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Hip dislocation is a serious complication among children with cerebral palsy (CP). The aim of this study was to compare the prevalence of hip dislocation among children with CP in an area providing regular care with an area providing hip surveillance services.
This is a cross-sectional study in seven Norwegian counties providing regular care and on...
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Background and purpose — Children with cerebral palsy (CP) have an increased risk of hip dislocation. Outcome studies after surgery to prevent hip dislocation in children with CP are usually retrospective series from single tertiary referral centers. According to the national CP surveillance program in Sweden (CPUP), hip surgery should preferably b...
Citations
... options and prognosis differ(96),(100),(101). For children with spastic CP, botulinum toxininjections, intrathecal baclofen (ITB), selective dorsal rhizotomy, and diazepam have been found to reduce spasticity effectively (95),(102),(103),(104),(105). ...
This teaching review aims to provide an overview of the current approach to children with cerebral palsy (CP), retrieving the best available evidence and summarizing existing knowledge in the field of CP in children. We also highlight areas where more research is needed and novel strategies for diagnosing and treating cerebral palsy. CP includes a group of permanent disorders of movement and posture that cause activity limitation. Multiple risk factors, occurring preconceptionally, prenatally, perinatally, or postneonatally, are involved in the pathogenesis of CP, with the prenatal ones accounting for 80-90% of cases. Due to its heterogeneity, CP has various classifications, but usually is classified based on clinical findings and motor impairment. Standardized function classification systems have been developed to address inconsistencies in previous classifications. The combination of clinical assessment and validated predictive tools is recommended for an early diagnosis, which is important for early intervention and prevention of secondary impairments. The therapeutic regimen in CP involves prevention and management of the motor and associated problems. It includes the enhancement of motor performance, the enrichment of cognition and communication skills, the prevention of secondary impairments, and the support of parents and caregivers. The care of CP children demands a multidisciplinary approach focused on improving motor skills, reducing comorbidities, enhancing the quality of life, and prolonging survival.
... As well as improved classification of hip pathology in CP patients, hip surveillance programs have led to earlier diagnosis and reduced risk of hip dislocation, mitigating the risk of dangerous sequelae related to dislocation [4,6,8]. Global hip surveillance programs have shown similar results regarding surgical rates to our own study [4,16,17]. For example, a study comparing the prevalence of hip dislocation in pediatric CP patients in Norway without a hip surveillance program versus in Sweden with a hip surveillance program showed that initial hip surgery was performed at a younger age in the population with the formal surveillance program [16]. ...
Background
Hip instability is a concern in pediatric cerebral palsy (CP) patients, with approximately one-third developing hip displacement. This may lead to pain, functional limitations, and decreased quality of life. Due to the progressive nature of hip displacement in CP, earlier surgical interventions may be beneficial. However, any shifts in practice to earlier surgical intervention, on a national scale, is not well described. The purpose of this study was to determine the recent trends in the surgical timing of hip interventions in children with CP.
Methods
A retrospective study was conducted using the PearlDiver Mariner all-payer claims database (PearlDiver Technologies, Colorado Springs, Colorado, United States). CP patients aged 10 years and younger were identified between 2010 and 2021. Hip surgeries including open reduction, adductor tenotomy, and pelvic osteotomy were identified. Patients were stratified by their age on the date of surgery and the year of the procedure. Linear regression analysis was conducted for temporal trends. Further, the compounded annual growth rate (CAGR) was calculated.
Results
A total of 309,677 CP patients were identified. For those aged one to four years old, the percentage undergoing hip surgery increased from 10.2% in 2010 to 19.4% in 2021. In the five- to 10-year-old age group, the surgery rate peaked at 14.9% in 2016 and steadily declined to 11.5% in 2021. The overall CAGR from 2010 to 2021 was +6.03% for the one- to four-year-old group and +0.88% for the five- to 10-year-old group. Linear regression demonstrated a significant association between year and the percentage of operations for patients ages one to four (R²=0.792, p<0.001), but not ages five-10 (R²=0.019, p=0.704).
