title: Comparison of the ratio of upper to lower chest wall in children with spastic quadriplegic cerebral palsy and normally developed children.
abstract: The upper chest wall does not grow properly in children with spinal muscular atrophy (SMA) with paradoxical breathing. This suggests that long-term inability to take a deep breath in developing children may result in underdevelopment of the upper chest wall. In addition, a rapid and paradoxical breathing pattern is frequently observed in children with severe cerebral palsy (CP), which often corresponds to the underdevelopment of the upper chest wall. The present study is designed to evaluate the ratio of the upper to lower chest wall in children with severe spastic quadriplegic CP, compared with normal children. We compared normal children with children that had spastic quadriplegic CP who did not have kyphosis or scoliosis. Test subjects were matched in terms of age, height, and weight. The diameters of upper chest (D(apex)) and of lower chest (D(base)) were measured on the anteroposterior (AP) view of a chest X-ray and the D(apex) to D(base) ratio was calculated. In selected cases the forced vital capacity (FVC) was measured using a Wright Respirometer. The D(apex) to D(base) ratio was significantly lower in the CP group than in the control group (p < 0.001). The ratio increased linearly with age (p < 0.001) in both CP (R = 0.372) and control groups (R = 0.477). The FVC/preFVC showed significant correlation with the D(apex) to D(base) ratio (R = 0.542, p < 0.01). The results of this study suggest a deviation of optimal chest wall structure in children with spastic quadriplegic CP.
authors.affiliation: Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 134 Shinchon-dong, Seodamun-gu, Seoul 120-752, Korea. pes1234@yumc.yonsei.ac.kr
authors.forename: Eun Sook
authors.initials: ES
authors.lastname: Park
authors.forename: Jung Hyun
authors.initials: JH
authors.lastname: Park
authors.forename: Dong-Wook
authors.initials: DW
authors.lastname: Rha
authors.forename: Chang Il
authors.initials: CI
authors.lastname: Park
authors.forename: Chan Woo
authors.initials: CW
authors.lastname: Park
mesh_terms: D016022:Case-Control Studies; D002547:Cerebral Palsy / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000473:pathology; D008297:Male; D009128:Muscle Spasticity / Q000473:pathology*; D011782:Quadriplegia / Q000473:pathology*; D012119:Respiration; D012140:Respiratory Tract Diseases / Q000473:pathology* / Q000503:physiopathology; D035423:Thoracic Cavity; D035441:Thoracic Wall; D013997:Time Factors; D014797:Vital Capacity; D014965:X-Rays