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Article

Musculoskeletal Pathology in Cerebral Palsy: A Classification System and Reliability Study

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Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
2
Hugh Williamson Gait Laboratory, Royal Children’s Hospital, Parkville, VIC 3052, Australia
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Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
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Orthopaedic Department, The Royal Children’s Hospital, Parkville, VIC 3052, Australia
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Department of Orthopedic Surgery, Sophia Children’s Hospital, Erasmus MC, 3015GD Rotterdam, The Netherlands
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Orthopaedic Department, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK
*
Author to whom correspondence should be addressed.
Academic Editor: Libor Velíšek
Received: 2 February 2021 / Revised: 9 March 2021 / Accepted: 16 March 2021 / Published: 23 March 2021
(This article belongs to the Section Pediatric Surgery)
This article presents a classification of lower limb musculoskeletal pathology (MSP) for ambulant children with cerebral palsy (CP) to identify key features from infancy to adulthood. The classification aims to improve communication, and to guide referral for interventions, which if timed appropriately, may optimise long-term musculoskeletal health and function. Consensus was achieved by discussion between staff in a Motion Analysis Laboratory (MAL). A four-stage classification system was developed: Stage 1: Hypertonia: Abnormal postures are dynamic. Stage 2: Contracture: Fixed shortening of one or more muscle-tendon units. Stage 3: Bone and joint deformity: Torsional deformities and/or joint instability (e.g., hip displacement or pes valgus), usually accompanied by contractures. Stage 4: Decompensation: Severe pathology where restoration of optimal joint and muscle-tendon function is not possible. Reliability of the classification was tested using the presentation of 16 clinical cases to a group of experienced observers, on two occasions, two weeks apart. Reliability was found to be very good to excellent, with mean Fleiss’ kappa ranging from 0.72 to 0.84. Four-stages are proposed to classify lower limb MSP in children with CP. The classification was reliable in a group of clinicians who work together. We emphasise the features of decompensated MSP in the lower limb, which may not always benefit from reconstructive surgery and which can be avoided by timely intervention. View Full-Text
Keywords: cerebral palsy; musculoskeletal pathology; spasticity; contracture; deformity; decompensation cerebral palsy; musculoskeletal pathology; spasticity; contracture; deformity; decompensation
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MDPI and ACS Style

Graham, H.K.; Thomason, P.; Willoughby, K.; Hastings-Ison, T.; Stralen, R.V.; Dala-Ali, B.; Wong, P.; Rutz, E. Musculoskeletal Pathology in Cerebral Palsy: A Classification System and Reliability Study. Children 2021, 8, 252. https://0-doi-org.brum.beds.ac.uk/10.3390/children8030252

AMA Style

Graham HK, Thomason P, Willoughby K, Hastings-Ison T, Stralen RV, Dala-Ali B, Wong P, Rutz E. Musculoskeletal Pathology in Cerebral Palsy: A Classification System and Reliability Study. Children. 2021; 8(3):252. https://0-doi-org.brum.beds.ac.uk/10.3390/children8030252

Chicago/Turabian Style

Graham, H. K., Pam Thomason, Kate Willoughby, Tandy Hastings-Ison, Renee V. Stralen, Benan Dala-Ali, Peter Wong, and Erich Rutz. 2021. "Musculoskeletal Pathology in Cerebral Palsy: A Classification System and Reliability Study" Children 8, no. 3: 252. https://0-doi-org.brum.beds.ac.uk/10.3390/children8030252

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