Australian Cerebral Palsy Musculoskeletal Health Network: assessment of hip, spine and fracture complications in children with Cerebral Palsy.

Abstract

Cerebral Palsy (CP) is the most common physical disability in childhood impacting 1 in 700 Australians. It is the 5th most costly condition at >AUD $5Billion p.a. CP is a disorder of movement and posture due to a static early brain lesion, however the musculoskeletal (MSK) sequelae are progressive. Major MSK complications are hip displacement, scoliosis and skeletal fragility, which lead to pain, disability and major orthopaedic surgery. Our Australian Cerebral Palsy Register has tracked the cause and severity of persons with CP. Our national Hip Surveillance Guidelines track progression of hip displacement which has shown a strong association with Gross Motor Function. Our Australasian Cerebral Palsy Clinical Trials network has implemented 3 international clinical practice guidelines on early detection, early intervention and efficacy of interventions to improve functional outcomes. Our team is well placed to develop a national program incorporating identification of hip displacement with scoliosis and fracture surveillance and to examine the inter-relationship between MSK complications. In a prospective cohort of n=500 children with cerebral palsy, our Australian CP MSK Health Network aims to: 1. Identify novel clinical outcome assessments and biomarkers of onset and progression of hip displacement, scoliosis deformity and osteoporosis/bone fragility to identify therapeutic targets and prevent progression; 2. Develop and integrate national hip, spine and fracture registries to develop practice guidelines that will lead to improved MSK health and wellbeing of children with CP; 3. Examine the inter-relationships between hip, spine and bone health on progression of MSK deformity to clarify the natural history of MSK complications and identify novel therapeutic targets; 4. Develop a fracture risk assessment and decision tool for children with CP to allow for accurate prognosis and timely intervention to reduce impact of skeletal fragility.