Orthopedic surgery and mobility goals for children with cerebral palsy GMFCS level IV: What are we setting out to achieve?

Blumetti, Francesco Camara; Wu, Janet; Bau, Karen; Martin, Brian J.; Hobson, Sally Anne; Axt, Matthias W.; Selber, Paulo

doi:10.1007/s11832-012-0454-7

Cited by 20 publications

(23 citation statements)

References 30 publications

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“…Over 90% of these children have musculoskeletal impairments that result in slower and less coordinated motor actions ( Abel and Damiano, 1996 , Johnson et al, 1997 , Norlin and Odenrick, 1986 ). These observations have fueled the original belief that the motor aberrations seen in children with CP primarily originated in the musculoskeletal machinery ( Pin et al, 2006 , Moreau et al, 2012 , Blumetti et al, 2012 , Dreher et al, 2012 , Taylor et al, 2013 ). However, this hypothesis has been significantly challenged in recent years, as it is becoming widely recognized that the white matter damage seen in these children likely impacts activity within the key brain networks that are involved in processing sensory information and the production of motor actions (cf.…”

Section: Introductionmentioning

confidence: 93%

Children with cerebral palsy have altered oscillatory activity in the motor and visual cortices during a knee motor task

Kurz

Proskovec

Gehringer

et al. 2017

NeuroImage: Clinical

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The neuroimaging literature on cerebral palsy (CP) has predominantly focused on identifying structural aberrations within the white matter (e.g., fiber track integrity), with very few studies examining neural activity within the key networks that serve the production of motor actions. The current investigation used high-density magnetoencephalography to begin to fill this knowledge gap by quantifying the temporal dynamics of the alpha and beta cortical oscillations in children with CP (age = 15.5 ± 3 years; GMFCS levels II–III) and typically developing (TD) children (age = 14.1 ± 3 years) during a goal-directed isometric target-matching task using the knee joint. Advanced beamforming methods were used to image the cortical oscillations during the movement planning and execution stages. Compared with the TD children, our results showed that the children with CP had stronger alpha and beta event-related desynchronization (ERD) within the primary motor cortices, premotor area, inferior parietal lobule, and inferior frontal gyrus during the motor planning stage. Differences in beta ERD amplitude extended through the motor execution stage within the supplementary motor area and premotor cortices, and a stronger alpha ERD was detected in the anterior cingulate. Interestingly, our results also indicated that alpha and beta oscillations were weaker in the children with CP within the occipital cortices and visual MT area during movement execution. These altered alpha and beta oscillations were accompanied by slower reaction times and substantial target matching errors in the children with CP. We also identified that the strength of the alpha and beta ERDs during the motor planning and execution stages were correlated with the motor performance. Lastly, our regression analyses suggested that the beta ERD within visual areas during motor execution primarily predicted the amount of motor errors. Overall, these data suggest that uncharacteristic alpha and beta oscillations within visuomotor cortical networks play a prominent role in the atypical motor actions exhibited by children with CP.

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Section: Introductionmentioning

confidence: 93%

Children with cerebral palsy have altered oscillatory activity in the motor and visual cortices during a knee motor task

Kurz

Proskovec

Gehringer

et al. 2017

NeuroImage: Clinical

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“…In ambulatory patients (GMFCS levels I, II and III), SEMS is widely accepted as the gold standard for improving gait. [9,22] It has been reported that surgical treatment is planned more accurately and the results are more successful by performing static and dynamic examination together. [4,14] A number of other studies in the orthopedic literature have also accepted a significant positive change in the level of GMFCS after SEMS.…”

Section: Discussionmentioning

confidence: 99%

Comparison of single event multilevel surgery and multiple surgical events in the lower extremities of children with spastic cerebral palsy

Aslan

Diril

Demirci

et al. 2019

Eklem Hastalik Cerrahisi

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Bu çalışmada serebral palsi (SP)'ye bağlı alt ekstremite rahatsızlıkları için tek aşamada çok seviyeli cerrahi (TAÇSC) ve çok aşamalı cerrahi (ÇAC) ile tedavi edilen hastalar karşılaştırıldı. Hastalar ve yöntemler: Çalışmaya geriye dönük olarak ameliyat öncesinde ve son takipte Kaba Motor Fonksiyon Sınıflandırma Sistemi (KMFSS) ile evrelendirilen 130 hasta (74 erkek, 56 kız; ort. yaş 7.7±4 yıl; dağılım, 4-13 yıl) dahil edildi. Hastalar grup 1 (ÇAC) ve grup 2 (TAÇSC) olmak üzere iki gruba ayrıldı. Değerlendirme ölçütü olarak Kaba Motor Fonksiyon Ölçütü-88 (KMFÖ-88) ve aile memnuniyetini ölçmek için Görsel Analog Ölçeği kullanıldı. Bulgular: Son takipte grup 2'nin KMFÖ-88 D ve E skorları daha iyiydi (sırasıyla, p= 0.037 ve p= 0.045). Benzer şekilde, aile memnuniyeti grup 2'de daha iyiydi (p= 0.047). Tüm hastaların ameliyat öncesi ve son takip KMFSS evreleri (I, II, III) arasında farklılık vardı (sırasıyla, 21/53/56 ve 53/49/28; p<0.001). Çocuk başına toplam 3.8 (dağılım, 2-7) ameliyat yapıldı. Sonuç: Bu çalışmada, TAÇSC SP'li çocukların hareket, postür ve bağımsızlığı açısından ÇAC'ye göre anlamlı katkı sağladı. Tek aşamada çok seviyeli cerrahi aile memnuniyetini de artırdı.

