Nolan KW, Arnold E, Besana NS, Davis R, Hines D, Pruitt C, VanBrunt J, Winik E; Department of Physical Therapy, Ithaca College - Rochester, Rochester, NY, USA. knolan@ithaca.edu.

PURPOSE: To evaluate the effects of a variable hip abduction orthosis on function in a child with cerebral palsy. SUBJECT: Seven-year-old child with quadriplegic cerebral palsy, mixed type (spasticity and dystonia). Functional skill equivalent met criteria for Level IV, Gross Motor Function Classification System (G.M.F.C.S.). METHODS AND MATERIALS: A variable hip abduction orthosis was recommended for the subject due to significant hip adductor spasticity, limitations of hip range of motion, difficulty with sitting posture and function, and "scissoring" during supported attempts with forward steps. Outcome measures included Gross Motor Function Measure (G.M.F.M.), Dimensions B and D, included during each data collection session. Additional measures (once per phase) included Canadian Occupational Performance Measure (C.O.P.M.), and Pediatric Evaluation of Disability Inventory (P.E.D.I.) (subscales included Functional Skills - Mobility, and Caregiver Assistance – Self-Care, and Mobility). During the baseline phase, the subject began wear of the orthosis, with gradually increased wear time. Several return visits to the orthotist were needed for adjustments. Five data collection sessions occurred during baseline phase. During the intervention phase, the subject generally wore the orthosis up to six hours per day. Five data collection sessions occurred during the intervention phase. During the final phase, the orthosis was withheld and represented a return to baseline. Five data collection sessions occurred during the final baseline phase. ANALYSES: Data from repeated measures (G.M.F.M., Dimensions B & D) and hip range of motion was analyzed using a two standard deviation bandwidth method, which assumes a .05 alpha level. RESULTS: Visual inspection of the data suggested significant finding in G.M.F.M. Dimension D (standing), between baseline and intervention phase. Clinically, but not statistically significant, improvement was noted in G.M.F.M. Dimension B (sitting). In all five parent identified occupational performance problems (mobility, self-care, being alone, household chores, and improved sitting) on the C.O.P.M., clinically significant improvements (two or more points) were made in the intervention phase. Scaled scores on the P.E.D.I. in the Functional Skills-Mobility and the Caregiver Assistance – Self-Care domains increased during the intervention phase. CONCLUSIONS: The new findings of this study do not provide support for the manufacturer’s claims of improvements in sitting stability and posture in children with cerebral palsy. However, significant improvement was found in standing and walking tasks. This variable abduction orthosis shows potential for effective support during standing and stepping activities for children with cerebral palsy. FUNDING SOURCE: None. Authors received no material gain as a result of the study.

Copyright 2004 by the American Physical Therapy Association

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