4.5 Year Follow-Up after Surgical Correction of Upper Extremity Deformities in Spastic Cerebral Palsy

1999 ◽  
Vol 24 (6) ◽  
pp. 719-723 ◽  
Author(s):  
G. NYLANDER ◽  
C. CARLSTRÖM ◽  
L. ADOLFSSON
Keyword(s):  
Cerebral Palsy ◽  
Upper Extremity ◽  
Reconstructive Surgery ◽  
Assessment System ◽  
Upper Extremities ◽  
Spastic Cerebral Palsy ◽  
Functional Evaluation ◽  
Postoperative Results ◽  
Hand Evaluation

Reconstructive surgery was carried out on 27 upper extremities in 24 children with deformities due to spastic cerebral palsy. Functional evaluation of the affected extremities was made preoperatively, at 6 months and at a mean of 4.5 years postoperatively using a score added to the assessment system described by the Committee on Spastic Hand Evaluation. According to the score, dysfunction of the arm was significantly reduced 6 months after the reconstructive surgery and the improvements remained essentially unchanged at the later follow-up. The addition of a score to the original assessment system facilitated the overall assessment of postoperative results.

Reduction in upper-extremity tone after lumbar selective dorsal rhizotomy in children with spastic cerebral palsy

2013 ◽  
Vol 12 (6) ◽  
pp. 588-594 ◽  
Author(s):  
Paul Gigante ◽  
Michael M. McDowell ◽  
Samuel S. Bruce ◽  
Genevieve Chirelstein ◽  
Claudia A. Chiriboga ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Lower Extremity ◽  
Upper Extremity ◽  
Upper Extremities ◽  
Spastic Cerebral Palsy ◽  
Selective Dorsal Rhizotomy ◽  
Dorsal Rhizotomy ◽  
Modified Ashworth Scale ◽  
Muscle Groups ◽  
Ashworth Scale

Object Randomized clinical trials have established that lumbar selective dorsal rhizotomy (SDR) reduces lower-extremity tone and improves functional outcome in children with spastic cerebral palsy. Significant data exist to support a secondary effect on upper-extremity function in patients with upper-extremity spasticity. The effects of SDR on upper-extremity tone, however, are not well characterized. In this report, the authors sought to assess changes in upper-extremity tone in individual muscle groups after SDR and tried to determine if these changes could be predicted preoperatively. Methods The authors retrospectively reviewed 42 children who underwent SDR at Columbia University Medical Center/Morgan Stanley Children's Hospital of NewYork-Presbyterian between 2005 and 2011. Twenty-five had upper-extremity spasticity. All underwent pre- and postoperative examination for measuring tone (Modified Ashworth Scale) and assessing functional outcome. Follow-up examinations with therapists were performed at least once at a minimum of 2 months postoperatively (mean 15 months). Results In the upper extremities, 23 (92%) of 25 patients had improvements of at least 1 Ashworth point in 2 or more independent motor groups on the Modified Ashworth Scale, and 12 (71%) of 17 families surveyed reported increases in motor control or spontaneous movement. The mean Modified Ashworth Scale scores for all upper-extremity muscle groups demonstrated an improvement from 1.34 to 1.22 (p < 0.001). Patients with a mean preoperative upper-extremity tone of 1.25–1.75 were most likely to benefit from reduction in tone (p = 0.0019). Proximal and pronator muscle groups were most likely to demonstrate reduced tone. Conclusions In addition to improvements in lower-extremity tone and function, SDR has demonstrable effects on upper extremities. Greater than 90% of our patients with elevated upper-extremity tone demonstrated reduction in tone in at least 2 muscle groups postoperatively. Patients with a mean Modified Ashworth Scale upper-extremity score of 1.25–1.75 may encounter the greatest reduction in upper-extremity tone.

scholarly journals A microcosting study of the surgical correction of upper extremity deformity in children with spastic cerebral palsy

