Functioning of a child with bilateral cerebral palsy submitted to multilevel surgery: case report

INTRODUCTION: Interventions in different joints may be necessary to correct crouch gait and others musculoskeletal changes that occur as time passes for Cerebral Palsy (CP) children. Multilevel surgery reduces the number of hospitalizations, contributes to the prevention of secondary disabilities, and improves ambulation ability of children with diplegia. OBJECTIVE: Document the changes in mobility outcomes of a bilateral CP child, type diplegia, child after lower limbs multilevel surgery in the Brazilian context MATERIAL AND METHODS: The participant was an eight-year-old girl, Gross Motor Function Classification System level III. The mother signed the informed consent form. The Gross Motor Function Measure–66 (GMFM-66) was performed one day before surgery and one, three, six and twelve months after surgery. To complete the child’s evolution records, additional information was obtained through the electronic system of the hospital. RESULTS: The GMFM-66 total score was: 49.6 pre-operative (CI95%: 47.3-51.9); 42.8 after one month (CI95%: 40.7-45.0); 49.9 after three months (CI95%: 47.6-52.1); 52.6 after six months (CI95%: 50.2-55.0) and 56.9 after one year (CI95%: 54.6-59.2), increasing after 6 months of surgery (*p<0.05). The participant presented satisfactory adherence to physiotherapy. CONCLUSION: This study describes the case of a Brazilian child with CP, using the public health system. The impact of multilevel surgery was predominant in mobility, with worsening of capacity soon after surgery and progressive improvement over the months. Factors that may have contributed to our results were adherence, frequency, contextual factors.

Shifting and reducing breathing disturbance in patients with very severe obstructive sleep apnea by modified Z-palatoplasty with one-layer closure in one-stage multilevel surgery

Very severe obstructive sleep apnea (OSA) with apnea–hypopnea index (AHI) ≥ 60 events/h differs in several areas from OSA with other severities, including having a low-level daytime partial pressure of oxygen and residual on-CPAP (continuous positive airway pressure) AHIs greater than 20/h. Patients with very severe OSA show narrow retroglossal space and confined framework, which is difficult to be enlarged via conventional Uvulopalatopharyngoplasty (UPPP) surgery, resulting in poor response to non-framework surgeries. Our latest report showed efficacy and efficiency for subjects undergoing modified Z-palatoplasty (ZPP) with one-layer closure in a one-stage multilevel surgery. It is unclear whether and how this procedure could help patients with very severe OSA characterized with confined framework. From Mar. 2015 to May 2018, we enrolled 12 patients with very severe OSA receiving one-stage multi-level surgery with modified ZPP with one-layer closure, CO2 laser partial tongue-base glossectomy, and bilateral septomeatoplasty. Our results show that the surgery reduced AHI from 73.8 ± 10.7 to 30.8 ± 23.2 events/h and achieved a mean AHI reduction of 58.3% (p < 0.001 against 0 reduction or no surgery). The surgery shifted components of the breathing disturbances. It reduced more apnea than hypopnea and might convert some apnea to hypopnea.