Effectiveness of selective muscle- release surgery for children with cerebral palsy: longitudinal and stratified analysis (original) (raw)
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Acta Medica Academica, 2010
Objective. To determine the outcome of rehabilitation treatment after orthopedic-surgical treatment of the lower extremities in relation to motor function and degree of disability in children with cerebral palsy. Subjects and methods. An historical-prospective study included 44 treated children with CP from May 2000 until June 2009 at the Department of Physical Medicine and Rehabilitation University Clinical Centre Tuzla. The main criteria for entering the study were diagnosed CP and performed orthopedic-surgery of the lower extremities during rehabilitation treatment. Assessment of the motor function score was performed according to the Gross Motor Function Measure 88 (GMFM-88), and classification of the degree of disability was developed based on the scale of the Gross Motor Function Classification System (GM-FCS). Results. In our study, motor functions were improved, so that the median value and interquartil range (IQR) of the total GMFM score before surgery was 35.7 (IQR from 22.9 to 57.2), and after postoperative rehabilitation 58.6 (IQR from 31.2 to 85.2) with a high statistical significance (p<0.0001). Median value GMFCS scores before surgery ranged around 5 (IQR from 4 to 5), and after postoperative rehabilitation ranged around 3 (IQR from 2 to 5), which shows a highly statistically significant reduction in the degree of disability (p<0.001). Conclusion. Surgical intervention performed on the lower extremities in children with cerebral palsy may improve motor function in all developmental stages and reduce the degree of disability with intensive rehabilitation.
Gross motor function change after multilevel soft tissue release in children with cerebral palsy
Biomedical Journal
Background: Improving motor function is a major goal of therapy for children with cerebral palsy (CP). However, changes in motor function after orthopedic surgery for gait disorders are seldom discussed. This study aimed to evaluate the postoperative changes in gross motor function and to investigate the prognostic factors for such changes. Methods: We prospectively studied 25 children with CP (4e12 years) who were gross motor function classification system (GMFCS) level II to IV and and underwent bilateral multilevel soft-tissue release for knee flexion gait. Patients were evaluated preoperatively and at 6 weeks and 3 and 6 months postoperatively for Gross Motor Function Measure (GMFM-66), range of motion, spasticity, and selective motor control. The associations between change in GMFM-66 score and possible factors were analyzed. Results: 25 children with gross motor function level II to IV underwent surgery at a mean age of 8.6 years (range, 4e12 years). Mean GMFM-66 score decreased from 55.9 at baseline to 54.3 at 6-weeks postoperatively and increased to 57.5 at 6-months postoperatively (p < 0.05). Regression analysis revealed better gross motor function level and greater surgical reduction of spasticity were predictors for decreased GMFM-66 score at 6-weeks postoperatively. Younger age was a predictor for increased GMFM-66 score at 6-months postoperatively. Conclusion: Reduction of contracture and spasticity and improvement of selective motor control were noted after surgery in children with CP. However, a down-and-up course of GMFM-66 score was noted. It is emphasized that deterioration of motor function in children with ambulatory ability and the improvement in young children after orthopedic surgery for gait disorders.
Pediatric Physical Therapy, 2006
ELECTIVE dorsal rhizotomy is a surgical procedure used in patients with CP that involves partial sensory deafferentation at the levels of the L-1 through S-2 nerve rootlets. The selection of rootlets for cutting is based on the lower-extremity muscular response to electrical stimulation of the rootlets. The operation is performed in children with CP to reduce spasticity and thereby improve motor function. In several of the most recent investigations in which the effectiveness of SDR was evaluated, three groups of researchers used the GMFM as the primary means of assessing outcome. The results of two of these three recent randomized trials indicated that SDR followed by intensive PT was more effective than intensive PT alone in bringing about an increase in gross motor function. According to the results of the third trial, SDR followed by intensive PT was not any more effective in improving gross motor function than intensive PT alone. 24 A metaanalysis of the combined results of the three investigations indicated that SDR followed by intensive PT was more effective in improving gross motor function than intensive PT only. 23
GMPM Gross Motor Performance Measure LoA Limits of agreement MDC Minimal detectable change QFM Quality Function Measure AIM Optimizing movement quality is a common rehabilitation goal for children with cerebral palsy (CP). The new Quality Function Measure (QFM)a revision of the Gross Motor Performance Measure (GMPM)evaluates five attributes: Alignment, Co-ordination, Dissociated movement, Stability, and Weight-shift, for the Gross Motor Function Measure (GMFM) Stand and Walk/Run/Jump items. This study evaluated the reliability and discriminant validity of the QFM. METHOD Thirty-three children with CP (17 females, 16 males; mean age 8y 11mo, SD 3y 1mo; Gross Motor Function Classification System [GMFCS] levels I [n=17], II [n=7], III [n=9]) participated in reliability testing. Each did a GMFM Stand/Walk assessment, repeated 2 weeks later. Both GMFM assessments were videotaped. A physiotherapist assessor pair independently scored the QFM from an assigned child's GMFM video. GMFM data from 112 children. That is, (GMFCS I [n=38], II [n=27], III [n=47]) were used for discriminant validity evaluation. RESULTS QFM mean scores varied from 45.0% (SD 27.2; Stability) to 56.2% (SD 27.5; Alignment). Reliability was excellent across all attributes: intraclass correlation coefficients (ICCs) ≥0.97 (95% confidence intervals [CI] 0.95-0.99), interrater ICCs ≥0.89 (95% CI 0.80-0.98), and test-retest ICCs ≥0.90 (95% CI 0.79-0.99). QFM discriminated qualitative attributes of motor function among GMFCS levels (maximum p<0.05).