Yonsei Med J.  2006 Apr;47(2):237-242. 10.3349/ymj.2006.47.2.237.

Comparison of the Ratio of Upper to Lower Chest Wall in Children with Spastic Quadriplegic Cerebral Palsy and Normally Developed Children

• Park ES
• Park JH
• Rha DW
• Park CI
• Park CW

• KMID: 1110748
• DOI: http://doi.org/10.3349/ymj.2006.47.2.237

Abstract

The upper chest wall does not grow properly in children with spinal muscular atrophy (SMA) with paradoxical breathing. This suggests that long-term inability to take a deep breath in developing children may result in underdevelopment of the upper chest wall. In addition, a rapid and paradoxical breathing pattern is frequently observed in children with severe cerebral palsy (CP), which often corresponds to the underdevelopment of the upper chest wall. The present study is designed to evaluate the ratio of the upper to lower chest wall in children with severe spastic quadriplegic CP, compared with normal children. We compared normal children with children that had spastic quadriplegic CP who did not have kyphosis or scoliosis. Test subjects were matched in terms of age, height, and weight. The diameters of upper chest (D(apex)) and of lower chest (D(base)) were measured on the anteroposterior (AP) view of a chest X-ray and the D(apex) to D(base) ratio was calculated. In selected cases the forced vital capacity (FVC) was measured using a Wright Respirometer. The D(apex) to D(base) ratio was significantly lower in the CP group than in the control group (p < 0.001). The ratio increased linearly with age (p < 0.001) in both CP (R = 0.372) and control groups (R = 0.477). The FVC/preFVC showed significant correlation with the D(apex) to D(base) ratio (R = 0.542, p < 0.01). The results of this study suggest a deviation of optimal chest wall structure in children with spastic quadriplegic CP.

Keyword

Chest wall; cerebral palsy; quadriplegia

MeSH Terms

X-Rays
Vital Capacity
Time Factors
Thoracic Wall
Thoracic Cavity
Respiratory Tract Diseases/*pathology/physiopathology
*Respiration
Quadriplegia/*pathology
Muscle Spasticity/*pathology
Male
Lung/pathology
Humans
Forced Expiratory Volume
Female
Child, Preschool
Child
Cerebral Palsy/*pathology
Case-Control Studies

Figure

• 

  Fig. 1 Measurement of the diameter of the chest apex (Dapex) and base (Dbase). Horizontal lines were drawn from the inner margin of the rib on one side to the other side perpendicular to the line connecting the spinous processes. The longest line of the 2nd rib (Dapex) and the 9th rib (Dbase) were measured.

• 

  Fig. 2 Changes in the percentage ratio of the chest wall with age. Percentage ratio was calculated as the Dapex/Dbase diameter × 100. Filled squares and the solid line represent the cerebral palsy group, whereas the cross marks and dotted line represent the control group.

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  Fig. 3 Relationship between the ratio of upper to lower chest wall diameter and the forced vital capacity. Percentage ratio was represented as Dapex/Dbase diameter × 100. The squares represent the cerebral palsy group, and the cross marks represent the control group.

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