Seating system for scoliosis in nonambulatory children with cerebral palsy: a randomized controlled trial

Korkmaz, Merve Damla; Korkmaz, Murat; Capan, Nalan; Sanli, Goktug; Tatar, Yasar; Aydin, Ayse Resa

doi:10.1590/1806-9282.20211260

Acessibilidade / Reportar erro

Brasil

Revista da Associação Médica Brasileira

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. Assoc. Med. Bras. 68 (5) • May 2022 • https://doi.org/10.1590/1806-9282.20211260 copy

Seating system for scoliosis in nonambulatory children with cerebral palsy: a randomized controlled trial

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

This study aimed to investigate the effect of an adaptive seating system on pelvic obliquity and spinal coronal/sagittal balance in children with nonambulatory cerebral palsy and scoliosis.

METHODS:

This was a single-blind, prospective, randomized interventional study. Nonambulatory children aged 6–15 years with cerebral palsy and scoliosis were included. The seating system was used for 4 h/day, and exercises were performed 3 days/week for 12 weeks. The Cobb angle, spinopelvic parameters, pelvic obliquity, Reimer's migration index, and Sitting Assessment Scale were measured before and after treatments.

RESULTS:

A total of 29 participants were randomized into two groups, namely, the seating system+exercise group (SSE-group; n=15) and the exercise group (E-group; n=14). There was no significant change in Cobb angle and Reimer's migration index for both hips in SSE-group, but there was a significant increase in E-group (p=0.002, 0.049, and 0.003, respectively). The sagittal vertical axis, pelvic incidence, and pelvic obliquity decreased in SSE-group. However, there was no difference in the other sagittal parameters and Sitting Assessment Scale-total scores among groups.

CONCLUSION:

The adaptive seating system was found to be superior in reducing the progression of Cobb angle and hip subluxation/dislocation, decreasing pelvic obliquity, and improving the sagittal balance of the spine/pelvis compared with exercise therapy.

KEYWORDS:
Cerebral palsy; Sitting; Scoliosis; Spine; Pelvis

Variable		SSE-group (n=15)	E-group (n=14)	p-value
Age (year)		9.67 (0.55)	10.86 (0.56)	0.084
Sex (male/female)		10/5	7/7	0.3
Type of CP
	Spastic	14	13
	Dyskinetic	1	1
Tanner stages				0.51
	Stage 1	9	5
	Stage 2	3	3
	Stage 3	2	3
	Stage 4	1	3
	Stage 5	0	0
In puberty		3	7
GMFCS levels				0.591
	Level IV	4	2
	Level V	11	12
Risser sign				0.51
	Level 0	11	7
	Level 1	2	2
	Level 2	2	3
	Level 3	–	2

			SSE-group (n=15)	E-group (n=14)	p-value ^b b p-value by Wilcoxon signed-rank test or paired samples t-test.
			Mean (SD)	Mean (SD)
Cobb angle (°)
	BT		23.77 (12.98)	26.31 (9.99)	0.001^* * p<0.05, statistically significant difference.
	PT		21.52 (11.64)	30.46 (12.10)
	p-value ^a a p-value by Mann-Whitney U test or independent t-test.		0.088	0.002
Pelvic obliquity (°)
	BT		6.46 (3.15)	7.39 (4.28)	0.002^* * p<0.05, statistically significant difference.
	AT		4.39 (2.34)	9.74 (5.49)
	p-value ^a a p-value by Mann-Whitney U test or independent t-test.		0.013	0.074
Thoracic kyphosis (°)
	BT		33.75 (11.95)	41.07 (9.97)	0.354
	AT		36.91 (14.47)	40.94 (10.98)
	p-value ^a a p-value by Mann-Whitney U test or independent t-test.		0.307	0.975
Lumbar lordosis (°)
	BT		36.25 (9.90)	36.16 (9.43)	0.847
	AT		40.43 (13.59)	37.90 (8.21)
	p-value ^a a p-value by Mann-Whitney U test or independent t-test.		0.691	0.451
Sagittal vertical axis (mm)
	BT		10.93 (7,46)	13.48 (6.58)	0.033^* * p<0.05, statistically significant difference.
	AT		8.02 (7,13)	15.26 (8.89)
	p-value ^a a p-value by Mann-Whitney U test or independent t-test.		0.016	0.331
Pelvic tilt (°)
	BT		20.99 (13.62)	13.37 (7.86)	0.747
	AT		18.69 (11.8)	13.5 (8.87)
	p-value ^a a p-value by Mann-Whitney U test or independent t-test.		0.910	0.826
Sacral slope (°)
	BT		31.04 (14.93)	31.84 (11.4)	0.270
	AT		27.16 (12.39)	33.1 (12.31)
	p-value ^a a p-value by Mann-Whitney U test or independent t-test.		0.100	0.802
Pelvic incidence (°)
	BT		52.4 (11.9)	45.22 (11.34)	0.037^* * p<0.05, statistically significant difference.
	AT		45.46 (10.33)	46.6 (5.97)
	p-value ^a a p-value by Mann-Whitney U test or independent t-test.		0.011	1.000
Reimer's migration ındex (%)
	Right hip
		BT	26.27 (11.20)	22.85 (7.65)	0.026^* * p<0.05, statistically significant difference.
		AT	24.80 (10.28)	28.29 (8.65)
		p-value ^a a p-value by Mann-Whitney U test or independent t-test.	0.345	0.049
	Left hip
		BT	39.80 (22,28)	32.43 (9.70)	0.001^* * p<0.05, statistically significant difference.
		AT	37.00 (24,19)	40.28 (9.42)
		p-value ^a a p-value by Mann-Whitney U test or independent t-test.	0.310	0.003
Sitting Assessment Scale
	Head control
		BT	2.9 (1.1)	2.1 (0.8)	0.561
		AT	3.0 (1.0)	2.1 (0.8)
		p-value^a a p-value by Mann-Whitney U test or independent t-test.	0.317	0.317
	Trunk control
		BT	1.9 (0.9)	1.5 (0.7)	0.384
		AT	3.0 (1.1)	1.8 (0.9)
		p-value^a a p-value by Mann-Whitney U test or independent t-test.	0.008	0.046
	Foot control
		BT	1.5 (0.6)	1.1 (0.4)	0.642
		AT	1.7 (1.0)	1.3 (0.5)
		p-value^a a p-value by Mann-Whitney U test or independent t-test.	0.102	0.157
	Arm control
		BT	2.2 (0.8)	1.6 (0.6)	0.030^* * p<0.05, statistically significant difference.
		AT	2.7 (0.9)	1.7 (0.7)
		p-value^a a p-value by Mann-Whitney U test or independent t-test.	0.005	0.157
	Hand control
		BT	1.6 (0.7)	1.3 (0.6)	0.003^* * p<0.05, statistically significant difference.
		AT	2.5 (1.0)	1.4 (0.6)
		p-value^a a p-value by Mann-Whitney U test or independent t-test.	0.006	0.317
	Total score
		BT	10.1 (3.3)	7.6 (2.7)	0.072
		AT	12.2 (4.4)	8.3 (2.9)
		p-value^a a p-value by Mann-Whitney U test or independent t-test.	0.002	0.026

Associação Médica Brasileira R. São Carlos do Pinhal, 324, 01333-903 São Paulo SP - Brazil, Tel: +55 11 3178-6800, Fax: +55 11 3178-6816 - São Paulo - SP - Brazil
E-mail: ramb@amb.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] *Corresponding author: mervedml@gmail.com