Posture, postural ability and mobility in cerebral palsy
Abstract: Cerebral palsy (CP) is the most common cause of motor disability in children and adolescents with a prevalence of 2-3/1000. CP is characterized by disorders of posture and movement with impairments ranging from mild to severe. The ability to control posture is an important prerequisite for all voluntary movements. A sustained asymmetric posture predisposes to progressive deformities in people with CP, such as scoliosis, hip dislocations and contractures. The aim of this thesis was to enhance knowledge of posture, postural ability and mobility in people with CP, their use of assistive devices and also to evaluate a clinical tool for assessment of posture and postural ability. Study I-III were cross-sectional studies of 562 children with CP, aged 3-18 years, describing sitting, standing, sit-to-stand and the use of assistive devices, wheeled mobility, and walking performance according to the Functional Mobility Scale. The results were analyzed relative to the expanded and revised version of the Gross Motor Function Classification System (GMFCS), neurological subtype and age. Study IV was a cross-sectional study describing postural asymmetries and ability to change position in 102 young adults with CP aged 19-23 years; and the relation of posture to pain, range of motion, hip dislocation, scoliosis and ability to change position. Study V evaluated the psychometric properties of the Posture and Postural Ability Scale for adults with CP at GMFCS I-V. The GMFCS is a good predictor of sitting and standing performance. Powered wheelchairs provided independent mobility in most cases while few self-propelled their manual wheelchairs. To achieve a high level of independent mobility, powered wheelchairs should be considered at an early age for children with impaired walking ability. The number of children who walked without aids increased up to 7 years, but the proportion of children walking independently on uneven surfaces was incrementally higher in each age group up to 18 years. Postural asymmetries were associated with scoliosis, hip dislocation, hip and knee contractures, and inability to change position. The Posture and Postural Ability scale showed an excellent interrater reliability for experienced raters, a high internal consistency and construct validity. It can detect postural asymmetries in adults with CP at all levels of gross motor function.
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