Scoliosis in cerebral palsy

Abstract: BackgroundIndividuals with cerebral palsy (CP) have an increased risk for scoliosis, especially those with low gross motor function, affecting both quality of life and overall function. The aims were to increase the knowledge on the development of, and predictors for scoliosis and the use of spinal orthoses in individuals with CP, and also to evaluate the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) questionnaire to examine health-related quality of life (HRQoL).MethodThe CPCHILD was distributed to 123 families and analysed for validity and test–retest reliability (Study I). Studies II–IV were based on registry data from the Cerebral Palsy Follow-up Programme (CPUP). Incidence was analysed for scoliosis related to age, sex and level of gross motor function according to the Gross Motor Function Classification System (GMFCS) for 962 individuals born 1990–2012 in southern Sweden (Study II). The use of spinal orthoses was analysed for 2800 children aged 1–14 years in relation to age, sex, GMFCS level, degree of scoliosis, treatment goals and goal attainment (Study III). The risk for developing severe scoliosis after 5 years of age and before the age of 16—with predictors based on risk factors at the age of 5—was analysed for 654 children with CP (Study IV).ResultsThe CPCHILD showed good construct validity and ability to discriminate between GMFCS levels, and test–retest reliability was high for total and domain scores (Study I). The number of people with scoliosis increased up to 20–25 years of age, and incidence was related to age, sex and GMFCS level (Study II). The use of spinal orthoses increased with age and GMFCS level, functional goals were most common, and goal attainment was high (57–87%) (Study III). The predictive ability of the risk score was high with an area under the curve value of 0.874 (Study IV).ConclusionSurveillance programmes for scoliosis in CP should be based on age, GMFCS level and should be initiated at a young age and continued into adulthood. The individual risk factors can help to initiate and implement preventive interventions and strategies at an early stage. Children with postural deficits with or at risk for scoliosis should be given the opportunity to explore the functional benefits of a spinal orthosis. The CPCHILD appears to be a valid and reliable proxy-reported measure for HRQoL in children with CP.