Bone and joint complications and reduced mobility are associated with pain in children with cerebral palsy

Schmidt, Steven M.; Hägglund, Gunnar; Alriksson-Schmidt, Ann

doi:10.1111/apa.15006

Cited by 11 publications

(17 citation statements)

References 37 publications

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“…Pain was reported as only yes or no by the child or the parents, and there was no grading of the severity of the pain. This limitation may explain why the association between hip contracture and pain was not statistically significant in this study, contrary to the results by Schmidt et al 1 …”

Section: Discussioncontrasting

confidence: 99%

“…Cerebral palsy (CP) is one of the most common neurological disabilities in children, with a global incidence of 2–3 events per 1000 live births 1‐3 . Frequent symptoms of CP are impaired muscle function and increased muscle tone, which can decrease both the ability to stand and walk and contribute to the development of lower limb contractures 4 .…”

Section: Introductionmentioning

confidence: 99%

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Cerebral palsy (CP) is one of the most common neurological disabilities in children, with a global incidence of 2-3 events per 1000 live births. [1][2][3] Frequent symptoms of CP are impaired muscle function and increased muscle tone, which can decrease both the ability to stand and walk and contribute to the development of lower limb contractures. 4 Contractures are common in children with low gross motor function, 5 and hip contracture is one of the most frequently observed, and treated, complications in children with CP.

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confidence: 99%

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Hip contractures were associated with low gross motor function in children with cerebral palsy

et al. 2020

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Aim The aim was to identify the prevalence of hip contractures and their association with gross motor function and pain in the lower extremities among Danish children with cerebral palsy (CP). Methods This cross‐sectional study was based on data collected during regular clinical examinations in 2018–2019 and registered in the National Danish Clinical Quality Database of children with CP. The study population was 688 children (59% boys) aged five to 12 years across all Gross Motor Function Classification System (GMFCS) levels. Any associations between hip contracture and gross motor function and pain were investigated with logistic regression analysis and presented as odds ratios (OR) with 95% confidence intervals (95% CI). Results The prevalence of hip contracture was 22% across all five GMFCS levels, and the incidence varied across the five Danish regions. The odds ratios for hip contracture were significantly higher at GMFCS level IV (OR 1.99, 95% CI 1.10–3.62) and V (OR 5.49, 95% CI 3.33–9.07) compared with level I. Hip contractures were not significantly associated with pain in the lower extremities (OR 1.43, 95% CI 0.95–2.15). Conclusion Hip contractures were frequent and associated with low gross motor function, but not lower extremity pain, in children with CP.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hip contractures were associated with low gross motor function in children with cerebral palsy

et al. 2020

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“…The social aspect of being able to keep up with their peers could also be one reason for the finding that few children were in FMS level 2-4 in our study. It has also been reported that pain in children with CP was primarily explained by bone and joint deformities, including knee flexion contracture, and additionally associated with reduced mobility, as evaluated with the FMS (Schmidt et al 2020). Another explanation could be economic factors: in Sweden, the assistive technology centers, at no cost to the family, provide assistive devices and aids such as wheelchairs.…”

Section: Knee Flexion Contracturementioning

confidence: 98%

“…Although the exact impact of knee flexion contracture and its contribution to the development of flexed knee gait is still not fully understood, it is associated with progressive deterioration of gait in the ambulating child (Bell et al 2002, Rodda et al 2006 and it results in difficulties maintaining functional standing, sitting, and transfer in non-ambulatory children (Miller 2005, Cloodt et al 2018). In addition, knee flexion contracture generates increased forces on the knee joint, which may cause pain (Rodda et al 2006, Steele et al 2012, Schmidt et al 2020.…”

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confidence: 99%

Knee flexion contracture impacts functional mobility in children with cerebral palsy with various degree of involvement: a cross-sectional register study of 2,838 individuals

