The cerebral palsy transition clinic: administrative chore, clinical responsibility, or opportunity for audit and clinical research?

Abstract

Purpose: The majority of children with orthopaedic conditions in childhood survive to adult life, and there is a need for many of them to transition to adult services. This includes children with disorders such as club foot or developmental dislocation of the hip as well as those with complex syndromic conditions, bone dysplasias or neuromuscular disorders such as cerebral palsy and myelomeningocele. In many tertiary paediatric centres, transition has become a formal process in which clinicians document and communicate the status of patients who have been under their care to ensure a smooth transfer to adult services. The purpose of this report is to support the need for clear communication when children with cerebral palsy transition to adult services and to suggest that this transition represents a significant opportunity for audit and clinical research.

Methods: Some of the factors to be considered in developing a minimum data sheet for the transfer or transition of children with cerebral palsy to adult services are described.

Conclusion: Using the model of adolescents with cerebral palsy transitioning to adult services, orthopaedic surgeons can be encouraged to develop similar methodology and documentation for many other conditions for the purposes of communication, facilitation of transition, audit and clinical research.

Fig. 1

Expanded and revised Gross Motor Function Classification System (GMFCS E & R) for children from their 6–12th birthday: descriptors and illustrations

Fig. 2

Expanded and revised Gross Motor Function Classification System (GMFCS E & R) for children from their 12–18th birthday: descriptors and illustrations

Fig. 3

The Melbourne Cerebral Palsy Hip Classification Scale (MCPHCS) expanded and revised

Fig. 4

Anteroposterior (AP) pelvic radiograph of a young adult aged 21 years, GMFCS level III at the time of transition. Previous surgical history included bilateral adductor releases as part of single-event multilevel surgery to improve gait and functioning. At the time of transition there were no complaints of pain, and the patient walked well with a Functional Mobility Scale score of 5, 5, 5. The right hip is grade II according to the MCPHCS and will probably function well in adult life. However, the left hip is subluxated, dysplastic and is MCPHCS grade IV. Advice was given to continue with hip surveillance and to consider reconstructive surgery at the onset of any symptoms. Referral to an orthopaedic surgeon with an interest in hip dysplasia in young adults was also made