Relationship between scoliosis, windswept hips and contractures with pain and asymmetries in sitting and supine in 2450 children with cerebral palsy

Casey, Jackie; Ágústsson, Atli; Rosenblad, Andreas; Rodby‐Bousquet, Elisabet

doi:10.1080/09638288.2021.1971308

Cited by 16 publications

(18 citation statements)

References 23 publications

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“…Our results indicate that a reduced ability to change and maintain a position increases the likelihood of an asymmetric posture. As noted above, asymmetric postures in sitting and lying are associated with scoliosis and windswept deformity in both children and adults with cerebral palsy ( 5 , 8 , 25 ), which might be explained by the longer time spent in these two positions. Several adults without asymmetries used adjustable beds and positioning equipment in lying.…”

Section: Discussionmentioning

confidence: 91%

“…Postural asymmetries are frequent and associated with a limited range of joint motion and an inability to change position (4,5). Asymmetric postures sustained for long periods of time are associated with deformities, contractures and pain, which most commonly affect the spine and the lower extremities (5)(6)(7)(8). Inability to move and having a sustained posture increases the likelihood for contractures, making each posture relative to the time spent in that position clinically important throughout a 24-h cycle (4,5,9).…”

Section: Introductionmentioning

confidence: 99%

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Postural Asymmetries and Assistive Devices Used by Adults With Cerebral Palsy in Lying, Sitting, and Standing

Rodby‐Bousquet

2021

Front. Neurol.

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Purpose: To describe the use of assistive devices and postural asymmetries in lying, sitting and standing positions in adults with cerebral palsy, and to analyze postural asymmetries and any associations with their ability to maintain or change position and time in these positions.Methods: A cross-sectional study based on data from the Swedish Cerebral Palsy follow-up program of 1,547 adults aged 16–76 years, at Gross Motor Function Classification System (GMFCS) levels I (n = 330), II (n = 323), III (n = 235), IV (n = 298), and V (n = 361). Assistive devices such as wheelchairs, seating systems, adjustable beds, standing equipment and time in each position were reported. The Posture and Postural Ability Scale was used to identify asymmetries and rate the ability to maintain or change position. Binary logistic regression models were used to estimate odds ratios (OR) for postural asymmetries in supine, sitting and standing.Results: Assistive devices were used by 63% in sitting (range 5–100% GMFCS levels I–V), 42% in lying (4–92% levels I-V), and 32% in standing (2–70% levels II–V). Wheelchairs were used as seating systems by 57%. Most adults had postural asymmetries in supine (75%; range 35–100% levels I–V), sitting (81%; 50–99% levels I–V) and standing (88%; 65–100% levels I–V). Men were more likely than women to have postural asymmetries, and the likelihood of postural asymmetries increased with age, GMFCS levels and inability to change position. Inability to maintain position increased the probability of postural asymmetries in all positions from OR 2.6 in standing to OR 8.2 in lying and OR 13.1 in sitting.Conclusions: Almost twice as many adults used assistive devices in sitting than in lying or standing. Two thirds of the adults who used standing devices used it for <1 h per day, indicating that they might spend the remaining 23 out of 24 h per day either sitting or lying. Asymmetric postures were frequent across all ages and were highly associated with inability to change or maintain position.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Postural Asymmetries and Assistive Devices Used by Adults With Cerebral Palsy in Lying, Sitting, and Standing

Rodby‐Bousquet

2021

Front. Neurol.

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“…For GMFCS levels IV and V, prevention of contractures at the hips, knees, and ankles is important for goals such as maintaining ability to assist with standing transfers, 100 allowing continued weight bearing for BMD, 67 and reducing asymmetries in lying and sitting positions that are associated with pain, windswept hips, and scoliosis. 101 Low levels of evidence support the use of night-time positioning to prevent contractures and windswept deformity. 102 However, supported-standing programmes may potentially be more effective because, in addition to promoting alignment, 65 they also promote weight bearing and active muscle contraction.…”

Section: Range Of Motionmentioning

confidence: 99%

Supported‐standing interventions for children and young adults with non‐ambulant cerebral palsy: A scoping review

