Terry Pountney

Hip subluxation and dislocation in cerebral palsy – a prospective study on the effectiveness of postural management programmes

BACKGROUND AND PURPOSE Hip subluxation and dislocation are common sequelae in children with bilateral cerebral palsy and are currently managed by surgical interventions. This study aimed to investigate the effectiveness of early postural management programmes on hip subluxation and dislocation at five years, and the need for treatment in children with bilateral cerebral palsy, and to compare these findings with a historical control group. METHODS A prospective cohort study followed 39 children who commenced using postural management equipment under 18 months of age. Levels of ability, type and amount of equipment use and treatments were recorded every three months. At 30 and 60 months, the hips were X-rayed and the hip migration percentage was measured. The results were compared with the historical control group. RESULTS Children who used equipment at recommended and moderate levels had significantly less chance of both hips being subluxed than those using equipment at minimal levels (two-tailed Fishers exact chi(2) p = 0.024). The frequency of children with hip problems was significantly less in the intervention group in comparison to the historical control group at five years (chi(2) = 11.53, df = 2, p = 0.006). The frequency of children receiving bilateral or unilateral treatments, i.e. surgery, use of a hip and spinal orthosis and/or botulinum toxin injections, in the intervention group was significantly less compared to the historical control group (two-tailed Fishers exact p = 0.001). CONCLUSION The early provision of postural management equipment has a role to play in reducing the number of hip problems and therefore the need for treatment of hip subluxation/dislocation in cerebral palsy at five years of age.

AN INVESTIGATION INTO THE DEVELOPMENT OF EARLY POSTURAL CONTROL

Eighteen normal infants were studied longitudinally using video and photographic records of their levels of lying and sitting ability. A developmental sequence of postural control in lying and sitting was confirmed in the normal infants. All infants reached level 4 prone and supine lying ability before achieving level 3 sitting ability (maintaining independent sitting). 34 children with cerebral palsy in a cross‐sectional study could be ascribed a level of sitting or lying ability. The relationship found in normal infants between lying and sitting was confirmed in all the children with cerebral palsy.

Content and Criterion Validation of the Chailey Levels of Ability

Summary This paper reports the validation of the Chailey Levels of Ability, which were established to assess motor ability in children and young adults with low levels of physical ability. This was a response to a need for a scale that detailed physical ability at low levels and could record discrete changes in ability. Rather than neurological signs, biomechanical and other developmental changes were detailed, providing a basis for the prescription of treatment and equipment. The Chailey Levels of Ability have been in use for 10 years and have gradually been refined for clinical use with children and young adults with cerebral palsy. They are used as an assessment measure that can be used as a prescriptive and evaluative measure. The validation of the Chailey Levels of Ability would enable them to be used for both clinical and research work as standardised tests. Content and concurrent criterion validation were performed to establish the validity of the Chailey Levels of Ability. Content validity was established and correlations were high and positive between the Chailey Levels of Ability and both the Alberta Infant Motor Scale and the Gross Motor Function Measure.

Adaptive Seating for Motor Handicap: Problems, a Solution, Assessment and Prescription

An analysis of the problems of available adaptive seating has led to the development of a modular seating system capable of assembly and adjustment without workshop facilities. Seven levels of sitting ability are defined and a methodical assessment procedure and prescription criteria for the provision of adaptive seating are described.

Early Development of Postural Control

Summary An investigation into the early postural development of normal infants has identified a sequence of lying abilities and a direct link between lying and sitting abilities.

Hip dislocation in cerebral palsy

The first report on treatment of hip contractures in cerebral palsy was published in 1880.1 Lateral migration of the hip (subluxation or partial dislocation) occurs in 30-60% of children with cerebral palsy who are not walking independently at 5 years.2-5 Its clinical course has been well documented, including its effect on function (such as pain affecting the ability to sit and hygiene).w1 We review the literature on current management of hip dislocation in cerebral palsy in terms of its clinical course, measurement, and treatments.

Adaptive Seating for the Motor Handicapped — Problems, a solution, assessment and prescription

Summary An analysis of the problems of available adaptive seating has led to the development of a modular seating system capable of assembly and adjustment without workshop facilities. Seven levels of sitting ability are defined and a methodical assessment procedure and prescription criteria for the provision of adaptive seating are described.

Repeatability and limits of agreement in measurement of hip migration percentage in children with bilateral cerebral palsy

Summary Objective To determine the repeatability and limits of agreement for X-ray measurement of hip migration percentage in children with cerebral palsy. Design An inter-rater and intra-rater study. Data Twenty hip and pelvic X-rays (40 hips) were measured by three health professionals on two separate occasions. Results Repeatability of the measure was expressed as 95% limits of agreement. Measurements of hip migration were within 7.6% of each other when measured by the same rater on two occasions. When two raters were compared, measurements were within 8.1% of each other. Conclusion Measurement of hip and pelvic X-rays can be made using the described method within limits of agreement that are acceptable for clinical decision-making. The information thus obtained on the degree and rate of hip subluxation/dislocation can be used to inform therapy and surgical decision-making.

The Chailey Standing Support for Children and Young Adults with Motor Impairment: A Developmental Approach

An analysis of the early standing posture and available postural support systems has led to the development of an adjustable, modular, upright standing frame. Problems with existing standing equipment are identified, developmental aspects of standing outlined and therapeutic requirements and solutions described.

A population study of Lesch–Nyhan disease in the UK

Aim  The aims of this study were to identify all people with Lesch–Nyhan disease (LND) born in the UK between 1988 and 2008, and to obtain a clinical profile including age at diagnosis, genetic background, family history, neurological signs, and medications.