Role of Physical Therapy in Postural Management to Prevent Hip Dislocation in Children with Spastic Cerebral Palsy
DOI:
https://doi.org/10.62464/ykxpkv10Keywords:
Cerebral palsy; Hip dislocation; Postural management; Physical therapy; Gross Motor Function Classification System.Abstract
Background: Cerebral palsy (CP) is a neurological disorder characterized by motor impairments stemming from non-progressive brain anomalies. A primary concern in children with spastic CP is hip migration, which can progress to subluxation or dislocation, particularly in non-ambulatory patients. Objective: This narrative review explores the efficacy of physical therapy approaches within postural management programs in preventing hip dislocation in children with spastic CP. Methods: Literature published between 1990 and 2022 is reviewed across databases—namely, PubMed, EDLINE, CINAHL, AMED and Google Scholar. Results: The review highlights diverse interventions, including passive stretching, weight-bearing exercises, standing devices, orthotic aids and the Vojta method, that underestimate the importance of early, individualized and multidisciplinary management in children with spastic CP. While some conservative strategies show promising outcomes, the evidence remains limited and of variable quality. Moreover, the studies have been heterogeneous in design, outcome measures and intervention protocols. Overall, the review indicates the need for tailored programs early in life, especially for children whose motor function is classified as Gross Motor Function Classification System levels IV and V, emphasizing the essential role of physiotherapists in preventive care. Conclusion: Early, tailored physiotherapy and postural management programs play a critical role in mitigating hip displacement in children with spastic CP. Strengthening interdisciplinary collaboration and standardizing intervention protocols are essential to both improving clinical outcomes and advancing the evidence base for conservative management strategies.
References
AACPDM Hip Surveillance Care Pathway Team. (n.d.). Hip surveillance: Bottom line evidence-informed recommendations for hip surveillance in individuals with cerebral palsy. American Academy for Cerebral Palsy and Developmental Medicine. https://www.aacpdm.org/publications/care-pathways/hip-surveillance
Ahya, K. P., & Suryawanshi, P. (2018). Neonatal periventricular leukomalacia: Current perspectives. Research and Reports in Neonatology, 8, 1–8. https://doi.org/10.2147/RRN.S125575
Angsupaisal, M., Russell, D., & Imms, C. (2015). Adaptive seating systems in children with severe cerebral palsy: A systematic review. Developmental Medicine & Child Neurology, 57(10), 954–965. https://doi.org/10.1111/dmcn.12762
Connelly, A., Flett, P., Graham, H. K., & Oates, J. (2009). Hip surveillance in Tasmanian children with cerebral palsy. Journal of Paediatrics and Child Health, 45(7–8), 437–443. https://doi.org/10.1111/j.1440-1754.2009.01534.x
Das, S. P., & Shankar Ganesh, G. (2019). Evidence-based approach to physical therapy in cerebral palsy. Indian Journal of Orthopaedics, 53(1), 20–34. https://doi.org/10.4103/ortho.IJOrtho_244_18
Eldessouky, A., & Smeda, G. (2016). Hip dislocation in cerebral palsy: Treatment options. Journal of Orthopaedic Research and Physiotherapy, 2, 026. https://doi.org/10.13188/2381-8538.1000016
Gericke, T. (2006). Postural management for children with cerebral palsy: A consensus statement. Developmental Medicine & Child Neurology, 48(4), 244–244. https://doi.org/10.1017/S0012162206000533
Gough, M. (2009). Continuous postural management and the prevention of deformity in children with cerebral palsy: An appraisal. Developmental Medicine & Child Neurology, 51(2), 105–110. https://doi.org/10.1111/j.1469-8749.2008.03194.x
Graham, H., Rosenbaum, P., Paneth, N., Dan, B., Lin, J.-P., Damiano, D. L., Becher, J. G., Gaebler-Spira, D., Colver, A., Reddihough, D. S., Crompton, K. E., & Lieber, R. L. (2016). Cerebral palsy. Nature Reviews Disease Primers, 2(1), 15082 https://doi.org/10.1038/nrdp.2015.82
Graham, H. K., & Selber, P. (2003). Musculoskeletal aspects of cerebral palsy. Journal of Bone and Joint Surgery. British Volume, 85(B), 157–166. https://doi.org/10.1302/0301-620X.85B2.13846
Hankinson, J., & Morton, R. E. (2002). Use of a lying hip abduction system in children with bilateral cerebral palsy: A pilot study. Developmental Medicine & Child Neurology, 44(3), 177 180. https://doi.org/10.1017/S001216220100189X
Hägglund, G., Lauge-Pedersen, H., Persson Bunke, M., & Rodby-Bousquet, E. (2016). Windswept hip deformity in children with cerebral palsy: A population-based prospective follow-up. Journal of Children's Orthopaedics, 10(3), 275–279. https://doi.org/10.1007/s11832-016-0736-9
Hägglund, G., Lauge-Pedersen, H., & Wagner, P. (2007). Characteristics of children with hip displacement in cerebral palsy. BMC Musculoskeletal Disorders, 8, 101. https://doi.org/10.1186/1471-2474-8-101
Howard, J. J., Graham, H. K., Johari, A., Narayanan, U., Bennett, L., Presedo, A., Shore, B. J., Guerschman, T., & Aroojis, A. (2024). Hip displacement in children with cerebral palsy: Surveillance to surgery – A current concepts review. SICOT-J, 10, 30. https://doi.org/10.1051/sicotj/2024034
