Multidimensional outcome measure of selective dorsal rhizotomy in spastic cerebral palsy

Carraro, Elena; Zeme, Sergio Mario; Ticcinelli, Valentina; Massaroni, Carlo; Santin, Marco; Peretta, Paola; Martinuzzi, Andrea; Trevisi, E.

doi:10.1016/j.ejpn.2014.06.003

Cited by 30 publications

(24 citation statements)

References 39 publications

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“…Specifically, a significant increase in max DF and reduction of max PF indicate a substantial shift of ankle angles used during walking. The shift in ankle angles suggests a reduction in equinus gait after SDR in children with CP, which is consistent with previous gait analysis data (28,29). Thus, gait in children with CP who undergo SDR appears to shift the gait kinematics toward a more typically developing gait, potentially due to changes in motor control.…”

Section: Discussionsupporting

confidence: 88%

Effects of Selective Dorsal Rhizotomy on Ankle Joint Function in Patients With Cerebral Palsy

2020

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Selective dorsal rhizotomy (SDR) is a neurosurgical technique performed to reduce muscle spasticity and improve motor functions in children with cerebral palsy (CP). In long term, muscle contractures were observed even after SDR. To better understand what is contributing to contracture formation, it is necessary to assess the effects of SDR on joint stiffness. We hypothesized that ankle passive range of motion (ROM) increases and the quasi-stiffness of the ankle joint decreases after SDR in children with CP. This retrospective study included 10 children with diplegic CP (median age 6 years 2 months) who had undergone SDR and for whom gait analysis data were collected 3 months before (Pre-SDR) and 13 months after (Post-SDR) surgery. Additional to clinical measures, ankle quasi-stiffness (the slope of the ankle moment vs. ankle angle plot) was analyzed from gait data. Passive ankle ROM at 0 • (p < 0.0001) and 90 • knee angles (p < 0.0001) increased after SDR. Dynamic EMG analysis showed improved phasic gastrocnemius activity (p < 0.0001). Equinus gait was improved with the reduction of peak plantar flexion (p < 0.0001), as well as an increase in peak dorsiflexion (p = 0.006) during walking was observed. Ankle joint quasi-stiffness (Pre-and post-SDR median = 0.056 Nm/kg/ • and 0.051 Nm/kg/ • , and interquartile range: 0.031 Nm/kg/ • and 0.019 Nm/kg/ • , respectively) decreased significantly (p = 0.0017) after SDR. Moreover, even though the total time of the gait cycle did not change (p = 0.99), the time interval from maximum dorsiflexion to maximum plantar flexion (Pre-and post-SDR median = 0.125 s and 0.156 s, and interquartile range: 0.153 and 0.253 s, respectively) increased significantly (p = 0.0068) after SDR. In conclusion, the decreased ankle quasi-stiffness and the enhanced time interval in the gait cycle due to SDR indicate better motor control and joint stability. Our findings suggest that the long-term contracture formation occurring even after surgical interventions may be related to the stiffening of non-contractile structures.

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Section: Discussionsupporting

confidence: 88%

Effects of Selective Dorsal Rhizotomy on Ankle Joint Function in Patients With Cerebral Palsy

2020

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“…Bakir et al reported an improvement in temporal parameters and variability in 12 children measured preand post SDR with three-dimensional gait analysis but made no mention of changes in kinematics [2]. In a small group of nine patients Carraro et al reported generally non-significant changes in energy consumption at 12 months after selective dorsal rhizotomy [9]. Similar non-significant changes were noted by Chan et al [10].…”

Section: Short Term Outcomessupporting

confidence: 66%

Gait analysis to guide a selective dorsal rhizotomy program

Roberts¹,

Stewart²,

Freeman³

2015

Gait & Posture

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“…Prior research on the impact of SDR on energy consumption has also reported reductions in energy, but compared to a control group of TD peers or no control group (Carraro et al, 2014;Nicolini-Panisson et al, 2018;Wang et al, 2018). For example, Trost and colleagues (2008) reported a 22% reduction in energetic cost after SDR (Trost et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

“…1. primary diagnosis of diplegic CP, 2. underwent a bilateral SDR before the age of 12 years of age, 3. had at least one gait analysis before (baseline) and after (follow-up) SDR that included both oxygen consumption and Ashworth Scores, 4.…”

Section: Participantsmentioning

confidence: 99%

“…Prior outcome studies have also suggested that SDR reduces energy consumption. For example, Carraro and colleagues found that energy was significantly reduced across multiple walking speeds after SDR for nine children with CP (Carraro et al, 2014). While these studies seem to indicate that spasticity contributes to elevated energy consumption in CP, there are several critical limitations.…”

Section: Introductionmentioning

confidence: 99%

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Spasticity reduction in children with cerebral palsy is not associated with reduced energy consumption during walking

Steele

et al. 2019

Preprint

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Word Count: 246 (250) Main Text Word Count: 2311 (4000) Declarations of interest: none Highlights • Energy consumption is not reduced after rhizotomy compared to matched peers • Spasticity has minimal contribution to elevated energy during walking • Matched control groups are critical in cerebral palsy research AbstractBackground: The average energy consumption during walking of children with cerebral palsy (CP) is over two times of that of typically developing (TD) children and fatigue is one of the top complaints of children with CP and their families. Spasticity has been theorized to contribute to increased energy consumption during walking in CP, but its role remains unclear.Methods: We retrospectively compared the energy consumption of walking in children with diplegic CP before and after selective dorsal rhizotomy (SDR), a surgery that reduces spasticity. A control group of participants with CP who also underwent gait analysis but did not undergo SDR was matched to the SDR group by pre-surgery age, spasticity, and energy consumption. Energy consumption and spasticity were compared at baseline and follow-up for both groups.Findings: As expected, the SDR group has a significantly greater decrease (-44%) in spasticity compared to matched peers with CP who did not undergo SDR (-16%, P<0.001). While both groups had a reduction in energy consumption between visits (12 % SDR and 14% no-SDR), there was no difference in the change in energy consumption between groups (P=0.4).Interpretation: Reducing spasticity did not contribute to greater reductions in energy consumption, suggesting that spasticity has minimal impact on elevated energy consumption during walking for children with CP. Energy consumption and spasticity decrease with age among children with CP. Identifying matched control groups of peers with CP is critical for research involving children with CP to account for changes due to development.

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Multidimensional outcome measure of selective dorsal rhizotomy in spastic cerebral palsy

Cited by 30 publications

References 39 publications

Effects of Selective Dorsal Rhizotomy on Ankle Joint Function in Patients With Cerebral Palsy

Effects of Selective Dorsal Rhizotomy on Ankle Joint Function in Patients With Cerebral Palsy

Gait analysis to guide a selective dorsal rhizotomy program

Spasticity reduction in children with cerebral palsy is not associated with reduced energy consumption during walking

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