|Abstract / Summary
Present thesis concerns cerebral palsy in orthopaedic surgery and further enlightens the perspectives on pain and seating performance. The centre of the thesis is the hip reconstructive procedure that many children with cerebral palsy undergo due to progressive dysplasia and subluxation of one or both hips. The studies in this thesis all relate to the hip reconstruction procedure and stems from concerns or difficulties we previously have encountered.
The hip reconstructive surgery is, among others, performed to avoid pain and to improve mobility and sitting function in these often severely disabled children. In the early postoperative period, during the hospital stay we have seen that it has been difficult to adequately manage the postoperative pain after hip reconstruction, hence study III was planned in order to test the efficacy of both epidural analgesia, local infiltration analgesia and an approximated placebo treatment in children with cerebral palsy undergoing unilateral hip reconstruction. We found that epidural analgesia is superior to both LIA and placebo with significantly lower pain scores and lower opioid consumption postoperatively and may be considered as first choice in children with CP.
No validated Danish pain assessment tools have been available for pain assessment in children with cerebral palsy. A literature search on the topic revealed that the r-FLACC pain score seemed valid and clinically feasible, though it only was developed in English. Study I is focused on the translation and clinical feasibility of the r-FLACC score and in study II a reliability and validation process following the COSMIN guidelines was undertaken.
Seating performance was evaluated using a Tekscan CONFORMat sensor. The Tekscan equipment has previously been used to assess plantar pressure of the feet in standing and walking persons; but the technical development now gives the possibility of measuring seated pressures and balance. In study IV the reproducibility of the parameters of seating performance of the CONFORMat sensor was determined in 65 healthy children and 5 appropriate measures of seating performance were defined including 3 measures for pelvic tilt. These measures were used in study V, where the seating performance of children with cerebral palsy undergoing unilateral hip reconstruction was evaluated before and after surgery. Results showed that unilateral hip reconstruction improves seated pelvic tilt but this was not correlated to supine radiographic pelvic tilt concluding that radiographic and interface pressure pelvic tilt are discrepant assessment methods that are not directly comparable.