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Event-related Potentials During Target-response Tasks to Study Cognitive Processes of Upper Limb Use in Children with Unilateral Cerebral Palsy
Published on: January 11, 2016
Dislocation of the hips in children with bilateral spastic cerebral palsy, 1985-2000
R E Morton1, B Scott, V McClelland
1Ronnie MacKeith Child Development Centre and Derbyshire Children's Hospital, Derby, UK. richard.morton@derbyhospitals.nhs.uk
Insights
Hip dislocation is common in children with severe cerebral palsy, increasing with age and disease severity. Early preventive surgery is crucial but often delayed, leading to poorer outcomes.
Area of Science:
- Orthopedics
- Pediatrics
- Neurology
Background:
- Bilateral spastic cerebral palsy (BSCP) is associated with a high risk of hip dislocation.
- Hip surveillance and management are critical for improving long-term outcomes in children with BSCP.
Purpose of the Study:
- To assess the incidence of hip dislocation in children with BSCP based on age and disease severity.
- To evaluate the effectiveness of preventive surgery and identify delays in orthopedic referral.
Main Methods:
- Retrospective review of medical records for 110 individuals with BSCP (1985-2000).
- Classification into Gross Motor Function Classification System (GMFCS) levels.
- Assessment of hip dislocation at ages 5, 10, and 15 years.
Main Results:
- Hip dislocation rates increased with age and GMFCS level, particularly in Levels IV and V.
- By age 15, 30% of Level IV and 50% of Level V individuals had hip dislocations.
- 42% of dislocated hips had no prior preventive surgery; 21% of operated hips still dislocated.
Conclusions:
- High rates of hip dislocation occur early in children with severe BSCP (GMFCS Levels IV and V).
- Timely orthopedic referral and early preventive surgery are essential but often delayed.
- Current management should incorporate radiological surveillance and early interventions.
Abstract:
The aim of this study was to assess the rate of hip dislocation at different ages in children with bilateral spastic cerebral palsy attending special schools in southern Derbyshire, UK, between 1985 and 2000. The medical notes of 110 individuals (68 males, 42 females) were obtained. They were divided into four groups according to the Gross Motor Function Classification System (GMFCS). We determined whether or not their hips were dislocated at the ages of 5, 10, and 15 years, and the kind of surgery performed in each case. The percentage of individuals with one or both hips dislocated increased with age and with severity of disease. Of those in GMFCS Level II (n=18), none had dislocations; Level III (n=16), none had dislocations at ages 5 and 10, but 11% had by the age of 15; Level IV (n=35), 8% had dislocations by age 5, 19% by age 10, and 30% by age 15; Level V (n=41), 22% had dislocations by age 5, 48% by age 10, and 50% by age 15. Forty-two per cent of individuals with hip dislocation had not had previous preventive surgery. Twenty-one per cent of hips operated on still proceeded to dislocation. We conclude that there was a high rate of hip dislocation, especially in GMFCS groups Levels IV and V, and that this often occurred very early. Preventive surgery avoided dislocation in many children. However, orthopaedic referral was often not made before dislocation was discovered, or the referral was made too late for surgery on soft tissue to be successful. These results may be compared with those from current programmes of hip management, involving radiological surveillance and early use of conservative and surgical interventions.