Conclusions
Rates of surgical hip procedures in one- to four-year-old CP patients have been increasing since 2010, whereas the rate in five- to 10-year-old CP patients has been decreasing since 2016. Recently, CP patients may be undergoing hip surgery at younger ages.
... Previous studies conducted in Europe and Australia with well-established hip surveillance programs have yielded different results, with their programs finding hip displacement in patients as young as 2 years. [17][18][19] The increased availability of GMFCS data that come from hip surveillance programs further supports the notion that these programs improve the comprehensive assessment of patients, enabling a more informed decision-making process when surgical interventions are considered. Unfortunately, the hip screen-ing program at our institution did not yield similar results to the programs in Europe and Australia, likely from confounders such as timing of referrals from outside providers. ...
Introduction
Surveillance programs aimed at monitoring hip displacement in patients with cerebral palsy have been demonstrated to decrease the incidence of hip dislocations and properly time surgical intervention, ultimately improving patient outcomes. The objective of this study was to determine whether the implementation of a hip screening to surveillance program at a tertiary academic teaching hospital in 2017 increased the frequency of radiographic evaluations and changed the timing of surgical intervention.
Methods
A total of 592 patients with cerebral palsy were identified, and 468 of these patients had initial radiograph date data available. In this analysis, 246 patients with initial radiograph dates after 2012 were included. The study population was divided into two groups based on the initial radiograph date, 2012 to 2016 versus 2017 to 2022. One hundred sixty patients (65%) were in the 2012 to 2016 group, and 86 (35%) were in the 2017 to 2022 group. Statistical analysis was conducted using various techniques, such as two-sample Student t -test, Mann-Whitney U test, chi square/Fisher exact test, and multivariable linear regression analysis.
Results
The average number of radiographs per year in the 2017 to 2022 group was 0.11 (95% CI: 0.02, 0.20, P = 0.017) higher than the 2012 to 2016 group. After adjusting for confounders using multivariable linear regression analysis, this difference was even larger (difference 0.16, 95% CI: 0.06, 0.25, P = 0.001). The surgical intervention rate was significantly lower in the 2017 to 2022 group compared with the 2012 to 2016 group (12.9% versus 40.6%, P < 0.001).
Discussion
The results of this study suggest that the implementation of a hip screening to surveillance program results in more frequent radiographic evaluations and possibly a reduced need for surgical intervention from 2017 to 2022. In the 2012 to 2016 group, more surgical interventions were performed likely because of the lack of any hip surveillance or screening program in place.
... However, it often remains asymptomatic until the hip reaches a state of significant displacement [1,2]. To mitigate the risk of significant displacement, hip surveillance programs have been established for children with CP in Sweden and Australia, which have demonstrated their effectiveness in enhancing the early detection of hip displacement, subsequently enabling timely interventions to prevent distressing dislocations [2][3][4]. An essential component of these surveillance programs involves the standardization of radiographic assessments, with the migration percentage (MP), also known as the Reimers Migration Index, serving as the primary metric [5][6][7]. ...
Introduction: Migration percentage (MP) is the standard radiographic measurement to quantify hip displacement in cerebral palsy (CP) hip surveillance programs. We aim to evaluate the use of MP and other descriptors of hip displacement in radiographic impressions by radiologists and orthopedic surgeons before and after the introduction of hip surveillance guidelines at our institution.
Methods: CP patients who underwent hip surveillance imaging at our institution in 2016 were retrospectively identified, and their radiographic impressions were collected between 2016 and 2019. Only patients with radiology and orthopedic impressions for the same image were included. The inclusion of MP was documented and compared between the two groups before and after the hip guidelines were implemented in 2018. We also examined the use of other qualitative descriptors for hip displacement within the impressions. Fisher’s Exact test was used for statistical significance (p<0.05).
Results: Two hundred and fifty-one radiographs were analyzed. One radiology (0.40%) and 33 orthopedic impressions (13.15%) incorporated MP (p<0.001). No statistical significance was found between the inclusion of MP before and after 2018 in the radiology group. In contrast, the orthopedic group showed a significant increase in MP inclusion following guideline implementation, rising from 12 to 21 incidences (p=0.013). Descriptors for hip displacement were more commonly utilized than MP for both orthopedic surgeons and radiologists.
