391-396. [PMID: 29318610 DOI: 10.1111/dmcn.13659] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2017] [Indexed: 11/28/2022]
Abstract
AIM To identify the prevalence of knee contracture and its association with gross motor function, age, sex, spasticity, and muscle length in children with cerebral palsy (CP). METHOD Cross-sectional data for passive knee extension were analysed in 3 045 children with CP (1 756 males, 1 289 females; mean age 8y 1mo [SD 3.84]). CP was classified using the Gross Motor Function Classification System (GMFCS) levels I (n=1 330), II (n=508), III (n=280), IV (n=449), and V (n=478). Pearson's χ2 test and multiple binary logistic regression were applied to analyse the relationships between knee contracture and GMFCS level, sex, age, spasticity, hamstring length, and gastrocnemius length. RESULTS Knee contracture greater than or equal to 5 degrees occurred in 685 children (22%). The prevalence of knee contracture was higher in older children and in those with higher GMFCS levels. Odds ratios (ORs) for knee contracture were significantly higher for children at GMFCS level V (OR=13.17), with short hamstring muscles (OR=9.86), and in the oldest age group, 13 years to 15 years (OR=6.80). INTERPRETATION Knee contracture is associated with higher GMFCS level, older age, and shorter muscle length; spasticity has a small effect. Maintaining muscle length, especially of the hamstrings, is important for reducing the risk of knee contracture. WHAT THIS PAPER ADDS Knee contracture occurs in children with cerebral palsy at all Gross Motor Function Classification System (GMFCS) levels. Knee contracture in children is associated with short hamstring muscles, higher GMFCS level, and older age. Short hamstring muscles present a greater risk for knee contracture than spasticity.
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Affiliation(s)
- Erika Cloodt
- Department of Health Sciences Lund, Division of Physiotherapy, Lund University, Lund, Sweden
| | - Andreas Rosenblad
- Centre for Clinical Research Västerås, Uppsala University, Region Västmanland, Västerås, Sweden
| | - Elisabet Rodby-Bousquet
- Centre for Clinical Research Västerås, Uppsala University, Region Västmanland, Västerås, Sweden.,Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
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Ágústsson A, Sveinsson Þ, Rodby-Bousquet E. The effect of asymmetrical limited hip flexion on seating posture, scoliosis and windswept hip distortion. Res Dev Disabil 2017; 71:18-23. [PMID: 28987968 DOI: 10.1016/j.ridd.2017.09.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/19/2017] [Accepted: 09/27/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Postural asymmetries with seating problems are common in adults with cerebral palsy. AIMS To analyse the prevalence of asymmetrical limited hip flexion (<90°) in adults with CP, and to evaluate the association between asymmetrical limited hip flexion and postural asymmetries in the sitting position. METHODS AND PROCEDURES Cross-sectional data of 714 adults with CP, 16-73 years, GMFCS level I-V, reported to CPUP, the Swedish cerebral palsy national surveillance program and quality registry, from 2013 to 2015. Hip range of motion was analysed in relation to pelvic obliquity, trunk asymmetry, weight distribution, scoliosis and windswept hip distortion. OUTCOMES AND RESULTS The prevalence of asymmetrical limited hip flexion increased as GMFCS level decreased. Of adults at GMFCS level V, 22% had asymmetrical limited hip flexion (<90°). The odds of having an oblique pelvis (OR 2.6, 95% CI:1.6-2.1), an asymmetrical trunk (OR 2.1, 95% CI:1.1-4.2), scoliosis (OR 3.7, 95% CI:1.3-9.7), and windswept hip distortion (OR 2.6, 95% CI:1.2-5.4) were higher for adults with asymmetrical limited hip flexion compared with those with bilateral hip flexion>90°. CONCLUSIONS AND IMPLICATIONS Asymmetrical limited hip flexion affects the seating posture and is associated with scoliosis and windswept hip distortion.
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Affiliation(s)
- Atli Ágústsson
- University of Iceland, School of Health Sciences, Research Centre of Movement Science, Reykjavík, Iceland.
| | - Þórarinn Sveinsson
- University of Iceland, School of Health Sciences, Research Centre of Movement Science, Reykjavík, Iceland.
| | - Elisabet Rodby-Bousquet
- Centre for Clinical Research, Uppsala University, Vestmanland County Hospital, Västerås, Sweden; Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden.
