Quantifying Active Ankle Range of Motion in Cerebral Palsy Following Selective Dorsal Rhizotomy

This study was conducted to determine whether an objective and quantitative measure for active ankle range of motion would be sensitive to differences between persons of able body and those with cerebral palsy (CP), and between pre- and postselective dorsal rhizotomy (SDR). Twelve children with spastic diplegia CP were tested before undergoing an SDR, and again after 8 months of intensive physical therapy (SDR group). Fourteen other children with spastic diplegia were tested initially and again 8 months following no intervention but maintaining their existing level of physical therapy (CP group). Twenty age-matched children of able body were tested once (AB group). A video system recorded active sagittal plane ankle movements as the seated child independently performed maximum dorsiflexion and plantarflexion. The data were tracked and analyzed to determine end-range dorsiflexion and plantarflexion, and total active ankle range of motion. Repeated-measures ANOVA and Tukey post hoc tests were used to test for significant differences among and between groups, p < 0. 05. Results for the SDR group indicated a significant increase in end-range dorsiflexion and total range of motion following the surgery, with no changes in any measures for the CP group. Results for both groups with CP indicated differences vs. the AB group. The measure provided additional information from what has previously been reported for active ankle range of motion. The integration of this measure with other objective measures for quantifying impairments and presurgical function may be useful in predicting post-SDR gait status and other functional activities.

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Standardized Outcomes Measures in Physical Therapy Practice for Treatment and Rehabilitation of Cerebral PALSY: A Systematic Review

Journal of Personalized Medicine ◽

10.3390/jpm11070604 ◽

2021 ◽

Vol 11 (7) ◽

pp. 604

Author(s):

Maria Dolores Apolo-Arenas ◽

Aline Ferreira de Araújo Jerônimo ◽

Alejandro Caña-Pino ◽

Orlando Fernandes ◽

Joana Alegrete ◽

...

Keyword(s):

Cerebral Palsy ◽

Physical Therapy ◽

Gait Training ◽

Physical Therapy Modalities ◽

Spastic Diplegia ◽

Evaluation Procedures ◽

Outcomes Measures ◽

Prisma Statement ◽

Spastic Hemiplegia

Cerebral palsy (CP) treatment includes physical therapy and various complementary therapies to the standard clinical treatment. However, there are not many reviews that focus on the methods used and evaluation procedures. This study aims to analyze which tools are most suitable for the evaluation and methodology of patients with CP treated with physical therapy. Following the PRISMA statement, through a PICOS strategy, PubMed/MEDLINE, Web of Science (WOS), Scopus, Science Direct, and Scielo were searched with the following terms: cerebral palsy AND (physical therapy modalities OR therapeutics) AND outcome assessment. The methodological quality of the RCTs was assessed with the Evidence Project risk of bias tool. Thirty-seven RCTs and six RCT protocols, comprising 1359 participants with different types of CP: spastic hemiplegia/paresis, spastic diplegia/paresis, and spastic CP, met the inclusion criteria, uncovering 21 variables measured through 77 different instruments and several interventions. The therapies most widely used in CP are gaming or technology-assisted therapies, aerobic training, hippotherapy, music therapy, gait training, and aquatic exercises. This study provides an overview of what the authors used in the neurorehabilitation field through procedure evaluation and checking the technological advance that began to be used.

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Comparison of functional outcomes from orthopedic and neurosurgical interventions in spastic diplegia

Neurosurgical FOCUS ◽

10.3171/foc.1998.4.1.6 ◽

1998 ◽

Vol 4 (1) ◽

pp. E5 ◽

Cited By ~ 5

Author(s):

Mark F. Abel ◽

Diane L. Damiano ◽

John F. McLaughlin ◽

Kit M. Song ◽

Catherine S. Graubert ◽

...

