Background and purpose - Surveillance of scoliosis in individuals with cerebral palsy (CP) is important for ensuring timely diagnosis and identification of curve progression. We analyzed the incidence of scoliosis in relation to age, sex, and gross motor function in a population-based cohort of individuals with CP. Patients and methods - This was a prospective register study of all 1,025 individuals born 1990-2012 in southern Sweden (1.4 million inhabitants) in the Swedish surveillance program for CP, which included >95% of the total population of people with CP in the area. Annual clinical examinations and radiographic measurement of the Cobb angle of those with a moderate or severe scoliosis were registered. We determined the incidence of scoliosis related to age, sex, and the Gross Motor Function Classification System (GMFCS) level. Results - The inclusion criteria were fulfilled by 962 individuals. The number of people (140/962) with scoliosis increased up to 20-25 years of age. The incidence of scoliosis was related to age and GMFCS level. In individuals at the lowest level of gross motor function (GMFCS V) scoliosis was seen in 10/131 before 5 years of age and at the age of 20 years 75% of these individuals had a Cobb angle ≥40°. No one in the highest level of motor function (GMFCS I) developed a Cobb angle ≥40° Interpretation - Surveillance programs for scoliosis in CP should be based on age and GMFCS level and should be initiated at a young age and continued into adulthood.

CPUPCerebral palsy follow-up program and quality register PAS Postural Ability Scale ROM Joint range of motion AIM The purpose was to describe posture, ability to change position, and association between posture and contractures, hip dislocation, scoliosis, and pain in young adults with cerebral palsy (CP).METHODS Cross-sectional data of 102 people (63 males, 39 females; age range 19-23y, median 21y) out of a total population with CP was analysed in relation to Gross Motor Function Classification System (GMFCS) levels I (n=38), II (n=21), III (n=13), IV (n=10), and V (n=20). The CP subtypes were unilateral spastic (n=26), bilateral spastic (n=45), ataxic (n=12), and dyskinetic CP (n=19). The Postural Ability Scale was used to assess posture. The relationship between posture and joint range of motion, hip dislocation, scoliosis, and pain was analysed using logistic regression and Spearman's correlation.RESULTS At GMFCS levels I to II, head and trunk asymmetries were most common; at GMFCS levels III to V postural asymmetries varied with position. The odds ratios (OR) for severe postural asymmetries were significantly higher for those with scoliosis (OR=33 sitting), limited hip extension (OR=39 supine), or limited knee extension (OR=37 standing CONCLUSIONS Postural asymmetries were associated with scoliosis, hip dislocations, hip and knee contractures, and inability to change position.Disorders of posture and movement are key problems in cerebral palsy (CP), 1 with half the population requiring assistance to stand or walk because of difficulties with aligning and stabilizing themselves against gravity.An asymmetric posture increases the risk of tissue adaptation, leading to contractures and progressive deformities.2-4 Contractures, and bone and joint deformities most commonly affect the lower extremities and the spine, leading to scoliosis, pelvic obliquity, hip dislocations, windswept deformities, flexed hips and knees, and foot deformities. 5 To increase function and minimize the risk of musculoskeletal deformities there is sometimes a need to align and stabilize the body segments and reduce the impact of gravity by providing appropriate support. In children with CP, approximately 30% to 40% use assistive devices to stand or sit.6 People with CP who are nonambulant are more vulnerable to development of contractures and deformities. 7,8 It is the amount of time spent in an abnormal posture that is critical to the development of a contracture. The longer a posture is held, the greater the risk for contracture. 9There is a decline in gross motor function in adults with CP such as reduced balance, joint range of motion (ROM), and increased pain.10-12 Scoliosis curve magnitude tends to increase with age even after bone maturity.7 However, contractures, hip dislocations, scoliosis, and other fixed deformities can be reduced by early detection and preventive treatment. [13][14][15][16] In Sweden a national health care program and quality register for children with CP (CPUP) was started in 1994 as an attempt to prevent h...

Objective: To evaluate reliability, internal consistency and construct validity of the Posture and Postural Ability Scale for adults with cerebral palsy. Design: Psychometric evaluation of a clinical assessment tool. Setting: Rehabilitation centres in Sweden and Iceland. Subjects: Thirty adults with cerebral palsy aged 19-22 years, six people at each level I-V of the Gross Motor Function Classification System. Main measures: The Posture and Postural Ability Scale contains a 7-point ordinal scale for postural ability in supine, prone, sitting and standing, and items for assessment of posture. Posture and postural ability was rated from photos and videos by three independent assessors. Interrater reliability was calculated using weighted kappa. Internal consistency was analysed with Cronbach's alpha if item deleted and corrected item-total correlation. Construct validity was evaluated based on known groups, using Jonckheere Terpstra for averaged values of the three raters relative to the Gross Motor Function Classification System. Results: There was an excellent interrater reliability (kappa = 0.85-0.99) and a high internal consistency (alpha = 0.96-0.97, item-total correlation = 0.60-0.91). Median values differed (P < 0.02) between known groups represented by the levels of gross motor function, showing construct validity for all items. 83Conclusion: The Posture and Postural Ability Scale showed an excellent interrater reliability for experienced raters, a high internal consistency and construct validity. It can detect postural asymmetries in adults with cerebral palsy at all levels of gross motor function.