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Pettersson K, Bjerke KM, Jahnsen R, Öhrvik J, Rodby-Bousquet E. Psychometric evaluation of the Scandinavian version of the caregiver priorities and child health index of life with disabilities. Disabil Rehabil 2017; 41:212-218. [PMID: 28927310 DOI: 10.1080/09638288.2017.1378930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To examine test-retest reliability and construct validity of the Scandinavian version of the caregiver priorities and child health index of life with disabilities (CPCHILD) questionnaire for children with cerebral palsy (CP). METHODS Families were recruited in Sweden and Norway and stratified according to the gross motor function classification system levels I-V for children born 2000-2011, mean age 7.9 (SD 3.2). Construct validity based on the first questionnaire (n = 106) was evaluated for known groups, using linear regression analysis. Intraclass correlation coefficient was used to estimate test-retest reliability (n = 64), and Cronbach's alpha was calculated as an indicator of internal consistency. RESULTS The questionnaire showed construct validity and the ability to discriminate between levels of gross motor function for the total score and all domain scores (p < 0.05). Test-retest reliability was high with intraclass correlation coefficient of 0.92 for the total score and of 0.72-0.92 for the domain scores. Cronbach's alpha was 0.96 for the total score and 0.83-0.96 for the domain scores. CONCLUSIONS The Scandinavian version of the CPCHILD for children with CP seems to be a valid and reliable proxy measure for health related quality of life. Implications for rehabilitation Valid and reliable outcome measures are needed to evaluate whether follow-up programs enhance health related quality of life in different countries. The Scandinavian version of the caregiver priorities and child health index of life with disabilities (CPCHILD) was evaluated for known-groups validity and test-retest reliability. The Scandinavian version of the CPCHILD is a sound and valid measurement for evaluation and comparison of health related quality of life of children with cerebral palsy in different countries.
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Affiliation(s)
- Katina Pettersson
- a Department of Clinical Sciences Lund, Orthopaedics , Lund University , Lund , Sweden.,b Centre for Clinical Research Västerås , Uppsala University , Västerås , Sweden
| | - Kari Marte Bjerke
- c Department of Clinical Neurosciences for Children , Oslo University Hospital , Oslo , Norway.,d Oslo Municipality , Oslo , Norway
| | - Reidun Jahnsen
- e Department of Clinical Neurosciences for Children , The Cerebral Palsy Follow-Up Program (CPOP), Oslo University Hospital , Oslo , Norway
| | - John Öhrvik
- b Centre for Clinical Research Västerås , Uppsala University , Västerås , Sweden.,f Department of Medicine , Karolinska Institutet , Solna , Sweden
| | - Elisabet Rodby-Bousquet
- a Department of Clinical Sciences Lund, Orthopaedics , Lund University , Lund , Sweden.,b Centre for Clinical Research Västerås , Uppsala University , Västerås , Sweden
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Abstract
PURPOSE Children with cerebral palsy (CP) are at increased risk for hip dislocation. This can be prevented in most cases using surveillance programmes that include radiographic examinations. Known risk factors for hip dislocation include young age, high Gross Motor Function Classification System (GMFCS) level and high migration percentage (MP). The head-shaft angle (HSA) has recently been described as an additional risk factor. The study aim was to determine inter- and intra-rater reliability of the HSA in a surveillance programme for children with CP. METHODS We included hip radiographs from the CP surveillance programme CPUP in southern Sweden during the first half of 2016. Fifty radiographs were included from children at GMFCS levels II-V, with a mean age of 6.6 (SD 3.2) years. Three raters measured the HSA of one hip (left or right) at baseline and four weeks later; intraclass correlation coefficient (ICC) was used to estimate inter- and intra-rater reliability. RESULTS Inter- and intra-rater reliability were excellent for the HSA, with ICC 0.92 (95% CI 0.87-0.96) and ICC 0.99 (95% CI 0.98-0.99), respectively. CONCLUSION The HSA showed excellent inter- and intra-rater reliability for children with CP, providing further evidence for use of the HSA as an additional factor for identifying risk for further hip displacement or dislocation.
