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Naik T.1, Potterton J.1
1University of Witwatersrand, Physiotherapy, Johannesburg, South Africa
Background: Children with diplegia as a result of CP or HIV encephalopathy have different pathogenesis but present with similar motor deficits. There are limited studies which have investigated and compared the clinical presentation of children presenting with spastic diplegia as a result of HIVE in comparison to HIV uninfected children with diplegia. With the advent of HAART, HIV infected children are surviving but with this comes with an increase in co-morbid complications that are not life-threatening but still have an adverse effect on activity and participation.
Purpose: The aim of this study was to determine if there are similarities and/or differences with regards to function, tone and strength between children with spastic diplegia as a result of CP and HIV encephalopathy.
Methods: Participants with spastic diplegia (GMFCS I to IV) between the ages of four and sixteen were consecutively selected at two state hospitals and two private practices in Johannesburg. Thirty three HIV infected and thirty one HIV uninfected participants were assessed using a Gross Motor Function Measure 66 (GMFM-66), Functional Mobility Scale (FMS), Modified Ashworth Scale for tone, and a hand-held dynamometer for strength.
Results: There were no statistically significant differences between the two groups for function, strength and tone. When the groups were separated into functional (GMFCS I and II) and non-functional groups (GMFCS III and IV), there were no statistically significant differences between the HIV infected and HIV uninfected participants for function (functional group p=0.52, non-functional group p=0.74), tone and strength. A minimally clinically important difference (MCID=3.87) was found for the GMFM-66 in the functional group in favour of the HIV infected participants. There was a trend for the HIV infected functional participants to be weaker and have milder tone from proximal to distal compared to their HIV uninfected counterparts while the non-functional HIV infected participants tended to be stronger but also have mild rather than severe tone from proximal to distal compared to their HIV uninfected counterparts.
Conclusion(s): In conclusion, the HIV infected group presented similarly to the HIV uninfected group. However, the HIV infected participants tended to be more functional and have less severe tone but were weaker.
Implications: The information obtained from this study will help clinicians better understand the clinical picture of spastic diplegia as a result of HIV. This will guide us in making more informed, evidence-based decisions with regard to rehabilitation, neurological and orthopaedic management as well and it will begin to fill some of the gaps that are evident in this field and will form the base upon which future research can be conducted.
Further research is required to compare functional and non-functional groups with larger sample sizes to determine if there are significant differences between the groups. Further research is also required in the adolescent HIV group to determine the natural progression of HIV infected adolescents with diplegia.
Funding acknowledgements: All funding was done personally by the primary author. No additional funding was used.
Topic: Paediatrics
Ethics approval: Ethical clearance was received from Human Research and Ethics Committee (Medical) of the University of Witwatersrand. Ethical clearance number M140936
All authors, affiliations and abstracts have been published as submitted.
