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]