ORIGINAL ARTICLES   Free access

European Journal of Physical and Rehabilitation Medicine 2016 October;52(5):682-90

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Can we prevent hip dislocation in children with cerebral palsy? Effects of postural management

Odoardo PICCIOLINI ¹, Michel LE MÉTAYER ², Dario CONSONNI ³, Massimo COZZAGLIO ¹, Matteo PORRO ¹, Verusca GASPARRONI ⁴, Artemisia PANOU ⁵, Fabio MOSCA ⁶, Nicola M. PORTINARO ⁵ ✉

¹ Pediatric Rehabilitation Unit, NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy; ² Responsible of Cours de Perfectionnement sur l’Infermité Motrice Cérébrale, Faculté de Médicine et Chirurgie, Université Paris Sud, Paris, France; ³ Unit of Epidemiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; ⁴ Centre of Pediatric Rehabilitation M. Montessori, Fermo, Italy; ⁵ Orthopedic Department, University of Milan, Pediatric Orthopedic Unit, Istituto Clinico Humanitas, Rozzano, Milan, Italy; ⁶ NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy

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.