Musculoskeletal Pathology in Cerebral Palsy: A Classification System and Reliability Study

Abstract

This article presents a classification of lower limb musculoskeletal pathology (MSP) for ambulant children with cerebral palsy (CP) to identify key features from infancy to adulthood. The classification aims to improve communication, and to guide referral for interventions, which if timed appropriately, may optimise long-term musculoskeletal health and function. Consensus was achieved by discussion between staff in a Motion Analysis Laboratory (MAL). A four-stage classification system was developed: Stage 1: Hypertonia: Abnormal postures are dynamic. Stage 2: Contracture: Fixed shortening of one or more muscle-tendon units. Stage 3: Bone and joint deformity: Torsional deformities and/or joint instability (e.g., hip displacement or pes valgus), usually accompanied by contractures. Stage 4: Decompensation: Severe pathology where restoration of optimal joint and muscle-tendon function is not possible. Reliability of the classification was tested using the presentation of 16 clinical cases to a group of experienced observers, on two occasions, two weeks apart. Reliability was found to be very good to excellent, with mean Fleiss’ kappa ranging from 0.72 to 0.84. Four-stages are proposed to classify lower limb MSP in children with CP. The classification was reliable in a group of clinicians who work together. We emphasise the features of decompensated MSP in the lower limb, which may not always benefit from reconstructive surgery and which can be avoided by timely intervention.

Decline in Motor Function during the COVID-19 Pandemic Restrictions and Its Recovery in a Child with Cerebral Palsy: A Case Report

“…Decreased physical activity also causes musculoskeletal problems, such as joint contractures, in children with CP. This patient corresponds to stage 1 in which abnormal postures are dynamic without contractures, according to the recently reported classification for lower limbs musculoskeletal pathology in children with CP [ 20 ]. It will be necessary to maintain the amount of physical activity to prevent the occurrence of secondary contractures.…”

Long-Term Evolution of the Hip and Proximal Femur after Hip Reconstruction in Non-Ambulatory Children with Cerebral Palsy: A Retrospective Radiographic Review

“…Cerebral palsy (CP) results from non-progressive brain injury that can cause progressive musculoskeletal pathology, such as muscle contractures and bone deformities [ 1 ]. Brain dysfunction and deformities can result in functional impairment, which is described using the Gross Motor Function Classification System (GMFCS) [ 2 ].…”

“…In non-ambulatory children, it has been postulated that the deficiency of weight-bearing during early development is associated with the lack of proximal femur remodelling as is found in ambulatory children. However, Rutz et al [ 14 ] reported that hip reconstruction is effective in improving hip congruity even when the femoral head is deformed, and it has been proposed that the femoral head is able to remodel itself after hip reconstruction [ 1 , 15 ].…”

Resistance to Neuromuscular Blockade by Rocuronium in Surgical Patients with Spastic Cerebral Palsy

“…Children with spastic CP, which accounts for about 77% of all cases, often require multiple surgeries throughout their lifetimes due to progressive motor and musculoskeletal dysfunction [ 1 , 2 , 24 , 25 , 26 ]. Surgical correction of gait abnormalities, relief of muscle hypertonia, bone osteotomies, device implants, and posterior spinal fusions are common for individuals with CP [ 27 , 28 ].…”