Daily care activities and hip pain in non-ambulatory children and young adults with cerebral palsy

Abstract

Hip movement pain was identified in 13 (32.5%) of 40 children and young adults with cerebral palsy who were in residential care. All of the participants were non-ambulatory (Level IV and V of the GMFCS), and their ages ranged from 8 to 26 years (median 16.5 years). Ten of the 13 participants had unilateral hip dislocation and three had bilateral dislocations. Degenerative hip changes were identified on radiographs of the painful dislocated hips. The occurrence of pain during a daily episode of washing, dressing, and transfer was recorded using non-verbal indicators. Washing of the lower body elicited significantly more pain responses than dressing (p=0.008) and transfer (p<0.001). None of the participants had daily pain during all of the care activities. Pain was present in 1/3 of the patients and was intermittent in nature, indicating that conservative management can be considered for persons with cerebral palsy at Levels IV and V of the GMFCS who have established hip dislocations and this type of pain. This management could include medication, attention to seating and positioning, and careful handling during daily care activities.