Postural asymmetry in non-ambulant adults with cerebral palsy: a scoping review

• Published in: Disability and rehabilitation Vol. 41; no. 9; pp. 1079 - 1088
• Main Authors: Holmes, Carlee, Brock, Kim, Morgan, Prue
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 24-04-2019
• Subjects: Cerebral palsy; Cerebral Palsy - physiopathology; Contracture - physiopathology; deformity; Hip Contracture - physiopathology; Hip Joint - physiopathology; Humans; Knee Joint - physiopathology; migration percentage; posture; Posture - physiology; scoliosis; Scoliosis - physiopathology; windswept; deformity; Cerebral palsy; windswept; posture; scoliosis; migration percentage
• ISSN: 0963-8288; 1464-5165
• DOI: 10.1080/09638288.2017.1422037

Purpose: Non-ambulant adults with cerebral palsy are vulnerable to development of postural asymmetry and associated complications. The primary aim of this scoping review was to identify postural deformities in non-ambulant adults with cerebral palsy.
Materials and methods: Comprehensive searches were undertaken in EMBASE, CINAHL, AMED, Cochrane, Psych INFO, and Joanna Briggs (1986-Jan 2017), supplemented by hand searching. Two reviewers independently extracted data using a customised tool focusing on study design, participant characteristics, postural descriptors, measurement tools, and interventions.
Results: From 2546 potential records, 17 studies were included. Variability in populations, reporting methodology, and measurement systems was evident. Data suggest more than 30% of this population have hip migration percentage in excess of 30%, more than 75% experience "scoliosis", and more than 40% demonstrate pelvic obliquity. Estimates ranged from 14% to 100% hip and 32% to 87% knee contracture incidence. Conservative interventions were infrequently and poorly described.
Conclusion: Many non-ambulant adults with cerebral palsy experience postural asymmetry associated with windswept hips, scoliosis, pelvic obliquity, and limb contracture. Options for non-radiographic monitoring of postural asymmetry should be identified, and conservative interventions formally were evaluated in this population.
Implications for rehabilitation
The common postural asymmetries of windswept hips, scoliosis, pelvic obliquity, and limb contracture require standardised clinical measurement.
Radiography is most commonly used to monitor postural asymmetry in this population, but standardised positioning is not applied and may not be feasible indicating a need for alternate methods and rigorous documentation.
The Posture and Postural Ability Scale may be considered for use in the management of body shape in adults with CP.