scholarly journals The effect of GMFCS level, age, sex, and dystonia on multi-dimensional outcomes after selective dorsal rhizotomy: prospective observational study

2021 ◽  
Vol 37 (5) ◽  
pp. 1729-1740
Author(s):  
Conor Scott Gillespie ◽  
◽  
Alan Matthew George ◽  
Benjamin Hall ◽  
Steven Toh ◽  
...  
Keyword(s):  
Motor Function ◽  
Self Care ◽  
Pediatric Neurosurgery ◽  
Care Quality ◽  
Fine Motor ◽  
Selective Dorsal Rhizotomy ◽  
Dorsal Rhizotomy ◽  
Significant Difference ◽  
Age Category ◽  
Gmfcs Level

Abstract Purpose Investigate the effect of age category (1–9 years vs 10–18 years), sex, Gross Motor Function Classification System (GMFCS) level, and presence of dystonia on changes in eight function test parameters 24 months after selective dorsal rhizotomy (SDR). Methods Prospective, single-center study of all children aged 3–18 years with bilateral cerebral palsy with spasticity who underwent SDR at a tertiary pediatric neurosurgery center between 2012 and 2019. A linear mixed effects model was used to assess longitudinal changes. Results From 2012 to 2019, 42 children had follow-up available at 24 months. Mean GMFM-66 scores increased after SDR (mean difference 5.1 units: 95% CI 3.05–7.13, p < 0.001). Statistically significant improvements were observed in CPQoL, PEDI Self-care and Mobility, 6MWT, Gillette, and MAS scores. There was no significant difference in the improvements seen for age category, sex, GMFCS level, and presence of dystonia for most of the parameters tested (5/8, 6/8, 5/8, and 6/8 respectively). Conclusion SDR may improve gross and fine motor function, mobility and self-care, quality of life, and overall outcome based on extensive scoring parameter testing at 24 months. Atypical patient populations may benefit from SDR if appropriately selected. Multi-center, prospective registries investigating the effect of SDR are required.

Intrathecal baclofen versus selective dorsal rhizotomy for children with cerebral palsy who are nonambulant: a systematic review

2020 ◽  
Vol 25 (1) ◽  
pp. 69-77
Author(s):  
Benjamin Davidson ◽  
Nathan Schoen ◽  
Shaina Sedighim ◽  
Renée Haldenby ◽  
Blythe Dalziel ◽  
...  
Keyword(s):  
Motor Function ◽  
Case Series ◽  
Intrathecal Baclofen ◽  
Risk Of Bias ◽  
Inclusion Criteria ◽  
Selective Dorsal Rhizotomy ◽  
Gross Motor ◽  
Gross Motor Function ◽  
Dorsal Rhizotomy ◽  
Gmfcs Level

OBJECTIVECerebral palsy (CP) is the most common childhood physical disability. Historically, children with hypertonia who are nonambulatory (Gross Motor Function Classification System [GMFCS] level IV or V) were considered candidates for intrathecal baclofen (ITB) therapy to facilitate care and mitigate discomfort. Selective dorsal rhizotomy (SDR) was often reserved for ambulant children to improve gait. Recently, case series have suggested SDR as an alternative to ITB in selected children functioning at GMFCS level IV/V. The objective for this study was to systematically review the evidence for ITB and SDR in GMFCS level IV or V children.METHODSMedline, Embase, Web of Science, and Cochrane databases were systematically searched. Articles were screened using the following inclusion criteria: 1) peer-reviewed articles reporting outcomes after SDR or ITB; 2) outcomes reported using a quantifiable scale or standardized outcome measure; 3) patients were < 19 years old at the time of operation; 4) patients had a diagnosis of CP; 5) patients were GMFCS level IV/V or results were reported based on GMFCS status and included some GMFCS level IV/V patients; 6) article and/or abstract in English; and 7) primary indication for surgery was hypertonia. Included studies were assessed with the Risk of Bias in Non-Randomized Studies - of Interventions (ROBINS-I) tool.RESULTSTwenty-seven studies met inclusion criteria. The most commonly reported outcomes were spasticity (on the Mean Ashworth Scale) and gross motor function (using the Gross Motor Function Measure), although other outcomes including frequency of orthopedic procedures and complications were also reported. There is evidence from case series that suggests that both ITB and SDR can lower spasticity and improve gross motor function in this nonambulatory population. Complication rates are decidedly higher after ITB due in part to the ongoing risk of device-related complications. The heterogeneity among study design, patient selection, outcome selection, and follow-up periods was extremely high, preventing meta-analysis. There are no comparative studies, and meaningful health-related quality of life outcomes such as care and comfort are lacking. This review is limited by the high risk of bias among included studies. Studies of SDR or ITB that did not clearly describe patients as being GMFCS level IV/V or nonambulatory were excluded.CONCLUSIONSThere is a lack of evidence comparing the outcomes of ITB and SDR in the nonambulatory CP population. This could be overcome with standardized prospective studies using more robust methodology and relevant outcome measures.

