Preventie en behandeling van scoliose bij kinderen met ernstige cerebrale parese, een inventariserend onderzoek

Abstract

Background: Scoliosis, a lateral curvature of the spine, is a common problem in children with severe cerebral palsy (CP) and has far-reaching consequences including those for trunk balance, activities of daily living (ADL) and quality of life. Unclarity exists about risk factors for scoliosis in children with severe CP and about treatment of this condition. National guidelines on diagnostics and treatment of scoliosis in children with severe CP are lacking. Therefore the aim of this study was to explore by means of a questionnaire current professional practice in diagnosis and treatment of scoliosis in children with severe CP. Methods: A questionnaire, which contained 45 questions, has been sent to pediatric rehabilitation physicians, pediatric orthopedic surgeons, pediatric physiotherapists and occupational therapists from November 2009 to January 2010. The questions focussed on prevalence, physical examination, radiography and treatment with physiotherapy, occupational therapy, spinal bracing, seat inclinations, lying support systems and surgery of scoliosis in children with severe CP. In the data-analysis, mainly descriptive statistics have been used. Findings: The respons rate of physicians was approximately 25 percent; that of therapists was considerably lower. The data of the questionnaires demonstrated considerable agreement between the different professions, regarding physical examination and radiography of scoliosis in children with severe CP. The same was true for the different forms of treatment. All professions focussed for treatment on the presence and progression of scoliosis in children with severe CP. However, the results also suggested that pediatric orthopedic surgeons focussed more on ADL. Treatment options considered most important were physiotherapy, occupational therapty and the application of seat inclinations. Remarkably, no standard rules for diagnosis, including those about positioning the child regarding radiography, were used. Conclusion: One the one hand, the study showed that various groups of professionals in general have similar ideas about diagnostics and treatment of scoliosis in children with severe CP. On the other hand, standards regarding diagnosis are absent. The development of guidelines for diagnostic and treatment options for scoliosis in patiënts with severe CP is urgently needed as the presence of standard diagnostics and standard therapeutic programs allows for a valid evaluation of factors playing a role in the progression or prevention of scoliosis.