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“…Only one patient maintained an FMS score of 2, 1, 1 at 2 years' follow-up. Most children lost their ability to do supported walking and standing transfers at 2 years' post-surgery [29]. Some external factors are known to influence the outcomes after OS, including post-operative rehabilitation, use of orthotic devices, pain-controlling strategies, adequate tone control, and presence of comorbidities [91].…”

Section: Discussionmentioning

confidence: 99%

“…The authors concluded that the role of orthopaedic surgery for children with CP at GMFCS level IV is limited to the treatment and prevention of spastic hip disease and scoliosis [29].…”

mentioning

confidence: 99%

Neuromusculoskeletal Rehabilitation of Severe Cerebral Palsy

Sharan¹,

Rajkumar²,

RajarajeshwariBalakrishnan³

et al. 2016

Cerebral Palsy - Current Steps

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Persons with Gross Motor Function Classification System (GMFCS) levels IV and V are considered as severe cerebral palsy (CP) and are non-ambulatory. These persons are at a higher risk of complications such as hip displacement (sub-luxation or dislocation), spinopelvic deformities, musculoskeletal pain, low bone mineral density and low energy fracture. The recommended management strategy at present for this group is wheelchairaided mobility, with which none of these complications can be prevented. There is a strong need to evaluate alternative methods of treatment that can allow assisted ambulation in persons with severe CP. The role of Single Event Multilevel Lever Arm Restoration and AntiSpasticity Surgery (SEMLARASS) and protocol-based active rehabilitation on gross motor function and ambulation of non-ambulatory persons with CP at GMFCS levels IV and V is examined. Active rehabilitation involves making the person with severe CP active through most of the waking hours and participating actively in the rehabilitation. A wellplanned and executed SEMLARASS, followed by intensive, protocol-based, sequenced multidisciplinary active rehabilitation, provides the persons with GMFCS levels IV and V a significant functional improvement in gross motor function and mobility. cognitive, social, behaviour, speech and communication, seizure disorder, respiratory illness and other musculoskeletal disorders [1]. A total of 17 million persons are estimated to have CP worldwide and CP is one of the most common causes of physical disability among children. The prevalence of CP is currently estimated to be 2.11/1000 live births [2] and varies between 1 and 5/1000 live births in different countries. 28% of persons with CP have epilepsy, 58% have difficulties with communication, 42% have visual problems and 23-56% have learning disabilities [3].Clinicians classify patients with CP to describe the specific problem, to predict prognosis and to guide treatment. Classification is based on the change in muscle tone, anatomical region of involvement and severity of the problem. Types of CP according to muscle tone are spastic (hemiplegia, diplegia and quadriplegia based on anatomical region of involvement), ataxic and dyskinetic (dystonia and choreoathetosis). Even though these terms do not have specific reliability among the observers, these terms are helpful for understanding the CP condition [4]. Gross Motor Function Classification System (GMFCS) is another system to classify gross motor function of children and youths with CP on the basis of their self-initiated movement with particular emphasis on sitting, walking and wheeled mobility. Children and youths with GMFCS levels IV and V are non-ambulatory and are considered as severe CP. Persons in GMFCS level IV use wheelchair, either manual or automatic, for transportation and persons in GMFCS level V are highly dependent because of the lack of balance in head, neck and trunk, and will require major assistive devices for physical assistance [5].According to data from North India, 69% of ...

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Orthopedic surgery and mobility goals for children with cerebral palsy GMFCS level IV: What are we setting out to achieve?

Abstract: Case series, Level IV.

Cited by 20 publications

References 30 publications

Children with cerebral palsy have altered oscillatory activity in the motor and visual cortices during a knee motor task

Children with cerebral palsy have altered oscillatory activity in the motor and visual cortices during a knee motor task

Comparison of single event multilevel surgery and multiple surgical events in the lower extremities of children with spastic cerebral palsy

Neuromusculoskeletal Rehabilitation of Severe Cerebral Palsy

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