scholarly journals No Increased Risk for Scoliosis After Early Selective Dorsal Rhizotomy - A Longitudinal Population-Based Controlled Registry Study from four to 25 years of Age

2020 ◽  
Author(s):  
Annika Lundkvist Josenby ◽  
Lena Westbom
Keyword(s):  
Spinal Pain ◽  
Control Group ◽  
Spastic Diplegia ◽  
Selective Dorsal Rhizotomy ◽  
Gross Motor ◽  
Dorsal Rhizotomy ◽  
Severe Spasticity ◽  
Increased Risk ◽  
Group Frequency ◽  
Gmfcs Level

Abstract Spasticity interfering with gross motor development in cerebral palsy (CP) can be reduced with selective dorsal rhizotomy (SDR). Although reported, it is unknown if SDR surgery increases the risk for later spine problems. Using CP-registry data from a geographically defined population with the same health care and habilitation services, the objectives were to compare reported scoliosis and spinal pain up to adult age in all SDR-operated with all non-SDR-operated individuals with same medical history, functional abilities, and level of spasticity at four years of age. Method In the total population with CP spastic diplegia in Skåne and Blekinge, born 1990-2006, 149 individuals had moderate to severe spasticity and no medical contraindications against SDR at four years of age and were included; 36 persons had undergone SDR at a median age of 4.0 years (range 2.5 – 6.6 years), and 113 individuals constituting the control group, had not. Data on scoliosis and spinal pain at 10, 15, 20 and 25 years of age were analyzed using Kaplan-Meier survival curves and Fisher’s exact test. Gross motor function classification (GMFCS) levels at four years of age (or pre-operatively) were used for stratification.Result Presence of scoliosis at 15, 20, and 25 years of age was the same in the SDR group as in the control group (p=0.734, 0.735 and 1.0). In severe functional disability (GMFCS IV), the SDR group had later onset and lower occurrence of scoliosis (p=0.004) than the control group. Frequency of reported spinal pain did not differ between the groups. Conclusion Neither scoliosis, nor spinal pain was more frequent after SDR than expected by natural history. On the contrary, in severe CP (GMFCS level IV), scoliosis was less frequently reported and had a later onset in the SDR group than in the same GMFCS-level control group.

Correlation of Gross Motor Function with Topographical Diagnosis in Children with Cerebral Palsy

2012 ◽  
Vol 23 (1) ◽  
pp. 10-14
Author(s):  
Nonica Laisram ◽  
Tufail Muzaffar ◽  
S Y Kothari
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Care Hospital ◽  
Weak Correlation ◽  
Chi Square ◽  
Gross Motor ◽  
Gross Motor Function ◽  
Topographical Distribution ◽  
Significant Difference ◽  
Gmfcs Level

