Situación de la articulación de la cadera en pacientes adultos con parálisis cerebral / Hip joint status in adult patients with cerebral palsy

Introducción: En parálisis cerebral, la migración de la cabeza femoral se define como la pérdida de cobertura de esta por parte del acetábulo y se mide mediante el índice de Reimer. El tratamiento quirúrgico puede ser preventivo, reconstructivo o de salvamento, siendo los índices de fracaso de la cirugía elevados y relacionados con la severidad de la parálisis cerebral. El objetivo de nuestro trabajo es obtener la incidencia de la migración de caderas en nuestra serie de pacientes adultos con parálisis cerebral, determinar el resultado de las que han sido intervenidas quirúrgicamente y establecer la recurrencia que presentan las diversas técnicas quirúrgicas. Material y métodos: Se ha diseñado un estudio retrospectivo observacional para determinar el estado de las caderas de pacientes adultos con parálisis cerebral, que se han visitado en la Unidad entre los años 2008 y 2021. Resultados: La incidencia global de desplazamiento de la cadera fue de un 75%, aquellos pacientes con afectaciones más severas (GMFCS IV y V) tienen más predisposición a la luxación y además son más severas. Las cirugías sobre partes blandas constituyeron un 49,5% de las intervenciones realizadas con una tasa de fracaso de hasta el 82%. La cirugía reconstructiva se realizó en un 45,5% de las ocasiones, con un porcentaje de fracaso mayor al 86%. Conclusión: Actualmente, la implementación de programas de vigilancia de cadera pretende mejorar el seguimiento y las intervenciones aplicadas en el desplazamiento de la cadera, con el objetivo de mantener una cobertura acetabular óptima y, en todo caso, reducir la tasa de fracaso de las posibles cirugías.(AU)

Introduction: In cerebral palsy, femoral head migration is defined as the loss of coverage of the femoral head by the acetabulum and is measured using the Reimer index. Surgical treatment can be preventive, reconstructive, or salvage, and failure rates of surgery are high and related to the severity of cerebral palsy. The aim of our work is to assess the incidence of hip migration in our series of adult patients with cerebral palsy, to determine the outcome of those who have undergone surgery, and to establish recurrence rates after the various surgical techniques. Material and methods: We designed a retrospective observational study to determine the hip status of adult patients with cerebral palsy visiting the Unit between 2008 and 2021. Results: The overall incidence of hip displacement was 75%, patients with more extensive disability (GMFCS IV and V) were more predisposed to dislocation, also more severe. Soft tissue surgery made up 49.5% of the operations performed with a failure rate of up to 82%. Reconstructive surgery was performed in 45.5% of cases with a failure rate of more than 86%. Conclusion: The current hip surveillance programmes have been implemented to improve follow-up and interventions in hip displacement, with the objective of maintaining optimal acetabular coverage and reducing the failure rate of potential surgeries.(AU)

[Hip joint status in adult patients with cerebral palsy]. / Situación de la articulación de la cadera en pacientes adultos con parálisis cerebral.

INTRODUCTION: In cerebral palsy, femoral head migration is defined as the loss of coverage of the femoral head by the acetabulum and is measured using the Reimer index. Surgical treatment can be preventive, reconstructive, or salvage, and failure rates of surgery are high and related to the severity of cerebral palsy. The aim of our work is to assess the incidence of hip migration in our series of adult patients with cerebral palsy, to determine the outcome of those who have undergone surgery, and to establish recurrence rates after the various surgical techniques. MATERIAL AND METHODS: We designed a retrospective observational study to determine the hip status of adult patients with cerebral palsy visiting the Unit between 2008 and 2021. RESULTS: The overall incidence of hip displacement was 75%, patients with more extensive disability (GMFCS IV and V) were more predisposed to dislocation, also more severe. Soft tissue surgery made up 49.5% of the operations performed with a failure rate of up to 82%. Reconstructive surgery was performed in 45.5% of cases with a failure rate of more than 86%. CONCLUSION: The current hip surveillance programmes have been implemented to improve follow-up and interventions in hip displacement, with the objective of maintaining optimal acetabular coverage and reducing the failure rate of potential surgeries.

Proxy-reported quality of life in adolescents and adults with dyskinetic cerebral palsy is associated with executive functions and cortical thickness.

