Anatomical and dynamic rotational alignment in spastic unilateral cerebral palsy
•Internal hip rotation is common even in mild unilateral CP.•Internal hip rotation is compensated by pelvic external rotation in unilateral CP.•Symmetrical foot progression overrules the neurological involvement. Even in mild unilateral cerebral palsy increased internal hip rotation can be noted on...
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| description | •Internal hip rotation is common even in mild unilateral CP.•Internal hip rotation is compensated by pelvic external rotation in unilateral CP.•Symmetrical foot progression overrules the neurological involvement.
Even in mild unilateral cerebral palsy increased internal hip rotation can be noted on physical- and gait examination. The influence of spasticity on femoral growth in the transverse plane is not clear. These deviations and asymmetry in movement pattern may negatively affect efficiency of gait and cause psychological concerns about appearance.
Is increased internal hip rotation on the involved side in mild unilateral CP common and is there compensatory external pelvic rotation to keep foot progression symmetrical?
This prospective study included 45 individuals with unilateral cerebral palsy, mean age 17.7 (13.0−24.0) years. All were Gross Motor Function Classification Level I. Physical examination, three-dimensional gait analysis and magnetic resonance imaging for assessment of rotational alignment was performed.
On physical examination internal hip rotation was mean 50.6 (SD 10.4) degrees on the involved side and 44.3 (SD 10.3) on the non-involved side, p = 0.001.
In gait analysis calculating the whole gait cycle, internal hip rotation was mean 2.3 (6.2) degrees on the involved side, and on the non-involved side external 1.8 (7.6) degrees, p = 0.004.
Increased external pelvic rotation was noted on the involved side, mean 2.0 (4.3) degrees with corresponding internal rotation on the non-involved side, mean 3.6 (4.4), p = 0.001. There was no difference in foot progression, p = 0.067, with mean 5.1 (8.6) and 3.9 (6.4) external respectively.
Magnetic resonance imaging revealed femoral torsion on the involved side mean 17.3 (11.3) degrees compared to 11.4 (10.8) on the non-involved side, p = 0.001.
Transverse plane asymmetry in the femur was noted in mild unilateral cerebral palsy. Increased anatomical and dynamic internal rotation was compensated for by external pelvic rotation. Rotational malalignment may contribute to gait deviations in this mild group and should be part of the overall assessment. |
| doi_str_mv | 10.1016/j.gaitpost.2020.07.010 |
| format | Article |
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Even in mild unilateral cerebral palsy increased internal hip rotation can be noted on physical- and gait examination. The influence of spasticity on femoral growth in the transverse plane is not clear. These deviations and asymmetry in movement pattern may negatively affect efficiency of gait and cause psychological concerns about appearance.
Is increased internal hip rotation on the involved side in mild unilateral CP common and is there compensatory external pelvic rotation to keep foot progression symmetrical?
This prospective study included 45 individuals with unilateral cerebral palsy, mean age 17.7 (13.0−24.0) years. All were Gross Motor Function Classification Level I. Physical examination, three-dimensional gait analysis and magnetic resonance imaging for assessment of rotational alignment was performed.
On physical examination internal hip rotation was mean 50.6 (SD 10.4) degrees on the involved side and 44.3 (SD 10.3) on the non-involved side, p = 0.001.
In gait analysis calculating the whole gait cycle, internal hip rotation was mean 2.3 (6.2) degrees on the involved side, and on the non-involved side external 1.8 (7.6) degrees, p = 0.004.
Increased external pelvic rotation was noted on the involved side, mean 2.0 (4.3) degrees with corresponding internal rotation on the non-involved side, mean 3.6 (4.4), p = 0.001. There was no difference in foot progression, p = 0.067, with mean 5.1 (8.6) and 3.9 (6.4) external respectively.
Magnetic resonance imaging revealed femoral torsion on the involved side mean 17.3 (11.3) degrees compared to 11.4 (10.8) on the non-involved side, p = 0.001.