2021

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Background and purpose — The impact of knee flexion contracture (KFC) on function in cerebral palsy (CP) is not clear. We studied KFC, functional mobility, and their association in children with CP. Subjects and methods — From the Swedish national CP register, 2,838 children were defined into 3 groups: no (≤ 4°), mild (5–14°), and severe (≥ 15°) KFC on physical examination. The Functional Mobility Scale (FMS) levels were categorized: using wheelchair (level 1), using assistive devices (level 2–4), walking independently (level 5–6). Standing and transfer ability and Gross Motor Function Classification (GMFCS) were assessed. Results — Of the 2,838 children, 73% had no, 14% mild, and 13% severe KFC. KFC increased from 7% at GMFCS level I to 71% at level V. FMS assessment (n = 2,838) revealed around 2/3 were walking independently and 1/3 used a wheelchair. With mild KFC (no KFC as reference), the odds ratio for FMS level 1 versus FMS level 5–6 at distances of 5, 50, and 500 meters, was 9, 9, and 8 respectively. Correspondingly, with severe KFC, the odds ratio was 170, 260, and 217. In no, mild, and severe KFC 14%, 47%, and 77% could stand with support and 11%, 25%, and 33% could transfer with support. Interpretation — Knee flexion contracture is common in children with CP and the severity of KFC impacts function. The proportion of children with KFC rose with increased GMFCS level, reduced functional mobility, and decreased standing and transfer ability. Therefore, early identification and adequate treatment of progressive KFC is important.

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Presence and predictors of pain after orthopedic surgery and associated orthopedic outcomes in children with cerebral palsy

Boyer

Novaczyk

Novacheck

et al. 2021

Paediatric and Neonatal Pain

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While children with cerebral palsy (CP) may undergo 8‐22 orthopedic surgeries in their lifetime, little is known about the associated pain. We aimed to assess the pain presence before and one year after lower extremity orthopedic surgery, predictors of pain presence at follow‐up, and the association between pain and orthopedic outcomes related to surgery. This retrospective study included 86 children with CP (M age = 10.0 years, SD = 3.2; range = 4.1‐17.3 years, Gross Motor Functional Classification System (GMFCS) level I‐III) who underwent orthopedic surgery and had completed questionnaires at gait analyses before (M = 2.7 months; range = 0.0‐5.7) and after surgery (M = 11.8 months; range = 9.0‐14.9). Pain presence, location, and Pediatric Outcomes Data Collection Instrument (PODCI) scores were documented before and after surgery at gait analyses. Pain prevalence was 60% at baseline and 56% at follow‐up. Significant predictors of pain presence at follow‐up included (1) pain presence at baseline (range of odds ratios [OR] across any/all locations = 3.22 to 15.54), (2) older age (range of OR for any pain, back, knee, and foot pain = 1.24‐1.26), (3) female sex (decreased OR for males for ankle pain = 0.12), (4) having hip surgery (decreased OR for foot pain = 0.20), and (5) lower GMFCS level (OR for foot pain = 0.41). Changes in PODCI Sports and Physical Function scores were associated with changes in hip and knee pain (P < .03); PODCI scores worsened for patients who had pain at both time points and improved for patients who had pain at baseline but not follow‐up. Pain was present for over half of the participants before and after orthopedic surgery. Pain presence at follow‐up was predicted by pain presence at baseline. Pain and functional outcomes were correlated at follow‐up. Prospective studies examining perioperative pain experience and factors predicting pain outcomes are warranted.

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Bone and joint complications and reduced mobility are associated with pain in children with cerebral palsy

Cited by 11 publications

References 37 publications

Hip contractures were associated with low gross motor function in children with cerebral palsy

Hip contractures were associated with low gross motor function in children with cerebral palsy

Knee flexion contracture impacts functional mobility in children with cerebral palsy with various degree of involvement: a cross-sectional register study of 2,838 individuals

Presence and predictors of pain after orthopedic surgery and associated orthopedic outcomes in children with cerebral palsy

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