Pain and Self-pressure Relief in Adolescents with Cerebral Palsy

Background & Purpose:

Background: Adolescents with cerebral palsy classified as Gross Motor Functional Classification System Level V, who use wheelchairs as their primary form of mobility, often attend school for up to eight hours per day and lack independent movement with limited ability to self-reposition. Despite the high levels of reported pain within this population, there is a lack of knowledge of perceived pain associated with pressure in sitting, and of self-pressure relief during prolonged sitting.

Purpose: The purposes of this study were to determine perceived pain during prolonged sitting with a standard pressure relief protocol, the feasibility of using SensiMATTM technology to detect adolescent pressure relief movements during standard classroom sitting, and to identify any associations of perceived or expressed pain measurements with SensiMATTM pressure readings and pressure relief movements.

Case Description:

Methods: A case series design was used. A convenience sample of six adolescent students (13-18 years) with CP classified as GMFCS V were recruited. The SensiMATTM was placed on the students’ wheelchair cushion and pain assessments were taken every 30 minutes during a five-hour period of one typical school day. Self-relief assessments using the SensiMATTM were recorded continuously, except during the one-hour repositioning when students were out of their chairs.

Outcomes:

Results: Two of the six students independently reported pain. Proxy pain assessments of three students showed increased movement in either their legs or head and trunk positioning after a period of prolonged sitting. All students had unrelieved pressure or did not self-relieve pressure for at least 1.5 consecutive hours during the five-hour study. Four students increased their self-pressure relief movements after a prolonged period of 3.5 hours.

Discussion:

Conclusions: Students demonstrated independent pressure relief movements and increased unrelieved pressure, with and without increased pain suggesting that students may be experiencing pain during periods of prolonged classroom sitting, or that students are independently relieving pressure to prevent or reduce pain.
Relevance to Allied Health: The SensiMATTM is a feasible piece of technology to measure independent pressure relief movements for individuals with CP with the most severe disabilities. With future adaptations, the SensiMATTM may be a useful piece of technology for school physical therapists to develop positioning protocols, specifically tailored to students in special education. Pressure relief activities can be associated with discomfort or pain, which need be further investigated.