Association between back erector balancing response and hip alterations in cerebral palsy
Keywords:
Cerebral palsy, hip dislocation, paraspinal muscles, surface electromyographyAbstract
Introduction: Disturbances of the hip joint are about the most common disorders in patients
with CP and mobility limitation. Intervention on spastic hip adductor and flexor muscles
are not always satisfactory at all to improve body balance. Purpose of this study is to assess
relationship among trunk stability and specific deficit of spinal erector reaction and develop-
ment of hip subluxation or dislocation in spastic CP patients, in base to Gross Motor Function
Classification System (GMFCS) level V. Methods: Activity of muscles longissimus thoracis (LT)
and iliocostalis lumborum (IC) was recorded by surface electromyography in 10 patients with
spastic quadriplegia and antero-posterior and lateral imbalance, compared to that obtained
in sitting position without destabilization. As well, the 20 patients’ hips were assessed by the
Reimers migration index (MI). Results: The highest rate of minimum MI of hips (< 30%) is
associated to right responses of LT to anteroposterior and lateral imbalances. On the opposite,
the highest rate of MI of hips ≥ 30% was associated to poor response of LT and IC imbalance.
Conclusion: Good response of erector spine muscles to vestibular stimulation is associated
to hips with MI lesser than 30% in class V patients of GMFCS.
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References
Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth
N, Dan B et al. Executive committee for the defi nition
of cerebral palsy. Proposed defi nition and classifi cation
of cerebral palsy. Dev Med Child Neurol. 2005; 47:
-576.
Robaina-Castellanos GR, Riesgo-Rodríguez S,
Robaina-Castellanos MS. Defi nición y clasifi cación de
la parálisis cerebral: ¿un problema ya resuelto? Rev
Neurol. 2007; 45: 110-117.
Camacho A, Pallás CR, de la Cruz J, Simón de las
Heras R, Mateos-Beato F. Parálisis cerebral: concepto
y registros de base poblacional. Rev Neurol. 2007; 45
(8): 503-508.
Dobson F, Boyd RN, Parrott J, Nattrass GR, Graham HK.
Hip surveillance in children with cerebral palsy. Impact
on the surgical management of spastichip disease. J
Bone Joint Surg Br. 2002; 84 (5): 720-726.
Soo B, Howard JJ, Boyd RN, Reid SM, Lanigan A, Wolfe
R et al. Hip displacement in cerebral palsy. J Bone Joint
Surg Am. 2006; 88 (1): 121-129.
Boyd RN, Jordan R, Pareezer L, Moodie A, Finn C,
Luther B et al. Australian cerebral palsy child study: pro-
tocol of a prospective population based study of motor
and brain development of preschool aged children with
cerebral palsy. BMC Neurol. 2013; 13: 57.
Palisano R, Rosenbaum P, Walter S, Rusell D, Wood
E, Galuppi B. Development and reliability of a system
to classify gross motor function in children with cerebral
palsy. Dev Med Child Neurol. 1997; 39: 214-223.
Pountney T, Green EM. Hip dislocation in cerebral palsy.
BMJ. 2006; 332 (7544): 772-775.
Krebs A, Strobl WM, Grill F. Neurogenic hip dislocation
in cerebral palsy: quality of life and results after hip
reconstruction. J Child Orthop. 2008; 2 (2): 125-131.
Hägglund G, Andersson S, Duppe H, Lauge-Pedersen
H, Nordmark E, Westborn L. Prevention of dislocation
of the hip in children with cerebral palsy. The fi rst ten
years of a population-based prevention program. J Bone
Joint Surg Br. 2005; 87 (1): 95-101.
Hägglund G, Lauge-Pedersen H, Persson M. Radio-
graphic threshold values for hip screening in cerebral
palsy. J Child Orthop. 2007; 1 (1): 43-47.
Park ES, Rha DW, Lee WC, Sim EG. The effect of obtu-
rator nerve block on hip lateralization in low functioning
children with spastic cerebral palsy. Yonsei Med J. 2014;
(1): 191-196.
Shore B, Spence D, Graham H. The role for hip surveil-
lance in children with cerebral palsy. Curr Rev Muscu-
loskelet Med. 2012; 5 (2): 126-134.
