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.

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 EFFECT OF HYDROTHERAPY ON SPASTICITY AND GROSS MOTOR FUNCTIONS AMONG SPASTIC CEREBRAL PALSY CHILDREN

2019 ◽  
Vol 8 (1) ◽  
pp. 13-18
Author(s):  
Zeenat Fatima ◽  
Yarmiyah Rashaquat
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Muscle Tone ◽  
Spastic Cerebral Palsy ◽  
Gross Motor ◽  
Motor Functions ◽  
Motor Functioning ◽  
Gross Motor Function ◽  
Quasi Experimental ◽  
Protocol Study

OBJECTIVES To determine the effects of hydrotherapy therapy on spastic cerebral palsy children using Modified ashworths scale and Gross motor functional classification scale after 32 weeks of training protocol. STUDY DESIGN Quasi experimental study STUDY SETTING Liaquat National Hospital PARTICIPANTS Spastic (diplegic, hemiplegic and quadriplegic) cerebral palsy children INTERVENTIONS 58 Spastic Cerebral Palsywere assessed on the basis of modified Ashworth scale and gross motor function measure for spasticity and change in gross motor function respectively. Assessment was done, before and at the end of 10th week. Each therapy session was of 40-45 minutes thrice a week in a pool with the temperature maintained at 32°C-34°C and at the end cool down activities were performed. RESULTS Results indicated marked improvement in Muscle tone and Gross Motor Functioning of the enrolled children with p=0.001. CONCLUSIONS It was concluded that pool therapy is effective in reducing spasticity and improving gross motor functions among CP.

scholarly journals Stem Cell Transplantation Efficacy in Cerebral Palsy: A Physical Therapist Perspective

2021 ◽  
Vol 3 (2) ◽  
Author(s):  
Alaa Noureldeen Kora
Keyword(s):  
Cerebral Palsy ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Motor Function ◽  
Classification System ◽  
Muscle Tone ◽  
Spastic Cerebral Palsy ◽  
Gross Motor ◽  
Gross Motor Function

 Background and Purpose Children with spastic cerebral palsy usually display elevation in muscle tone, a decline in gross motor functional abilities , feeding problems and sometimes it may accompanied by visual problems. Studies on stem cell treatment are in their early stages concerning their effect on cerebral palsy.   Methods  A child with spastic cerebral palsy on level v on gross motor function classification system was selected for autologous bone marrow derived mononuclear transplantation cell. Muscle tone, gross, fine motor abilities, feeding abilities and visual abilities were assessed on 4 occasions, prior the transplantation, immediately after the transplantation, after 6 months and after 1 year.  Results No effect of stem cell transplantation was shown on the child. Conclusion Further research studies should be done on the subject but using different population rather than children on level V Gross motor function classification system

The Effectiveness of Therapeutic Horseback Riding in Children with Spastic Cerebral Palsy

2004 ◽  
Vol 21 (2) ◽  
pp. 103-121 ◽  
Author(s):  
Rong-Ju Cherng ◽  
Hua-Fang Liao ◽  
Henry W.C. Leung ◽  
Ai-Wen Hwang
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Muscle Tone ◽  
Spastic Cerebral Palsy ◽  
Second Phase ◽  
Horseback Riding ◽  
Therapeutic Horseback Riding ◽  
Gross Motor ◽  
Regular Treatment ◽  
Gross Motor Function

This study investigated the effectiveness of a16-week therapeutic horseback riding (THR) program on the gross motor function measures (GMFM) and the muscle tone of hip adductors in 14 children with spastic cerebral palsy (age: 3 years, one month to 11 years, 5 months). In the first phase of 16 weeks, nine of the children received the THR in addition to their regular treatment, while the rest received their regular treatment only. In the second phase (also 16 weeks), the arrangements were reversed. After THR, some of the children improved significantly in the GMFM E (walk/run/jump) score and the total score. The effect appears to be sustained for at least 16 weeks. No effect of THR on muscle tone was noted. We conclude that THR may be beneficial for some children with spastic cerebral palsy.

scholarly journals Short-Term and Long-Term Effects of Riding for Children with Cerebral Palsy Gross Motor Functions

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
L. Žalienė ◽  
D. Mockevičienė ◽  
B. Kreivinienė ◽  
A. Razbadauskas ◽  
Ž. Kleiva ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Long Term Effects ◽  
Short Term ◽  
Gross Motor ◽  
Motor Functions ◽  
Gross Motor Skills ◽  
Gross Motor Function ◽  
Group I

Aim. To evaluate the effects of riding for beginners (short-term) and advanced (long-term) riders with cerebral palsy on their whole mobility. The study involved 15 subjects (two girls and eleven boys). The subjects were aged from 3 to 19 years (8.73 years ± 5.85). All of the subjects had been diagnosed with a spastic form of cerebral palsy. The duration of the participation differed as follows: the advanced subjects had been riding for 1-4 years (2.66 years ± 1.16), while the beginners have been riding for two weeks (10 sessions). Group I (advanced riders) consisted of eight subjects (7 boys and 1 girl) who had therapy sessions regularly once a week and differed only in terms of the duration of their participation in the experiment. Group II (beginners) consisted of seven children (1 girl and 6 boys) who participated in only 10 riding sessions. All of the subjects were assessed according to the Gross Motor Function Measure (GMFM) and Gross Motor Function Classification System for CP (GMFCS) both before the investigation and after it. Conclusions. Ten riding lessons did not have an influence on the beginner riders with cerebral palsy gross motor functions and their gross motor function level did not change. However, in half of the advanced riders with cerebral palsy, the gross motor functions significantly improved. Meanwhile, the level of the performance of the gross motor skills in the four advanced riders increased, but this difference was not statistically significant.

Effect of position on gross motor function and spasticity in spastic cerebral palsy children

2021 ◽  
pp. 1-14
Author(s):  
Wardah Rauf ◽  
Samia Sarmad ◽  
Iqra Khan ◽  
Muhammad Jawad ◽  
Admin
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
System Level ◽  
Spastic Cerebral Palsy ◽  
Sitting Position ◽  
Gross Motor ◽  
Motor Functioning ◽  
Five Dimensions ◽  
Gross Motor Function ◽  
Quasi Experimental

Abstract Objective: To evaluate the effect of positioning on gross motor function and spasticity in spastic quadriplegic cerebral palsy children with Gross Motor Function Classification System level IV and V. Methods: A quasi-experimental study was conducted at two Paediatric Physical Therapy Centres from November 2018 to July 2019. The study was comprised of seventy four children with quadriplegic cerebral palsy aged between 3 to 8 years. Data was obtained and gross motor functional abilities and spasticity were assessed by GMFM-88 and Modified Ashworth Scale respectively. Twenty four-hour positioning in specific seats, night positioning and standing frames for six months. The child was being positioned in 24 hours according to his challenges for the period of six months. Semi reclined positioning was performed to manage aspiration, oral leak and to develop retention. Prone positioning was done to develop righting reactions, functional sitting position was used in the treatment regime to attain better upright position and neutral pelvic standing using standing frames. SPSS 24 was used to analyse the data. Results: Paired t-test reported significant improvement in the test scores in lying position, rolling, sitting position, crawling, kneeling, standing, walking or running. n=59 subjects exhibited improvement in the spasticity before and after interventional procedures, while n=15 showed no improvement as the value of p<0.05. Conclusion: Twenty-Four-hour proper body positioning and postural techniques improved gross motor functioning in all of the five dimensions of functioning. The overall spasticity in quadriplegic cerebral palsy children was also reduced due to appropriate positioning techniques.  Continuous....

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