Spasticity and strength changes as a function of selective dorsal rhizotomy

This investigation quantified pre- and postsurgery (8 months) hamstring muscle spasticity and strength in children with cerebral palsy (CP) undergoing a selective dorsal rhizotomy. Nineteen children with CP (CP group) and six children with able bodies (AB group) underwent testing with a dynamometer. For the spasticity measure, the dynamometer measured the resistive torque of the hamstring muscles during passive knee extension at four different speeds. Torque angle data were processed to calculate the work done by the machine to extend the knee for each speed. Linear regression was used to calculate the slope of the line of best fit for the work velocity data. The slope simultaneously encompassed three key elements associated with spasticity (velocity, resistance, and stretch) and was considered the measure of spasticity. For the strength test, the dynamometer moved the leg from full knee extension to flexion while a maximum concentric contraction of the hamstring muscles was performed. Torque angle data were processed to calculate the work done on the machine by the child. Hamstring spasticity values for the CP group were significantly greater than similar values for AB group prior to surgery; however they were not significantly different after surgery. Hamstring strength values for the CP group remained significantly less than those for the AB group after surgery, but were significantly increased relative to their presurgery values. The results of spasticity testing in the present investigation agreed with previous studies indicating a reduction in spasticity for the CP group. The results of strength testing did not agree with those in the previous literature; a significant increase in strength was observed for the CP group.

Download Full-text

Spasticity and strength changes as a function of selective dorsal rhizotomy

Journal of Neurosurgery ◽

10.3171/jns.1998.88.6.1020 ◽

1998 ◽

Vol 88 (6) ◽

pp. 1020-1026 ◽

Cited By ~ 45

Author(s):

Jack R. Engsberg ◽

Kenneth S. Olree ◽

Sandy A. Ross ◽

T. S. Park

Keyword(s):

Knee Extension ◽

Selective Dorsal Rhizotomy ◽

Content Type ◽

Dorsal Rhizotomy ◽

Resistive Torque ◽

Angle Data ◽

Hamstring Muscles ◽

Work Done ◽

Torque Angle ◽

Fine Print

Object. The goal of this investigation was to quantify changes in hamstring muscle spasticity and strength in children with cerebral palsy (CP) as a function of their having undergone a selective dorsal rhizotomy. Methods. Nineteen children with CP (CP group) and six children with able bodies (AB group) underwent testing with a dynamometer. For the spasticity measure, the dynamometer measured the resistive torque of the hamstring muscles during passive knee extension at four different speeds. Torque—angle data were processed to calculate the work done by the machine to extend the knee for each speed. Linear regression was used to calculate the slope of the line of best fit for the work—velocity data. The slope simultaneously encompassed three key elements associated with spasticity (velocity, resistance, and stretch) and was considered the measure of spasticity. For the strength test, the dynamometer moved the leg from full knee extension to flexion while a maximum concentric contraction of the hamstring muscles was performed. Torque—angle data were processed to calculate the work done on the machine by the child. Hamstring spasticity values for the CP group were significantly greater than similar values for the AB group prior to surgery; however, they were not significantly different after surgery. Hamstring strength values for the CP group remained significantly less than those for the AB group after surgery, but were significantly increased relative to their presurgery values. Conclusions. The results of spasticity testing in the present investigation agreed with those of previous studies, indicating a reduction in spasticity for the CP group. The results of strength testing did not agree with those in the previous literature; a significant increase in strength was observed for the CP group.

Download Full-text

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.

Download Full-text

Maximum Active Resultant Knee Joint Torques in Children with Cerebral Palsy

Journal of Applied Biomechanics ◽

10.1123/jab.14.1.52 ◽

1998 ◽

Vol 14 (1) ◽

pp. 52-61 ◽

Cited By ~ 20

Author(s):

Jack R. Engsberg ◽

Kenneth S. Olree ◽

Sandy A. Ross ◽

Tae S. Park

Keyword(s):

Cerebral Palsy ◽

Knee Joint ◽

Knee Extension ◽

Spastic Diplegia ◽

Joint Torques ◽

Additional Information ◽

Angle Data ◽

Children With Cerebral Palsy ◽

Work Done ◽

Published Research

This investigation quantified maximum active resultant joint torques in children with spastic diplegia cerebral palsy and nondisabled children. An isokinetic dynamometer rotated the limb (10°/s) while the resultant knee joint torques (both assistive and resistive) during knee extension and flexion in 6 nondisabled children and 26 children with cerebral palsy were recorded. Torque-angle data were processed to calculate maximum values during extension and flexion and work done during the movements. An independentttest determined if significant differences existed between groups (p< .05). Maximum extensor and maximum flexor torques and work during extension and flexion were significantly less for the children with cerebral palsy. Results supported previously published research indicating that children with spastic diplegia were weaker than nondisabled children. Additional information regarding the weakness of the children with spastic diplegia near the end range of extension motion is presented.

