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Can we prevent hip dislocation in children with cerebral palsy? Effects of postural management
Odoardo Picciolini1, Michel LE Métayer, Dario Consonni
1Pediatric Rehabilitation Unit, NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy - odoardo.picciolini@mangiagalli.it.
Insights
Postural management effectively prevents hip dislocation progression in children with cerebral palsy (CP). This conservative treatment stabilizes hip development, unlike standard care which shows worsening displacement over time.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Hip dislocation is a common complication in children with cerebral palsy (CP).
- Musculoskeletal deformities develop over time due to motor impairments.
- Early intervention is crucial to manage hip development in CP.
Purpose of the Study:
- To evaluate the impact of a combined postural management and neurodevelopmental treatment (NDT) program on hip displacement progression in children with CP.
- To compare the outcomes of this intensive program with standard NDT alone.
Main Methods:
- A prospective, comparative, non-randomized study involving 51 children with CP.
- The treatment group (30 children) received NDT twice weekly plus a 5-hour daily molded seating program for two years.
- The control group (21 children) received only NDT twice weekly for two years.
- Hip radiographs were assessed using the migration percentage (MP) at baseline and at 1 and 2 years.
Main Results:
- A statistically significant difference (P<0.001) in migration percentage (MP) trends was observed between the groups.
- The control group showed significant hip worsening (MP increased from 23.0 to 37.7).
- The treatment group demonstrated stability in hip displacement (MP changed from 28.8 to 26.8).
Conclusions:
- Conservative postural management is effective in preventing the natural progression of hip deformity in children with CP.
- A comprehensive program including radiographic monitoring, NDT, and postural management can modify hip dislocation progression.
Background:
Hip dislocation is common in children with cerebral palsy (CP). At birth they do not have musculoskeletal deformities but they develop over time due to the combined effects of the movement disorder and impaired gross motor function. Early detection and treatment of a hip at risk is needed to modify the natural of hip development in CP.
Aim:
The aim of this study was to determine the effect of postural management treatment on hip displacement's progression in children CP.
Design:
Prospective comparative non-randomized study.
Setting:
Rehabilitative outpatient unit.
Population:
Fifty-one children with CP were studied; the treated group (N.=30) was compared to a control group (N.=21).
Methods:
The treated group followed a two year's long combined treatment program consisting a neurodevelopment treatment (NDT) two times a week and a 5 hours daily siège moulé postural program. The control group underwent only NDT twice a week for two years. Hip radiographs were measured with the migration percentage (MP) method at baseline, at 1 and 2 years of follow-up.
Results:
A significant difference has been observed in the MP (%) trend (P<0.001) between treatment and control groups. At 2 years, there was a marked worsening (MP from 23.0 to 37.7) in the control group, compared to the stability (from 28.8 to 26.8) in the treatment group.
Conclusions:
This study supports the evidence that conservative postural management of hip deformity is useful to prevent the natural progression of hip dislocation.
Clinical Rehabilitation Impact:
Hip radiographic follow up program together with NDT and postural management program is useful to modify the natural progression of hip dislocation in children with CP.
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