PURPOSE: Quality of life (QOL) is a key outcome for people with cerebral palsy (CP), and executive functioning is an important predictor of QOL in other health-related conditions. Little is known about this association in CP or about its neural substrate. We aim to analyze the influence of executive functioning (including cognitive flexibility) as well as that of other psychological, motor, communication and socioeconomic variables on QOL and to identify neuroanatomical areas related to QOL in adolescents and adults with CP. METHODS: Fifty subjects diagnosed with dyskinetic CP (mean age 25.96 years) were recruited. Their caregivers completed the primary caregiver proxy report version of the CP QOL-Teen questionnaire. Motor status, communication, IQ, four executive function domains, anxiety/depression and socioeconomic status were evaluated. Correlations and multiple linear regression models were used to relate CP QOL domains and total score to these variables. Thirty-six participants underwent an MRI assessment. Correlations were examined between cortical thickness and CP QOL total score and between cortical thickness and variables that might predict the CP QOL total score. RESULTS: Executive functions predict scores in four domains of CP QOL (General well-being and participation, Communication and physical health, Family health and Feelings about functioning) in the regression model. Among the cognitive domains that comprise executive function, only cognitive flexibility measured in terms of performance on the Wisconsin card sorting test (WCST) predicts the CP QOL total score. Monthly income, fine motor functioning and communication ability predict scores on the domains Access to services and Family Health, Feelings about functioning and School well-being, respectively. The clusters resulting from the correlation between cortical thickness and both CP QOL total score and WCST performance overlapped in the posterior cingulate and precuneus cortices. CONCLUSIONS: Cognitive flexibility predicts proxy report CP QOL-Teen total score in dyskinetic CP. This relationship has its anatomical correlate in the posterior cingulate and precuneus cortices.

Resultados tras cirugía multinivel en pacientes afectados de parálisis cerebral / Outcome after single-event multi-level surgery in patients with cerebral palsy

Objetivo. La cirugía multinivel de extremidades inferiores es un procedimiento que se lleva a cabo en pacientes afectados de parálisis cerebral (PC). El objetivo en pacientes deambulantes es mejorar el patrón de marcha y para los no deambulantes facilitar la realización de transferencias. El objetivo de nuestro estudio es cuantificar la mejora del patrón de marcha en pacientes intervenidos con esta técnica. Diseño. Estudio prospectivo de pacientes afectados de PC a los que se les ha practicado cirugía multinivel entre marzo del 2011 y marzo del 2013. Material y método. Se ha valorado a 11 pacientes sometidos a cirugía multinivel, cuantificando los cambios en la marcha tras la intervención quirúrgica, aplicando la Edinburgh Visual Gait Score (EVGS). También se han determinado los cambios en la velocidad de la marcha (pasos por segundo) y en la Gross Motor Function Classification System (GMFCS). Los pacientes han sido valorados entre un año y 2 después de la cirugía. Resultados. Se ha observado una mejora media de 9 puntos al aplicar la EVGS. En 8 pacientes no hay cambios en GMFCS y en 5 ha mejorado la velocidad de la marcha. Todos los pacientes que practicaban alguna modalidad de deporte adaptado la continúan realizando en la actualidad en las mismas condiciones. Conclusiones. Aunque se ha observado una mejora global en las puntuaciones de la EVGS y en la velocidad de la marcha, no se han evidenciado cambios en GMFCS. Aun así, la valoración por parte de la familia es satisfactoria. Necesitamos futuros estudios a largo plazo y con una muestra mayor para averiguar si la mejora observada se mantiene al final del crecimiento (AU)

Objective. Single-event multilevel surgery (SEMLS) of the lower limbs is a procedure for children with cerebral palsy (CP). Its aim is to improve gait pattern and/or facilitate transfers, according to the patient's walking ability. The aim of our study was to quantify the improvement in gait pattern in patients treated with this procedure. Design. Prospective study of patients with cerebral palsy who underwent SEMLS between March 2011 and March 2013. Material and method. We evaluated 11 patients who underwent SEMLS by quantifying gait changes after surgery, using the Edinburgh Visual Gait Score (EVGS). We determined changes in gait speed (steps per second) and in the Gross Motor Function Classification System (GMFCS). Patients were assessed at one and two years after surgery. Results. We observed an average improvement of 9 points when applying the EVGS. The GMFCS was unchanged in 8 patients, and gait speed improved in 5 patients. All patients who used to practice some kind of adapted sport are still doing so in the same conditions. Conclusions. Despite finding a global improvement in the EVGS and gait speed, no change was observed in the GMFCS. Nevertheless, family satisfaction was satisfactory. Future long-term studies with a larger number of patients are needed to check whether the improvement remains at the end of growth (AU)