Recovery of muscle strength following multi-level orthopaedic surgery in diplegic cerebral palsy

Seniorou, Maria; Thompson, Nicky; Harrington, Marian; Theologis, Tim

doi:10.1016/j.gaitpost.2007.07.008

Cited by 71 publications

(58 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, these same procedures may also have adverse effects on mobility activities such as walking, running, or jumping. 7,26 Others have reported similar findings, noting variability in direction of change among measures as well as among subscales within the same measure in children with CP. 7,18,26 …”

Section: Discussionmentioning

confidence: 62%

“…Mobility, Pain Interference and Fatigue PROMIS® domains were selected based on their relevance to post-surgical changes likely to be observed. 6,7-9,11 PROMIS® Pediatric PROs use a five-option response scale that ranges from ‘no trouble’ to ‘not able to do’ (mobility) and from “never” to “almost always” (pain interference and fatigue). PROMIS® measures are scored on a T metric where the mean=50 and Standard Deviation=10.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Ability of PROMIS Pediatric Measures to Detect Change in Children With Cerebral Palsy Undergoing Musculoskeletal Surgery

Mulcahey

Haley

Slavin

et al. 2016

Journal of Pediatric Orthopaedics

View full text Add to dashboard Cite

Background The Patient Reported Outcomes Measurement Information System (PROMIS®) was developed to provide patient-reported outcome (PROs) measures that are designed as being universally relevant across health conditions, low burden and precise. A major problem for research and clinical practice in cerebral palsy (CP) is the void of outcomes instruments that are capable of evaluating the wide range of abilities and broad age spectrum inherent in this clinical population. Given the tremendous potential of PROMIS® , the research questions for this study were “How do PROMIS® pediatric computer adaptive tests (CAT) and short forms (SF) detect change in children with CP following elective musculoskeletal surgery?” and “How do PROMIS® instruments compare to the Pediatric Quality of Life Inventory™ Cerebral Palsy Module Version 3.0 (PedsQL CP), Pediatric Outcomes Data Collection Instrument (PODCI), the Timed Up and Go (TUG) and the Gross Motor Functional Measure (GMFM). Methods PROMIS® Pediatric CATs and SFs and the PedsQL, PODCI, TUG and GMFM were administered before and after surgery. Effect Size (ES) and Standardized Response Mean (SRM) were calculated. Floor and ceiling effects were evaluated and, exposure rates for the PROMIS® item banks were examined. Results ES and SRM for all PROMIS® Pediatric Measures were non-significant. PedsQL CP detected significant, positive change in mobility at 6 (ES =0.26; SRM = 0.31) and 12 (ES = 0.36; SRM=0.36) months; pain at 12 months (ES=0.29; SRM=0.34); and fatigue at 6 (ES=0.24; SRM=0.22) and 12 (ES=0.36; SRM=0.41) months. Significant negative changes were detected by the PODCI (ES= - 0.20; SRM= - 0.26), GMFM (ES= - 0.13; SRM = -0.24) and TUG (ES= - 0.29; SRM= - 0.25). Ceiling effects were high. Exposure to an appropriate range of the PROMIS® Mobility item bank was limited. Conclusion PROMIS® measures were less able to detect change than other measures. PROMIS® measures may be improved by tailoring start\stop rules or by adding items to include content appropriate for children with mobility impairments. Level of Evidence Diagnostic Study, Level III

show abstract

Section: Discussionmentioning

confidence: 62%

Section: Methodsmentioning

confidence: 99%

Ability of PROMIS Pediatric Measures to Detect Change in Children With Cerebral Palsy Undergoing Musculoskeletal Surgery

Mulcahey

Haley

Slavin

et al. 2016

Journal of Pediatric Orthopaedics

View full text Add to dashboard Cite

show abstract

“…Complications include overlengthening of the tendon (usually iatrogenic) and weakness. (99) Recent research suggests that the tendon may actually be long but the muscle fibers are short, so lengthening of the tendon may be deleterious to the muscle (see above).…”

Section: Orthopaedic Management Of Motor Disorders In Cerebral Palsymentioning

confidence: 99%

New Clinical and Research Trends in Lower Extremity Management for Ambulatory Children with Cerebral Palsy