McLean

Paleg²,

Livingstone

2022

Develop Med Child Neuro

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Aim To describe the evidence, outcomes, and lived experience of supported standing for children and young adults with cerebral palsy aged 25 years or younger, classified in Gross Motor Function Classification System levels IV and V. Method This scoping review included searches in eight electronic databases and manual searching from database inception to May 2020 and updated on 21st February 2022. Two of three reviewers independently screened titles and abstracts and extracted and appraised data. Methodological quality and risk of bias were appraised using tools appropriate to study type. Content analysis and frequency effect sizes were calculated for qualitative and descriptive evidence. Results From 126 full‐text references, 59 citations (one study was reported over two citations) were included: 16 systematic reviews, 17 intervention studies reporting over 18 citations, eight analytical cross‐sectional studies, five descriptive cross‐sectional/survey studies, five qualitative studies, and one mixed‐methods study were identified, along with six clinical guidelines. Maintenance of bone mineral density and contracture prevention outcomes were supported by the most experimental studies and evidence syntheses, while evidence supporting other outcomes was primarily quasi‐experimental or descriptive. Qualitative evidence suggests that programmes are influenced by attitudes, device, child, and environmental factors. Interpretation Individualized assessment and prescription are essential to match personal and environmental needs. Although experimental evidence is limited due to many factors, lived‐experience and cohort data suggest that successful integration of standing programmes into age‐appropriate and meaningful activities may enhance function, participation, and overall health. What this paper adds Supported‐standing interventions may provide an important psychosocial and physical change of position. Supported standing is not passive for those classified in Gross Motor Function Classification System level IV or V. Supported standing may enhance social participation, functional abilities, and fitness. Children need choice in where and when to stand.

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“…Research has shown the impact of poor posture on quality of sleep. 16 Chronic sleep disruption can have an impact on cognitive functioning, mood and fatigue (Reynolds et al, 2010). 8 Reported improved sleep quality following provision of a sleep system.…”

Section: Introductionmentioning

confidence: 99%

“…2,7,15 Children with CP commonly experience poor posture and resulting secondary complications including pain and sleep disturbance at night, the likelihood of which increases with age and higher GMFCS levels. 7,16 There have been fewer studies investigating quality of life 8,10,11 and outcomes for carers. 7,8 Following a systematic review 6 recommendations were made for further research to establish benefits, including pain, posture and sleep quality and the impact on users and carers.…”

Section: Introductionmentioning

confidence: 99%

An exploratory study: The effects of sleep systems on sleep quality, pain and carer goals for non-ambulant children and young people with cerebral palsy

Wood

Brown

2022

Journal of Rehabilitation and Assistive Technologies Engineerin

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Introduction Sleep systems are supports used in lying, forming part of 24 h posture management programmes, for children and adults with severe motor disorders. Improved posture reduces likelihood of secondary complications such as pain and poor sleep quality, thus improving quality of life. The study aims are to investigate the effect of sleep systems on sleep quality and quantity, pain for young people with Cerebral Palsy and outcomes for carers. Methods Baseline data were gathered for 1 month prior to sleep system provision. Comparative data with the sleep system in place, were gathered for 5 months. The sample comprised four children with Cerebral Palsy, GMFCS level V, average age of 11.5, who did not have a sleep system. Data on sleep quality and quantity was gathered using the Chailey Sleep Questionnaire and sleep diaries and pain levels using the Paediatric Pain Profile. GAS Light verbal outcome measure was used to measure carer goals. Results Descriptive statistics and paired sample t-tests were used, demonstrating pain levels remained static, improvements in sleep quality and quantity were found and carer goals achieved. Conclusion A small sample size and subjective data collection methods were used; further research is required to obtain more conclusive results.

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Relationship between scoliosis, windswept hips and contractures with pain and asymmetries in sitting and supine in 2450 children with cerebral palsy

Cited by 16 publications

References 23 publications

Postural Asymmetries and Assistive Devices Used by Adults With Cerebral Palsy in Lying, Sitting, and Standing

Postural Asymmetries and Assistive Devices Used by Adults With Cerebral Palsy in Lying, Sitting, and Standing

Supported‐standing interventions for children and young adults with non‐ambulant cerebral palsy: A scoping review

An exploratory study: The effects of sleep systems on sleep quality, pain and carer goals for non-ambulant children and young people with cerebral palsy

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