Conclusion: MP is underutilized in radiologic and orthopedic impressions in hip surveillance programs. Extensive education for both specialties regarding MP is crucial for the successful management of hip displacement in CP hip surveillance programs.
... [7][8][9][10][11][12] Several studies have reported a significant decrease in the incidence of hip dislocation in regions where a hip surveillance programme has been introduced. 6,11,13 Currently, radiological hip analysis in surveillance programmes, such as the Cerebral Palsy Integrated Pathway Scotland (CPIPS), is performed manually by experts. 14 Radiograph analysis is time-consuming both to perform and upload data, and is prone to variability between clinicians. ...
Aims
Hip disease is common in children with cerebral palsy (CP) and can decrease quality of life and function. Surveillance programmes exist to improve outcomes by treating hip disease at an early stage using radiological surveillance. However, studies and surveillance programmes report different radiological outcomes, making it difficult to compare. We aimed to identify the most important radiological measurements and develop a core measurement set (CMS) for clinical practice, research, and surveillance programmes.
Methods
A systematic review identified a list of measurements previously used in studies reporting radiological hip outcomes in children with CP. These measurements informed a two-round Delphi study, conducted among orthopaedic surgeons and specialist physiotherapists. Participants rated each measurement on a nine-point Likert scale (‘not important’ to ‘critically important’). A consensus meeting was held to finalize the CMS.
Results
Overall, 14 distinct measurements were identified in the systematic review, with Reimer’s migration percentage being the most frequently reported. These measurements were presented over the two rounds of the Delphi process, along with two additional measurements that were suggested by participants. Ultimately, two measurements, Reimer’s migration percentage and femoral head-shaft angle, were included in the CMS.
Conclusion
This use of a minimum standardized set of measurements has the potential to encourage uniformity across hip surveillance programmes, and may streamline the development of tools, such as artificial intelligence systems to automate the analysis in surveillance programmes. This core set should be the minimum requirement in clinical studies, allowing clinicians to add to this as needed, which will facilitate comparisons to be drawn between studies and future meta-analyses.
Cite this article: Bone Jt Open 2023;4(11):825–831.
... Individuals with CP have an increased risk of developing hip dislocation, which is painful, has major consequences for function and quality of life, and thus requires extensive and costly orthopedic surgery with long-term rehabilitation (53). Research from the Swedish CP Follow-Up Program shows that systematic follow-up and early intervention contributes to prevent hip dislocation and severe contractures (53,54). In Norway, registration of hip Xray assessments has been a challenge, where only 48% of children had a registered hip x-ray in 2020/2021, according to protocols (12). ...
The Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP) has systematically collected data on individuals with cerebral palsy (CP) and been a driver of knowledge dissemination for over 20 years. NorCP data have increased the competence of health professionals in both the municipal and specialist healthcare services through publication of multiple scientific articles ranging from risk factors for CP to lifelong interventions, quality improvement projects, and training services. This has led to a streamlined process in the diagnosis and follow-up of children and youths with CP in Norway to ensure that they receive"the right treatment at the right time," regardless of where they live using evidence-based interventions based on needs that are revealed in the registrations.
NORSK SAMMENDRAG Norsk kvalitets- og oppfølgingsregister for cerebral parese (NorCP) har systematisk samlet inn data om personer med cerebral parese og vært en pådriver for kunnskapsformidling i over 20 år. NorCP data har økt kompetansen til helsepersonell i både kommune- og spesialisthelsetjenesten gjennom publisering av flerevitenskapelige artikler om risikofaktorer for CP til livslange intervensjoner, kvalitetsforbedringsprosjekter samt kurs og kompetansetjenester. Dette har ført til økt kvalitet på diagnostisering og oppfølging av barn ogunge med CP i Norge, som sikrer at de får «riktig behandling til rett tid», uansett hvor de bor i landet medbruk av evidensbaserte intervensjoner basert på behov som avdekkes ved registreringene.
