Effects Of Standing Frames On The Hip And Spine

Hip and spine problems are common in children at the more severe scale of CP. Primary causes of abnormal development of the hip and spine include muscle imbalance, abnormal positioning and delayed and insufficient weight bearing. Secondary complications include contractures, malformation of joints, decreased bone mineral density, and increased incidence of fractures (Gudjonsdottir and Mercer 1997). As physiotherapists we should concern ourselves with strategies that help in the management of these problems.

The hip

A good understanding of the normal development of the proximal femur is essential to understanding the abnormalities experienced by children with CP. Several articles provide a useful overview of the hip and spine in CP and are worth reading for background information: Cornell (1995); Gudjonsdottir and Stemmons Mercer (1997).

By means of summary, children with CP will demonstrate the following hip abnormalities:

  • persistent excessive femoral anteversion (Shands, 1958)
  • significantly higher acetabular index at all ages (Vidal et al. 1985)
  • progressively increasing migration percentage (MP) of roughly 5.5% per year until the value reaches 50% at which the hips will easily dislocate. This usually occurs at around 10-12 years of age in those children who are untreated.

The spine & Hipd dislocation

Hip dislocation, pelvic obliquity, and scoliosis in children with CP are related problems (Cornell 1995). The sequence and relationship of these problems is unclear but we do know that the hip and spine must be treated simultaneously because alignment of one affects alignment of the other.

Factors contributing to the development of scoliosis

  • Samilson (1981) reported an incidence of scoliosis of 7% in ambulatory and 39% in non-ambulatory subjects with CP.
  • Madigan (1981) reported that scoliosis is most common in children with spastic CP, with the highest incidence in those with spastic quadriplegia.

Evidence for physiotherapy interventions in the management of hip and spine problems

Physiotherapy, in the form of correct positioning, standing and walking forms the main basis for conservative management of the hip and spine. As reported by Cornell (1995) the effect of weight bearing on the development of the acetabulum appears to be the crucial factor in reducing the incidence of hip dislocation in the CP population.  However, there have been no detailed clinical trials investigating the use of standing in the management of the hip and spine in children with CP. We can only make recommendations based on our knowledge of the effect of standing on muscle spasticity and bone mineral density and aimed at reducing the risk factors listed above.

‘Active movement  and weight bearing with good alignment helps to oppose deforming forces, maintain muscle length, promote normal joint formation, and delay bone loss.’ (Gudjonsdottir and Mercer, 1997 P.183)

 

 

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