A Prospective Cohort Study of the Effects of Lower Extremity Orthopaedic Surgery on Outcome Measures in Ambulatory Children With Cerebral Palsy

Gorton, George E.; Abel, Mark F.; Oeffinger, Donna; Bagley, Anita; Rogers, Sarah; Damiano, Diane L.; Romness, J Mark; Tylkowski, Chester

doi:10.1097/bpo.0b013e3181c11c0c

Cited by 66 publications

(89 citation statements)

References 45 publications

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“…The mean clinical follow-up, including assignment of GMFCS level by an experienced physiotherapist, was 5 years (SD 2 years 8 months; range 2-12y). The median number of surgical procedures per SEMLS session was eight (range [4][5][6][7][8][9][10][11][12][13][14]. The mean GPS decreased significantly from 15.4°(SD 3.9°; range 8.9-25.9°) to 11.1°(SD 2.5°; range 6.1-18.8°) (p<0.001).…”

Section: Resultsmentioning

confidence: 98%

“…The improvement in gait after SEMLS ranges between 20% and 50% in reported studies. [11][12][13]29 However, there is considerable variation in the mean change reported in most studies, indicating that changes in gait after SEMLS are variable. The factors responsible for this variation are poorly understood.…”

Section: Discussionmentioning

confidence: 99%

“…This is supported by a number of cohort studies, a systematic review, and one randomized controlled trial. [11][12][13]29 Changes after SEMLS may include large improvements in gait, especially when musculoskeletal deformities are severe and underlying strength and selective motor control are relatively good. However, in a systematic review of SEMLS, changes in gross motor function were generally small and inconsistent.…”

mentioning

confidence: 99%

“…9,10 Robust evidence for improvement in gait parameters after SEMLS has been reported in a number of controlled studies and in one randomized controlled trial. [11][12][13] The randomized controlled trial reported a mean improvement in Gross Motor Function Measure (GMFM) 66 of 4.9% at 24 months after SEMLS and that GMFCS levels remained stable in the majority of children. 13 However, other studies using the GMFCS as an outcome measure after orthopaedic surgery reported that the majority of the study participants improved by one level and that some participants improved by two or three levels.…”

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confidence: 99%

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Stability of the Gross Motor Function Classification System after single‐event multilevel surgery in children with cerebral palsy

Rutz

Tirosh

Thomason

et al. 2012

Develop Med Child Neuro

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ABBREVIATIONS FMSFunctional Mobility Scale GPS Gait Profile Score SEMLS Single-event multilevel surgery AIM There are conflicting reports about the stability of the Gross Motor Function Classification System (GMFCS) in children with cerebral palsy (CP) after orthopaedic surgery. We studied the stability of the GMFCS in children with bilateral spastic CP after single-event multilevel surgery, using the Gait Profile Score (GPS) as the primary outcome measure.METHOD This was a retrospective cohort study of 107 children (46 females, 61 males) with bilateral spastic CP, classified as GMFCS level II or III, who underwent surgery at a single tertiary institution between 1997 and 2008. The mean age at surgery was 10 years 7 months (SD 2y 8mo). The primary outcome measure was the GPS. Changes in GMFCS level were studied at multiple time points before and after intervention.RESULTS Gait dysfunction was partially corrected, with a mean improvement of 28% in the GPS.The GMFCS remained stable and unchanged in 95% of children and improved by one level in 5% of children. The improvement in GPS was three times the minimal clinically important difference. The mean age at final postoperative GPS assessment was 11 years 10 months (SD 2y 10mo) and at final GMFCS assessment was 15 years 7 months (SD 3y 9mo).INTERPRETATION Stability of the GMFCS was confirmed in the majority of children with bilateral spastic CP after single-event multilevel surgery, despite statistically and clinically significant improvements in gait dysfunction and functional mobility. This information is important in realistic goal-setting and in counselling families.The Gross Motor Function Classification System (GMFCS) is a standardized method to classify gross motor function in children with cerebral palsy (CP) from 1 to 18 years of age. 1,2It is a five-level categorical grading system which classifies differences in gross motor function that are meaningful and significant to children with CP and their families.3 Distinctions between GMFCS levels are based on functional limitations with an emphasis on sitting and walking and the need for assistive devices and wheeled mobility. Children may be quickly and easily classified at any given time, such as during a clinic appointment or gait laboratory assessment, by determining which level best corresponds to the child's current gross motor function. A set of age-appropriate descriptive criteria are used and good correlations have been demonstrated between classifications assigned by parents and by health professionals. 1,2,4 Since the original description by Palisano et al. 1 in 1997, the GMFCS has become widely accepted, widely used, and is considered by many to be an essential tool to communicate about gross motor function in CP. 5,6The GMFCS is a valid and reliable classification tool which is expected to be relatively stable over time, with or without intervention. Palisano et al. 3 reported that 73% of 610 children with CP remained at the same GMFCS level at multiple ratings over time , and McCormick et ...