... Infants diagnosed with hemiplegic CP have also been shown to have improved hand function following an early intervention with constraint induced motor therapy [6]. Other literature has also demonstrated that children diagnosed with bilateral CP and who undergo regular surveillance experience fewer complications related to their CP including hip displacement, joint contractures and scoliosis [28][29][30]. Compared to interventions occurring in a hospital or outpatient clinic setting, patient improvements have previously been demonstrated to be the greatest when interventions occur at home in a setting familiar and comfortable to the patient [31,32]. ...
Objective
To determine the sensitivity and specificity of the 21-month neurodevelopmental outcome for predicting the presence of neurodevelopmental impairment at 36 months corrected age in a population of preterm infants under 29 weeks gestation.
Study design
This is a retrospective observational cohort study. Preterm infants born under 29 weeks gestation who were followed up at both 18–21 months and 36 months corrected age with outcome data available were enrolled.
Results
Overall, 713 preterm infants <29 weeks gestation and were included in the final analysis. The specificity of the 21-month assessment for predicting neurodevelopmental impairment at 36 months corrected age was 66% (95% confidence interval[CI] 62–71%) with a positive predictive value of 61% (95% CI 56–66%).
Conclusion
In preterm neonates born <29 weeks gestation, the 18–21 months corrected neurodevelopmental outcome had low specificity and positive predictive value for predicting the presence of neurodevelopmental impairment at 36 months corrected age.
... A higher GMFCS level indicates poorer motor function. Multiple studies have demonstrated a direct relationship between GMFCS grading and hip dislocation [24,25]. Observations on the rate of MP progression among different GMFCS levels revealed that MP increased by 0.2% per year in GMFCS level I children, while it surged by 9.5% annually in level V children [10]. ...
Background and objectives: Hip dislocation is a prevalent occurrence among children afflicted with spastic cerebral palsy. It has the potential to induce impairment of function, and a decline in the quality of life. Early prevention and management of hip dislocation remains an intricate problem. Our objective is to elucidate the risk factors influencing hip dislocation in children with spastic cerebral palsy.
Methods: We included children with spastic cerebral palsy who were admitted to Dongzhimen Hospital, Beijing University of Chinese Medicine between January 2016 and January 2023. Participants' comprehensive clinical information, encompassing aspects such as gender, age, gestational age, birth weight, Gross Motor Function Classification System (GMFCS) level, and age of first standing, could be meticulously retrieved from medical records. All participants underwent pelvic X-ray examination. The severity of hip dislocation was assessed through the meticulous calculation of the Migration Percentage (MP) of the femoral head. Meanwhile, Acetabular Index (AI) and Neck-Shaft Angle (NSA) were obtained. Correlation analysis and multiple linear regression analysis were performed in the subsequent process.
Results: A total of 291 patients (206 males and 85 females) fulfilled the inclusion criteria and were subsequently included in the analytical scope. The mean age was 8.3 years, ranging from 2 to 16 years. Correlation analysis showed that gender, age, gestational age, and birth weight were not related to MP (p> 0.05). Multiple linear regression analysis revealed that GMFCS level (p< 0.001), AI (p < 0.001), NSA (p < 0.001), and age of first standing (p < 0.001) bore the stature of independent risk factors for MP.
Conclusions: Our finding has revealed that GMFCS level, AI, NSA, and age of first standing are independent risk factors for the progression of MP in spastic cerebral palsy children. This study provided a new insight for the anticipation of hip dislocation.
... 15 En países como Suecia y Australia se han implementado programas de prevención de LPC en niños con PC, los cuales han tenido buenos resultados en términos de la disminución de la incidencia de luxación de cadera en estos pacientes. 16,17 Además, en la etapa preventiva de la LPC se suele indicar la cirugía en aquellos pacientes con un porcentaje de migración de Reimers mayor a 30% o 33% o según la afectación de la funcionalidad o la presencia de dolor, 15 tal como se observó en el presente estudio. En esta investigación, el bajo número de procedimientos realizados en la etapa preventiva demuestra las limitaciones que existen en la ciudad (Bogotá) para la implementación de programas para la vigilancia y seguimiento de las deformidades en pacientes con PC. ...