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Affiliation(s)
- M. Hermanson
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Skåne University Hospital, Lund, Sweden,Dr M. Hermanson, Sahlgrenska University Hospital/Östra. S-416 85 Göteborg, Sweden. E-mail:
| | - G. Hägglund
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Skåne University Hospital, Lund, Sweden
| | - J. Riad
- Department of Clinical Sciences, Skaraborgs Hospital/Skövde, Sweden
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Rodby-Bousquet E, Paleg G, Casey J, Wizert A, Livingstone R. Physical risk factors influencing wheeled mobility in children with cerebral palsy: a cross-sectional study. BMC Pediatr 2016; 16:165. [PMID: 27724880 PMCID: PMC5057439 DOI: 10.1186/s12887-016-0707-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 10/05/2016] [Indexed: 11/20/2022] Open
Abstract
Background There is a lack of understanding of the factors that influence independent mobility and participation in meaningful activities. The purpose of this study was to analyse physical factors influencing independent use of manual and power wheelchairs in a total population of children with cerebral palsy (CP). Methods A cross-sectional study based on the most recent examination of all children with CP, born 2002–2013, reported into the Swedish cerebral palsy registry (CPUP), from January 2012 to June 2014. There were 2328 children (58 % boys, 42 % girls), aged 0–11 years, at all levels of gross motor function and hand function. Hazard ratios adjusted for age and sex were used to calculate the risk for not being able to self-propel based on Gross Motor Function Classification System (GMFCS) levels, upper extremity range of motion and hand function including Manual Ability Classification System (MACS), House functional classification system, Thumb-in-palm deformity, Zancolli (spasticity of wrist/finger flexors) and bimanual ability. Results In total 858 children used wheelchairs outdoors (692 manual, 20 power, 146 both). Only 10 % of the 838 children self-propelled manual wheelchairs, while 90 % were pushed. In contrast 75 % of the 166 children who used power mobility outdoors were independent. Poor hand function was the greatest risk factor for being unable to self-propel a manual wheelchair, while classification as GMFCS V or MACS IV-V were the greatest risk factors for not being able to use a power wheelchair independently. Conclusions The majority of children with CP, aged 0–11 years did not self-propel manual wheelchairs regardless of age, gross motor function, range of motion or manual abilities. Power mobility should be considered at earlier ages to promote independent mobility for all children with CP who require a wheelchair especially outdoors.
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Affiliation(s)
- Elisabet Rodby-Bousquet
- Centre for Clinical Research, Uppsala University, Vestmanland County Hospital, SE-721 89, Västerås, Sweden. .,Department of Clinical Sciences Lund, Orthopaedics, Lund University, University Hospital, Lund, Sweden.
| | - Ginny Paleg
- Montgomery County Infants & Toddlers Program, Maryland, USA
| | - Jackie Casey
- Institute of Nursing and Health Research, School of Health Sciences, University of Ulster, Coleraine, Northern Ireland
| | - Alicja Wizert
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, University Hospital, Lund, Sweden
| | - Roslyn Livingstone
- Sunny Hill Health Centre for Children, Vancouver, British Columbia, Canada
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Hägglund G, Lauge-Pedersen H, Persson Bunke M, Rodby-Bousquet E. Windswept hip deformity in children with cerebral palsy: a population-based prospective follow-up. J Child Orthop 2016; 10:275-9. [PMID: 27318818 PMCID: PMC4940244 DOI: 10.1007/s11832-016-0749-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 05/30/2016] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To analyze the development of windswept hip deformity (WS) in a total population of children with cerebral palsy (CP) up to 20 years of age, the association between WS and hip dislocation, and femoral varus osteotomy and scoliosis, and the impact of a hip surveillance program on the subsequent incidence of WS. METHODS This is a prospective study on children with CP in southern Sweden included in the Swedish follow-up programme and registry for CP (CPUP). All children born between 1990 and 1995 with CP were included; those born between 1990 and 1991 did not partake in the hip surveillance program until they were older (3-5 years of age) and served as a historic control group. Children born between 1992 and 1995 were included in the hip surveillance program from about 2 years of age and constituted the study group. RESULTS In the control group, 12 of 68 children (18 %) developed WS. In the study group of 139 children, 13 (9 %) developed WS (p = 0.071). Of all 25 children with WS, 21 also developed scoliosis and 5 developed a hip dislocation. The number of children with WS starting in the lower extremities was significantly lower in the study group (p = 0.028). No difference between the two groups was seen regarding WS that started in combination with scoliosis. CONCLUSION With early inclusion in a hip surveillance program and early treatment of contractures, it appears possible to reduce the frequency of WS starting in the lower extremities.