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Section: Resultsmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Stability of the Gross Motor Function Classification System after single‐event multilevel surgery in children with cerebral palsy

Rutz

Tirosh

Thomason

et al. 2012

Develop Med Child Neuro

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“…The surgical group showed significant improvement in function after 1 year compared with the nonsurgical group as measured by the Gillette gait index, with few significant changes noted in outcome measures. 11 Thomson et al conducted a randomized controlled trial of single-event multilevel surgery on 19 children (mean age of nine years and eight months) with spastic diplegia. The children were randomized into two groups i.e., surgical group (11 children) and the control group (8 children).…”

Section: Discussionmentioning

confidence: 99%

Lower extremity soft tissue surgery in spastic cerebral palsy: experience from a government rehabilitation unit

2018

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Background: Spastic cerebral palsy (CP) remains the most common type of CP and may be managed surgically or non-surgically depending upon its severity. Recent advances have replaced single-level surgery by the concept of multilevel surgery where multiple levels of musculoskeletal pathology, in one/both lower limbs, are addressed during one operative procedure, requiring only one hospital admission and one period of rehabilitation. This study assessed the outcome of lower limb soft tissue surgery in children with spastic CP in a government rehabilitation unit and measured its feasibility with limited infrastructure facilities and patient compliance.Methods: The study comprised of 26 patients aged between 2-12 years. Physical examination and GMFCS scores were recorded and evaluation of sitting balance, standing balance and gait were done. Musculotendinous soft tissue lower limb surgery was performed at one or more levels unilaterally or bilaterally and the results were interpreted.Results: Complete or near complete correction of deformities were attained by all children postoperatively. Significant improvements were noted in the gross motor functional classification system (GMFCS) scores. All parents and children were satisfied with the surgical outcome and reported improvement in functional abilities and locomotion in the follow-up along with better quality of life and mobility. Conclusions: Lower limb soft tissue surgery is a valuable aid in improving functional abilities and locomotion in children with spastic CP. Surgery should be undertaken depending upon clinical indications and can be successfully carried out in government hospitals with ordinary infrastructure in developing countries as well.

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Multilevel Orthopedic Surgery for Patients with Cerebral Palsy

Pierz

Shrader

2020

Orthopedic Care of Patients With Cerebral Palsy

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A Prospective Cohort Study of the Effects of Lower Extremity Orthopaedic Surgery on Outcome Measures in Ambulatory Children With Cerebral Palsy

Cited by 66 publications

References 45 publications

Stability of the Gross Motor Function Classification System after single‐event multilevel surgery in children with cerebral palsy

Stability of the Gross Motor Function Classification System after single‐event multilevel surgery in children with cerebral palsy

Lower extremity soft tissue surgery in spastic cerebral palsy: experience from a government rehabilitation unit

Multilevel Orthopedic Surgery for Patients with Cerebral Palsy

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