Influence of gait analysis on decision-marketing for lower extremity surgery

Children with severe cerebral palsy living in residential care are larger than similar children living at home

RC HENDERSON MD PHD A, R I GROSSBERG MD B, J MATUSZEWKI
BS A, N MENON BA A, J JOHNSON MD C, H H KECSKEMETHY RD CSP D,
L VOGEL MS PT PCS C, R RAVAS PT MS B, M WYATT MPT B, S J
BACHRACH MD E, R D STEVENSON MD F

  1. 1. Department of Orthopaedics and Pediatrics, University of North Carolina, Chapel Hill, NC;
  2. 2. Hattie Larlham Center for Children with Disabilities, Mantua, OH;
  3. 3. Children’s Care Hospital and School, Sioux Falls, SD;
  4. 4. AI DuPont Hospital for Children, Wilmington, DE;
  5. 5. HMS School for Children with Cerebral Palsy, Philadelphia, PA;
  6. 6. Department of Pediatrics, University of Virginia, Charlottesville, VA, USA

Objective: To describe differences in growth among non-ambulatory adolescents (<19y) with cerebral palsy (CP) living in residential centers compared with similar adolescents living at home.

Design: Multicenter, cross-sectional, observational study.

Participants: Seventy-five participants with quadriplegic CP living in three residential care facilities compared with 205 similar participants living at home.

Method: Medical history and detailed anthropometric assessment were obtained. Primary outcome measures included anthropometric measures of height (estimated from knee height), weight, triceps and subscapular skinfolds, and mid upper-arm muscle area. Z-scores were calculated from reference values for normally developing children. Age, use of a feeding tube, and Gross Motor Functional Classification System (GMFCS) level were included as important confounders. All participants were GMFCS Level IV or V.

Results: In a simple comparison, the residential participants had lower height z-scores, higher triceps (p<0.001), and subscapular (p=0.09) skinfolds, and similar weight and mid-upper arm muscle area (not significant) than children living at home. However, children in residential care were more likely to be older (mean age 13y vs 9y6mo; p<0.0001), more severely impaired at GMFCS Level V (p=0.0004), and gastronomy tube-fed (p<0.0001). In univariate analyses, age, GMFCS level, and tube feeding were also significantly associated with growth (either negatively or positively). Because of these confounders, data from all participants were combined for multivariate analyses to evaluate the independent association of each factor with growth. Tube feeding had a significant and independent positive association with skin-folds’ z-scores. Worsening GMFCS was negatively associated with weight, triceps skinfold, and arm muscle area z-scores. Surprisingly, residential living was associated with significantly greater height, weight, skinfold thickness, and mid-arm muscle area z-scores. Furthermore, living situation was also the factor most strongly associated positively with height, weight, and skinfold z-scores when the analyses were repeated on the subset of participants not tube fed or the subset at GMFCS Level V.

Conclusions: Controlling for age, gross motor functional severity, and use of a feeding tube, children with severe CP in residential care were larger compared with similar children living at home. The reasons for these findings are unclear, but recent research suggests that larger growth may be associated with better health. Further work should focus on care practices that improve health and well-being along with growth, and the necessary resources needed to provide that care.

 
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