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Affiliation(s)
- Gunnar Hägglund
- />Department of Clinical Sciences, Lund, Orthopaedics, Lund University, 22185 Lund, Sweden
| | - Henrik Lauge-Pedersen
- />Department of Clinical Sciences, Lund, Orthopaedics, Lund University, 22185 Lund, Sweden
| | - Måns Persson Bunke
- />Department of Clinical Sciences, Lund, Orthopaedics, Lund University, 22185 Lund, Sweden
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Persson-Bunke M, Czuba T, Hägglund G, Rodby-Bousquet E. Psychometric evaluation of spinal assessment methods to screen for scoliosis in children and adolescents with cerebral palsy. BMC Musculoskelet Disord 2015; 16:351. [PMID: 26578150 PMCID: PMC4650493 DOI: 10.1186/s12891-015-0801-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/03/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In cerebral palsy (CP) there is an increased risk of scoliosis. It is important to identify a progressive scoliosis early-on because the results of surgery depend on the magnitude of the curve. The Swedish follow-up program for cerebral palsy (CPUP) includes clinical examinations of the spine. The reliability and validity of the assessment method have not been studied. In this study we evaluate the interrater reliability of the clinical spinal examination used in CPUP and scoliometer measurement in children with CP and we evaluate their validity compared to radiographic examination. METHODS Twenty-eight children (6-16 years) with CP in Gross Motor Function Classification System levels II-V were included. Clinical spinal examinations and scoliometer measurements in sitting position were performed by three independent examiners. The results were compared to the Cobb angle as determined by radiographic measurement. Interrater reliability was calculated using weighted kappa. Concurrent validity was analyzed using the Cobb angle as gold standard. Sensitivity, specificity, area under receiver operating characteristic curves (AUC) and likelihood ratios (LR) were calculated. Cut-off values for scoliosis were set to ≥ 20° Cobb angle and ≥ 7° scoliometer angle. RESULTS There was an excellent interrater reliability for both clinical examination (weighted kappa = 0.96) and scoliometer measurement (weighted kappa = 0.86). The clinical examination showed a sensitivity of 75 % (95 % CI: 19.4-99.4 %), specificity of 95.8 % (95 % CI: 78.9-99.9 %) and an AUC of 0.85 (95 % CI: 0.61-1.00). The positive LR was 18 and the negative LR was 0.3. The scoliometer measurement showed a sensitivity of 50 % (95 % CI: 6.8-93.2 %), specificity of 91.7 % (95 % CI: 73.0-99.0 %) and AUC of 0.71 (95 % CI: 0.42-0.99). The positive LR was 6 and the negative LR was 0.5. CONCLUSION The psychometric evaluation of the clinical examination showed an excellent interrater reliability and a high concurrent validity compared to the Cobb angle. The findings should be interpreted cautiously until research with larger samples may further quantify the psychometric properties. Clinical spinal examinations seem appropriate as a screening tool to identify scoliosis in children with CP.
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Affiliation(s)
- Måns Persson-Bunke
- Department of Clinical Sciences, Lund, Orthopaedics, Lund University, S-221 85, Lund, Sweden. .,Department of Orthopaedic, Skane University Hospital, SE 221 85, Lund, Sweden.
| | - Tomasz Czuba
- National Competence Center for Quality Registers, Lund University, University Hospital, S-221 85, Lund, Sweden.
| | - Gunnar Hägglund
- Department of Clinical Sciences, Lund, Orthopaedics, Lund University, S-221 85, Lund, Sweden.
| | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences, Lund, Orthopaedics, Lund University, S-221 85, Lund, Sweden. .,Centre for Clinical Research, Uppsala University, County Hospital, S-721 89, Västerås, Sweden.
