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Effects of the standing program with hip abduction on hip acetabular development in children with spastic diplegia
Lourdes Macias-Merlo1, Caridad Bagur-Calafat2, Montserrat Girabent-Farrés3
1a Early Intervention Public Service of Catalunya, Universitat Internacional De Catalunya , Barcelona , Spain.
Insights
A daily standing program with hip abduction in early childhood can improve hip development in children with cerebral palsy. This intervention helps maintain stable hip acetabular development, reducing risks associated with hip dysplasia.
Area of Science:
- Pediatric Orthopedics
- Neurorehabilitation
- Developmental Pediatrics
Background:
- Hip dysplasia is a concern in children with cerebral palsy (CP) due to high muscle tone and delayed weight-bearing.
- Early intervention is crucial for managing hip development in children with CP.
Purpose of the Study:
- To investigate the effect of a daily standing program with hip abduction on acetabular development.
- To assess the impact of this intervention in ambulatory children with spastic diplegia CP.
Main Methods:
- Study involved 26 children with spastic diplegia CP (GMFCS Level III).
- Thirteen children participated in a daily standing program with hip abduction for at least 1 hour from 12-14 months to 5 years.
- Radiologic results were compared to a control group of 13 children not in the program.
Main Results:
- Children in the standing program maintained stable hip migration percentages (13-23%) at age 5.
- Children not in the program showed a wider range of migration percentages (12-47%).
- The difference between groups was statistically significant (p < 0.01).
Conclusions:
- Daily standing programs with hip abduction may enhance acetabular development in ambulatory children with spastic diplegia CP.
- This intervention can contribute to more stable hips and potentially reduce hip subluxation.
- Postural management and standing programs are beneficial for improving hip health and function in children with CP.
Purpose:
Early identification and intervention with conservative measures is important to help manage hip dysplasia in children with a high adductor and iliopsoas tone and delay in weight bearing. The effect of a daily standing program with hip abduction on hip acetabular development in ambulatory children with cerebral palsy was studied.
Method:
The participants were 26 children with spastic diplegia cerebral palsy (CP), classified at Level III according to the Gross Motor Function Classification System (GMFCS). Thirteen children stood with hip abduction at least 1 h daily from 12 to 14 months of age to 5 years with an individually fabricated standing frame with hip abduction.
Results:
At the age of 5 years, radiologic results of the study group were compared with a comparison group of 13 children with spastic diplegia CP who had not taken part in a standing program. The migration percentage in all children who stood with abduction remained within stable limits (13-23%) at 5 years of age, in comparison to children who did not stand in abduction (12-47%) (p < 0.01).
Conclusions:
The results indicate that a daily standing program with hip abduction in the first 5 years may enhance acetabular development in ambulatory children with spastic diplegia CP.
Implications For Rehabilitation:
Abnormal acetabular development is a problem related to mobility problems and spasticity muscles around the hip. The literature suggests that postural management and standing programs could reduce levels of hip subluxation and increase function in children with cerebral palsy. A standing program with hip abduction can be a beneficial to develop more stable hips in children with spastic diplegic GMFCS level III.
