Selective dorsal rhizotomy in children with spastic hemiparesis

2010 ◽  
Vol 6 (4) ◽  
pp. 353-358 ◽  
Author(s):  
Allison Oki ◽  
Wende Oberg ◽  
Beth Siebert ◽  
Dutch Plante ◽  
Marion L. Walker ◽  
...  
Keyword(s):  
Stride Length ◽  
The Other ◽  
Assessment Scale ◽  
Selective Dorsal Rhizotomy ◽  
Dorsal Rhizotomy ◽  
Spastic Hemiparesis ◽  
Gait Assessment ◽  
Modified Ashworth Scale ◽  
Ashworth Scale

Object Neurological conditions including cerebral palsy, brain injury, and stroke often result in severe spasticity, which can lead to significant deformity and interfere with function. Treatments for spasticity include oral medications, intramuscular botulinum toxin type A injections, orthopedic surgeries, intrathecal baclofen pump implantation, and selective dorsal rhizotomy (SDR). Selective dorsal rhizotomy, which has been well studied in children with spastic diplegia, results in significant reduction in spasticity and improved function in children. To the authors' knowledge, there are no published outcome data for SDR in patients with spastic hemiparesis. The object of this study was to examine the effects of SDR on spastic hemiparesis. Methods A 2-year study was undertaken including all children with spastic hemiparesis who underwent SDR at the authors' institution. The degree of spasticity, as measured by the Modified Ashworth Scale or quality of gait rated using the visual gait assessment scale, the gait parameters, and velocity were compared in patients before and after undergoing SDR. Results Thirteen children (mean age 6 years 7 months) with spastic hemiparesis underwent SDR performed by the same surgeon during a 2-year period. All of the patients had a decrease in tone in the affected lower extremity after the procedure. The mean reduction in tone in 4 muscle groups (hip adductors, knee flexors, knee extensors, and ankle plantar flexors) according to the modified Ashworth scale score was 2.6 ± 1.26 (p < 0.0001). The quality of gait was assessed in 7 patients by using the visual gait assessment scale. This score improved in 6 patients and remained the same in 1. Stride length and gait velocity were measured in 4 children. Velocity increased in 3 patients and decreased in a 3-year-old child. Parents and clinicians reported an improvement in quality of gait after the procedure. Stride length increased bilaterally in 3 patients and increased on one side and decreased on the other in the other patient. Conclusions Selective dorsal rhizotomy showed efficacy in the treatment of spastic hemiparesis in children. All of the patients had decreased tone after SDR as measured by the modified Ashworth scale. The majority of patients had qualitative and quantitative improvements in gait.

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 Assessment and Treatment of Spasticity in Children with Cerebral Palsy

2014 ◽  
Vol 31 (3) ◽  
pp. 163-169 ◽  
Author(s):  
Lidija Dimitrijević ◽  
Hristina Čolović ◽  
Marija Spalević ◽  
Anita Stanković ◽  
Dragan Zlatanović ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Spastic Cerebral Palsy ◽  
Pharmacological Agents ◽  
Surgical Interventions ◽  
Oral Medications ◽  
Abnormal Movements ◽  
Modified Ashworth Scale ◽  
Assessment And Treatment ◽  
Ashworth Scale

Summary Spastic cerebral palsy (CP) is the most common type of CP. Up to 80% of all individuals with cerebral palsy suffer from some degree of spasticity. Spasticity adversely affects muscles and joints of the extremities, causing abnormal movements, and it is especially harmful in growing children. Several methods have been developed and used to assess spasticity. The most commonly used test in clinical practice is the Modified Ashworth Scale (MAS). The test is based on the assessment of resistance to passive strech of muscle group at one nonspecified velocity. Management of spasticity in CP involves multidisciplinary intervention intended to increase functionality, sustain health, and improve quality of life for children and their carers. This may include: oral medications, intrathecal medications, physiotherapy, occupational therapy, orthoses, surgical interventions, and pharmacological agents such as botulinum toxin.

Ultrasound-Guided BoNT-A (Botulinum Toxin A) Injection Into the Subscapularis for Hemiplegic Shoulder Pain: A Randomized, Double-Blind, Placebo-Controlled Trial

Stroke ◽  
2021 ◽  
Author(s):  
Botao Tan ◽  
Lang Jia
Keyword(s):  
Quality Of Life ◽  
Range Of Motion ◽  
Shoulder Pain ◽  
Scale Score ◽  
Visual Analog Scale ◽  
Visual Analog Scale Score ◽  
Analog Scale ◽  
Modified Ashworth Scale ◽  
Ashworth Scale

