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Characteristics of children with hip displacement in cerebral palsy.

https://arctichealth.org/en/permalink/ahliterature87624
Source
BMC Musculoskelet Disord. 2007;8:101
Publication Type
Article
Date
2007
Author
Hägglund Gunnar
Lauge-Pedersen Henrik
Wagner Philippe
Author Affiliation
Department of Orthopaedics, Lund University Hospital, S-221 85 Lund, Sweden. gunnar.hagglund@med.lu.se
Source
BMC Musculoskelet Disord. 2007;8:101
Date
2007
Language
English
Publication Type
Article
Keywords
Adolescent
Age Distribution
Cerebral Palsy - epidemiology - physiopathology
Child
Child, Preschool
Cohort Studies
Comorbidity
Disease Progression
Female
Hip Dislocation - epidemiology - physiopathology - radiography
Humans
Incidence
Longitudinal Studies
Male
Mass Screening
Muscle, Skeletal - physiopathology
Predictive value of tests
Prognosis
Quadriplegia - epidemiology - physiopathology
Radiography - standards
Registries
Risk factors
Sweden - epidemiology
Abstract
BACKGROUND: Hip dislocation in children with cerebral palsy (CP) is a common and severe problem. The dislocation can be avoided, by screening and preventive treatment of children with hips at risk. The aim of this study was to analyse the characteristics of children with CP who develop hip displacement, in order to optimise a hip surveillance programme. METHODS: In a total population of children with CP a standardised clinical and radiological follow-up of the hips was carried out as a part of a hip prevention programme. The present study is based on 212 children followed until 9-16 years of age. RESULTS: Of the 212 children, 38 (18%) developed displacement with Migration Percentage (MP) >40% and further 19 (9%) MP between 33 and 39%. Mean age at first registration of hip displacement was 4 years, but some hips showed MP > 40% already at two years of age. The passive range of hip motion at the time of first registration of hip displacement did not differ significantly from the findings in hips without displacement.The risk of hip displacement varied according to CP-subtype, from 0% in children with pure ataxia to 79% in children with spastic tetraplegia. The risk of displacement (MP > 40%) was directly related to the level of gross motor function, classified according to the gross motor function classification system, GMFCS, from 0% in children in GMFCS level I to 64% in GMFCS level V. CONCLUSION: Hip displacement in CP often occurs already at 2-3 years of age. Range of motion is a poor indicator of hips at risk. Thus early identification and early radiographic examination of children at risk is of great importance. The risk of hip displacement varies according to both CP-subtype and GMFCS. It is sometimes not possible to determine subtype before 4 years of age, and at present several definitions and classification systems are used. GMFCS is valid and reliable from 2 years of age, and it is internationally accepted.We recommend a hip surveillance programme for children with CP with radiographic examinations based on the child's age and GMFCS level.
PubMed ID
17963501 View in PubMed
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Development of lower limb range of motion from early childhood to adolescence in cerebral palsy: a population-based study.

https://arctichealth.org/en/permalink/ahliterature94885
Source
BMC Med. 2009;7:65
Publication Type
Article
Date
2009
Author
Nordmark Eva
Hägglund Gunnar
Lauge-Pedersen Henrik
Wagner Philippe
Westbom Lena
Author Affiliation
Department of Health Sciences, Division of Physiotherapy, Lund University, SE-221 00 Lund, Sweden. eva.nordmark@med.lu.se
Source
BMC Med. 2009;7:65
Date
2009
Language
English
Publication Type
Article
Abstract
BACKGROUND: The decreasing range of joint motion caused by insufficient muscle length is a common problem in children with cerebral palsy (CP), often worsening with age. In 1994 a CP register and health care programme for children with CP was initiated in southern Sweden. The aim of this study was to analyse the development of the passive range of motion (ROM) in the lower limbs during all the growth periods in relation to gross motor function and CP subtype in the total population of children with CP. METHODS: In total, 359 children with CP born during 1990-1999, living in the southernmost part of Sweden in the year during which they reached their third birthday and still living in the area in the year of their seventh birthday were analysed. The programme includes a continuous standardized follow-up with goniometric measurements of ROM in the lower limbs. The assessments are made by each child's local physiotherapist twice a year until 6 years of age, then once a year. In total, 5075 assessments from the CPUP database from 1994 to 1 January 2007 were analysed. RESULTS: The study showed a decreasing mean range of motion over the period 2-14 years of age in all joints or muscles measured. The development of ROM varied according to GMFCS level and CP subtype. CONCLUSION: We found a decreasing ROM in children with CP from 2-14 years of age. This information is important for both the treatment and follow-up planning of the individual child as well as for the planning of health care programmes for all children with CP.
PubMed ID
19863779 View in PubMed
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Development of spasticity with age in a total population of children with cerebral palsy.

https://arctichealth.org/en/permalink/ahliterature91346
Source
BMC Musculoskelet Disord. 2008;9:150
Publication Type
Article
Date
2008
Author
Hägglund Gunnar
Wagner Philippe
Author Affiliation
Department of Orthopaedics, Lund University Hospital, S-221 85 Lund, Sweden. gunnar.hagglund@med.lu.se
Source
BMC Musculoskelet Disord. 2008;9:150
Date
2008
Language
English
Publication Type
Article
Keywords
Adolescent
Aging - physiology
Cerebral Palsy - physiopathology
Child
Child, Preschool
Health Status Indicators
Humans
Infant
Muscle Spasticity - physiopathology
Muscle, Skeletal - physiopathology
Range of Motion, Articular
Severity of Illness Index
Sweden - epidemiology
Abstract
BACKGROUND: The development of spasticity with age in children with cerebral palsy (CP) has, to our knowledge, not been studied before. In 1994, a register and a health care program for children with CP in southern Sweden were initiated. In the programme the child's muscle tone according to the modified Ashworth scale is measured twice a year until six years of age, then once a year. We have used this data to analyse the development of spasticity with age in a total population of children with cerebral palsy. METHODS: All measurements of muscle tone in the gastrocnemius-soleus muscle in all children with CP from 0 to 15 years during the period 1995-2006 were analysed. The CP subtypes were classified according to the Surveillance of Cerebral Palsy in Europe network system. Using these criteria, the study was based on 6218 examinations in 547 children. For the statistical analysis the Ashworth scale was dichotomized. The levels 0-1 were gathered in one category and levels 2-4 in the other. The pattern of development with age was evaluated using piecewise logistic regression in combination with Akaike's An Information Criterion. RESULTS: In the total sample the degree of muscle tone increased up to 4 years of age. After 4 years of age the muscle tone decreased each year up to 12 years of age. A similar development was seen when excluding the children operated with selective dorsal rhizotomy, intrathecal baclofen pump or tendo Achilles lengthening. At 4 years of age about 47% of the children had spasticity in their gastro-soleus muscle graded as Ashworth 2-4. After 12 years of age 23% of the children had that level of spasticity. The CP subtypes spastic bilateral and spastic unilateral CP showed the same pattern as the total sample. Children with dyskinetic type of CP showed an increasing muscle tone up to age 6, followed by a decreasing pattern up to age 15. CONCLUSION: In children with CP, the muscle tone as measured with the Ashworth scale increases up to 4 years of age and then decreases up to 12 years of age. The same tendency is seen in all spastic subtypes. The findings may have implications both for clinical judgement and for research studies on spasticity treatment.
PubMed ID
18990204 View in PubMed
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