Transverse plane asymmetry in the femur was noted in mild unilateral cerebral palsy. Increased anatomical and dynamic internal rotation was compensated for by external pelvic rotation. Rotational malalignment may contribute to gait deviations in this mild group and should be part of the overall assessment.</description><identifier>ISSN: 0966-6362</identifier><identifier>ISSN: 1879-2219</identifier><identifier>EISSN: 1879-2219</identifier><identifier>DOI: 10.1016/j.gaitpost.2020.07.010</identifier><identifier>PMID: 32738739</identifier><language>eng</language><publisher>England: Elsevier B.V</publisher><subject>Adolescent ; Adult ; anatomical variation ; Biomechanical Phenomena - physiology ; cerebral palsy ; Cerebral Palsy - physiopathology ; clinical article ; clinical assessment ; Female ; Femoral torsion ; foot ; Foot progression ; Gait ; gait disorder ; Gross Motor Function Classification System ; hip ; human ; Humans ; joint mobility ; Magnetic resonance imaging ; Male ; Medicin och hälsovetenskap ; Muscle Spasticity - physiopathology ; nuclear magnetic resonance imaging ; Orthopedics ; Ortopedi ; Pelvic rotation ; pelvis ; Physical examination ; priority journal ; Prospective Studies ; prospective study ; rotation ; spasticity ; three-dimensional imaging ; torsion ; Unilateral cerebral palsy ; Young Adult</subject><ispartof>Gait & posture, 2020-09, Vol.81, p.153-158</ispartof><rights>2020 Elsevier B.V.</rights><rights>Copyright © 2020 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c494t-f45ee55650d8408c572619a810f2b69d5e93a8686aa89fd77c3588b51c36a2f73</citedby><cites>FETCH-LOGICAL-c494t-f45ee55650d8408c572619a810f2b69d5e93a8686aa89fd77c3588b51c36a2f73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.gaitpost.2020.07.010$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32738739$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://gup.ub.gu.se/publication/297501$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:144577188$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Riad, Jacques</creatorcontrib><creatorcontrib>Finnbogason, Thröstur</creatorcontrib><creatorcontrib>Broström, Eva</creatorcontrib><title>Anatomical and dynamic rotational alignment in spastic unilateral cerebral palsy</title><title>Gait & posture</title><addtitle>Gait Posture</addtitle><description>•Internal hip rotation is common even in mild unilateral CP.•Internal hip rotation is compensated by pelvic external rotation in unilateral CP.•Symmetrical foot progression overrules the neurological involvement.
Even in mild unilateral cerebral palsy increased internal hip rotation can be noted on physical- and gait examination. The influence of spasticity on femoral growth in the transverse plane is not clear. These deviations and asymmetry in movement pattern may negatively affect efficiency of gait and cause psychological concerns about appearance.
Is increased internal hip rotation on the involved side in mild unilateral CP common and is there compensatory external pelvic rotation to keep foot progression symmetrical?
This prospective study included 45 individuals with unilateral cerebral palsy, mean age 17.7 (13.0−24.0) years. All were Gross Motor Function Classification Level I. Physical examination, three-dimensional gait analysis and magnetic resonance imaging for assessment of rotational alignment was performed.
On physical examination internal hip rotation was mean 50.6 (SD 10.4) degrees on the involved side and 44.3 (SD 10.3) on the non-involved side, p = 0.001.
In gait analysis calculating the whole gait cycle, internal hip rotation was mean 2.3 (6.2) degrees on the involved side, and on the non-involved side external 1.8 (7.6) degrees, p = 0.004.
Increased external pelvic rotation was noted on the involved side, mean 2.0 (4.3) degrees with corresponding internal rotation on the non-involved side, mean 3.6 (4.4), p = 0.001. There was no difference in foot progression, p = 0.067, with mean 5.1 (8.6) and 3.9 (6.4) external respectively.
Magnetic resonance imaging revealed femoral torsion on the involved side mean 17.3 (11.3) degrees compared to 11.4 (10.8) on the non-involved side, p = 0.001.
