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.

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

2013 ◽  
Vol 35 (5) ◽  
pp. E6 ◽  
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.

scholarly journals Longitudinal Construct Validity of the GMFM-88 Total Score and Goal Total Score and the GMFM-66 Score in a 5-Year Follow-up Study

2009 ◽  
Vol 89 (4) ◽  
pp. 342-350 ◽  
Author(s):  
Annika Lundkvist Josenby ◽  
Gun-Britt Jarnlo ◽  
Christina Gummesson ◽  
Eva Nordmark
Keyword(s):  
Construct Validity ◽  
Motor Function ◽  
Measurement Properties ◽  
Limited Information ◽  
Gross Motor ◽  
Gross Motor Function ◽  
Dorsal Rhizotomy ◽  
Measurement Design ◽  
Longitudinal Construct Validity

Background The Gross Motor Function Measure (GMFM) is the instrument most commonly used to measure gross motor function in children with cerebral palsy (CP). Different scoring options have been developed, and their measurement properties have been assessed. Limited information is available regarding longitudinal construct validity. Objective The objective of this research was to study the longitudinal construct validity of 3 scoring options: the 88-item GMFM (GMFM-88) total, the GMFM-88 goal total, and the 66-item GMFM (GMFM-66). Design A clinical measurement design was used in this study. Methods Forty-one children with CP diplegia who were undergoing selective dorsal rhizotomy (SDR) were monitored with the GMFM for 5 years. The mean age at SDR was 4.4 years (range=2.5–6.6). Two subgroups for gross motor function before surgery were created according to the Gross Motor Function Classification System (GMFCS): GMFCS levels I to III and GMFCS levels IV and V. This study included results obtained before SDR and at 6, 12, and 18 months and 3 and 5 years after SDR. The effect size (ES) and the standardized response mean (SRM) were calculated. Results At 6 months postoperatively, ES and SRM values were small (≤0.5) for all GMFM scoring options. The GMFM-88 total and goal total scores showed large changes in ES values (range=0.8–0.9) and SRM values (range=0.9–1.3) at 12 months postoperatively, whereas the GMFM-66 scores showed lower ES values (range=0.3–0.4) and SRM values (range=0.7–0.8) for both subgroups. Later postoperatively, larger values for longitudinal construct validity were found. The ES and SRM values generally were lower for the GMFM-66 scores than for the GMFM-88 total and goal total scores. Limitations All children underwent an extensive intervention, and changes in gross motor function were expected. Conclusion All 3 scoring options showed large longitudinal construct validity in the long-term follow-up. The GMFM-88 total and goal total scores revealed large changes in gross motor function earlier postoperatively than the GMFM-66 scores.

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 Long-term functional benefits of selective dorsal rhizotomy for spastic cerebral palsy

2013 ◽  
Vol 12 (2) ◽  
pp. 142-150 ◽  
Author(s):  
Roy W. R. Dudley ◽  
Michele Parolin ◽  
Bruno Gagnon ◽  
Rajeet Saluja ◽  
Rita Yap ◽  
...  
Keyword(s):  
Motor Function ◽  
Muscle Tone ◽  
Early Adulthood ◽  
Orthopedic Procedures ◽  
Spastic Cerebral Palsy ◽  
Gross Motor ◽  
Gross Motor Function ◽  
Dorsal Rhizotomy ◽  
And Performance

