Motor function levels and pelvic parameters in walking or ambulating children with cerebral palsy

Abstract

Pelvic parameters vary according to the GMFCS level but do not appear to affect spinal curvature. The sacrum is positioned in front of the head of the femur (i.e. negative PT) in GMFCS level I and progressively moves backwards (i.e. positive PT) in GMFCS levels II, III and IV.

Spinal sagittal alignment and head control in patients with cerebral palsy

“…10 Patients with walking abilities are classified from GMFCS I to GMFCS IV level, while non-ambulant patients are GMFCS V. Three studies have explored and described the spino-pelvic sagittal alignment of walking CP patients, who often present retraction of hip flexors (right anterior, iliopsoas). 3,8,9 Pelvic incidence was found to be similar to that of healthy controls, indicating that the shape of the pelvis was not affected by the disease. 3 However, the pelvis was anteverted (low pelvic tilt) and sacrum was more horizontal (high sacral slope).…”

“…The literature is, therefore, very poor on the subject, with only six relevant articles available for analysis (only one including GMFCS V patients) and sagittal alignment parameters are currently lacking. [3][4][5][6]8,9…”

“…Therefore, spino-pelvic parameters from walking CP are not similar to those of sitting CP. Bernard et al 9 have investigated the influence of the GMFCS level on the sagittal alignment of ambulating CP children (GMFCS I to IV). They reported that the higher the GMFCS is, the higher the pelvic tilt (retroversion) and the lower sacral slope (vertical sacrum) are.…”