Transverse plane asymmetry in the femur was noted in mild unilateral cerebral palsy. Increased anatomical and dynamic internal rotation was compensated for by external pelvic rotation. Rotational malalignment may contribute to gait deviations in this mild group and should be part of the overall assessment.</description><subject>Adolescent</subject><subject>Adult</subject><subject>anatomical variation</subject><subject>Biomechanical Phenomena - physiology</subject><subject>cerebral palsy</subject><subject>Cerebral Palsy - physiopathology</subject><subject>clinical article</subject><subject>clinical assessment</subject><subject>Female</subject><subject>Femoral torsion</subject><subject>foot</subject><subject>Foot progression</subject><subject>Gait</subject><subject>gait disorder</subject><subject>Gross Motor Function Classification System</subject><subject>hip</subject><subject>human</subject><subject>Humans</subject><subject>joint mobility</subject><subject>Magnetic resonance imaging</subject><subject>Male</subject><subject>Medicin och hälsovetenskap</subject><subject>Muscle Spasticity - physiopathology</subject><subject>nuclear magnetic resonance imaging</subject><subject>Orthopedics</subject><subject>Ortopedi</subject><subject>Pelvic rotation</subject><subject>pelvis</subject><subject>Physical examination</subject><subject>priority journal</subject><subject>Prospective Studies</subject><subject>prospective study</subject><subject>rotation</subject><subject>spasticity</subject><subject>three-dimensional imaging</subject><subject>torsion</subject><subject>Unilateral cerebral palsy</subject><subject>Young Adult</subject><issn>0966-6362</issn><issn>1879-2219</issn><issn>1879-2219</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1v1DAQhi0EotvCX6hy5JLUduKvG1XFl1QJDnC2HHuy8pI4wXZA--9xtLvlBJxmPPO871h6EboluCGY8LtDszc-L3PKDcUUN1g0mOBnaEekUDWlRD1HO6w4r3nL6RW6TumAMe5aSV-iq5aKVopW7dCX-2DyPHlrxsoEV7ljMOVVxTmb7OewjUe_DxOEXPlQpcWkXPZr8KPJEMveQoR-axYzpuMr9GIoFV6f6w369v7d14eP9ePnD58e7h9r26ku10PHABjjDDvZYWmZoJwoIwkeaM-VY6BaI7nkxkg1OCFsy6TsGbEtN3QQ7Q2qT77pFyxrr5foJxOPejZen0ffSwe644pKXHj1V36Js_sjughJ1zEhiJT_vLVfF11G-3WTUCUYJoV_c-KL8Y8VUtaTTxbG0QSY16RpV0DBKd6-xU-ojXNKEYYnc4L1lrQ-6EvSektaY6FL0kV4e76x9hO4J9kl2gK8PQFQUvjpIepkPQQLzkewWbvZ_-_Gb2LAv_M</recordid><startdate>20200901</startdate><enddate>20200901</enddate><creator>Riad, Jacques</creator><creator>Finnbogason, Thröstur</creator><creator>Broström, Eva</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>F1U</scope></search><sort><creationdate>20200901</creationdate><title>Anatomical and dynamic rotational alignment in spastic unilateral cerebral palsy</title><author>Riad, Jacques ; Finnbogason, Thröstur ; Broström, Eva</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c494t-f45ee55650d8408c572619a810f2b69d5e93a8686aa89fd77c3588b51c36a2f73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>anatomical variation</topic><topic>Biomechanical Phenomena - physiology</topic><topic>cerebral palsy</topic><topic>Cerebral Palsy - physiopathology</topic><topic>clinical article</topic><topic>clinical assessment</topic><topic>Female</topic><topic>Femoral torsion</topic><topic>foot</topic><topic>Foot progression</topic><topic>Gait</topic><topic>gait disorder</topic><topic>Gross Motor Function Classification System</topic><topic>hip</topic><topic>human</topic><topic>Humans</topic><topic>joint mobility</topic><topic>Magnetic resonance imaging</topic><topic>Male</topic><topic>Medicin och hälsovetenskap</topic><topic>Muscle Spasticity - physiopathology</topic><topic>nuclear magnetic resonance imaging</topic><topic>Orthopedics</topic><topic>Ortopedi</topic><topic>Pelvic rotation</topic><topic>pelvis</topic><topic>Physical examination</topic><topic>priority journal</topic><topic>Prospective Studies</topic><topic>prospective study</topic><topic>rotation</topic><topic>spasticity</topic><topic>three-dimensional imaging</topic><topic>torsion</topic><topic>Unilateral cerebral