Cerebral Palsy Hip pathology
What it is
Cerebral Palsy CP is a non-progressive and permanent neurological disorder of the upper level of the nervous system (brain) that affects the motor skills of the affected person.
What causes it
The most common cause for CP is hypoxia, issues with blood flow to the brain which is very sensitive when oxygen is not delivered to it. It can also be caused by traumatic or infection injury to the brain in the developing early stages of life.
Different types
There are different types, depending on the cause and also time of onset. There are also syndromic-genetic types which manifest like CP. In general, no child is the same and the variability of CP is vast.
Symptoms
Symptoms are highly variable depending on the type of CP, neuro-motor involvement can be symmetrical or not and affect the lower limbs or all four at the same time.Most concerning symptoms relate to increased muscle tone and persistent pain secondary to that. Other symptoms are triggered by secondary joint deformities developing arthritic changes, wear and tear.
How it can be diagnosed
CP is diagnosed through a thorough clinical assessment however the gold standard method to diagnose CP is with cross-sectional imaging in the form of a brain MRI. A paediatrician or neurologist will be most suited to make this initial assessment.
Possible complications
These mainly relate to long term disability and the secondary deformities that children can acquire as a result of the imbalance created by the muscle pull around joints. If joints become off-centred, they can develop painful arthritic changes.
Treatment options
non-surgical and surgical.Depending on the severity of deformities and functional abilities but also on the family goals, these details can be discussed with your paediatric orthopaedic consultant in the clinical setting.
Recovery
This is an essential part of any treatment carried out for children with CP and needs to be carefully prepared from the very onset of any treatment method carried out. The success of any option of treatment is directly linked to the time and quality of physiotherapy and occupational input the child has during their growth.
How it can be prevented
It is difficult to prevent cerebral palsy but we can prevent or reduce the risk of onset of pain and decreased function by careful assessment and planning.
Children with cerebral palsy or any other neurological pathology with acquired deformities have the risk of their hips becoming unstable during their growth. It is well accepted that the more the child mobilises, the less the risk of the hips migrating outside of the joint.
Walking children have a significant lower risk of their hips migrating and becoming with time painful.
Hips that become unstable and come out of the joints, will have a higher risk of acquiring degenerative changes and becoming painful, further decreasing the child’s quality of life.
The best method of ensuring the good health of the child’s hips is to monitor them regularly via a well established network of physiotherapists in the community (Cerebral Palsy Integrated Pathway) and reviews from the paediatricians. If any range of movement parameter is found to be abnormal, it is then the role of the cerebral palsy specialists to review these children for early management. The younger the age, the better to have the most efficient impact with the least intervention.