Touching Lives - November 2005
Cerebral palsy is caused by damage to the areas of the brain that control movement, and in the UK one baby in every 500 is born with the condition. In bilateral cerebral palsy both sides of the body are affected, and these children are at particular risk of developing hip problems, including dislocation, which can lead to pain, limited movement and may require surgery.
^An Action Medical Research team has been looking at ways of reducing the incidence of hip dislocation in children with bilateral cerebral palsy.^ Dr Terry Pountney and her colleagues at Chailey Heritage Clinical Services, a Sussex-based assessment and treatment centre for children with cerebral palsy, were given a grant of £146,658 to assess how effective specially designed postural management equipment can be in reducing the numbers of children experiencing hip dislocation.
Dr Pountney explains, “Children with bilateral cerebral palsy may experience problems with the hips because the joint moves differently or less than it should. This results in muscles pulling on the bones around the hip joint, disrupting its development.”
^With previous Action Medical Research funding, the team developed a range of postural supports^ which encourage the joints of children with cerebral palsy to develop with less risk of deformity, while helping to maximise mobility. These supports include specially designed seats, standing supports, adapted tricycles and padded sleeping supports.
In this latest project the team provided 38 infants with the postural equipment and monitored hip development at intervals up to five years of age. They found that using the supports helped to reduce the number of children experiencing dislocation, and significantly lessened the need for surgery.
Dr Pountney explains how the study worked. “Children under 18 months old were referred to us by paediatricians and therapists in the South East. We then visited the child and their family and showed them the equipment, discussed how it would best suit their child and then fitted it for them.”
The team visited the children every three months to record how the equipment was being used and any progress in their mobility. ^At the ages of two-and-a-half and five years, they x-rayed the child’s hips to see whether there were any problems.^
The team used data from a previous study as a control group against which to compare their findings for two key aspects — they noted some significant results. The percentage of children who’d experienced ‘hip subluxation’ (movement of the hip joint, but not full dislocation) went from 58 percent to 37, a reduction of 21 percent. But the biggest difference was observed in the occurrence of surgical intervention, which took a dramatic downturn from 33 to a far smaller five percent.
^”These results are really significant” commented Dr Pountney “and are part of the reason that we have already seen changes in practice^, with hip problems being spotted earlier and managed using postural management programmes. Surgery — a major life event for families — can, in many cases, now be delayed until the child is older, or prevented altogether.”
The team now plan to check on the children from the study on an annual basis to get a better idea of long term outcomes. Dr Pountney says, “Although the findings from our latest research are very positive, five years of age is still very young and there is continuing risk of hip problems as children grow.”