Investigation of the inter-dependence between intra-abdominal pressure and spinal stability

Abstract

Introduction: Many researchers have explored the link between intra-abdominal pressure and the biomechanical stability of the spine. Children severely affected with cerebral palsy have low engagement of the abdominal region and correspondingly very poor spine stability. Rehabilitation programs often seek to improve such resources, but a link has never been objectively demonstrated in this patient population who may greatly benefit from potential gains. Thus, the purpose is to evaluate the interdependency between intra-abdominal pressure and spinal stability in cerebral palsy patients undergoing a targeted rehabilitation program.

Methods: A non-randomized prospective cohort treatment study of patients with gross motor function classification system types 4 and 5 over five years old while undergoing a high-frequency rehabilitation program targeting spinal stability. Blinded measures of intra-abdominal pressure and seated spinal stability were acquired. All measures were taken at baseline and bi-annually for 2 years. GMFCS classification were taken at baseline to distinguish the study group. Study directives were approved by independent ethical committees. Non-parametric Wilcoxon tests were utilized to perform data analyses.

Findings: Measures of intra-abdominal pressure, by way of customized indentometer, improved from 3.23 to 4.46 lbs./in. of compression between baseline and 24 months (p < 0.05). Seated spinal stability improved from scores of 2.3 to 3.1 after 24 months (p < 0.05). Results showed a trend of collinearity between intra-abdominal pressure and seated spinal stability.

Interpretation: Results suggest a correlation between intra-abdominal compression and, correspondingly, better seated spinal stability for GMFCS class 4 and 5 patients.