2016 ◽  
Vol 20 (3) ◽  
pp. 173-178 ◽  
Author(s):  
Juul Vera Alewijnse ◽  
Ellen M. van Rooijen ◽  
Mick Kreulen ◽  
Mark JC Smeulders ◽  
Siok Swan Tan
Keyword(s):  
Cerebral Palsy ◽  
Upper Extremity ◽  
Surgical Correction ◽  
Spastic Cerebral Palsy

scholarly journals Short-term Gait Parameters Change in Mild Spastic Cerebral Palsy after Selective Dorsal Rhizotomy Guided by Our Newly-Modified Protocol

2021 ◽  
Author(s):  
wenbin jiang ◽  
Shuyun Jiang ◽  
Yan Yu ◽  
Qijia Zhan ◽  
Min Wei ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Lower Limbs ◽  
Spastic Cerebral Palsy ◽  
Selective Dorsal Rhizotomy ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Dorsal Rhizotomy ◽  
Gait Parameters

Abstract Background Selective Dorsal Rhizotomy (SDR) guided by our modified protocol can decrease spasticity in certain muscles. This study aimed to investigate gait parameters changes in cerebral palsy (CP) with focal spasticity after SDR in short-term follow-up. Methods CP classified as Gross Motor Function Classification System (GMFCS) level Ⅰ and Ⅱ who underwent SDR were included. Changes of spasticity, gait parameters and gait deviation index (GDI) were retrospectively reviewed. Results This study contained 26 individuals with 44 affected and 8 intact lower limbs (4 monoplegia, 4 hemiplegia and 18 diplegia). Mean age was 5.7 ± 1.9 years-old and follow-up duration was 9.9 ± 6.6 months. After SDR, average spasticity of 108 target muscles decreased from 2.9 ± 0.8 to 1.8 ± 0.6 in Modified Ashworth Scale (MAS). Kinematic curves changed after the surgery in sagittal and transverse plane in affected sides, further investigation showed improvements in ankle and knee. No changes were found in temporal-spatial parameters except decrease in cadence in affected sides. GDI improved significantly in affected limbs. Conclusion In short-term follow up, the new-protocol-guiding SDR can lower focal spasticity, GA showed improvements in kinematic parameters and GDI. Longer follow-up duration is needed to clarify the long-term outcome.

Modulation of gait inter-limb coordination in children with unilateral spastic cerebral palsy after intensive upper extremity intervention

2019 ◽  
Vol 237 (6) ◽  
pp. 1409-1419 ◽  
Author(s):  
Alexis N. Sidiropoulos ◽  
Siyun Chen ◽  
Terry R. M. Kaminski ◽  
Andrew M. Gordon
Keyword(s):  
Cerebral Palsy ◽  
Upper Extremity ◽  
Spastic Cerebral Palsy ◽  
Limb Coordination

Cerebral palsy and rhizotomy: A 3-year follow-up evaluation with gait analysis

1991 ◽  
Vol 74 (2) ◽  
pp. 178-184 ◽  
Author(s):  
Christopher L. Vaughan ◽  
Barbara Berman ◽  
Warwick J. Peacock
Keyword(s):  
Cerebral Palsy ◽  
Gait Analysis ◽  
Range Of Motion ◽  
Stride Length ◽  
Sagittal Plane ◽  
Spastic Cerebral Palsy ◽  
Normal Range ◽  
Early Functional Outcome ◽  
Selective Posterior Rhizotomy

✓ A recent increase in the popularity of selective posterior rhizotomy for reduction of spasticity in cerebral palsy has led to a demand for more objective studies of outcome and long-term follow-up results. The authors present the results of gait analysis on 14 children with spastic cerebral palsy, who underwent selective posterior rhizotomy in 1985. Sagittal plane gait patterns were studied before surgery and at 1 and 3 years after surgery using a digital camera system. The parameters measured included the range of motion at the knee and thigh, stride length, speed of walking, and cadence. The range of motion at the knee was significantly increased at 1 year after surgery and further improved to a nearly normal range at 3 years after surgery. In contrast, postoperative measurements of thigh range exceeded normal values at 1 year, but decreased toward normal range at 3 years. While improvements in range of motion continued between Years 1 and 3, the children developed a more extended thigh and knee position, which indicated a more upright walking posture. Stride length and speed of walking also improved, while cadence remained essentially unchanged. This 3-year follow-up study, the first to examine rhizotomy using an objective approach, has provided some encouraging results regarding early functional outcome.

