To evaluate whether medial knee support (MKS) in seating systems aggravates hip displacement in children with cerebral palsy (CP).
Retrospective chart review.
Rehabilitation department of tertiary university hospital.
Children with CP (N=76) using seating systems (intervention group, n=42; mean age 6.86y) and using regular wheelchairs (control group, n=34; mean age 8.15y).
The intervention group was provided with a seating system with MKS. We enrolled children who did not use a seating system in the control group, retrospectively.
Main Outcome Measures
By radiographic images, Reimer’s migration index (MI), lateral center edge angle (CEA), and femur neck shaft angle (NSA) were measured. We compared the demographic data, clinical variables, and radiographs between the 2 groups.
In the intervention group, there was a significant deterioration in the MI, from 26.89% to 44.18% after using the system (P<.001). The progression of MI was 14.72% and 7.82% per year in the intervention and control groups, respectively (P=.016).
We should consider the possibility that seating systems with MKS may exacerbate hip displacement in children with CP.
List of abbreviations:CEA (lateral center edge angle), CP (cerebral palsy), GMFCS (Gross Motor Function Classification System), MI (Reimer’s migration index), MKS (medial knee support), NSA (femur neck shaft angle)
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Archives of Physical Medicine and Rehabilitation
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- A report: the definition and classification of cerebral palsy April 2006.Dev Med Child Neurol Suppl. 2007; 109: 8-14
- An update on the prevalence of cerebral palsy: a systematic review and meta-analysis.Dev Med Child Neurol. 2013; 55: 509-519
- Orthotic management in cerebral palsy.Acta Orthop Traumatol Turc. 2004; 43: 165-172
- Prevention of hip displacement in children with cerebral palsy: a systematic review.Dev Med Child Neurol. 2017; 59: 1130-1138
- Progressive bone and joint abnormalities of the spine and lower extremities in cerebral palsy.Radiographics. 2002; 22: 257-268
- The natural history of hip development in cerebral palsy.Dev Med Child Neurol. 2012; 54: 951-957
- Femoral anteversion and neck-shaft angles in hip instability in cerebral palsy.J Pediatr Orthop. 1993; 14: 719-723
- Dislocation and subluxation of the hip in cerebral palsy: pathogenesis, natural history and management.J Bone Joint Surg Am. 1972; 54: 863-873
- Secondary conditions of the musculoskeletal system in adolescents and adults with cerebral palsy.Phys Occup Ther Pediatr. 2009; 21: 49-68
- The use and impact of assistive devices and other environmental modifications on everyday activities and care in young children with cerebral palsy.Disabil Rehabil. 2005; 27: 849-861
- Assessment of forces imparted on seating systems by children with special needs during daily living activities.in: Proceedings of the Biomedical Engineering and Sciences (IECBES), 2012 IEEE EMBS Conference on: IEEE. 2012: 475-478
- Changes of musculoskeletal deformity in severely disabled children using the custom molded fitting chair.Ann Rehabil Med. 2013; 37: 33-40
- Orthotic management of children with cerebral palsy.J Prosthet Orthot. 2002; 14: 150-158
- Hip subluxation and dislocation in cerebral palsy–a prospective study on the effectiveness of postural management programmes.Physiother Res Int. 2009; 14: 116-127
- Changes in postural alignment when using kneeblocks for children with severe motor disorders.Disabil Rehabil Assist Technol. 2007; 2: 287-291
- Characteristics of children with hip displacement in cerebral palsy.BMC Musculoskelet Disord. 2007; 8: 101
- Development and reliability of a system to classify gross motor function in children with cerebral palsy.Dev Med Child Neurol. 1997; 39: 214-223
- Content validity of the expanded and revised Gross Motor Function Classification System.Dev Med Child Neurol. 2008; 50: 744-750
- The effect of femoral rotation on the projected femoral neck-shaft angle.J Pediatr Orthop. 2000; 20: 736-739
- The stability of the hip in children: a radiological study of the results of muscle surgery in cerebral palsy.Acta Orthop Scand Suppl. 1980; 184: 1-100
- Reliability of hip migration index in children with cerebral palsy: the classic and modified methods.Ann Rehabil Med. 2012; 36: 33-38
- Validity and reliability of measuring femoral anteversion and neck-shaft angle in patients with cerebral palsy.J Bone Joint Surg Am. 2010; 92: 1195-1205
- Lower-extremity strength profiles in spastic cerebral palsy.Dev Med Child Neurol. 1998; 40: 100-107
- Management of hip disorders in patients with cerebral palsy.J Am Acad Orthop Surg. 2002; 10: 198-209
- Dislocation after total hip arthroplasty. Causes and prevention.Clin Orthop Relat Res. 1990; : 159-170
- Variation of rotation moment arms with hip flexion.J Biomech. 1999; 32: 493-501
- A three-dimensional biomechanical model of hip musculature.J Biomech. 1981; 14: 803-812
- Bone mineral density and vitamin D status in ambulatory and non-ambulatory children with cerebral palsy.Osteoporos Int. 2015; 26: 141-150
- Kinesiology of the hip: a focus on muscular actions.J Orthop Sports Phys Ther. 2010; 40: 82-94
- A musculoskeletal model of the human lower extremity: the effect of muscle, tendon, and moment arm on the moment-angle relationship of musculotendon actuators at the hip, knee, and ankle.J Biomech. 1990; 23: 157-169
- Dislocation following total hip replacement.Dtsch Arztebl Int. 2014; 111: 884-890
- Risk factors for dislocation during the first 3 months after primary total hip replacement.J Arthroplasty. 1999; 14: 662-668
- Functional impact of a rigid pelvic stabilizer on children with cerebral palsy who use wheelchairs: users' and caregivers' perceptions.Pediatr Rehabil. 1999; 3: 101-118
- Prediction of hip displacement in children with cerebral palsy: development of the CPUP hip score.Bone Joint J. 2015; 97: 1441-1444
Published online: August 10, 2018
Supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2016R1D1A1B03935130).
© 2018 by the American Congress of Rehabilitation Medicine