Object Large-scale natural history studies of gross motor development have shown that children with spastic cerebral palsy (CP) plateau during childhood and actually decline through adolescence. Selective dorsal rhizotomy (SDR) is a well-recognized treatment for spastic CP, but little is known about long-term outcomes of this treatment. The purpose of this study was to assess the durability of functional outcomes in a large number of patients through adolescence and into early adulthood using standardized assessment tools. Methods The authors analyzed long-term follow-up data in children who had been evaluated by a multidisciplinary team preoperatively and at 1, 5, 10, and 15 years after SDR. These evaluations included quantitative, standardized assessments of lower-limb tone (Ashworth Scale), Gross Motor Function Measure (GMFM), and performance of activities of daily living (ADLs) by the Pediatric Evaluation of Disability Inventory in children who had been stratified by motor severity using the Gross Motor Function Classification System (GMFCS). In addition, group-based trajectory modeling (GBTM) was used to identify any heterogeneity of response to SDR among these treated children, and to find which pretreatment variables might be associated with this heterogeneity. Finally, a chart review of adjunct orthopedic procedures required by these children following SDR was performed. Results Of 102 patients who underwent preoperative evaluations, 97, 62, 57, and 14 patients completed postoperative assessments at 1, 5, 10, and 15 years, respectively. After SDR, through adolescence and into early adulthood, statistically significant durable improvements in lower-limb muscle tone, gross motor function, and performance of ADLs were found. When stratified by the GMFCS, long-lasting improvements for GMFCS Groups I, II, and III were found. The GBTM revealed 4 groups of patients who responded differently to SDR. This group assignment was associated with distribution of spasticity (diplegia was associated with better outcomes than triplegia or quadriplegia) and degree of hip adductor spasticity (Ashworth score < 3 was associated with better outcomes than a score of 3), but not with age, sex, degree of ankle plantar flexion spasticity, or degree of hamstring spasticity. In a sample of 88 patients who had complete records of orthopedic procedures and botulinum toxin (Botox) injections, 52 (59.1%) underwent SDR alone, 11 (12.5%) received only Botox injections in addition to SDR, while 25 patients (28.4%) needed further lower-extremity orthopedic surgery after SDR. Conclusions In the majority of patients, the benefits of SDR are durable through adolescence and into early adulthood. These benefits include improved muscle tone, gross motor function, and performance of ADLs, as well as a decreased need for adjunct orthopedic procedures or Botox injections. The children most likely to display these long-term benefits are those in GMFCS Groups I, II, and III, with spastic diplegia, less hip adductor spasticity, and preoperative GMFM scores greater than 60.

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.

scholarly journals EFFECTIVENESS OF THE COMBINED USE OF ROBOTIC KINESIOTHERAPY AND BOTULINUM THERAPY IN THE COMPLEX REHABILITATION OF CHILDREN WITH CEREBRAL PALSY

2018 ◽  
Vol 11 (9) ◽  
pp. 360
Author(s):  
Balgayeva Maira ◽  
Bulekbayeva Sholpan
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Muscle Tone ◽  
Botulinum Toxin Type A ◽  
Main Group ◽  
Control Group ◽  
Spastic Diplegia ◽  
Gross Motor ◽  
Gross Motor Function ◽  
Combined Use

Objective: The objective of this study is to evaluate the effectiveness of combined use of robotic kinesiotherapy and botulinum therapy in the complex rehabilitation of children with spastic diplegia.Methods: In the research, 162 children were participated in the age from 4 to 6 years with spastic diplegia. The main group was carried out using robotic kinesiotherapy with the help of the Lokomat complex and intramuscular injection of botulinum toxin type A (BtA), as a part of complex rehabilitation. Children from the control group received rehabilitative treatment with traditional methods.Results: During the comparative study of groups, higher results were obtained in the main group, where average according to Gross Motor Function Measure 88 increased from 69.99 to 76.41 with a difference of 6.42 points (p=0.0001). In the control group, this indicator increased from 67.01 to 69.41 with a difference of 2.4 points. In the main group, a moderate coupling was noticed between overall motor activity improvement and muscle tone improvement (rs=0.411, p=0.001). Herewith, the correlation was pronounced more with children of the III level in Gross Motor Function Classification System (rs=0.483, p=0.002) in comparison with the II development level (rs=0.304, p=0.042).Conclusion: Research results indicated that the children with spastic diplegia have significant improvement in motor characteristics when the combined applying of robotic walking and botulinum therapy compared with conventional therapy. In our opinion, the data obtained allow to recommend this method as one of the perspective methods of rehabilitation treatment for children with spastic forms of cerebral palsy.

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