Download Full-text

Hip Spasticity and Strength in Children with Spastic Diplegia Cerebral Palsy

Journal of Applied Biomechanics ◽

10.1123/jab.16.3.221 ◽

2000 ◽

Vol 16 (3) ◽

pp. 221-233 ◽

Cited By ~ 15

Author(s):

Jack R. Engsberg ◽

Sandy A. Ross ◽

Kevin W. Hollander ◽

T.S. Park

Keyword(s):

Cerebral Palsy ◽

Linear Regression ◽

Work Values ◽

Spastic Diplegia ◽

Velocity Data ◽

Concentric Contraction ◽

Angle Data ◽

Children With Cerebral Palsy ◽

Best Fit ◽

Torque Angle

Hip spasticity and strength from 44 children with cerebral palsy (CP) and 44 children with able bodies (AB) were compared. For spasticity, a KinCom dynamometer abducted the passive hip at 4 different speeds and recorded the resistive adductor torques. Work values for the torque-angle data were calculated at each speed. Linear regression derived the slope for the line of best fit for the work-velocity data to determine the spasticity measure. For strength, the KinCom rotated the hip from maximum adduction to maximum abduction at a speed of 10°/s while the child performed a maximum abduction concentric contraction. Tests were reversed to record maximum adduction. Maximum torques and work by the abductors and adductors were calculated. Spasticity in the adductors for the CP group was significantly greater than values recorded for the AB group. All strength measures were significantly less than the AB group. Results provide objective information, quantifying hip spasticity and strength in children with CP.

Download Full-text

Motor and functional outcome of selective dorsal rhizotomy in children with spastic diplegia at 12 and 24 months of follow-up

Acta Neurochirurgica ◽

10.1007/s00701-021-04954-5 ◽

2021 ◽

Author(s):

Tarik Alp Sargut ◽

Hannes Haberl ◽

Simone Wolter ◽

Sascha Tafelski ◽

Anne van Riesen ◽

...

Keyword(s):

Muscle Strength ◽

Evaluation Process ◽

Knee Extension ◽

Spastic Diplegia ◽

Medical Council ◽

Selective Dorsal Rhizotomy ◽

Dorsal Rhizotomy ◽

Time Period ◽

Modified Ashworth Scale ◽

The Right

Abstract Background Selective dorsal rhizotomy (SDR) in ambulatory children affected by cerebral palsy (CP) is a surgical treatment option to lower spasticity and thereby improve gait and ambulation. The aim of the current study is to investigate the outcome of children with respect to spasticity, muscle strength, and overall function after SDR. Methods All children who underwent SDR via a single-level laminotomy in the time period from January 2007 to April 2015 at our center were enrolled in this study. Within a standardized evaluation process, the following was assessed routinely pre-operatively and 12 and 24 months following surgery: extent of spasticity at hip adductors and hamstrings as characterized by the Modified Ashworth Scale (MAS), maximal muscle strength as characterized by the Medical Council Research Scale (MRC), overall function regarding ambulation as characterized by the Gross Motors Function Classification System (GFMCS), and overall function as characterized by the Gross Motor Function Measure (GMFM-88). Results Matching sets of pre- and post-operative assessments of the chosen outcome parameters were available for 109 of the 150 children who underwent SDR within the observation period. After 24 months, the MAS scores of hip adductors (n = 59) improved in 71% and 76% of children on the right and left side, respectively. In 20% and 19%, it remained unchanged and worsened in 9% and 5% of children on the right and left side, respectively (p < 0.00625). For hamstrings, the rates for the right and left sides were 81% and 79% improvement, 16% and 16% unchanged, and 4% and 5% worsened, respectively (p < 0.00625). Muscle strength of ankle dorsiflexion and knee extension significantly improved after 24 months. Overall function assessed by GMFM-88 improved significantly by 4% after 12 months (n = 77) and by 7% after 24 months (n = 56, p < 0.0001). Conclusions The presented data underlines the benefit of SDR in a pediatric patient collective with bilateral spastic CP. The procedure resulted in an effective and permanent reduction of spasticity and improved overall function without causing relevant weakness of the lower extremities.

Download Full-text

The effect of GMFCS level, age, sex, and dystonia on multi-dimensional outcomes after selective dorsal rhizotomy: prospective observational study

Child s Nervous System ◽

10.1007/s00381-021-05076-0 ◽

2021 ◽

Vol 37 (5) ◽

pp. 1729-1740

Author(s):

Conor Scott Gillespie ◽

◽

Alan Matthew George ◽

Benjamin Hall ◽

Steven Toh ◽

...

Keyword(s):

Motor Function ◽

Self Care ◽

Pediatric Neurosurgery ◽

Care Quality ◽

Fine Motor ◽

Selective Dorsal Rhizotomy ◽

Dorsal Rhizotomy ◽

Significant Difference ◽

Age Category ◽

Gmfcs Level

Abstract Purpose Investigate the effect of age category (1–9 years vs 10–18 years), sex, Gross Motor Function Classification System (GMFCS) level, and presence of dystonia on changes in eight function test parameters 24 months after selective dorsal rhizotomy (SDR). Methods Prospective, single-center study of all children aged 3–18 years with bilateral cerebral palsy with spasticity who underwent SDR at a tertiary pediatric neurosurgery center between 2012 and 2019. A linear mixed effects model was used to assess longitudinal changes. Results From 2012 to 2019, 42 children had follow-up available at 24 months. Mean GMFM-66 scores increased after SDR (mean difference 5.1 units: 95% CI 3.05–7.13, p < 0.001). Statistically significant improvements were observed in CPQoL, PEDI Self-care and Mobility, 6MWT, Gillette, and MAS scores. There was no significant difference in the improvements seen for age category, sex, GMFCS level, and presence of dystonia for most of the parameters tested (5/8, 6/8, 5/8, and 6/8 respectively). Conclusion SDR may improve gross and fine motor function, mobility and self-care, quality of life, and overall outcome based on extensive scoring parameter testing at 24 months. Atypical patient populations may benefit from SDR if appropriately selected. Multi-center, prospective registries investigating the effect of SDR are required.

Download Full-text