Pain and its relationship with postural asymmetry in adults with cerebral palsy: A preliminary exploratory study

Friday, December 4, 2020 - 12:00 PM

Carlee Holmes, Kim Brock & Prue Morgan (2021): Pain and its relationship with postural asymmetry in adults with cerebral palsy: A preliminary exploratory study, Disability and Health, In Press, DOI: 10.1016/j.dhjo.2021.101063

Many adults with cerebral palsy who are reliant on wheelchairs for mobility experience significant changes to their muscles and joints over time. These changes commonly affect the rib cage, spine, pelvis and hips causing difficulty with sitting in wheelchairs, lying in bed, and reduced function . We do not know if these changes to the muscles and joints are causing pain especially in those adults who may have difficulties with cognition and /or communication. Nor do we know if the pain is present all the time, or just during the day or during the night.

This study investigated pain in adults with CP who were unable to communicate, using a checklist of pain responses observed by a family member or carer. The checklist included responses related to facial expressions, body movements, crying or moaning, behaviour and changes in breathing or skin colour. Caregivers completed the checklist during the day and at night. We compared the pain responses with measurements of the person’s posture and joints. Information from this study will provide health professionals with a greater understanding of how people with CP who are unable to communicate might experience pain, and identify if an intervention, such as customised seating, is helpful to manage chronic pain.

This study of 17 non-ambulant adults with cerebral palsy indicated that they experienced high levels of pain during both the day and night. The study also found that there were links between changes to the musculoskeletal system and pain severity, especially changes to posture involving the spine and rib cage. This is the part of the musculoskeletal system that protects many vital organs such as the lungs, stomach and bowels. Changes to the spine and rib cage may squash these organs potentially causing pain and difficulty associated with breathing or constipation, for example. The findings of this study helps us to better understand the relationship between pain and joint changes, and the importance of measuring pain when trialling treatments to manage postural changes.

Carlee Holmes is a senior physiotherapist at the Young Adult Complex Disability Service, St. Vincent’s Hospital Melbourne and a research associate with the CRE CP Achieve. Professor Prue Morgan is Head of Physiotherapy at Monash University and a CRE CP Achieve investigator. Dr Kim Brock is a senior research physiotherapist and clinician at St Vincent’s Hospital Melbourne. Carlee Holmes completed this study as part of a PhD with Monash University.