Background and Purpose: This study aimed to assess the efficacy of an ultrasound-guided lateral approach for BoNT-A (botulinum toxin A) injections into the subscapularis in patients with hemiplegic shoulder pain. Methods: This single-center trial used a randomized, double-blind, placebo-controlled design. The key inclusion criteria were a visual analog scale score of ≥4 cm and a modified Ashworth scale score of ≥1+. The patients were randomized to receive either BoNT-A injections or a placebo. The outcomes included the visual analog scale score, modified Ashworth scale score, pain-free passive range of motion of the hemiplegic shoulder, Fugl-Meyer assessment score for the upper extremities, and Stroke-Specific Quality-of-Life score. Results: A total of 49 hemiplegic shoulder pain patients were screened, and 36 were included. The participants receiving the BoNT-A injection reported a significant decrease in pain (visual analog scale, −1.39 [95% CI, −2.41 to −0.36]; P =0.002) and spasticity (modified Ashworth scale score for shoulder internal rotation, −0.72 [95% CI, −1.10 to −0.35]; P =0.001; modified Ashworth scale score for shoulder abduction, −0.44 [95% CI, −0.90 to −0.01]; P =0.026) and improved pain-free passive shoulder internal rotation range of motion (14.56 [95% CI, 6.70–21.41]; P <0.001) and quality of life (Stroke-Specific Quality-of-Life upper extremity subscale, P =0.025) compared with those receiving the placebo at the end point. The shoulder abduction range of motion did not significantly improve after the BoNT-A injection at the end point ( P =0.127). In addition, the patients in the BoNT-A group showed significant improvements in the visual analog scale score and shoulder external rotation range of motion at the 12-week follow-up. No injection-related adverse events were observed during or after the interventions in either group. Conclusions: The ultrasound-guided lateral approach for BoNT-A injections into the subscapularis is a precise and reliable method for reducing pain and spasticity and improving quality of life in stroke survivors with hemiplegic shoulder pain. Registration: URL: https://www.chictr.org.cn ; Unique identifier: ChiCTR1900023513.

A review of orthopedic surgeries after selective dorsal rhizotomy

2006 ◽  
Vol 21 (2) ◽  
pp. E2 ◽  
Author(s):  
Donncha F. O'Brien ◽  
Tae Sung Park
Keyword(s):  
Quality Of Life ◽  
Cerebral Palsy ◽  
Orthopedic Surgery ◽  
Young Age ◽  
Evidence Based ◽  
Selective Dorsal Rhizotomy ◽  
Evidence Based Treatment ◽  
Dorsal Rhizotomy ◽  
Historical Controls

✓ Selective dorsal rhizotomy (SDR) is an evidence-based treatment for cerebral palsy (CP) spasticity. During their lifetime, patients with CP spasticity may require orthopedic surgery for muscles and joints to correct physical deformities and provide a better quality of life. In this review, the authors discuss the timing of such orthopedic surgery, its necessity, and whether it is influenced by the performance of SDR. A review of findings from the authors' 19 years of experience yields the following conclusions: 1) that SDR reduces orthopedic surgery requirements when compared with historical controls; 2) that SDR performed in patients at a young age (2–4 years) can reduce future orthopedic surgery requirements; 3) that independent walkers and diplegic patients will have the smallest amount of orthopedic surgery post-SDR; and 4) that patients who need assistance walking and those with quadriplegia will have the greatest amount, although the frequency of orthopedic surgery for quadriplegic patients is not as high as popularly believed.

Quality of life after selective dorsal rhizotomy: an assessment of family-reported outcomes using the CPQoL questionnaire

2020 ◽  
Vol 36 (9) ◽  
pp. 1977-1983
Author(s):  
James M. W. Robins ◽  
Abbey Boyle ◽  
Kate McCune ◽  
Rajib Lodh ◽  
John R. Goodden
Keyword(s):  
Quality Of Life ◽  
Selective Dorsal Rhizotomy ◽  
Dorsal Rhizotomy

P 1175. Increased Quality of Life in Children with Cerebral Palsy after Selective Dorsal Rhizotomy

2018 ◽  
Author(s):  
Elisa Wittmack ◽  
Franziska Hentschel ◽  
Akosua Sarpong-Bengelsdorf ◽  
Julia Funk ◽  
Antje Niemeyer ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cerebral Palsy ◽  
Selective Dorsal Rhizotomy ◽  
Dorsal Rhizotomy ◽  
Children With Cerebral Palsy

scholarly journals Advanced quantitative estimation methods for spasticity: a literature review

2019 ◽  
Vol 48 (3) ◽  
pp. 030006051988842
Author(s):  
Zichong Luo ◽  
Wai Leung Ambrose Lo ◽  
Ruihao Bian ◽  
Sengfat Wong ◽  
Le Li
Keyword(s):  
Surface Electromyography ◽  
Quantitative Estimation ◽  
Estimation Methods ◽  
Clinical Scales ◽  
Post Stroke ◽  
Modified Ashworth Scale ◽  
Neural Information ◽  
Neural Factors ◽  
Ashworth Scale

Post-stroke spasticity seriously affects patients’ quality of life. Spasticity is considered to involve both neural and non-neural factors. Current clinical scales, such as the Modified Ashworth Scale and the Modified Tardieu Scale, lack reliability and reproducibility. These scales are also unable to identify the neural and non-neural contributions to spasticity. Surface electromyography and biomechanical and myotonometry measurement methods for post-stroke spasticity are discussed in this report. Surface electromyography can provide neural information, while myotonometry can estimate muscular properties. Both the neural and non-neural contributions can be estimated by biomechanical measurement. These laboratory methods can quantitatively assess spasticity. They can provide more valuable information for further study on treatment and rehabilitation than clinical scales.

