Hip Surveillance In Cerebral Palsy : A New Path To Change Quality Of Life
Cerebral palsy (CP) is non progressive disorder arises due to an injury in the immature brain, might results in disability lifelong.
Cerebral palsy (CP) is the most common cause of physical disability worldwide. Spastic Hip Displacement is the second most common deformity seen in spastic CP, about 35 % of CP patients. During the growth of a child with CP, deformities may appear, get worse, Neglected Hip Displacement results in severe pain and impaired functional ability to sit, stand and walk, rendering a major burden on the quality of life. Hip Surveillance is of great importance in prevention of hip displacement and guiding the treatment plan. Hip Displacement occurs mostly in non ambulatory patients, directly related to the pathological severity of cp.
Hip surveillance is determined by: Gross Motor Functional Classification System (GMFCS), Clinical assessment and radiological Measurement which is an important part of Surveillance in prevention and considered to be the key for determining the management plan.
The most acceptable measurement for hip displacement is Reimer’s Migration Percentage (MP). The hip should be examined at age of 18 months with well taken AP view of Pelvis and both hip joints in supine position. This should be repeated at 6-12 months interval.
Previously; The treatment approach for the hips of a children with CP focused on their expected activities of daily life during adulthood, and should relate to the severity of the pathology of the patient, rather than the deformity itself.
Nowadays ; For both ambulatory and non ambulatory young CP cases, , it is important to keep the hips well centered with a level pelvis in order to achieve good sitting comfort, prevent pain, and avoid biomechanical conditions that can allow scoliosis.
hip surveillance changed Management approaches & Options which contributed in changing the outcomes & the quality of life of cp cases. Management Options includes preventative treatment using physical therapy, bracing, and Botulinum Toxin Injection. Preventative Surgery involves soft tissue lengthening and indicated in: MP < 40%, MP >10% over the last year and Hip Abduction < 30 degrees. Surgical Treatment by reconstructive options including Femoral osteotomy and Pelvic osteotomy; indicated in: MP>50%, hip subluxation without degenerative changes. Salvage Surgery: indicated in long standing painful hip dislocation with degenerative changes.
Hip surveillance allows for early detection and appropriate interventions.
The Key to a successful program is a co-ordination of physiatrist and orthopaedic surgeons.