Tag Archive for: hip surveillance

x-ray of child with dislocated hip

Hip surveillance helps identify dislocations in children with cerebral palsy

x-ray of child with dislocated hip

Hip surveillance is a process used to monitor the hips closely and frequently, identifying the problems earlier.

Children with cerebral palsy (CP) have an increased risk for hip displacement. Hip displacement in children with CP can happen slowly over time and can be painful, but a hip surveillance program can prevent this. Hip surveillance is a process used to monitor the hips closely and frequently, identifying the problems earlier. It is an ongoing process that continues for every child until skeletal maturity.

“Every child with cerebral palsy should be referred for hip surveillance regardless of determination by the Gross Motor Function Classification System,” said Sean Tabaie, M.D., orthopaedic surgeon at Children’s National Hospital.

Dr. Tabaie created a hip surveillance manual for primary care providers who care for this patient population. In most cases, these patients are monitored and followed closely by their primary care team. Education material regarding hip surveillance, including the background knowledge, is often not available to those practitioners in a concise format. To successfully initiate a hip surveillance program, it is important to promote education and provide the appropriate materials to that group of practitioners.

“Our goal is to improve the care of children with cerebral palsy by decreasing the overall presentation of dislocated hips in our clinic settings and promote the appropriate timing of referrals for evaluation of hip subluxation secondary to cerebral palsy or neuromuscular conditions,” said Tabaie.

Download the Surveillance Guidelines for Children with Cerebral Palsy here.

little girl in wheelchair

A holistic and proactive approach to the management of the patients with cerebral palsy

little girl in wheelchair

The cerebral palsy program at Children’s National Hospital takes a comprehensive approach to meet children’s needs from infancy through young adulthood.

Though children with cerebral palsy (CP) often require significant rehabilitative and surgical support, most often each service is provided in the individual specialty itself. Patients and their families frequently experience a great deal of stress coordinating care, getting to appointments, keeping track of medications and managing treatments on their own.

However, the CP program at Children’s National Hospital, co-led by an orthopaedic surgeon, Sean Tabaie, M.D., and a pediatric rehabilitation specialist, Olga Morozova, M.D., working together and in collaboration with Shannon Kelly, M.D., (Orthopaedics) and Jeff Rabin, D.O., (Physical Medicine and Rehabilitation) has evolved into a truly comprehensive approach. The program is designed to meet the needs of these children from infancy through young adulthood with the goal of improving function and preventing musculoskeletal deformities and complications.

Providing children and their families with a single point of care coordination allows the care team to track and anticipate a multitude of potential challenges for each child as early as possible and intervene in smaller ways before they bring pain and long-term complications or require major surgical interventions. Key highlights of this collaborative program include:

  • Hip surveillance: Patients with CP are followed closely to identify hip pathology prior to serious subluxation or dislocation. Early identification allows for the use of medical or surgical interventions to prevent a minor issue from becoming a major one.
  • Serial casting for children with early signs of muscle contractures: Dr. Morozova uses agents to relax the muscles and Dr. Tabaie applies the cast in the operating room followed by continued weekly serial casting in the clinic. “Proper medical management and bracing at regular intervals can improve muscle function and prevent the need for larger surgeries and more intense rehabilitation later,” says Dr. Morozova.
  • Advanced coordination between physical therapy in the hospital and outpatient services in the region, building on the hospital’s partner agreement with the HSC Health Care System.
  • Single event multi-level surgeries (SEMLS): Ensuring that surgical procedures capture all surgical needs at one time by assessing the entire anatomy and scheduling multiple surgical or pharmaceutical interventions to occur in a single session.

The doctors point out that offering these services in one cohesive location and combining treatments into the same appointment or procedure date is something that many patients with CP and their families truly appreciate.

“I think families of children with CP will travel great distances if the care they receive is comprehensive and eliminates some of the back and forth travel they do now,” says Dr. Tabaie.

Today, the team sees close to 100 patients with CP per month and hopes to expand to reach as many families in the region and beyond who need them.

Dr. Tabaie says, “Our goal is to identify patients early and start managing them to help their quality of life today, prepare them to grow as healthily and in as little pain as possible and set them up to be as healthy as they can possibly be as adults, too.”