Keyword(s):

Clinical Trials ◽

Motor Function ◽

Three Dimensional ◽

Gait Velocity ◽

Spastic Diplegia ◽

Five Dimensions ◽

Dorsal Rhizotomy ◽

Multicenter Clinical Trials ◽

Functional Outcome Measures ◽

Post Hoc

Selective dorsal rhizotomy (SDR) and orthopedic surgery, in the form of muscle-tendon (MT) lengthening surgery are commonly performed in ambulatory children with spastic diplegia to improve their level of motor function. This investigation is a post hoc comparison of the functional effects from each of these surgical options in 30 patients with spastic diplegia who underwent one of these interventions as their initial surgical procedure. Sixteen children underwent SDR and 14 underwent MT surgery in two separate prospective clinical trials. The same functional outcome measures preoperatively and approximately 1 year postoperatively were used in both studies including temporospatial parameters from three-dimensional gait analysis, the total score, and score on each of the five dimensions of the Gross Motor Function Measure (GMFM). Comparisons indicate that patients who underwent SDR had significant improvements in GMFM Dimensions 2, 4, and 5 as well as in total score, although 63% of those studied had a 10% or more reduction in gait velocity. Gait was more predictably improved in the MT group, with only 21% demonstrating reductions in velocity. Conversely, the change in GMFM scores in the MT group was not as pervasive and skewed toward higher skills with only GMFM Dimension 5 and total score improved significantly. Several important hypotheses are derived from these comparisons. Multicenter clinical trials are needed to define more clearly the indications for and to assess more comprehensively the outcomes from each intervention.

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Soft Tissue Release and Osteotomies in the Treatment of Patients with Spastic Diplegic Cerebral Palsy

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1016/j.jotr.2017.12.004 ◽

2018 ◽

Vol 24 (1) ◽

pp. 80-83

Author(s):

Ng Bobby Kin-Wah ◽

Chau Wai-Wang ◽

Hung Alec Lik-Hang ◽

Lam Tsz-Ping ◽

Cheng Jack Chun-Yiu

Keyword(s):

Cerebral Palsy ◽

Soft Tissue ◽

Soft Tissue Release ◽

Spastic Diplegia ◽

Single Event ◽

Selective Dorsal Rhizotomy ◽

Dorsal Rhizotomy ◽

Surgery Patient ◽

Before And After ◽

Mid Term Results

We aim to study the outcome of soft tissue releases by tendon elongations and osteotomies in fixed joint contractures by clinical examination and patient self-reported assessment on 20 patients (14 males and 6 females) with spastic diplegic cerebral palsy treated with single-event multilevel surgery (SEMLS) between 2000 and 2012. A questionnaire was used to collect information on problems encountered before and after surgery and decision on surgery. Comparing patients with Gross Motor Function Classification System class I/II, (N = 8), III (N = 8) and IV/V, patients of classes IV/V showed much slower mean recovery time than I/II group (14.00 vs. 4.38 months, p < 0.01). SEMLS in the treatment of patients with spastic diplegia had good mid-term results in most patients. The patients who had unfavourable outcomes are associated with mental retardation, general or local complications and previous selective dorsal rhizotomy surgery. Patient selection and good rehabilitations preoperation and postoperation provided the most favourable outcomes of SEMLS.

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Selective dorsal rhizotomy for spasticity not associated with cerebral palsy: reconsideration of surgical inclusion criteria

Neurosurgical FOCUS ◽

10.3171/2013.8.focus13294 ◽

2013 ◽

Vol 35 (5) ◽

pp. E6 ◽

Cited By ~ 20

Author(s):

William C. Gump ◽

Ian S. Mutchnick ◽

Thomas M. Moriarty

Keyword(s):

Cerebral Palsy ◽

Spinal Cord Injuries ◽

Spastic Diplegia ◽

Inclusion Criteria ◽

Selective Dorsal Rhizotomy ◽

Dorsal Rhizotomy ◽

Common Diagnosis

Children with spastic diplegia from cerebral palsy (CP) experience measurable improvement in their spasticity and motor function following selective dorsal rhizotomy (SDR). The role of this operation in the treatment of other spasticity causes is less well defined. A literature review was undertaken to survey outcomes from SDRs performed outside the CP population. Multiple sclerosis was the most common diagnosis found, accounting for 74 of 145 patients described. Selective dorsal rhizotomies have also been reported in patients with traumatic brain and spinal cord injuries, ischemic and hemorrhagic stroke, neurodegenerative disease, hypoxic encephalopathy, and other causes of spasticity. Outcomes from surgery are generally described as favorable, although postoperative assessments and follow-up times are not standardized across reports. Long-term outcomes are sparsely reported. Larger numbers of patients and more detailed outcomes data have the potential to form a basis for expanding the inclusion criteria for SDR.

