Improving gait and lower-limb muscle strength in children with cerebral palsy following Selective Percutaneous Myofascial Lengthening and functional physiotherapy

Abstract

BACKGROUND: Selective Percutaneous Myofascial lengthening (SPML) is an innovative minimally invasive surgical procedure, using micro incisions often combined with alcohol nerve block, for managing muscle contractures and stiffness in children with cerebral palsy (CP). There is lack of evidence of effects of a combined intervention of SPML and physiotherapy on gait function and muscle strength in CP. OBJECTIVE: This study investigated the change in gait function and muscle strength in children with CP who underwent gait laboratory assessment before and after SPML, combined with obturator nerve blocks, and 9-month post-surgical functional physiotherapy. METHODS: Ten children with bilateral spastic CP, Gross Motor Function Classification System (GMFCS) level II-IV, age 5-7 years, participated in this study. The Global Gait Graph Deviation Index (Global GGDI) and isometric muscle strength (hand-held dynamometry) were the primary outcome measures. Changes in spatiotemporal gait parameters, gross motor function and GMFCS level were secondarily examined. RESULTS: A significant improvement of Global GGDI was found (p < 0.05). The mean strength in hip flexors, extensors and adductors, knee extensors, and ankle dorsiflexors increased significantly (p < 0.05). Children improved significantly their GMFCS level and gross motor capacity (p < 0.05). CONCLUSIONS: SPML procedure combined with functional physiotherapy can improve gait function and lower-limb muscle strength.

Association between Gait Deviation Index and Physical Function in Children with Bilateral Spastic Cerebral Palsy: A Cross-Sectional Study

“…Moreover, other studies have shown that lower leg muscle strength may play a critical role in gait [25,26]. In other words, functional decline-represented by the FTSST and GDI findings-may be prevented if gait impairment is ameliorated through exercise therapy and orthopedic treatments to address the aspects of body structure and function in pediatric patients [27][28][29][30], such as strength, balance, or bony abnormalities, particularly in those with GMFCS level I and II spastic cerebral palsy. However, gait quality and physical function in children with cerebral palsy are complex topics that warrant further investigation.…”

Minimally Invasive SPML Surgery for Children with Cerebral Palsy: Program Development

“…Most recently, a report including 10 children treated on multiple sites confirmed improvements in gross motor function, muscle strength, and step length. Joint mobility data were collected but not reported [11]. No studies that assess joint excursion after lengthening surgeries were found.…”

“…The selective percutaneous myofascial lengthening (SPML) surgical procedure is a minimally invasive method to lengthen contracted musculoskeletal tissues to improve bilateral interactive walking, subsequent functional mobility, and quality of life in children with CP. Developed by RM Nuzzo, SPML differs from other orthopedic surgeries in its aims and procedures [ 11 – 14 ]. Most surgical approaches plan the procedures as a sort of blueprint, with shape and depth, even jigs and patterns used as templates.…”

The Effect of Cerebral Palsy Disease Severity, Socioeconomic Status, and Educational Background on Selective Percutaneous Myofascial Lengthening Reoperation Rates

“…CP is one of the most common neurological disorders that is encountered in a healthcare setting. Spastic CP can lead to contractures that can limit the quality of life in patients [6]. These contractures can be released with surgery, and one such surgery is the SPML operation.…”