External Rotation Osteotomy of Femur in Patients with Spastic Cerebral Palsy

1998 ◽  
Vol 02 (01) ◽  
pp. 1-8
Author(s):  
Ken N. Kuo ◽  
David W. Hang ◽  
Peter A. Smith
Keyword(s):  
Cerebral Palsy ◽  
Internal Rotation ◽  
External Rotation ◽  
Spastic Cerebral Palsy ◽  
Femoral Torsion ◽  
Younger Patients ◽  
Foot Progression Angle ◽  
Kinematic Study ◽  
Rotation Osteotomy

Fifteen subjects with ambulatory spastic cerebral palsy underwent proximal femoral external rotation osteotomy between 1990 to 1992 for severe intoeing gait due to internal femoral torsion. Among them 13 patients returned for follow-up. Preoperatively, maximum internal rotation of the hip on physical examination corrected from 77° to 50° postoperatively. Foot progression angle changed from 10° intoeing gait preoperatively to 9° outtoeing gait postoperatively ( p < 0.05). The recurrence rate for internal femoral torsion after correction is 9.5 degrees/year for the group of 10-year-olds and younger, and 2.1 degrees/year for the group older than 10-year-olds. In the kinematic study, foot progression angle changed from internal rotation of 9.2° to external rotation of 16.5° ( p < 0.05). Our study showed that external rotation osteotomy of the femur is a safe and effective procedure. The rate of recurrence for femoral internal torsion was greater for younger patients (≤10-year-old) when the surgery was performed.

scholarly journals Three-dimensional Alignment of the Upper Extremity in the Standing Neutral Position in Healthy Subjects

2022 ◽  
Author(s):  
Yuki Yoshida ◽  
Noboru Matsumura ◽  
Yoshitake Yamada ◽  
Satoshi Hiraga ◽  
Kazunori Ishii ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Internal Rotation ◽  
Glenohumeral Joint ◽  
Three Dimensional ◽  
Upper Extremities ◽  
Neutral Position ◽  
Functional Evaluation ◽  
Ct Scanner ◽  
Angular Rotation ◽  
The Mean

Abstract Background: Though alignment of the spine and lower extremities in the standing neutral position has been evaluated, a few studies evaluating the alignment of the upper extremities have also been made. This study assessed the normal alignment of the upper extremities in the standing neutral position and clarified the three-dimensional angular rotations of the upper extremity joints.Methods: Computed tomography (CT) images of 158 upper extremities from 79 healthy volunteers were prospectively acquired in the standing neutral position using an upright CT scanner. Three-dimensional coordinate systems of the thorax, scapula, humerus, and forearm were designated, and three-dimensional angular rotations of the scapulothoracic, glenohumeral, and elbow joints were calculated.Results: The mean angle of the scapulothoracic joint was 8.5° ± 5.9° of upward rotation, 28.7° ± 5.9° of internal rotation, and 7.9° ± 5.2° of anterior inclination. The mean angle of the glenohumeral joint was 4.4° ± 5.9° of abduction, 9.4° ± 12.3° of internal rotation, and 0.3° ± 4.4° of extension. The mean angle of the elbow joint was 9.6° ± 3.7° of valgus, 88.8° ± 14.3° of pronation, and 15.4° ± 4.2° of flexion. Correlations in angular rotation values were found, and interactions for keeping the upper extremities in a neutral position were observed.Conclusions: This study clarified the three-dimensional angular rotation of upper extremity joints in the standing neutral position using an upright CT scanner. Our results may provide important insights for the functional evaluation of upper extremity alignment.

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