Ebba Jarlman - Institutionen för kliniska vetenskaper, Lund

Title: Cerebral Palsy – pain and skeletal health

Main supervisor: Ann I. Alriksson-Schmidt

Reviewers: Per Swärd, Karin Dalhammar, Kristina Mattson

Abstract

Background

Cerebral Palsy (CP) is a common motor disorder and is associated with secondary musculoskeletal complications such as deformities, pain, reduced bone mineral density (BMD), and fragility fractures. However, individuals with CP vary substantially in their level of mobility, and the prevalence of secondary complications differs across mobility subgroups.

Research questions: 

Study I: In individuals with CP: 

• How prevalent is pain in the foot and lower leg?
• Which factors are associated with an increased risk of pain in the foot and lower leg?

Studies II–III: In children with CP: 

• How does BMD vary according to mobility level?
• How does BMD change over time?
• Which factors are associated with low BMD or poor bone accrual, do these associations differ by level of mobility?
• How are low BMD and poor bone accrual associated with the development of secondary complications such as pain, fractures, or skeletal deformity?

Preliminary results

1. Pain in the foot and lower leg was common in individuals with CP, affecting 21%.
2. Older age, higher mobility level, female sex and decreased range of motion of the ankle were associated with increased odds of foot and lower-leg pain. 
3. BMD differed substantially by mobility level: a BMD Z-score ≤ −2 was observed in 13% of children with high mobility compared with 73% of children with low mobility.
4. Low BMI was associated with low BMD regardless of level of mobility, whereas other risk factors differed between mobility subgroups.

Significance

Individuals with CP at different levels of mobility face varying challenges and risks for secondary complications. By identifying mobility-specific risk factors and stratifying outcomes according to mobility level, this research aims to facilitate earlier identification of individuals at risk of pain, low BMD, and poor bone accrual, thereby supporting more individualized prevention, monitoring, and management strategies in the care of individuals with CP.

Published studies

1. Jarlman E, Hägglund G, Alriksson AI. Foot and lower leg pain in children and adults with cerebral palsy: a population-based register study on 5,122 individuals. BMC Musculoskelet disord. 2024 May 18;25(1):391. Doi: doi: 10.1186/s12891-024-07486-y. PMID: 38762469. PMCID: PMC11102238.