Prevalence of hip dislocation among children with cerebral palsy in regions with and without a surveillance programme: a cross sectional study in Sweden and Norway

<p>Abstract</p> <p>Background</p> <p>Hip dislocation is a serious complication among children with cerebral palsy (CP). The aim of this study was to compare the prevalence of hip dislocation among children with CP in an area providing regular care with an area providing hip surveillance services.</p> <p>Methods</p> <p>This is a cross-sectional study in seven Norwegian counties providing regular care and one Swedish healthcare region where a hip surveillance programme was introduced in 1994. Data were provided by the Norwegian Cerebral Palsy Register and the CP Register in Southern Sweden. Children born 1996 - 2003 with moderate to severe CP, defined as Gross Motor Classification System (GMFCS) levels III - V, were included. In all, 119 Norwegian and 136 Swedish children fulfilled the criteria. In Norway, data on hip operations and radiographs of the hips were collected from medical records, while these data are collected routinely in the Swedish register. The hip migration percentage was measured on the recent radiographs. Hip dislocation was defined as a migration percent of 100%.</p> <p>Results</p> <p>The proportion of children at GMFCS levels III - V was 34% in the Norwegian and 38% in the Swedish population. In the Norwegian population, hip dislocation was diagnosed in 18 children (15.1%; CI: 9.8 - 22.6) compared with only one child (0.7%; 95% CI: 0.01 - 4.0) in Southern Sweden (p = < 0.001). Hip surgery was performed in 53 (44.5%) of the Norwegian children and in 43 (32%) of the Swedish children (p = 0.03). The total number of hip operations was 65 in Norway and 63 in Sweden. Norwegian children were first operated at a mean age of 7.6 years (SD: 2.9) compared with 5.7 years (SD: 2.3) in Sweden (p = 0.001).</p> <p>Conclusions</p> <p>The surveillance programme reduced the number of hip dislocations and the proportion of children undergoing hip surgery was lower. However, with the surveillance programme the first operation was performed at a younger age. Our results strongly support the effectiveness of a specifically designed follow-up programme for the prevention of hip dislocation in children with CP.</p

Motor strategies of postural control after hemispheric stroke [Stratégies motrices du contrôle postural après AVC hémisphérique]

International audienceAfter stroke, the causes of balance disorders include motor disorders, sensory loss, perceptual deficits and altered spatial cognition. This review focuses on motor strategies for postural control after stroke. Weight-bearing asymmetry, smaller surface of stability, increased sway, body tilting and sometimes pushing syndrome are observed. Weakness and sensory impairments account only for some of these disturbances; altered postural reactions and anticipated postural adjustments as well as abnormal synergistic muscular activation play an important part. These disorders are often linked to cognitive impairments (visuospatial analysis, perception of verticality, use of sensory information, attention, etc.), which explain the preeminent disorders of postural control seen with right rather than left-hemisphere lesions. Most of the motor changes are due to an impaired central nervous system but some could be considered adaptive behaviors. These changes have consequences for rehabilitation and need further studies for building customized programs based on the motor comportment of a given patien

Sensibilité visuelle et proprioceptive de la posture debout des patients atteints de polyradiculonévrites inflammatoires démyélinisantes chroniques (PIDC)

National audienceIntroduction L’étude des réactions posturales à une stimulation sensorielle permet de mieux comprendre les stratégies posturales comme nous l’avons proposé après AVC (Bonan et al., 2013). Nous rapportons ici l’analyse chez des PIDC. Matériel et méthode Étude prospective chez 15 contrôles (57 ± 13 ans, 6 M, 9 F) et 15 PIDC (63 ± 15 ans, 13 M, 2 F) avec une comparaison de la déviation moyenne principale du centre de pression (mm) durant la stimulation (35s) sur stabilométrie ; la proprioception stimulée par vibrations tendineuses des triceps suraux (TS) et tibiaux antérieurs (TA) et la vision stimulée par flux optocinétique dans 4 directions (haut, bas, droite, gauche). Résultats Les chutes ont été plus fréquentes chez les PIDC que chez les témoins (expliquant la perte de 31,1 % versus 2,2 % des enregistrements ; p &lt; 000,1), essentiellement en condition visuelle (40 % versus 3,3 % sous optocinétique) notamment en rotation optocinétique vers le bas (16,6/9,5 mm, p = 0,019) et à droite (10/4,8 mm, p = 000,9). Ceci objective l’hypersensibilité aux informations visuelles des sujets PIDC. Cependant, les PIDC restaient sensibles aux stimulations proprioceptives et réagissaient sans différence aux témoins pour la stimulation des TS et de façon plus importante en antépulsion lors de la vibration des TA (13,48/7,89 mm, p = 0,017). Discussion–conclusion Les PIDC sont beaucoup plus sensibles aux informations visuelles, comme attendu, mais restent sensibles aux stimulations proprioceptives malgré les troubles sensitifs, ce qui encourage la rééducation visant à la récupération d’informations proprioceptives plutôt qu’à la compensation par les informations visuelle