Development of the Chest Wall in Children with Cerebral Palsy according to GMFCS Levels

뇌성마비 아동의 대동작운동기능 수준에 따른 흉곽발달 양상

  • Jung, Jee Woon (Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University) ;
  • Ko, Joo Yeon (Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University)
  • 정지운 (CHA의과학대학교 분당차병원 재활의학팀) ;
  • 고주연 (CHA의과학대학교 분당차병원 재활의학팀)
  • Received : 2013.09.10
  • Accepted : 2013.10.10
  • Published : 2013.10.25

Abstract

Purpose: The purpose of this study was to provide quantitative data regarding development of the chest wall in children with cerebral palsy (CP) according to Gross Motor Function Classification System (GMFCS) levels and age using the radiological image diameter measurement method. Methods: Subjects included 112 children with CP and 110 healthy children, All of the children underwent simple chest x-ray. The diameters of the upper chest ($D_{apex}$) and lower chest ($D_{base}$) were measured on the anteroposterior (AP) view of a chest x-ray, and the $D_{apex}$ to $D_{base}$ ratio was calculated. Chest wall ratios were compared among children with CP at GMFCS levels I ~ III, GMFCS levels IV and V, and healthy children. Results: The results showed significant differences between the upper and lower chest wall diameters of children with CP at GMFCS levels IV and V, and healthy children (F=4.54, p=0.01; F=3.20, p=0.04). Results of comparison between the chest wall ratios of children with CP and healthy children, showed that the upper chest walls of healthy children were significantly larger in children younger than 48 months (p<0.05), and both the upper and lower chest walls of healthy children were significantly larger compared to children with CP in children older than 48 months (p<0.05). Conclusion: Radiographic measurement for examination of chest wall development is relatively simple, and the results yield quantitative data on development of the chest wall for children with CP. In addition, therapeutic interventions may be considered based on the results.

Keywords

References

  1. Fitzgerald DA, Follett J, Van Asperen PP. Assessing and managing lung disease and sleep disordered breathing in children with cerebral palsy. Paediatr Respir Rev. 2009;10(1):18-24.
  2. Lee HY, K. K, Cha YJ. A survey on stress and coping style in mothers of cerebral palsied children. J Korean Soc Phys Ther. 2012;24(2):98-106.
  3. Toder DS, Respiratory problems in the adolescent with developmental delay. Adolesc Med. 2000;11(3);617-31.
  4. O'Donnell DM. Pulmonary complications in neuromuscular disease. Adolesc Med. 2000;11(3): 633-45.
  5. Stamer MH. Posture and movement of the child with cerebral palsy. San Antonio, Texas, Therapy Skill Builders, 2000:14-6.
  6. Seddon PC, Khan Y. Respiratory problems in children with neurological impairment. Arch Dis Child. 2003;88(1):75-8. https://doi.org/10.1136/adc.88.1.75
  7. Massery MP. Chest development as a component of normal motor development: implications for pediatric physical therapists. Ped Phys Ther. 1991;3(1):3-8.
  8. Bach JR, Bianchi C. Prevention of pectus excavatum for children with spinal muscular atrophy type 1. Am J Phys Med Rehabil. 2003;82(10):815-9. https://doi.org/10.1097/01.PHM.0000083669.22483.04
  9. Lissoni A, Aliverti A, Molteni F et al. Spinal muscular atrophy: kinematic breathing analysis. Am J Phys Med Rehabil. 1996;75(5):332-9. https://doi.org/10.1097/00002060-199609000-00005
  10. Lissoni A, Aliverti A, Tzeng A et al. Kinematic analysis of patients with spinal muscular atrophy during spontaneous breathing and mechanical ventilation. Am J Phys Med Rehabil. 1998;77(3):188-92. https://doi.org/10.1097/00002060-199805000-00002
  11. Kisner C, Colby LA. Therapeutic Exercise: Foundations and Techniques. 5th ed. Philadelphia, F. A Davis CO, 2007:851-8.
  12. Leopando MT, Moussavi Z, Holbrow J et al. Effect of a soft Boston orthosis on pulmonary mechanics in severe cerebral palsy. Pediatr Pulmonol. 1999;28(1):53-8. https://doi.org/10.1002/(SICI)1099-0496(199907)28:1<53::AID-PPUL9>3.0.CO;2-2
  13. Estenne M, De Troyer A. The effects of tetraplegia on chest wall statics. Am Rev Respir dis. 1986;134(1):121-4.
  14. Park ES, Park JH, Rha DW et al. Comparison of the ratio of upper to lower chest wall in children with spastic quadriplegic cerebral palsy and normally developed children. Yonsei Medical Journal. 2006;47(2):237-42. https://doi.org/10.3349/ymj.2006.47.2.237
  15. Ko JY, Woo JH, Her JG. The Reliability and Concurrent Validity of the GMFCS for Children with Cerebral Palsy. J Phys Ther Sci. 2011;23(2):255-8. https://doi.org/10.1589/jpts.23.255
  16. De Troyer A, Deisser P. The effects of intermittent positive pressure breathing on patients with respiratory muscle weakness. Am Rev Respir Dis. 1981;124(2):132-7.
  17. Papastamelos C, Panitch HB, England SE et al. Developmental changes in chest wall compliance in infancy and early childhood. J Appl Physiol. 1995;78(1):179-84.
  18. Netscher DT, Peterson R. Normal and abnormal development of the extremities and trunk. Ped Plastic Surg. 1990;17(1):13-21.
  19. Kim MH, Lee WH, Yun MJ. The effects on respiratory strength training on respiratory function and trunk control in patient with stroke. J Korean Soc Phys Ther. 2012;24(5):340-7.