Pap K, Kiss S, Vízkelety T, Szoke G. Open adductor
tenotomy in the prevention of hip subluxation in cerebral
palsy. Int Orthop. 2005; 29 (1): 18-20.
Bishay SN. Short-term results of musculotendinous
release for paralytic hip subluxation in children with
spastic cerebral palsy. Ann R Coll Surg Engl. 2008; 90
(2): 127-132.
Kim HT, Jang JH, Ahn JM, Lee JS, Kang DJ. Early re-
sults of one-stage correction for hip instability in cerebral
palsy. Clin Orthop Surg. 2012; 4 (2): 139-148.
Knaus A, Terjesen T. Proximal femoral resection arthro-
plasty for patients with cerebral palsy and dislocated
hips: 20 patients followed for 1-6 years. Acta Orthop.
; 80 (1): 32-36.
Rodby-Bousquet E, Czuba T, Hägglund G, Westborn
L. Postural asymmetries in young adults with cerebral
palsy. Dev Med Child Neurol. 2013; 55 (11): 1009-1015.
Descarreaux M, Lafond D, Cantin V. Changes in the
fl exion-relaxation response induced by hip extensor
and erector spinae muscle fatigue. BMC Musculoskelet
Disord. 2010; 11: 112.
Prosser LA, Lee SC, van Sant AF, Barbe MF, Lauer RT.
Trunk and hip muscle activation patterns are different
during walking in young children with and without cere-
bral palsy. Phy Ther. 2010; 90 (7): 986-997.
Prosser LA, Lee SC, Barbe MF, van Sant AF, Lauer RT.
Trunk and hip muscle activity in early walkers with and
without cerebral palsy-a frequency analysis. J Electro-
myogr Kinesiol. 2010; 20 (5): 851-859.
Palastanga N, Field D, Soames R. Anatomía y movi-
miento humano. Estructura y funcionamiento. Barcelo-
na: Paidotribo; 2000.
Ali-Morell OJ, Zurita-Ortega F, Martínez-Porcel R,
Padilla-Obispo I. Refl ejo vestibulocervical y función
motora gruesa en una población con parálisis cerebral.
Rehabilitación. 2014; 48: 39-45.
Hermens HJ, Freriks B, Disselhorst-Klug C, Rau G. De-
velopment of recommendations for SEMG sensors and
sensor placement procedures. J Electromyogr Kinesiol.
; 10: 361-374.
Reimers J. The stability of the hip in children. A radio-
logical study of the results of muscle surgery in cerebral
palsy. Acta Orthop Scand Suppl. 1980; 184: 1-100.
Robin J, Graham HK, Baker R, Selber P, Simpson P,
Symons S et al. A classifi cation system for hip disease in
cerebral palsy. Dev Med Child Neurol. 2009; 51: 183-192.
Ferrari A, Ferrara C, Balugani M, Sassi S. Severe scolio-
sis in neurodevelopmental disabilities: clinical signs and
therapeutic proposals. Eur J Phys Rehab Med. 2010;
(4): 563-580.
Porter D, Michael S, Kirkwood C. Patterns of postural
deformity in non-ambulant people with cerebral palsy:
what is the relationship between the direction of scolio-
sis, direction of pelvic obliquity, direction of windswept
hip deformity and side of hip dislocation? Clin Rehabil.
; 21 (12): 1087-1096.
Larnet P, Risto O, Hägglund G, Wagner P. Hip displace-
ment in relation to age and gross motor function in children
with cerebral palsy. J Child Orthop. 2014; 8 (2): 129-134.
Zurita F, Alí O, Martínez R. Reacciones laberínticas
de enderezamiento cervical y escoliosis en la parálisis
cerebral. Rev Ped Elec. 2011; 8 (1): 2-15.
Miller F, Slomczykowski M, Cope R, Lipton GE. Computer
modelling of the pathomechanics of spastic hip dislocation
in children. J Pediatr Orthop. 1999; 19 (4): 486-492.
Alí-Morell OJ, Zurita-Ortega F, Martínez-Porcel R,
González-Astorga E, Cano-Mañas MJ. Registro de la
actividad muscular en abductores y aductores en las
alteraciones de cadera de los individuos con parálisis
cerebral. Rehabilitación. 2013; 47: 35-43.
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