Abstract There is a need for appropriate classification to describe gross motor function status in a child with cerebral palsy (CP). It was hypothesised that: greater the number of limbs involved, higher would be the Gross Motor Function Classification System (GMFCS) level; and, there would be spectrum of GMFCS level for each of the topographical types of the cerebral palsy. A cross-sectional study of 182 children of both sexes in the age group of 7 months to 30 years having spastic CP who attended CP clinic from 2008 to 2009 in tertiary care hospital were assessed for topographical diagnosis and GMFCS levels. Topographical distribution showed diplegia (42%), quadriplegia (30%), hemiplegia (23%), triplegia (4%) and monoplegia (1%). GMFCS levels were almost evenly distributed, level II (26%) was most common followed by level V (23%). Statistical analysis was done using Cramer's ratio and Pearson's Chi-square test. Cramer's ratio of 0.277 showed fairly weak correlation between GMFCS levels and topographical CP types. Pearson's Chi-square (12) =41.7, p=0.000 indicates that there is significant difference between expected and observed values of number of limbs involved in GMFCS levels, further substantiating the weak correlation. These results mean that GMFCS in different topographical groups have different distributions. It was also observed that GMFCS had weak correlation with the number of limbs involved, thus reflecting that the GMFCS is a better indicator of gross motor function impairment than the traditional topographical categorisation of CP that specifies the number of limbs involved.

scholarly journals Effect of selective dorsal rhizotomy for treatment of spasticity related to cerebral palsy - report on one-year postoperative results in the Polish population

2020 ◽  
Vol 29 (58) ◽  
pp. 19-26
Author(s):  
Leszek Sagan ◽  
◽  
Jarosław Ogłodziński ◽  
Łukasz Madany ◽  
Monika Jarosz ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Metabolic Diseases ◽  
Neurosurgical Procedures ◽  
Polish Population ◽  
Selective Dorsal Rhizotomy ◽  
Gross Motor ◽  
Motor Functioning ◽  
Dorsal Rhizotomy ◽  
Significant Difference ◽  
One Year

Aim: Selective dorsal rhizotomy (SDR) is a form of surgical treatment that reduces tone in lower extremities by selective sectioning of lumbosacral dorsal roots fibers. However, the method occasionally still arouses some controversies. Since it was introduced in Poland, relatively recently, the discussion on its efficacy is even more vivid. To address this issue we present the analysis of patients treated with SDR in our institution. Material and methods: Out of 96 operated patients 76 were eligible for the study and 30 of them showed up for one-year follow up and were finally analyzed. Modified Ashworth Scale (MAS) was used to measure spasticity and the Gross Motor Function Measure (GMFM) to asses gross motor functioning of the patients. Results: For spasticity of different muscles measured by MAS there were significant differences between pre-treatment and post- -treatment (p < 0.05, after Holm-Bonferroni correction; effect size 1.26 < d> 2.32). Furthermore, for gross motor functioning measured by GMFM, there was significant difference between both time points treatment (d = 0.68). Conclusions: To our knowledge this is the first report on results of SDR for cerebral palsy treatment in Polish population. The treatment significantly diminished spasticity and improved gross motor functioning on the long term basis. This should provide reassurance to parents considering the procedure and influence the discussion on including SDR in the group of neurosurgical procedures founded by health system authorities in Polandneurodegenerative and metabolic diseases are suspected, genetic testing is performed. Despite the progress that has been made in treating some ataxia disorders in recent years, with few exceptions, for most of patients the therapy of choice is symptomatic and supportive treatment.

scholarly journals Profile of motor abilities of children with cerebral palsy as a predictor of their functional independence in self-care and mobility

2020 ◽  
Vol 148 (1-2) ◽  
pp. 87-93
Author(s):  
Milena Milicevic
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Classification System ◽  
Self Care ◽  
Functional Independence ◽  
Fine Motor ◽  
Gross Motor ◽  
Motor Functions ◽  
Motor Abilities ◽  
Children With Cerebral Palsy

