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IDENTIFICATION OF POSTURAL ABNORMALITY
IN YOUNG ADULTS WITH CEREBRAL PALSY
Carlee Holmes1, Dr. Kim Brock1, Assoc. Prof. Prue Morgan2
1 St Vincent’s Hospital (Melbourne), 2 Monash University (Melbourne)BACKGROUND AND OBJECTIVES
Adults with cerebral palsy (CP) who are wheelchair dependent (Gross Motor
Function Classification System, GMFCS, Level IV or V [1]) are particularly
vulnerable to spinal, pelvic and hip postural asymmetry arising from
neuromuscular dysfunction. A common postural problem is characterised by
abduction and external rotation of one lower limb and adduction and internal
rotation of the opposite lower limb, known as ‘windsweeping’ (Figure 1).
Regular radiographs to monitor skeletal changes in this population are
challenging to implement due to cognition and / or an inability to achieve a
standardised supine position. The Goldsmith Indices of Body Symmetry [2]
(GIofBS, Figure 2), used in paediatrics, may be a simple clinical measurement
tool to facilitate the postural monitoring process in adults with CP however its
clinical utility in this population is unknown. This study aimed to describe the
postural status of adults with CP (GMFCS IV and V) using the GIofBS and
compare to normative data on young adults with no movement disorders.
Figure 1. Windsweeping to the left
STUDY DESIGN
Case control study
PARTICIPANTS AND SETTING
Participants were 23 adults with CP (GMFCS IV and V) (mean age 23 years,
range 17-38), attending an outpatient tertiary clinic, and 48 healthy peers
without movement disorders (mean age 23 years, range 18-34).
METHODS
All participants underwent a single measurement of spinal and pelvic/hip
alignment using the GIofBS. A Windsweeping Index (indicative of severity of
overall postural asymmetry), chest right/left ratio (thoracic symmetry), and a
chest depth/width ratio (thoracic shape) were calculated. Descriptive analyses
were utilised with non-parametric group comparisons.Contact: carlee.holmes@svha.org.au
RESULTS
The windsweeping index for participants with CP was Md 10.5 (IQR 23.6),
compared to healthy peers Md 2.9 (IQR 3.7) (Figure 3). A Mann Whitney U test
demonstrated a significant difference between the two groups (p<0.000). There
were no significant differences (p>0.05) between the two groups for chest
right/left ratio (Md CP: 0.99; healthy peers: 1.02) and chest depth/width ratio
(Md CP 0.65; healthy peers 0.60).
CONCLUSIONS
The GIofBS measurement procedure is well tolerated by adults with
significant physical disability. There was a significant difference in the
windsweeping index for those with CP compared to healthy adults. The
GIofBS appears able to identify and quantify the degree of windsweeping
in this population, making it potentially suitable for use in regular clinical
monitoring and for future evaluation of the efficacy of interventions to
manage postural asymmetry. Further investigation regarding the value of
GIofBS to describe thoracic shape and thoracic asymmetry is warranted.
REFERENCES1. Palisano, R. (1997). Gross motor function classification system for cerebral palsy. Developmental Medicine
and Child Neurology, 39, 214-223. 2. Goldsmith, E., Golding, R., Garstang, R., & Macrae, W. (1992). A technique to measure windswept
deformity. Physiotherapy, 78(4), 235-242. 3. Simple Stuff Works. (2018). Anatomical Measuring Instrument Goldsmith Indices of Body Symmetry
Retrieved from http://www.measurepositionprotect.com
Figure 3 Windsweeping Index Box contains median (centre line) and 50% of cases
(Q1-Q2). Outliers (>1.5x IQR) are indicated by circles and extreme values (3x IQR) by
asterisks.
Subjects Windsweeping Index
Md (range)
Chest Left /Right Ratio
Md (range)
Chest Depth/Width Ratio
Md (range)
CP n = 23
10.5
(0.8 – 81.0)
0.99
(0.69 – 1.30)
0.65
(0.50 – 0.80)
Peersn = 48
2.9
(0.0 – 14.3)
1.02
(0.86 – 1.27)
0.60
(0.52 – 0.75)
Between group
significance
P < 0.000 P >0.05 P >0.05
Figure 2 GIofBS Anatomical Measuring
Instrument [3]
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