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Sustained non-spastic gait pattern more than 25-years after Selective Dorsal Rhizotomy in adults with Cerebral Palsy and spastic diplegia

Gait & Posture ◽

10.1016/j.gaitpost.2019.07.118 ◽

2019 ◽

Vol 73 ◽

pp. 230-231

Keyword(s):

Cerebral Palsy ◽

Gait Pattern ◽

Spastic Diplegia ◽

Selective Dorsal Rhizotomy ◽

Dorsal Rhizotomy ◽

Spastic Gait

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

Journal of Neurosurgery ◽

10.3171/jns.1991.74.2.0178 ◽

1991 ◽

Vol 74 (2) ◽

pp. 178-184 ◽

Cited By ~ 69

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.

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Keyhole interlaminar dorsal rhizotomy for spastic diplegia in cerebral palsy

Acta Neurochirurgica ◽

10.1007/s00701-015-2453-1 ◽

2015 ◽

Vol 157 (7) ◽

pp. 1187-1196 ◽

Cited By ~ 11

Author(s):

Marc Sindou ◽

George Georgoulis

Keyword(s):

Cerebral Palsy ◽

Spastic Diplegia ◽

Dorsal Rhizotomy

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Changes in ankle spasticity and strength following selective dorsal rhizotomy and physical therapy for spastic cerebral palsy

Journal of Neurosurgery ◽

10.3171/jns.1999.91.5.0727 ◽

1999 ◽

Vol 91 (5) ◽

pp. 727-732 ◽

Cited By ~ 51

Author(s):

Jack R. Engsberg ◽

Sandy A. Ross ◽

Tae Sung Park

Keyword(s):

Cerebral Palsy ◽

Physical Therapy ◽

Spastic Cerebral Palsy ◽

Control Group ◽

Selective Dorsal Rhizotomy ◽

Content Type ◽

Dorsal Rhizotomy ◽

Angle Data ◽

Work Done ◽

Fine Print

Object. In this investigation the authors quantified changes in ankle plantarflexor spasticity and strength following selective dorsal rhizotomy (SDR) and intensive physical therapy in patients with cerebral palsy (CP).Methods. Twenty-five patients with cerebral palsy (CP group) and 12 able-bodied volunteers (AB controls) were tested with a dynamometer. For the spasticity measure, the dynamometer was used to measure the resistive torque of the plantarflexors during passive ankle dorsiflexion at five different speeds. Data were processed to yield a single value that simultaneously encompassed the three key elements associated with spasticity: velocity, resistance, and stretch. For the strength test, the dynamometer rotated the ankle from full dorsiflexion to full plantarflexion while a maximum concentric contraction of the plantarflexors was performed. Torque angle data were processed to include the work done by the patient or volunteer on the machine. Plantarflexor spasticity values for the CP group were significantly greater than similar values for the AB control group prior to surgery but not significantly different after surgery. Plantarflexor strength values of the CP group were significantly less than those of the AB control group pre- and postsurgery. Postsurgery strength values did not change relative to presurgery values.Conclusions. The spasticity results of the present investigation agreed with those of previous studies indicating a reduction in spasticity for the CP group. The strength results did not agree with the findings of most previous related literature, which indicated that a decrease in strength should have occurred. The strength results agreed with a previous investigation in which knee flexor strength was objectively examined, indicating that strength did not decrease as a consequence of an SDR. The methods of this investigation could be used to improve SDR patient selection.

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