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Abstract
Hip displacement, defined in this study as a migration percentage (MP) of more than 40%, is a common, debilitating complication of cerebral palsy (CP). In this prospective study we analysed the risk of developing hip displacement within five years of the first pelvic radiograph. All children with CP in southern and western Sweden are invited to register in the hip surveillance programme CPUP. Inclusion criteria for the two groups in this study were children from the CPUP database born between 1994 and 2009 with Gross Motor Function Classification System (GMFCS) III to V. Group 1 included children who developed hip displacement, group 2 included children who did not develop hip displacement over a minimum follow-up of five years. A total of 145 children were included with a mean age at their initial pelvic radiograph of 3.5 years (0.6 to 9.7). The odds ratio for hip displacement was calculated for GMFCS-level, age and initial MP and head-shaft angle. A risk score was constructed with these variables using multiple logistic regression analysis. The predictive ability of the risk score was evaluated using the area under the receiver operating characteristics curve (AUC). All variables had a significant effect on the risk of a MP > 40%. The discriminatory accuracy of the CPUP hip score is high (AUC = 0.87), indicating a high ability to differentiate between high- and low-risk individuals for hip displacement. The CPUP hip score may be useful in deciding on further follow-up and treatment in children with CP. Cite this article: Bone Joint J 2015;97-B:1441–4.
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Affiliation(s)
- M. Hermanson
- Lund University, Östra
Sjukhuset, Surgery, S-416
85 Göteborg, Sweden
| | | | - J. Riad
- Skaraborgs Hospital/Skövde,
S-541 85 Skövde, Sweden
| | | | - P. Wagner
- Uppsala University, County
Hospital, S-721 89 Västerås, Sweden
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Rodby-Bousquet E, Persson-Bunke M, Czuba T. Psychometric evaluation of the Posture and Postural Ability Scale for children with cerebral palsy. Clin Rehabil 2015; 30:697-704. [PMID: 26130659 DOI: 10.1177/0269215515593612] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 06/07/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate construct validity, internal consistency and inter-rater reliability of the Posture and Postural Ability Scale for children with cerebral palsy. DESIGN Evaluation of psychometric properties. SETTING Five child rehabilitation centres in the south of Sweden, in November 2013 to March 2014. SUBJECTS A total of 29 children with cerebral palsy (15 boys, 14 girls), 6-16 years old, classified at Gross Motor Function Classification System (GMFCS) levels II (n = 10), III (n = 7), IV (n = 6) and V (n = 6). MAIN MEASURES Three independent raters (two physiotherapists and one orthopaedic surgeon) assessed posture and postural ability of all children in supine, prone, sitting and standing positions, according to the Posture and Postural Ability Scale. Construct validity was evaluated based on averaged values for the raters relative to known-groups in terms of GMFCS levels. Internal consistency was analysed with Cronbach's alpha and corrected Item-Total correlation. Inter-rater reliability was calculated using weighted kappa scores. RESULTS The Posture and Postural Ability Scale showed construct validity and median values differed between GMFCS levels (p < 0.01). There was a good internal consistency (alpha = 0.95-0.96; item-total correlation = 0.55-0.91), and an excellent inter-rater reliability (kappa score = 0.77-0.99). CONCLUSION The Posture and Postural Ability Scale shows high psychometric properties for children with cerebral palsy, as previously seen when evaluated for adults. It enables detection of postural deficits and asymmetries indicating potential need for support and where it needs to be applied.
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Affiliation(s)
- Elisabet Rodby-Bousquet
- Centre for Clinical Research, Uppsala University, County Hospital, Västerås, Sweden Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | - Tomasz Czuba
- National Musculoskeletal Competence Centre for Quality Registers, Lund University, Lund, Sweden
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Paleg G, Rodby-Bousquet E, Huang HH. Go baby go! Solutions for maximizing augmented mobility for children. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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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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Wingstrand M, Hägglund G, Rodby-Bousquet E. Ankle-foot orthoses in children with cerebral palsy: a cross sectional population based study of 2200 children. BMC Musculoskelet Disord 2014; 15:327. [PMID: 25274143 PMCID: PMC4192348 DOI: 10.1186/1471-2474-15-327] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 09/25/2014] [Indexed: 05/28/2023] Open
Abstract
Background Ankle-foot orthosis (AFO) is the most frequently used type of orthosis in children with cerebral palsy (CP). AFOs are designed either to improve function or to prevent or treat muscle contractures. The purpose of the present study was to analyse the use of, the indications for, and the outcome of using AFO, relative to age and gross motor function in a total population of children with cerebral palsy. Methods A cross-sectional study was performed of 2200 children (58% boys, 42% girls), 0–19 years old (median age 7 years), based on data from the national Swedish follow-up programme and registry for CP. To analyse the outcome of passive ankle dorsiflexion, data was compared between 2011 and 2012. The Gross motor classification system (GMFCS) levels of included children was as follows: I (n = 879), II (n = 357), III (n = 230), IV (n = 374) and V (n = 355). Results AFOs were used by 1127 (51%) of the children. In 215 children (10%), the indication was to improve function, in 251 (11%) to maintain or increase range of motion, and 661 of the children (30%) used AFOs for both purposes. The use of AFOs was highest in 5-year-olds (67%) and was more frequent at lower levels of motor function with 70% at GMFCS IV-V. Physiotherapists reported achievement of functional goals in 73% of the children using AFOs and maintenance or improvement in range of ankle dorsiflexion in 70%. Conclusions AFOs were used by half of the children with CP in Sweden. The treatment goals were attained in almost three quarters of the children, equally at all GMFCS levels. AFOs to improve range of motion were more effective in children with a more significant decrease in dorsiflexion at baseline. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-327) contains supplementary material, which is available to authorized users.