Introduction/Objective. Limitations of mobility and motor deficits are identified as predominant in the clinical picture of cerebral palsy. This research aimed to describe the profile of motor abilities of children with cerebral palsy, which included gross motor, manual, and bimanual fine motor functions, and to determine the extent to which their functional independence in self-care and mobility was influenced by the profile of their motor abilities. Methods. A convenience sample of 117 participants with cerebral palsy (56.4% males), aged 7?18 years (M = 13.2, SD = 3.4), was included. The Gross Motor Function Classification System ? Expanded and Revised, Manual Ability Classification System, Bimanual Fine Motor Function and the Functional Independence Measure ? Version for Children, were used. Data was analyzed by descriptive statistics and hierarchical multiple regression. Results. More than a half of sample exhibited different levels of gross motor, manual, and bimanual function. Lower functional independence in self-care and mobility was associated with higher functional limitations. Manual abilities were the strongest predictor of functional independence in self-care (? = -0.63, p < 0.001), while gross motor functions were the strongest predictor in the mobility domain (? = -0.65, p < 0.001). Conclusion. Improvement of gross motor and manual abilities of children with cerebral palsy is confirmed as one of the basic preconditions for achieving a greater independence and for minimizing or eliminating a need for assistance in mobility and in everyday self-care activities.

Orem’s Self-Care Model with Multiple Sclerosis Patients’ Balance and Motor Function

2019 ◽  
Vol 33 (1) ◽  
pp. 46-54
Author(s):  
Ardashir Afrasiabifar ◽  
Zahra Mehri ◽  
Hamid Reza Ghaffarian Shirazi
Keyword(s):  
Multiple Sclerosis ◽  
Motor Function ◽  
Intervention Group ◽  
Self Care ◽  
Nursing Intervention ◽  
Control Group ◽  
Care Model ◽  
Significant Difference ◽  
The Mean ◽  
Multiple Sclerosis Patients

Orem’s self-care model has been introduced as a nursing model to empower participants with chronic diseases. This study aims to investigate the effectiveness of nursing interventions using Orem’s self-care model with multiple sclerosis participants’ balance and motor function. Sixty-three participants with multiple sclerosis were randomly assigned to intervention and control groups. The nursing intervention using Orem’s self-care model was performed for eight sessions of 45–60 minutes in the intervention group. In the intervention group, a significant increase (improvement) was observed in the mean scores of balance before (17.09 ± 1.97) and after the intervention (33.75 ± 6.01). A significant decrease (improvement) was observed in the mean of motor functions before (4.12 ± 0.34) and after the intervention (1.59 ± 0.71) ( p = 0.001). However, no significant difference existed in the mean scores of balance ( p = 0.10) and motor function in the control group ( p = 0.20). The nursing intervention using Orem’s self-care model improved balance and motor function of participants with multiple sclerosis.

Poster 382 Gait Changes in Patients Diagnosed With Cerebral Palsy (GMFCS level 3) After Selective Dorsal Rhizotomy: A Retrospective Study

PM&R ◽  
2011 ◽  
Vol 3 ◽  
pp. S306-S307
Author(s):  
Pravardhan Birthi ◽  
Henry J. Iwinski ◽  
Robert B. Nickerson ◽  
Hank White
Keyword(s):  
Cerebral Palsy ◽  
Retrospective Study ◽  
Selective Dorsal Rhizotomy ◽  
Dorsal Rhizotomy ◽  
Level 3 ◽  
Gmfcs Level

Combined Selective Dorsal Rhizotomy and Single-Event Multilevel Surgery in a Child with Spastic Diplegic Cerebral Palsy: A Case Report

2021 ◽  
pp. 1-6
Author(s):  
Kayli Gimarc ◽  
Suzanne Yandow ◽  
Samuel Browd ◽  
Connie Leibow ◽  
Kelly Pham
Keyword(s):  
Cerebral Palsy ◽  
Case Report ◽  
Motor Function ◽  
Single Event ◽  
Selective Dorsal Rhizotomy ◽  
Gross Motor ◽  
Dorsal Rhizotomy ◽  
Functional Gait ◽  
Gait Impairments