More than 25 years after selective dorsal rhizotomy: physical status, quality of life, and levels of anxiety and depression in adults with cerebral palsy

2021 ◽  
pp. 1-10
Author(s):  
Berendina E. Veerbeek ◽  
Robert P. Lamberts ◽  
Elisa Kosel ◽  
A. Graham Fieggen ◽  
Nelleke G. Langerak
Keyword(s):  
Muscle Strength ◽  
Muscle Tone ◽  
Functional Mobility ◽  
Anxiety And Depression ◽  
Physical Status ◽  
Selective Dorsal Rhizotomy ◽  
Dorsal Rhizotomy ◽  
Lower Extremity Muscle ◽  
Sf 36

OBJECTIVE The primary purpose of selective dorsal rhizotomy (SDR) is to ameliorate spasticity in the lower extremities of children with cerebral palsy (CP). In correctly selected patients, this neurosurgical procedure has been shown to have a beneficial effect on many aspects of the child’s life. However, given the challenges faced by adults with CP, it would be valuable to document the status of this population compared to their peers later in adulthood. Therefore, the aim of this study was to determine the physical status, mental health, and health-related quality of life (HRQoL) of adults with CP who underwent SDR at least 25 years ago, compared to matched typically developing (TD) individuals. The second aim was to investigate relationships between physical status and the other outcome measures. METHODS Adults with CP were recruited from a database of children who had undergone SDR performed using the technique introduced by Professor Warwick Peacock at Red Cross War Memorial Children’s Hospital in Cape Town, South Africa, between 1981 and 1991. These individuals were matched for age, sex, body mass index, and socioeconomic status to a TD adult cohort from a similar background. The parameters assessed were lower-extremity muscle tone, passive range of motion, muscle strength, selectivity, functional mobility and dynamic balance (Timed Up and Go [TUG] test), HRQoL (SF-36), and anxiety and depression levels. RESULTS Twenty-six adults with CP who had a median age of 35.8 years (interquartile range 34.2–41.4 years) (female/male: n = 10/16; Gross Motor Function Classification System level I/II/III: n = 13/10/3), were compared to 26 TD adults. Muscle tone was similar, whereas passive range of motion, muscle strength, selectivity, TUG, and SF-36 physical functioning (concept and summary) scores differed between the cohorts. Other SF-36 parameters, anxiety levels, and depression levels were not different. Strong correlations were found between the muscle strength and TUG scores. CONCLUSIONS Normalized lower-extremity muscle tone was sustained 25–35 years after SDR. Whereas the lower scores for physical assessments are in line with findings in other CP populations, remarkably, relatively good mental health and HRQoL scores were reported in this CP group despite their physical limitations. The strong correlation between muscle strength and TUG suggests that strength training after SDR may have value in improving functional mobility and balance.

scholarly journals A group-delivered self-management program reduces spasticity in people with multiple sclerosis: A randomized, controlled pilot trial

2017 ◽  
Vol 3 (1) ◽  
pp. 205521731769999 ◽  
Author(s):  
Cinda L Hugos ◽  
Dennis Bourdette ◽  
Yiyi Chen ◽  
Zunqiu Chen ◽  
Michelle Cameron
Keyword(s):  
Multiple Sclerosis ◽  
Pilot Trial ◽  
Management Program ◽  
Group Instruction ◽  
Impact Scale ◽  
Modified Ashworth Scale ◽  
Fatigue Impact Scale ◽  
Clinically Significant ◽  
Ashworth Scale

Background Spasticity affects more than 80% of people with multiple sclerosis (MS), affecting activity, participation, and quality of life. Based on an international guideline, an MS spasticity group education and stretching program, MS Spasticity: Take Control (STC), has been developed. Objective The objective of this paper is to determine whether STC with home stretching is associated with greater changes in spasticity than usual care (UC), consisting of an illustrated stretching booklet and home stretching but without group instruction or support, in people with MS. Methods Ambulatory MS patients with self-reported spasticity interfering with daily activities were randomized to STC or UC. Individuals completed questionnaires regarding MS, spasticity, walking, fatigue and mood, and physical measures of spasticity and walking. Results Thirty-eight of 40 participants completed both assessments. Mean total score and scores on two subscales of the MS Spasticity Scale-88 improved more with STC than with UC ( p < 0.03). There was no significant change in the Modified Ashworth Scale in either group. Mean scores on the Modified Fatigue Impact Scale, the Beck Depression Inventory-II, and the physical component of the Multiple Sclerosis Impact Scale-29 showed statistically and clinically significant improvements in the STC group only. Conclusions Participation in STC improved self-reported impact of spasticity more than UC and provided encouraging improvements in other measures.

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