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Alriksson-Schmidt A, Hägglund G, Rodby-Bousquet E, Westbom L. Follow-up of individuals with cerebral palsy through the transition years and description of adult life: the Swedish experience. J Pediatr Rehabil Med 2014; 7:53-61. [PMID: 24919938 DOI: 10.3233/prm-140273] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the process of providing healthcare through the transition years to individuals with cerebral palsy (CP) and to present data on living arrangements, education/occupation status, and use of personal assistance in young Swedish adults with CP. METHODS A descriptive cross-sectional study of 102 participants (63 males) participating in a standardized follow-up program called CPUP. Data were analyzed in relation to the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS). RESULTS Of the participants, 58 "lived with parents", 29 reported "independent living", and 15 reported "special service housing". Living arrangements differed among GMFCS levels (p< 0.001) and 14 of 20 with severe disabilities lived with their parents. Thirty-four of 70 reported personal assistance; use of assistance correlated (p< 0.001) with GMFCS (r(s) =0.71) and MACS (r(s) = 0.70). Thirty five were "students", 20 "employed", 36 in "daily activities", and 9 were "unemployed". Of those employed, 18 had GMFCS levels I-II. CONCLUSION Some young adults with CP and severe functional limitations manage independent living - however, many still live with their parents. Although many are students, a large number are unemployed. There is disconnect between the pediatric and adult healthcare systems. CPUP may facilitate in making the transition smoother.
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Affiliation(s)
| | - Gunnar Hägglund
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Elisabet Rodby-Bousquet
- Centre for Clinical Research, Uppsala University, Central Hospital Västerås, Västerås, Sweden
| | - Lena Westbom
- Department of Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
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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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Rodby-Bousquet E, Ágústsson A, Jónsdóttir G, Czuba T, Johansson AC, Hägglund G. Interrater reliability and construct validity of the Posture and Postural Ability Scale in adults with cerebral palsy in supine, prone, sitting and standing positions. Clin Rehabil 2012. [DOI: 10.1177/0269215512465423] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To evaluate reliability, internal consistency and construct validity of the Posture and Postural Ability Scale for adults with cerebral palsy. Design: Psychometric evaluation of a clinical assessment tool. Setting: Rehabilitation centres in Sweden and Iceland. Subjects: Thirty adults with cerebral palsy aged 19–22 years, six people at each level I–V of the Gross Motor Function Classification System. Main measures: The Posture and Postural Ability Scale contains a 7-point ordinal scale for postural ability in supine, prone, sitting and standing, and items for assessment of posture. Posture and postural ability was rated from photos and videos by three independent assessors. Interrater reliability was calculated using weighted kappa. Internal consistency was analysed with Cronbach’s alpha if item deleted and corrected item–total correlation. Construct validity was evaluated based on known groups, using Jonckheere Terpstra for averaged values of the three raters relative to the Gross Motor Function Classification System. Results: There was an excellent interrater reliability (kappa = 0.85–0.99) and a high internal consistency (alpha = 0.96–0.97, item–total correlation = 0.60–0.91). Median values differed ( P < 0.02) between known groups represented by the levels of gross motor function, showing construct validity for all items. Conclusion: The Posture and Postural Ability Scale showed an excellent interrater reliability for experienced raters, a high internal consistency and construct validity. It can detect postural asymmetries in adults with cerebral palsy at all levels of gross motor function.
