Are Seating Systems With a Medial Knee Support Really Helpful for Hip Displacement in Children With Spastic Cerebral Palsy GMFCS IV and V?

Arch Phys Med Rehabil. 2019 Feb;100(2):247-253. doi: 10.1016/j.apmr.2018.07.423. Epub 2018 Aug 10.


Objective: To evaluate whether medial knee support (MKS) in seating systems aggravates hip displacement in children with cerebral palsy (CP).

Design: Retrospective chart review.

Setting: Rehabilitation department of tertiary university hospital.

Participants: Children with CP (N=76) using seating systems (intervention group, n=42; mean age 6.86y) and using regular wheelchairs (control group, n=34; mean age 8.15y).

Interventions: The intervention group was provided with a seating system with MKS. We enrolled children who did not use a seating system in the control group, retrospectively.

Main outcome measures: By radiographic images, Reimer's migration index (MI), lateral center edge angle (CEA), and femur neck shaft angle (NSA) were measured. We compared the demographic data, clinical variables, and radiographs between the 2 groups.

Results: In the intervention group, there was a significant deterioration in the MI, from 26.89% to 44.18% after using the system (P<.001). The progression of MI was 14.72% and 7.82% per year in the intervention and control groups, respectively (P=.016).

Conclusion: We should consider the possibility that seating systems with MKS may exacerbate hip displacement in children with CP.

Keywords: Cerebral palsy; Hip dislocation; Rehabilitation; Technology; Wheelchair.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Biomechanical Phenomena
  • Cerebral Palsy / complications
  • Cerebral Palsy / rehabilitation*
  • Child
  • Child, Preschool
  • Disease Progression
  • Female
  • Hip Dislocation / complications
  • Hip Dislocation / diagnostic imaging
  • Hip Dislocation / rehabilitation*
  • Hospitals, University
  • Humans
  • Knee Joint / diagnostic imaging
  • Knee Joint / physiopathology*
  • Male
  • Retrospective Studies
  • Self-Help Devices*
  • Severity of Illness Index
  • Sex Factors
  • Sitting Position*
  • Socioeconomic Factors