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. 2024 May 27;13(11):3129.
doi: 10.3390/jcm13113129.

Sitting Postural Management to Prevent Migration Percentage Progression in Non-Ambulatory Children with Cerebral Palsy: Randomized Controlled Trial Preliminary Data

Silvia Faccioli  1   2 , Irene Maggi  1 , Emanuela Pagliano  3 , Claudia Migliorini  4 , Arianna Michelutti  5 , Liliana Guerra  6 , Anna Ronchetti  7 , Giovanna Cristella  8 , Nicoletta Battisti  9 , Lara Mancini  10 , Odoardo Picciolini  11 , Silvia Alboresi  1 , Antonio Trabacca  12 , Shaniko Kaleci  13
Affiliations

Sitting Postural Management to Prevent Migration Percentage Progression in Non-Ambulatory Children with Cerebral Palsy: Randomized Controlled Trial Preliminary Data

Silvia Faccioli et al. J Clin Med. .

Abstract

Background/Objectives: To determine whether a sitting position with the femoral heads centered into the acetabulum is more effective than the usual sitting position in preventing migration percentage progression in non-ambulatory children with bilateral cerebral palsy. Methods: This was a multicenter, randomized controlled trial.

Inclusion criteria: spastic or dyskinetic cerebral palsy, Gross Motor Function Classification System level IV-V, age 1-6 years, migration percentage <41%, and informed consent.

Exclusion criteria: contractures affecting the hip, anterior luxation, previous hip surgery, and lumbar scoliosis. The treatment group sat with their hips significantly abducted to reduce the head into the acetabulum in a customized system for at least five hours/day for two years. Controls sat with the pelvis and lower limbs aligned but the hips less abducted in an adaptive seating system. The primary outcome was migration percentage (MP) progression. Health-related quality of life and family satisfaction were among the secondary outcomes. The study was approved by the local ethics board and conducted in accordance with CONSORT reporting guidelines.

Clinicaltrials: gov ID: NCT04603625.

Results: Overall median MP progression was 1.6 after the first year and 2.5 after the second year. No significant differences were observed between the groups. MP exceeded 40% and 50% in 1.8% and 0% of the experimental group and 5.4% and 3.6% of controls in years 1 and 2, respectively. Both groups expressed satisfaction with the postural system and stable health-related quality of life. Conclusions: MP remained stable over the two-year period in both groups. Considering outliers which progressed over 50%, a more protective trend of the hip-centering sitting approach emerged, but this needs to be confirmed in a final, larger dataset.

Keywords: botulinum toxins; hip dislocation; hip surveillance; physical therapy; posture; rehabilitation; self-help devices.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Example of the customized seating system, which maintains the femoral heads centered into the acetabulum and ensures a comfortable and safe position (HCS group).
Figure 2
Figure 2
Examples of adaptive seating systems, ensuring axial alignment and a comfortable and safe position (TS group).
Figure 3
Figure 3
Example of an anterior–posterior radiograph of the pelvis with calculation of the migration percentage (MP): MP = A/B × 100. A represents the portion of ossified femoral head laying lateral to Perkin’s line (vertical line drawn through the lateral acetabular margin and perpendicular to Hilgenreiner’s line, which passes through the superior aspect of the triradiate cartilage). B represents the whole ossified femoral head.
Figure 4
Figure 4
Participant flow diagram.
See this image and copyright information in PMC

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