Kiebza, K. W., Żurawski, A., & Dwornik, M. (2016). Vojta method in the treatment of developmental hip dysplasia: A case report. Therapeutics and Clinical Risk Management, 12, 1271–1276. https://doi.org/10.2147/TCRM.S109462
Kim, B. R., Yoon, J. A., Han, H. J., Yoon, Y. I., Lim, J., Lee, S., Cho, S., Shin, Y. B., Lee, H. J., Suh, J. H., Jang, J., Beom, J., Park, Y., Choi, J.-H., & Ryu, J. S. (2022). Efficacy of a hip brace for hip displacement in children with cerebral palsy: A randomized clinical trial. JAMA Network Open, 5(11), e2243004. https://doi.org/10.1001/jamanetworkopen.2022.43004
Larnert, P., Risto, O., Hägglund, G., & Wagner, P. (2014). Hip displacement in relation to age and gross motor function in children with cerebral palsy. Journal of Children's Orthopaedics, 8(2), 129- 134. https://doi.org/10.1007/s11832-014-0570-7
Liang, X., Tan, Z., Yun, G., Cao, J., Wang, J., Liu, Q., & Chen, T. (2021). Effectiveness of exercise interventions for children with cerebral palsy: A systematic review and meta-analysis of randomized controlled trials. Journal of Rehabilitation Medicine, 53(4), 1–10. https://doi.org/10.2340/16501977-2772
Macías-Merlo, L., Bagur-Calafat, C., Girabent-Farrés, M., & Stuberg, W. (2015). Effects of the standing program with hip abduction on hip acetabular development in children with spastic diplegia cerebral palsy. Disability and Rehabilitation, 37(7), 610–616. https://doi.org/10.3109/09638288.2014.935492
Martinsson, C., & Himmelmann, K. (2021). Abducted standing in children with cerebral palsy: Effects on hip migration percentage and hip and knee range of motion after 7 years. Pediatric Physical Therapy, 33(2), 101- 107. https://doi.org/10.1097/PEP.0000000000000789
Martinsson, C., & Himmelmann, K. (2011). Effect of weight-bearing in abduction and extension on hip stability in children with cerebral palsy. Pediatric Physical Therapy, 23(2), 150–157. https://doi.org/10.1097/PEP.0b013e318218ef2c
Mutch, L., Alberman, E., Hagberg, B., Kodama, K., & Perat, M. V. (1992). Cerebral palsy epidemiology: Where are we now and where are we going? Developmental Medicine & Child Neurology, 34(6), 547–551. https://doi.org/10.1111/j.1469-8749.1992.tb11471.x
Paleg, G., & Livingstone, R. (2022). Evidence-informed clinical perspectives on postural management for hip health in children and adults with non-ambulant cerebral palsy. Journal of Pediatric Rehabilitation Medicine, 15(1), 39–48. https://journals.sagepub.com/doi/10.3233/PRM-220002?utm_source=chatgpt.com
Palisano, R., Rosenbaum, P., Walter, S., Russell, D., Wood, E., & Galuppi, B. (1997). Development and reliability of a system to classify gross motor function in children with cerebral palsy. Developmental Medicine & Child Neurology, 39(4), 214–223. https://doi.org/10.1111/j.1469-8749.1997.tb07414.x
Picciolini, O., Albisetti, M., Cozzaglio, F., Spreafico, F., Mosca, V., & Gasparroni, O. (2009). Postural management to prevent hip dislocation in children with cerebral palsy. Hip International, 19(1), 13–17. https://doi.org/10.1177/112070000901900103
Picciolini, O., Le Metayer, M., Consonni, D., Cozzaglio, M., Porro, M., Gasparroni, V., Panou, A., Mosca, F., & Portinaro, N. M. (2016). Can we prevent hip dislocation in children with cerebral palsy? Effects of postural management. European Journal of Physical and Rehabilitation Medicine, 52(5), 682–690.
Pin, T. W. (2007). Effectiveness of static weight-bearing exercises in children with cerebral palsy. Pediatric Physical Therapy, 19(1), 62–73. https://doi.org/10.1097/PEP.0b013e31802f14fa
Polczyk, S. (2018). Early use of Vojta therapy in children with postural asymmetry at risk of hip dysplasia. Pediatrics & Therapeutics, 8, 1000340. https://doi.org/10.4172/2161-0665.1000340
Pountney, T., Mandy, A., Green, E., & Gard, P. (2002). Management of hip dislocation with postural management. Child: Care, Health and Development, 28(2), 179–185. https://doi.org/10.1046/j.1365-2214.2002.00255.x
Pountney, T., Green, E., Lacey, P., Mulcahy, C., & Kerr, C. (2006). Posture management for children with cerebral palsy: Consensus statement. Chailey Heritage Clinical Services / Association of Chartered Physiotherapists for Children.
Rodby-Bousquet, E., Czuba, T., Hägglund, G., & Westbom, L. (2013). Postural asymmetries in young adults with cerebral palsy. Developmental Medicine & Child Neurology, 55(11), 1009–1015. https://doi.org/10.1111/dmcn.12196
Terjesen, T., & Horn, J. (2022). Risk factors for hip displacement in cerebral palsy: A population-based study of 121 nonambulatory children. Journal of Children’s Orthopaedics, 16(4), 306–312. https://pmc.ncbi.nlm.nih.gov/articles/PMC9382709/?utm_source=chatgpt.com
Wynter, M., Gibson, N., Kentish, M., Love, S. C., Thomason, P., Willoughby, K., & Graham, H. K. (2014). Australian hip surveillance guidelines for children with cerebral palsy. AusACPDM.
Ungureanu, A., Rusu, L., Rusu, M. R., & Marin, M. I. (2022). Balance rehabilitation approach by Bobath and Vojta methods in cerebral palsy: A pilot study. Children, 9(10), 1481. https://doi.org/10.3390/children9101481
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