Prevention of hip dislocation in children with spastic paralysis by using a specific therapeutic wheelchair
Rehabilitation (Stuttg), 30 (3):
109--115 (August 1991)Abstract
The hip joints of children with spastic cerebral palsy, notably in those with more severe forms of paresis as well as those with bilateral or tetraparetic involvement, are in any case exposed to extraordinarily great risks. Totally inconspicuous at birth, constant dominance of the spastically contracting hip adductor and flexor muscles leads to gradually advancing malpositioning of the femoral heads, along with flattening of the hip socket and its eventual total destruction. Complete dislocation of the hip joints results, in very severely affected cases already at age 2-3, but in the majority of children only several years later. In this equally tragic as, on the other hand, almost invariably preventable maldevelopment, the wheelchair takes on a doubly crucial role. This, for one, has to do with the many hours the child has to spend in it every day. On account of the fact that the regular wheelchair, above all when "sportively styled", is forcing both legs, i.e. the thighs and lower legs as well as the feet, to adopt a strictly parallel position, it enhances, and accelerates, the highly undesirable development of spastic hip dislocation. If, however, the wheelchair is redesigned in an appropriate manner, i.e. provided with an abduction seating orthosis, along with laterally repositioned foot rests, it will in the majority of cases be possible to prevent the development of hip dislocation. Detailed guidelines to achieve this end are included, and instructions are given for adapting commercially available wheelchairs.