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Could ultrasound scans help identify early hip problems for children with cerebral palsy?

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What did the project achieve?

“Our results show that 3D ultrasound has the potential to replace X-ray scans for routine screening for hip problems in children with cerebral palsy,” says Dr Adam Shortland of Guy’s Hospital, London. “These findings could offer real clinical potential, and we are hopeful that more children will start to benefit from this alternative imaging technique within the next three years.”

Around 2,000 babies in the UK are diagnosed with cerebral palsy every year.1 They face lifelong difficulties with movement and coordination. Many develop problems with their hips during childhood, which can cause pain, reduced movement and can lead to hip dislocation. Early and accurate prediction of hip problems, which allows prompt treatment, is vital.

This research involved studying images, using X-ray and a new 3D ultrasound imaging technique, of the hips of 25 children with cerebral palsy – and comparing the results from these two assessments.

“We found there was an excellent agreement between these methods in spotting early signs of hip dislocation,” says Dr Shortland. “This suggests that 3D ultrasound could be a better technique than X-ray, in which images can only be seen in 2D, to screen for hip problems – enabling doctors to monitor children with cerebral palsy more closely without exposing them to radiation.”

The team also found that the ultrasound investigations were accepted by the children taking part in the study, even those with severe learning or communication difficulties.

“This is a step forward in developing a safe new technique that can be used regularly to track hip health more closely, helping doctors to give the most appropriate treatments to children with cerebral palsy,” says Dr Shortland. “We hope this work will soon lead to earlier detection and treatment of hip problems that can help prevent further pain and disability.”

References

  1. Wimalasundera, N. & Stevenson, V.L., Cerebral palsy. BMJ Practical Neurology 2016; 16:184-194.
  2. Office for National Statistics, Vital statistics in the UK: births, deaths and marriages - 2019 https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/datasets/vitalstatisticspopulationandhealthreferencetables [website accessed 13 July 2021]

This research was completed on

Almost 2,000 babies born each year in the UK are diagnosed with cerebral palsy.1,2 They face lifelong difficulties with movement and coordination. Many start to have problems with their hips during childhood, which can cause pain and reduce mobility. Dr Adam Shortland, of Guy’s Hospital, London, is developing a new way to screen for these hip problems, using 3D ultrasound scans. Successful screening means children who have early signs of hip problems can be offered treatment, with the aim of stopping those problems from getting worse, and sparing children from the pain and reduced mobility that goes with them.

How are children’s lives affected now?

Hip problems are common in children with cerebral palsy.3

Some children’s hip problems get so bad that their hips become dislocated. This is a severe problem, which often causes pain and makes it hard for children to stand, walk or even sit comfortably. It can cause other problems too, such as fractures and skin ulcers.

Children’s hip problems begin when the thigh bone becomes slightly out of line with the hip socket. In some children, this doesn’t pose a problem, but without treatment, it can get worse over time. If this is spotted early, more severe hip problems can be prevented.

“At the moment, we use X-rays to screen for hip problems in children with cerebral palsy,” says Dr Shortland. “Though beneficial, having repeated X-rays exposes children to radiation. Also, X-rays only provide 2D images, which aren’t as useful as 3D images would be.”

How could this research help?

The researchers are developing a new way to screen for early hip problems in children with cerebral palsy using a technique called 3D ultrasound.

Ultrasound scans use high-frequency sound waves to create images of inside the body. Advantages of ultrasound scans over X-rays include the fact that they do not expose children to radiation (there are no known risks from the sound waves used) and they can provide 3D – rather than 2D – images.

“We hope to develop a safe new technique that can be used regularly to spot early hip problems in children with cerebral palsy,” says Dr Shortland. “We are also investigating whether the new technique can be used to predict whether any hip problems a child has are likely to get worse.”

Early and accurate prediction of hip problems would allow prompt treatment, with the aim of sparing children from more severe problems and the pain and disability they can cause.

References

1. NHS Choices. Cerebral palsy. http://www.nhs.uk/Conditions/Cerebral-palsy/Pages/Introduction.aspx Website accessed 7 February 2017.

2. Office for National Statistics. Overview of the UK population: February 2016. Figure 1: UK births and deaths. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigrati...  Website accessed 7 February 2017.

3. Hägglund G et al. Characteristics of children with hip displacement in cerebral palsy. BMC Musculoskeletal Disorders 2007 Oct 26; 8: 101.

 

 

 

 

Project Leader Dr Adam P Shortland BSc PhD MIPEM SRCS CSci
Project Team Professor Steve Keevil MA MSc PhD ARCP HonMRCR CSci FIPEM CPhysMiss Becky East MEng MScMr Martin Gough MB BCh BAO(NUI) FRSCI(Orth) MCh(NUI)Dr Jonathan Noble BSc MSc PhD
Project Location One Small Step Gait Laboratory, Guy's and St Thomas' Foundation Trust, King's College London
Project Location Other Department of Medical Physics, Guy's and St Thomas' Foundation Trust, King's College, London,Paediatric Orthopaedics, Evelina London Children's Hospital, St Thomas's Hospital, King's College London,Division of Imaging Sciences and Biomedical Engineering, King's College London
Project duration 3 years
Date awarded 29 November 2016
Project start date 9 May 2017
Project end date 8 November 2020
Grant amount £151,551
Grant code GN2532

 

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