palsy</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Riad, Jacques</creatorcontrib><creatorcontrib>Finnbogason, Thröstur</creatorcontrib><creatorcontrib>Broström, Eva</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Göteborgs universitet</collection><jtitle>Gait & posture</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Riad, Jacques</au><au>Finnbogason, Thröstur</au><au>Broström, Eva</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Anatomical and dynamic rotational alignment in spastic unilateral cerebral palsy</atitle><jtitle>Gait & posture</jtitle><addtitle>Gait Posture</addtitle><date>2020-09-01</date><risdate>2020</risdate><volume>81</volume><spage>153</spage><epage>158</epage><pages>153-158</pages><issn>0966-6362</issn><issn>1879-2219</issn><eissn>1879-2219</eissn><abstract>•Internal hip rotation is common even in mild unilateral CP.•Internal hip rotation is compensated by pelvic external rotation in unilateral CP.•Symmetrical foot progression overrules the neurological involvement.
Even in mild unilateral cerebral palsy increased internal hip rotation can be noted on physical- and gait examination. The influence of spasticity on femoral growth in the transverse plane is not clear. These deviations and asymmetry in movement pattern may negatively affect efficiency of gait and cause psychological concerns about appearance.
Is increased internal hip rotation on the involved side in mild unilateral CP common and is there compensatory external pelvic rotation to keep foot progression symmetrical?
This prospective study included 45 individuals with unilateral cerebral palsy, mean age 17.7 (13.0−24.0) years. All were Gross Motor Function Classification Level I. Physical examination, three-dimensional gait analysis and magnetic resonance imaging for assessment of rotational alignment was performed.
On physical examination internal hip rotation was mean 50.6 (SD 10.4) degrees on the involved side and 44.3 (SD 10.3) on the non-involved side, p = 0.001.
In gait analysis calculating the whole gait cycle, internal hip rotation was mean 2.3 (6.2) degrees on the involved side, and on the non-involved side external 1.8 (7.6) degrees, p = 0.004.
Increased external pelvic rotation was noted on the involved side, mean 2.0 (4.3) degrees with corresponding internal rotation on the non-involved side, mean 3.6 (4.4), p = 0.001. There was no difference in foot progression, p = 0.067, with mean 5.1 (8.6) and 3.9 (6.4) external respectively.
Magnetic resonance imaging revealed femoral torsion on the involved side mean 17.3 (11.3) degrees compared to 11.4 (10.8) on the non-involved side, p = 0.001.
Transverse plane asymmetry in the femur was noted in mild unilateral cerebral palsy. Increased anatomical and dynamic internal rotation was compensated for by external pelvic rotation. Rotational malalignment may contribute to gait deviations in this mild group and should be part of the overall assessment.</abstract><cop>England</cop><pub>Elsevier B.V</pub><pmid>32738739</pmid><doi>10.1016/j.gaitpost.2020.07.010</doi><tpages>6</tpages></addata></record> |
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| subjects | Adolescent Adult anatomical variation Biomechanical Phenomena - physiology cerebral palsy Cerebral Palsy - physiopathology clinical article clinical assessment Female Femoral torsion foot Foot progression Gait gait disorder Gross Motor Function Classification System hip human Humans joint mobility Magnetic resonance imaging Male Medicin och hälsovetenskap Muscle Spasticity - physiopathology nuclear magnetic resonance imaging Orthopedics Ortopedi Pelvic rotation pelvis Physical examination priority journal Prospective Studies prospective study rotation spasticity three-dimensional imaging torsion Unilateral cerebral palsy Young Adult |
| title | Anatomical and dynamic rotational alignment in spastic unilateral cerebral palsy |
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