Introducción. La parálisis cerebral (PC) produce una alteración del tono y del balance muscular que puede generar luxación paralítica de cadera (LPC), especialmente en los pacientes más comprometidos Objetivo. Describir los desenlaces clínicos y radiológicos de los pacientes con PC que recibieron tratamiento quirúrgico de la LPC en el Instituto Roosevelt. Metodología. Estudio observacional retrospectivo realizado en 92 pacientes entre 4 y 18 años con PC y LPC operados entre 2010 y 2014. Se realizaron análisis bivariados para realizar comparaciones entre los hallazgos clínicos y radiológicos antes de la operación de corrección de la LPC y al finalizar el periodo posoperatorio mediante las pruebas de McNemar, T de student y U de- Mann-Whitney. Resultados. La media de edad fue 7,45 años, el 84,8% de los pacientes tenía PC espástica y el 59,8% fue clasificado en el nivel V del Gross motor function classification system. Se realizaron 155 cirugías en los 92 pacientes, los procedimientos más frecuentes fueron reducción cerrada y osteotomías pélvica, femoral varizante y femoral desrotadora. En el posoperatorio el dolor y la dificultad para realizar el aseo, sedestación y abducción de caderas disminuyeron significativamente (p<0,001). Además, hubo diferencias estadísticas en los índices y ángulos radiológicos pre y posoperatorios. Conclusión: Si bien se encontró una mejoría significativa en los desenlaces clínicos y radiológicos evaluados, los procedimientos reconstructivos y de salvamento predominaron, en detrimento de los preventivos, por lo que es necesario fortalecer los programas de seguimiento y prevención de la LPC y sus complicaciones en la institución para disminuir morbilidad en los pacientes con PC.
... Self-monitoring of spasticity may support shared decision-making and improve the timing and execution of BoNT-A treatment. Indeed, the benefits of self-monitoring have been shown in chronic conditions (11,12). Therefore, we designed a spasticity monitoring tool, consisting of: (i) a commercially available smartphone app (Physitrack ® (Physitrack PLC, London) connected to an online platform) to complete a daily self-assessment of spasticity-related symptoms and perceived activity limitations; and (ii) an existing commercially available online platform (Physitrack ® ) for healthcare professionals to consult the sampled app-data. ...
... A temporary period of close monitoring of spasticity might help to adequately adjust spasticity management to the actual demands of the person. In people with chronic obstructive pulmonary disease, cerebral palsy, or chronic heart failure, self-monitoring has shown to be effective in detecting relevant changes in health status (12), reducing long-term complications (11), and reducing healthcare utilization (22). It is therefore likely that shared decision-making in spasticity management can be improved when self-monitoring is used in critical periods of treatment, tailored to patient-relevant outcomes and combined with systematically sampled data by healthcare professionals. ...
Objective:
To investigate the feasibility and usability of an online spasticity monitoring tool amongst people with hereditary spastic paraplegia or chronic stroke receiving botulinum toxin treatment, and their healthcare providers.
Methods:
Mixed methods cohort study, measuring recruitment success and adherence to the monitoring in 3 rehabilitation institutions. In addition, the System Usability Scale (SUS) and interviews with patients and their healthcare providers were used for quantitative and qualitative analysis, respectively. A deductive directed content analysis was used for qualitative evaluation.
Results:
Of the 19 persons with hereditary spastic paraplegia and 24 with stroke who enrolled in the study, recruitment success and adherence were higher amongst people with hereditary spastic paraplegia compared with stroke. Usability was found "marginal" by rehabilitation physicians and "good" by patients and physical therapists (SUS scores 69, 76, and 83, respectively). According to all participant groups, online monitoring potentially contributes to spasticity management if it is tailored to the actual needs and capabilities of patients, and if it can easily be integrated into the daily/working routines of all users.
Conclusion:
Online monitoring of spasticity in people with hereditary spastic paraplegia or stroke receiving treatment with botulinum toxin may be feasible, provided that the monitoring tool is tailored to the needs of all users.
