Bone age and linear skeletal growth of children with cerebral palsy

Abstract

The aim of this study was to compare the linear growth of children with cerebral palsy (CP) with that of children without CP. The segmental lengths (humerus, ulna, femur, tibia, and spine), recumbent length, body weight, and bone age of 62 children with CP (age range 2.25 to 14 years, mean 7.13 years) were measured and compared with 68 children without CP (age range 1.50 to 12.67 years, mean 6.73 years). The results show that bone-age delay is common in children with CP (68% with a delay of more than 1 year). The linear growth of children with CP is similar to that of children without CP when bone age is used instead of chronological age. There is a strong correlation between segmental lengths and body height. Hence, this study favours using segmental lengths for estimating height in children with CP and using the comparison group as a reference for this purpose. Nutritional and non-nutritional factors on bone-age delay are discussed.

Idade óssea na paralisia cerebral

“…But the fact that we have studied patients with hemiplegia, in which the normal side was the control group, and the fact that we have also observed a delay in the affected side compared to the unaffected, not only corroborates this statement, but we can also correlate with the involvement of non-nutritional factors 6 8 , 9 , 11 , 12 …”

“…Even so, tetraparetic patients showed a longer development delay, and this may be related to nutritional and non-nutritional factors 6 7 , 9 - 11 , 13 , 14 …”

“…Regarding nutritional factors, the inadequate intake of protein can be cited as one of the main causes, 8 as high energy demand, besides the presentation of motor difficulty in swallowing foods 9 . On the other hand, non-nutritional factors can be subdivided into direct pathway (negative neurotrophic effect) and indirect (endocrine system, immobility, lack of cargo, etc.)…”

Skeletal maturation in children with cerebral palsy and its relationship with motor functioning

“…Direct measurement of height to quantify a growth spurt in children with CP is often difficult or even impossible, due to contractures, skeletal deformities, or inability of the child to stand erect. Kong et al 4 found a strong association between skeletal age and linear skeletal growth in children with CP, and recommended that skeletal age with reference to the child’s own chronological age should be used to describe growth. A reliable and simple method that can be used to measure skeletal age in growing children is the Greulich and Pyle technique 5–7 .…”

“…Skeletal growth abnormalities in children with CP have been found in several studies 4,8–11 . However, the data are conflicting; some reported a delayed skeletal age in children with CP, 4,10 while others reported a normal, 8,11 or even an advanced skeletal age 9 . The majority of these studies have focused on children with severe CP, most of whom were non‐ambulant 4,8,11 .…”