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Affiliation(s)
- Elisabet Rodby-Bousquet
- Department of Orthopaedics, Lund University, Skåne University Hospital, Lund, Sweden
- Centre for Clinical Research, Uppsala University, Central Hospital, Västerås, Sweden
| | | | | | - Tomasz Czuba
- National Musculoskeletal Competence Centre for Quality Registers, Lund University, Skåne University Hospital, Lund, Sweden
| | | | - Gunnar Hägglund
- Department of Orthopaedics, Lund University, Skåne University Hospital, Lund, Sweden
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Rodby-Bousquet E, Hägglund G. Use of manual and powered wheelchair in children with cerebral palsy: a cross-sectional study. BMC Pediatr 2010; 10:59. [PMID: 20712899 PMCID: PMC2933698 DOI: 10.1186/1471-2431-10-59] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Accepted: 08/16/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mobility is important for the cognitive and psychosocial development of children. Almost one third of children with cerebral palsy (CP) are non-ambulant. Wheelchairs can provide independent mobility, allowing them to explore their environment. Independent mobility is vital for activity and participation and reduces the dependence on caregivers. The purpose of this study was to describe the use of manual and powered wheelchair indoors and outdoors in relation to the degree of independent wheelchair mobility or need for assistance in a total population of children with CP. METHODS A cross-sectional study was performed including all children aged 3-18 years with CP living in southern Sweden during 2008. Data was extracted from a register and health care programme for children with CP (CPUP). There were a total of 562 children (326 boys, 236 girls) in the register. Information on the child's use of manual and powered wheelchair indoors and outdoors and the performance in self-propelling or need for assistance were analysed related to age, CP subtype and gross motor function. RESULTS Wheelchairs for mobility indoors were used by 165 (29%) of the 562 children; 61 used wheelchair for independent mobility (32 using manual only, 12 powered only, 17 both) and 104 were pushed by an adult. For outdoor mobility wheelchairs were used by 228 children (41%); 66 used a wheelchair for independent mobility (18 using manual only, 36 powered only, 12 both) and 162 were pushed. The use of wheelchair increased with age and was most frequent in the spastic bilateral and dyskinetic subtypes. Most powered wheelchairs were operated by children at GMFCS level IV. CONCLUSION In this total population of children with CP, aged 3-18 years, 29% used a wheelchair indoors and 41% outdoors. A majority using manual wheelchairs needed adult assistance (86%) while powered wheelchairs provided independent mobility in most cases (86%). To achieve a high level of independent mobility, both manual and powered wheelchairs should be considered at an early age for children with impaired walking ability.
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Rodby-Bousquet E, Hägglund G. Sitting and standing performance in a total population of children with cerebral palsy: a cross-sectional study. BMC Musculoskelet Disord 2010; 11:131. [PMID: 20573201 PMCID: PMC2908562 DOI: 10.1186/1471-2474-11-131] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 06/23/2010] [Indexed: 11/12/2022] Open
Abstract
Background Knowledge of sitting and standing performance in a total population of children with cerebral palsy (CP) is of interest for health care planning and for prediction of future ability in the individual child. In 1994, a register and a health care programme for children with CP in southern Sweden was initiated. In the programme information on how the child usually sits, stands, stands up and sits down, together with use of support or assistive devices, is recorded annually. Methods A cross-sectional study was performed, analysing the most recent report of all children with CP born 1990-2005 and living in southern Sweden during 2008. All 562 children (326 boys, 236 girls) aged 3-18 years were included in the study. The degree of independence, use of support or assistive devices to sit, stand, stand up and sit down was analysed in relation to the Gross Motor Function Classification System (GMFCS), CP subtype and age. Result A majority of the children used standard chairs (57%), could stand independently (62%) and could stand up (62%) and sit down (63%) without external support. Adaptive seating was used by 42%, external support to stand was used by 31%, to stand up by 19%, and to sit down by 18%. The use of adaptive seating and assistive devices increased with GMFCS levels (p < 0.001) and there was a difference between CP subtypes (p < 0.001). The use of support was more frequent in preschool children aged 3-6 (p < 0.001). Conclusion About 60% of children with CP, aged 3-18, use standard chairs, stand, stand up, and sit down without external support. Adding those using adaptive seating and external support, 99% of the children could sit, 96% could stand and 81% could stand up from a sitting position and 81% could sit down from a standing position. The GMFCS classification system is a good predictor of sitting and standing performance.
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