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

Abstract

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.

Ankle contractures are frequent among children with cerebral palsy and associated with lower gross motor function and degree of spasticity

“…Our finding of GMFCS levels IV–V being associated with a higher prevalence of ankle contracture compared to GMFCS levels I–III is substantiated by Østensjø et al 18 who found that children with GMFCS levels I and II had significantly fewer deviations in ROM in the lower extremities, hip, knee and ankle, than children with GMFCS levels III–IV. Besides, two other studies found that a higher GMFCS level was associated with respectively knee contracture 7 and hip contracture 12 …”

“…Besides, two other studies found that a higher GMFCS level was associated with respectively knee contracture 7 and hip contracture. 12 It is a strength of this study that it includes data on a total population of children with a confirmed CP diagnosis at all GMFCS levels aged 6 to 14 years from a national registry with high coverage. Given the prevalence and distribution of sex, GMFCS levels and muscle tone of the plantar flexors, our study population is likely to be representative of children with CP in the same age group in other countries with similar treatment options as in the CPOP.…”

“…11 A number of factors have been suggested to contribute to the development of contractures in children with CP including reduced mobility of specific joints, severity of CP, older age, spasticity, reduced muscle excursion due to muscle weakness and inability to stand or walk. 4,5,12 Information on contributing factors to the development of ankle contractures is clinically relevant to initiate early treatment and choose adequate treatment strategies, thus efficiently use healthcare resources and prevent the negative consequences of ankle contractures. However, so far only two Swedish studies, Nordmark et al 4 and Hägglund and Wagner, 6 have investigated whether age and spasticity are contributing factors to the development of reduced passive range of dorsiflexion of the foot.…”

The Effects of Botulinum Toxin and Casting in Spastic Children With Cerebral Palsy: A Systematic Review and Meta-Analysis

“…For instance, contracture of the calf muscle causes ankle flexion or equinus posture of the foot, which negatively affects standing, balancing, and walking. Contracture of the pelvic floor muscle results in hip flexion deformity [13][14][15]. Interventions are therefore concentrated on enhancing lower limb posture, which is expected to improve balance and gait.…”