Lower urinary tract symptoms in children with mild to moderate spastic cerebral palsy: Associations with functional level, trunk and respiratory parameters.

INTRODUCTION AND OBJECTIVE

Lower urinary tract symptoms (LUTS) are common in children with cerebral palsy (CP). Increased severity of functional impairment and impairments in trunk-related structures may be associated with increased severity of LUTS. The aim of our study was to examine the distribution of LUTS in children with mild to moderate spastic type CP and to investigate the relationship between LUTS severity and functional level, trunk control, trunk muscle strength and endurance, respiratory functions and rib cage mobility.

METHODS

Fifty-three children with spastic CP with Gross Motor Functional Classification System (GMFCS) levels I-II and III were included in the study. LUTS was assessed using Dysfunctional Voiding and Incontinence Scoring System (DVISS); functional levels were assessed using GMFCS; and trunk control was assessed using Trunk Control Measurement Scale (TCMS). Transversus Abdominis (TrA) muscle strength was measured with Stabilizer Compression Biofeedback Unit; trunk muscle strength was measured with Sit-ups and Modified Push-up test; trunk muscle endurance was measured with McGill's trunk flexion, trunk extension, lateral bridge tests and prone bridge test. Pulmonary function was assessed by Contec SP10 Spirometer and chest mobility was assessed by chest circumference measurement.

RESULTS

There was statistically significant difference between GMFCS level I and level III mean DVISS scores (p = 0.002). There was moderate negative correlation between DVISS and TCMS score (p = 0.002; r = -0.416), moderate positive correlation between TrA muscle strength (p = 0.001; r = 0.482), modified push-up test (p = 0.025; r = -0.308), trunk extension test (p = 0.021; r = -0.316), prone bridge test (p = 0.008; r = -0.362), FEV1/FVC (p = 0.020; r = -0.320), FEV1 (p = 0.005; r = -0.384), PEF (p = 0.007; r = -0.367).

CONCLUSION

This study shows that LUTS is common in children with mild to moderate spastic CP and that the severity of these symptoms increases significantly as the severity of functional impairment increases. In addition, it was determined that the decrease in trunk control, trunk muscle strength and endurance, respiratory functions and chest mobility were associated with an increase in LUTS. These findings suggest that isolated pelvic floor training alone may not be sufficient to improve lower urinary tract health in children with CP, but instead, a holistic rehabilitation approach that supports motor function, trunk stability and respiratory capacity should be adopted.