Functional Outcomes Following Single-Event Multilevel Surgery of the Upper Extremity for Children with Hemiplegic Cerebral Palsy

Smitherman, J. Adam; Davids, Jon R.; Tanner, Stephanie L.; Hardin, James W.; Wagner, Lisa; Peace, Laura C.; Gidewall, Mary Ann

doi:10.2106/jbjs.j.00295

Cited by 42 publications

(44 citation statements)

References 50 publications

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“…However, the assessment of spasticity or motor function in the upper limbs is preferable because defects in arm-hand performance due to stroke or CP lead to greater problems in daily life than defects involving the lower limbs (6–8). …”

Section: Introductionmentioning

confidence: 99%

Transient Changes in Brain Metabolites after Transcranial Direct Current Stimulation in Spastic Cerebral Palsy: A Pilot Study

et al. 2017

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BackgroundMuscle spasticity is a disability caused by damage to the pyramidal system. Standard treatments for spasticity include muscle stretching, antispastic medications, and tendon release surgeries, but treatment outcomes remain unsatisfactory. Anodal transcranial direct current stimulation (tDCS) in patients with muscle spasticity is known to result in significant improvement in spastic tone (p < 0.001). However, the mechanism of action by which tDCS treatment affects spasticity remains unclear. This pilot study aimed to investigate the effect of anodal tDCS upon brain metabolites in the left basal ganglia and ipsilateral primary motor cortex (M1) in children with spastic cerebral palsy (CP).Materials and methodsThis study consisted of three steps: a baseline evaluation, a treatment period, and a follow-up period. During the treatment period, patients were given 20 min of 1 mA anodal tDCS over the left M1 for five consecutive days. Outcomes were compared between pre- and immediate posttreatment in terms of brain metabolites, Tardieu scales, and the quality of upper extremity skills test.ResultsTen patients with spastic CP were enrolled. Following tDCS, there were significant increases in the ratio of N-acetylaspartate (NAA)/creatine (Cr) (p = 0.030), choline (Cho)/Cr (p = 0.043), and myoinositol (mI)/Cr (p = 0.035) in the basal ganglia. Moreover, increased glutamine–glutamate (Glx)/Cr ratio in the left M1 (p = 0.008) was found. In addition, we also observed improvements in the extent of spasticity and hand function (p = 0.028).ConclusionFive consecutive days of anodal tDCS over the left M1 appeared statistically to reduce the degree of spasticity and increase NAA, Cho, mI, and Glx. Future research studies, involving a larger sample size of spastic CP patients undergoing tDCS is now warranted.

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Section: Introductionmentioning

confidence: 99%

Transient Changes in Brain Metabolites after Transcranial Direct Current Stimulation in Spastic Cerebral Palsy: A Pilot Study

et al. 2017

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“…A summary of the included studies is presented in Table SI. The three prospective studies stated measurement time points in advance and two retrospective studies described the use of a standard protocol which included follow‐up time‐points . Five studies provided information about missing data and loss to follow‐up (Table SI) .…”

Section: Resultsmentioning

confidence: 99%

“…In all retrospective studies the risk of bias was critical for the items on selection (owing to lack of allocation concealment, loss to follow‐up), confounding (inherently to non‐controllable studies, different baseline characteristics), and measurement of outcomes (blinding of outcome assessment). Three studies were judged to be at serious risk of bias in at least one domain, but not at critical risk of bias in any domain.…”

Section: Resultsmentioning

confidence: 99%

“…Patients' functional performance of activities was evaluated with the Assisting Hand Assessment (AHA) and the Shriners Hospital Upper Extremity Evaluation (SHUEE) spontaneous functional analysis . Significant improvement on the spontaneous functional use (SHUEE spontaneous functional analysis and AHA) was found in all four studies . For the AHA, a change of five AHA units or more does (with 95% certainty) reflect a real change exceeding any random measurement error …”

Section: Resultsmentioning

confidence: 99%

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Effects of upper extremity surgery on activities and participation of children with cerebral palsy: a systematic review

Louwers

Warnink‐Kavelaars

Daams

et al. 2019

Develop Med Child Neuro

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AimTo evaluate and synthesize the evidence for effects of upper extremity surgery (UES) on activities and participation of children and adolescents with cerebral palsy (CP).MethodThe databases MEDLINE, Embase, and PsycINFO were searched for publications up to September 2018. Studies included were comparative studies with or without concurrent comparison groups or case series with pretest/posttest outcomes with a minimal sample size of 10 participants; those that reported the effects of UES with a follow‐up time of at least 5 months; those including patients diagnosed with CP aged up to 20 years; and those that used a validated activity‐based instrument. Risk of bias was assessed using the ROBINS‐I (Risk Of Bias In Non‐randomised Studies ‐ of Interventions) tool and quality assessment was performed using the Grading of Recommendations Assessment, Development and Evaluation.ResultsTwelve studies, involving 310 children and adolescents, were included. The ability and perception of the patient to use the hand(s) and perform activities (measured with the Shriners Hospital Upper Extremity Evaluation, Assisting Hand Assessment, and House Functional Classification) improved significantly after UES. The quality of evidence was very low for each of the activity outcomes of interest.InterpretationThe very low evidence prohibits recommendations on the use of UES to guide clinical practice. More high‐quality comparative studies are needed to obtain better insight into the effects of UES on activities and participation.What this paper adds Low quality of evidence for effects of upper extremity surgery (UES) on activities and participation.Limited evidence for improvement in activities and participation after UES.

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“…In the study by Smitherman et al 34 , forty children with hemiplegic cerebral palsy who underwent upper-extremity single-event multilevel surgery were compared with twenty-six children who did not receive any upper-extremity interventions. On the basis of Shriners Hospital for Children Upper Extremity Evaluation, the authors concluded that singleevent multilevel surgery significantly improved dynamic segmental alignment and, to a lesser degree, spontaneous use of the upper extremity in comparison with nonoperative treatment.…”

Section: Upper Extremitymentioning

confidence: 99%

What’s New in Pediatric Orthopaedic Surgery

Zaltz

Hosalkar

Wenger

2012

Journal of Bone and Joint Surgery

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Functional Outcomes Following Single-Event Multilevel Surgery of the Upper Extremity for Children with Hemiplegic Cerebral Palsy

Cited by 42 publications

References 50 publications

Transient Changes in Brain Metabolites after Transcranial Direct Current Stimulation in Spastic Cerebral Palsy: A Pilot Study

Transient Changes in Brain Metabolites after Transcranial Direct Current Stimulation in Spastic Cerebral Palsy: A Pilot Study

Effects of upper extremity surgery on activities and participation of children with cerebral palsy: a systematic review

What’s New in Pediatric Orthopaedic Surgery

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