<b><i>Introduction:</i></b> Children with spastic diplegic cerebral palsy (CP) often have functional and gait impairments related to spasticity and loss of range of motion (ROM). Selective dorsal rhizotomy (SDR) and single-event multilevel surgery (SEMLS) are surgical interventions that are used to manage spasticity and functional gait impairments, respectively. This is the first known case report of a child with spastic diplegic CP who underwent combined SDR and SEMLS. <b><i>Case Report:</i></b> Our patient is a 7-year-old girl with spastic diplegic CP, functioning at the Gross Motor Function Classification System (GMFCS) level II, who presented with spasticity and contractures in bilateral lower extremities leading to functional gait impairments, despite conservative management. Combined SDR/SEMLS was offered with the goal of simultaneously managing spasticity and contractures while reducing the need for multiple procedures. Postoperatively, the patient’s functional mobility, ROM, spasticity, and strength were assessed at various follow-up intervals. The patient had increased lower extremity weakness and functional decline postoperatively. Persistent genu recurvatum and knee instability required prolonged rehabilitation services, and she demonstrated functional gains with these interventions. At follow-ups, spasticity was resolved and ROM improved. By the 12-month follow-up, the Gross Motor Function Measure-66 was improved to 68.9 (55th percentile) from the preoperative level of 62.1 (35th percentile). By the 30-month follow-up, she was able to participate in novel recreational activities. <b><i>Discussion/Conclusion:</i></b> Multidisciplinary teams may consider combined SDR/SEMLS for management of spasticity, gait impairment, and contracture in carefully selected patients with spastic CP.

Short- and long-term effects of selective dorsal rhizotomy on gross motor function in ambulatory children with spastic diplegia

2011 ◽  
Vol 7 (5) ◽  
pp. 557-562 ◽  
Author(s):  
Petra E. M. van Schie ◽  
Maaike Schothorst ◽  
Annet J. Dallmeijer ◽  
R. Jeroen Vermeulen ◽  
Willem J. R. van Ouwerkerk ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Motor Function ◽  
Botulinum Toxin Type A ◽  
Spastic Diplegia ◽  
Selective Dorsal Rhizotomy ◽  
Gross Motor ◽  
Gross Motor Function ◽  
Dorsal Rhizotomy

Object The primary aim of this prospective cohort study was to evaluate the short-term (1 year) and long-term (mean 6 years) effects of selective dorsal rhizotomy (SDR) on gross motor function and spasticity in ambulatory children with spastic diplegia. Secondary aims were to investigate side effects, additional treatment during follow-up (botulinum toxin type A injections or orthopedic surgery), and parental satisfaction. Methods Thirty-three children who had undergone SDR at a mean age of 6 years and 7 months (± 2 years) were included. There were 7 children at Gross Motor Function Classification System (GMFCS) Level I, 7 at Level II, and 19 at Level III. Gross motor function was assessed with the Gross Motor Function Measure–66 (GMFM-66). Spasticity was measured according to a modified Tardieu scale. Side effects, additional treatment, and parental satisfaction were recorded using a parental questionnaire and medical records. Results At 1-year follow-up, mean GMFM-66 scores improved significantly by 4.3 ± 4.1 points. Children at GMFCS Levels I and II showed significantly more improvement (7.2 points) on the GMFM-66 compared with children at GMFCS Level III (2.9 points). On long-term follow-up (mean 6 years ± 22 months), mean GMFM-66 scores improved significantly by 6.5 ± 5.9 points, without a difference between children at GMFCS Levels I and II and Level III. No relapse of spasticity was noted. Ten children (30%) needed orthopedic surgery and 13 children (39%) received botulinum toxin type A treatment after SDR. Twenty (91%) of the 22 parents who answered the questionnaire at long-term follow-up believed that their child's functioning had improved after SDR. Conclusions Selective dorsal rhizotomy resulted in short- and long-term improvements in gross motor function, without relapse of spasticity. However, the majority of the children still needed additional surgery or botulinum toxin A treatment.

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