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Sitting Postural Management to Prevent Migration Percentage Progression in Non-Ambulatory Children with Cerebral
Silvia Faccioli1,2, Irene Maggi1, Emanuela Pagliano3
1Pediatric Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS of Reggio Emilia, 42122 Reggio Emilia, Italy.
Insights
A specialized sitting position did not significantly prevent hip migration in children with cerebral palsy compared to standard seating. However, a trend suggests potential benefits for hip-centering in preventing severe migration, requiring further research.
Area of Science:
- Pediatrics
- Orthopedics
- Rehabilitation Medicine
Background:
- Bilateral cerebral palsy often leads to hip instability.
- Non-ambulatory children with cerebral palsy are at risk for hip migration percentage progression.
- Effective seating interventions are crucial for managing hip health in this population.
Purpose of the Study:
- To compare a hip-centering sitting position with standard seating for preventing hip migration in non-ambulatory children with cerebral palsy.
- To evaluate the impact of seating interventions on migration percentage (MP) progression.
- To assess secondary outcomes including health-related quality of life and family satisfaction.
Main Methods:
- A multicenter, randomized controlled trial involving children aged 1-6 years with spastic or dyskinetic cerebral palsy (GMFCS IV-V).
- Inclusion criteria: migration percentage <41%. Exclusion criteria: hip contractures, previous hip surgery.
- Intervention group used a customized system with hips significantly abducted for ≥5 hours/day; control group used an adaptive system with less abduction for two years.
Main Results:
- Median migration percentage (MP) progression was 1.6 after year 1 and 2.5 after year 2, with no significant group differences.
- MP exceeded 40% in 1.8% of the intervention group vs. 5.4% of controls in year 1.
- Both groups reported satisfaction and stable health-related quality of life.
Conclusions:
- Both seating positions maintained stable MP over two years.
- A potential protective trend for the hip-centering approach was observed in outliers exceeding 50% MP.
- Larger datasets are needed to confirm the efficacy of hip-centering seating for preventing hip migration progression.
Abstract:
Background/Objectives: To determine whether a sitting position with the femoral heads centered into the acetabulum is more effective than the usual sitting position in preventing migration percentage progression in non-ambulatory children with bilateral cerebral palsy. Methods: This was a multicenter, randomized controlled trial.
Inclusion Criteria:
spastic or dyskinetic cerebral palsy, Gross Motor Function Classification System level IV-V, age 1-6 years, migration percentage <41%, and informed consent.
Exclusion Criteria:
contractures affecting the hip, anterior luxation, previous hip surgery, and lumbar scoliosis. The treatment group sat with their hips significantly abducted to reduce the head into the acetabulum in a customized system for at least five hours/day for two years. Controls sat with the pelvis and lower limbs aligned but the hips less abducted in an adaptive seating system. The primary outcome was migration percentage (MP) progression. Health-related quality of life and family satisfaction were among the secondary outcomes. The study was approved by the local ethics board and conducted in accordance with CONSORT reporting guidelines.
Clinicaltrials:
gov ID: NCT04603625.
Results:
Overall median MP progression was 1.6 after the first year and 2.5 after the second year. No significant differences were observed between the groups. MP exceeded 40% and 50% in 1.8% and 0% of the experimental group and 5.4% and 3.6% of controls in years 1 and 2, respectively. Both groups expressed satisfaction with the postural system and stable health-related quality of life. Conclusions: MP remained stable over the two-year period in both groups. Considering outliers which progressed over 50%, a more protective trend of the hip-centering sitting approach emerged, but this needs to be confirmed in a final, larger dataset.
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