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Positioning for Children GMFCS Levels IV-V: Focus on Hip Health


The incidence of hip displacement or dislocation in children with cerebral palsy is closely related to motor activity level as categorized by the Gross Motor Functional Classification Scale (GMFCS). The incidence ranges from 0%  in children with motor function GMFCS I to 90%  in children with motor function GMFCS V.  Without intervention, hip development for many children with cerebral palsy GMFCS levels IV-V and less frequently GMFCS III, involves the progression from a normal hip at infancy to progressive displacement and eventual dislocation.  A summary of the incidence of hip displacement  in cerebral palsy and  the management strategies can be found in the web document Evidence for Practice: Surveillence and Management of Hip Displacement and Dislocation in Children with Neuromotor Disorders.

Hip subluxation/dislocation can have an impact on comfort, sleep, postural control and activities of daily living so prevention of progressive displacement is an important goal in the overall management of children with cerebral palsy.   An integrated approach to surveillance and treatment is thought to be most effective and frequently involves postural management, tone management and surgery. The use of positioning devices for postural management is a component of the integrated management approach for hip health  and is highlighted in this collection of resources.   Positioning devices include adaptive seats, lying supports, standing systems, and body-weight support walkers.

The  “Evidence” tab  provides current  research evidence. The “Clinical Tool” tab contains an illustrated positioning plan for incorporating GMFCS levels, age and development based on expert clinical experience and the research evidence.

Last Updated: Jan 16, 2014