Hip and Spine in Cerebral Palsy
Background: Children with cerebral palsy (CP) have an increased risk of scoliosis, contractures including windswept hip deformity (WS), and hip dislocation. In 1994, a follow-up program and registry for children and adolescents with CP (CPUP) was initiated in Sweden to allow the early detection and prevention of hip dislocations and other musculoskeletal deformities.
Purpose: To analyze the prevalence of scoliosis and WS in children with CP and to study the effect of CPUP. To evaluate the psychometric properties of screening methods to detect scoliosis and postural asymmetries in children with CP.
Methods: Studies I and II were cross-sectional studies of the total population of children and adolescents with CP in southern Sweden. Clinical and radiographical data from the CPUP registry were used to identify all children with WS and scoliosis. The impact of such hip surveillance and the preventive contracture program, CPUP, was analyzed. In studies III and IV, the interrater reliability and validity of the clinical spinal examination used in CPUP and of the Posture and Postural Ability Scale (PPAS) were evaluated in children and adolescents (6-16 years) with CP.
Results: The prevalence of WS decreased nonsignificantly from 12 to 7% but the numbers of children with WS, scoliosis and hip dislocation decreased significantly (p<0.05). It appears that the hip surveillance program has resulted in a reduction in the incidence of WS starting in the lower extremities but not in the incidence of WS starting with scoliosis. The prevalence of moderate or severe scoliosis was 11%. The risk of developing a moderate or severe scoliosis increased with Gross Motor Function Classification System (GMFCS) and age. The clinical spinal assessment showed excellent interrater reliability (weighted kappa=0.96) and high concurrent validity compared with radiographic Cobb angle measurement. The sensitivity was 75%, and specificity was 99.8%. The sensitivity of the scoliometer measurement was 50% and the specificity was 91.7%. Clinical spinal assessment seems useful to screen for scoliosis in children with CP. The PPAS showed an excellent interrater reliability (kappa scores 0.77-0.99), high internal consistency, and construct validity. It can be used to detect postural asymmetries in children and adolescents with CP at all levels of gross motor function.
Conclusion: WS starting in the lower extremity seems to have been reduced by the hip surveillance program.The risk for scoliosis increased with GMFCS-level and age. The screening methods used for scoliosis and postural asymmetries appear valid and reliable.
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