Patterns of postural deformity in non-ambulant people with cerebral palsy: what is the relationship between the direction of scoliosis, direction of pelvic obliquity, direction of windswept hip deformity and side of hip dislocation?
OBJECTIVE
To investigate: (a) associations between the direction of scoliosis, direction of pelvic obliquity, direction of windswept deformity and side of hip subluxation/ dislocation in non-ambulant people with cerebral palsy; and (b) the lateral distribution of these postural asymmetries.


METHODS
Cross-sectional observational study.


METHODS
Posture management services in three centres in the UK.


METHODS
Non-ambulant people at level five on the gross motor function classification system for cerebral palsy.


METHODS
Direction of pelvic obliquity and lateral spinal curvature determined from physical examination, direction of windswept hip deformity derived from range of hip abduction/adduction, and presence/side of unilateral hip subluxation defined by hip migration percentage.


RESULTS
A total of 747 participants were included in the study, aged 6-80 years (median 18 years 10 months). Associations between the direction of scoliosis and direction of pelvic obliquity, and between the direction of windswept hip deformity and side hip subluxation/dislocation were confirmed. A significant association was also seen between the direction of scoliosis and the direction of the windswept hip deformity (P<0.001) such that the convexity of the lateral spinal curve was more likely to be opposite to the direction of windsweeping. Furthermore, significantly more windswept deformities to the right (P=0.007), hips subluxed on the left (P=0.002) and lateral lumbar/lower thoracic spinal curves convex to the left (P=0.03) were observed.


CONCLUSIONS
The individual asymmetrical postural deformities are not unrelated in terms of direction and not equally distributed to the left/right. A pattern of postural deformity was observed.
Porter
David
D
School of Health & Social Care, Oxford Brookes University, Oxford, UK. dporter@brookes.ac.uk
Michael
Shona
S
Kirkwood
Craig
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002547:Cerebral Palsy / Q000150:complications / Q000503:physiopathology*; D002648:Child; D015331:Cohort Studies; D005260:Female; D006429:Hemiplegia / Q000503:physiopathology*; D006617:Hip Dislocation / Q000209:etiology / Q000503:physiopathology; D006621:Hip Joint / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000503:physiopathology*; D011187:Posture; D012600:Scoliosis / Q000209:etiology / Q000503:physiopathology*