Radiological hip indices correlate with GMFCS level I and GMFM-66 scores in cerebral palsy

Year 2019, Volume: 13 Issue: 1, 13 - 20, 29.04.2019

Özlem Elvan , Mert Keskinbora Havva Didem Çelikcan Alev Bobuş Anıl Özgür Mustafa Kömür Zeliha Kurtoğlu Olgunus

Abstract

Objectives: The aim of this study was to evaluate the certain radiological hip parameters and the effects of these parameters on the functional capacity of cerebral palsy (CP) children, to compare the Gross Motor Function Measure (GMFM-66
scores) of hemiparetic and diparetic children with spastic CP in Gross Motor Function Classification System (GMFCS) level 1,
and to define possible differences or similarities with the control group.

Methods: The radiographic parameters measured for CP and control groups were caput-collum-diaphyseal angle (CCD), migration index (MI), center edge angle (CEA), acetabular index (AI) and pelvic obliquity. The functional capacity of the CP group was
assessed by GMFM-66.

Results: No significant differences were found in terms of sides of the same individual in each group. Significant differences
were found between groups for left CCD, right MI, right and left AI, and right and left CEA. Correlation analyses revealed significant relationships between radiological parameters. Hemiparetics had statistically higher GMFM-66 dimension E score than
diparetics.

Conclusion: The threshold values for hip parameters were determined with CP in GMFCS level 1. The hemiparetic and
diparetic children with CP, who were at the GMFCS level I and age group, had similar hip morphology. Development of
femoral head and acetabulum in these children were not different from control group. Evaluating the functional levels of
patients according to GMFM-66 scores with radiographic parameters is believed to contribute to the monitoring CP children. 

Keywords

cerebral palsy; functional capacity; gross motor functional classification system; gross motor function measure; radiographic hip parameters

References

• 1. Martins E, Cordovil R, Oliveira R, Letras S, Lourenço S, Pereira I, Ferro A, Lopes I, Silva CR, Marques M. Efficacy of suit therapy on functioning in children and adolescentswith cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol 2016;58:348– 60. 2. Damiano D, Abel M, Romness M, Oeffinger D, Tylkowski C, Gorton G, Bagley A, Nicholson D, Barnes D, Calmes J, Kryscio R, Rogers. Comparing functional profiles of children with hemiplegic and diplegic cerebral palsy in GMFCS Levels I and II: are separate classifications needed? Dev Med Child Neurol 2006;48:797–803. 3. Oeffinger DJ, Rogers SP, Bagley A, Gorton G, Tylkowski CM. Clinical applications of outcome tools in ambulatory children with cerebral palsy. Phys Med Rehabil Clin N Am 2009;20:549–65. 4. Soo B, Howard JJ, Boyd RN. Hip displacement in cerebral palsy. J Bone Joint Surg Am 2006;88:121–9. 5. Hägglund G, Lauge-Pedersen H, Wagner P. Characteristics of children with hip displacement in cerebral palsy. BMC Musculoskelet Disord 2007;26:101. 6. Morrell DS, Pearson JM, Sauser DD. Progressive bone and joint abnormalities of the spine and lower extremities in cerebral palsy. Radiographics 2002;22:257–68. 7. Palisano R, Hanna SE, Rosenbaum P, Russell D, Walter SD, Wood EP, Galuppi BE. Validation of a model of gross motor function for children with cerebral palsy. Phys Ther 2000;80:974–85. 8. Cobanoglu M, Cullu E, Omurlu I. The effect of hip reconstruction on gross motor function levels in children with cerebral palsy. Acta Orthop Traumatol Turc 2018;52:44–8. 9. Hägglund G, Andersson S, Düppe H, Lauge-Pedersen H, Nordmark E, Westbom LJ. Prevention of dislocation of the hip in children with cerebral palsy. The first ten years of a population-based prevention programme. Bone Joint Surg Br 2005;87:95–101. 10. Dobson F, Boyd RN, Parrott J, Nattrass GR, Graham HK. Hip surveillance in children with cerebral palsy. J Bone Joint Surg Br 2002;84:720–6. 11. Wood E, Rosenbaum P. The Gross Motor Function Classification System for cerebral palsy: a study of reliability and stability over time. Dev Med Child Neurol 2000;42:292–6. 12. Terjesen T. Development of the hip joints in unoperated children with cerebral palsy. Acta Orthopaedica 2006;77:125–31. 13. Scrutton D, Baird G. Surveillance measures of the hips of children with bilateral cerebral palsy. Arch Dis Child 1997;76:381–4. 14. Rethlefsen SA, Ryan DD, Kay RM. Classification systems in cerebral palsy. Orthop Clin North Am 2010;41:457–67. 15. Günel MK. Rehabilitation of children with cerebral palsy from a physiotherapist’s perspective. Acta Orthop Traumatol Turc 2009;43: 173–80. 16. Russell DJ, Avery LM, Rosenbaum PL, Raina PS, Walter SD, Palisano RJ. Improved scaling of the gross motor function measure for children with cerebral palsy: evidence of reliability and validity. Phys Ther 2000;80:873–85. 17. Grunert S, Brückl R, Rosemeyer B. Rippstein and Müller roentgenologic determination of the actual femoral neck-shaft and antetorsion angle. 1: Correction of the conversion table and study of the effects of positioning errors. Radiologe 1986;26:293–304. 18. Baflalo¤lu H, Akbafl A. ‹nsan femurlar›nda torsiyon ve kolladiafizer aç›lar›, birbirleri aras›ndaki iliflkiler ve aç› de¤erleri üzerinde etkili baz› faktörler. Acta Orthop Traumatol Turc 1996;30:299–302. 19. Suh DH, Hong JY, Suh SW, Park JW, Lee SH. Analysis of hip dysplasia and spinopelvic alignment in cerebral palsy. Spine J 2014;14: 2716–23. 20. Özçelik A, Ömero¤lu H, Ulukan ‹, Seber ‹. Türk toplumunda çocuk ve eriflkinlerin normal kalçalar›nda merkez-kenar aç›s› (CE) de¤erleri. J Arthrop Arthros Surg 2001;12:115–9. 21. Omero¤lu H, Ozçelik A, Inan U, Seber S. Assessment of the correlation between commonly used radiographic parameters in normal,subluxated and dislocated hips. J Pediatr Orthop B 2006;15:172– 7. 22. Suh SW, Suh DH, Kim JW, Park JH, Hong JY. Analysis of sagittal spinopelvic parameters in cerebral palsy. Spine J 2013;13:882–8. 23. Reid SM, Carlin JB, Reddihough DS. Using the Gross Motor Function Classification System to describe patterns of motor severity in cerebral palsy. Dev Med Child Neuro 2011;53:1007–12. 24. Boese CK, Dargel J, Oppermann J, Eysel P, Scheyerer MJ, Bredow J, Lechler P. The femoral neck-shaft angle on plain radiographs: a systematic review. Skeletal Radiol 2016;45:19–28. 25. Gose S, Sakai T, Shibata T, Murase T, Yoshikawa H, Sugamoto K. Morphometric analysis of acetabular dysplasia in cerebral palsy: three-dimensional CT study. J Pediatr Orthop 2009;29:896– 902. 26. Chang CH, Kuo KN, Wang CJ, Chen YY, Cheng HY, Kao HK. Acetabular deficiency in spastic hip subluxation. J Pediatr Orthop 2011;31:648–54. 27. Hazneci B, Vurucu S, Örs F, Tan AK, Gençdo¤an S, Dinçer K, Kalyon TA. Factors affecting the functional level in children with cerebral palsy. Turk J Phys Med Rehab 2006;52:105–9.