Damiano

Alter

Chambers

2009

Physical Medicine and Rehabilitation Clinics of North America

104

View full text Add to dashboard Cite

SynopsisCerebral palsy is the most prevalent physical disability in childhood and includes a group of disorders with varying manifestations and levels of capability in individuals given this diagnosis. This chapter will focus on current and future intervention strategies for improving mobility and participation over the lifespan for ambulatory children with cerebral palsy (CP). The provision and integration of physical therapy, medical and orthopedic surgery management focused primarily on the lower extremities will be discussed here. Some of the newer trends are: more intense and task-related exercise strategies, greater precision in tone identification and management, and a shift towards musculoskeletal surgery that focuses more on promoting dynamic bony alignment and less on releasing or lengthening tendons. Advances in basic and clinical science and technology development are changing existing paradigms and offering renewed hope for improved functioning for children with CP who are currently facing a lifelong disability with unique challenges at each stage in life.

show abstract

“…This is despite prolonged and extensive rehabilitation with an additional resistance strengthening programme to which other lower limb muscles responded well. 19 This stresses the importance of limiting lengthening to fascial portion of hamstrings with rigorous open surgical technique.…”

Section: Discussionmentioning

confidence: 99%

Is percutaneous medial hamstring myofascial lengthening as anatomically effective and safe as the open procedure?

Mansour

Derienne

Daher

et al. 2017

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

BackgroundMedial hamstring fractional lengthening is commonly performed in children with cerebral palsy (CP) to decrease contracture and/or to improve gait. Percutaneous procedures are gaining more and more popularity, even in the paediatric population, with equivocal results. The purpose of this paper was to determine the efficacy and safety of percutaneous medial hamstring myofascial lengthening (PHL).MethodsThis is a prospective randomised controlled trial including 31 knees from 18 consecutive patients with CP scheduled for medial hamstring lengthening in the setting of multilevel tendon lengthening procedures in a university hospital. Other concomitant lower extremity surgeries were not exclusionary. A first paediatric orthopaedic surgeon executes the PHL at one level, as recently described in the literature. Another surgeon opens and extends the wound to explore what had been cut during the PHL and completes fractional lengthening (OHL) of both the semimembranosus (SM) and semitendinosus (ST) when possible. Popliteal angle (PA) was assessed by a third surgeon immediately before PHL, after PHL and then after OHL, using a goniometer in a standardised reproducible manner. All three surgeons were blinded to the others’ findings. Primary endpoints included ease of performing PHL, the percentage of tendon-fascia/ muscle portion sectioned percutaneously and improvement of PA. Comparison between improvement of PA after PHL and OHL was done using a paired t-test with a 95% confidence interval.ResultsThe first surgeon was at ease in palpating and identifying the semimembranosus tendon before PHL in ten knees only. PHL led to an undesirable cut of the semimembranosus muscle fibres to more than 50% of the muscle section area in eight cases (<50% in 23 cases, between 50% and 75% in eight cases), and of the semitendinosus muscle fibres to more than 50% in all cases (complete rupture in six cases, more than 75% in eight cases and approximately 50% in 17 cases). Mean PA measured 52° pre-operatively and decreased to 40° after PHL. After OHL, the PA averaged 22°. There was a significant difference between the PA value after PHL (M = 40, SD = 11.8) and the PA value after OHL (M = 22, SD = 8.7), p < 0.0001. The gain in PA did not correlate with the extent of semimembranosus muscle divided (p = 0.38) nor with the extent of semitendinosus muscle divided (p = 0.35). No major iatrogenic neurovascular injury was observed.ConclusionsTo the authors’ knowledge, this is the first prospective study concerning the anatomic effects of PHL. Although it is a quick procedure, it is often associated with difficulty by the operating surgeon to identify and evaluate what should be cut percutaneously, leading to abusive injury of the muscle itself rather than the fascia alone. In addition, the gain in PA is statistically less following PHL than following OHL despite undesirable extensive muscle injury following PHL. This may be due to the multiple fascial cuts (fractional lengthening) usually performed in OHL.

show abstract

Recovery of muscle strength following multi-level orthopaedic surgery in diplegic cerebral palsy

Cited by 71 publications

References 31 publications

Ability of PROMIS Pediatric Measures to Detect Change in Children With Cerebral Palsy Undergoing Musculoskeletal Surgery

Ability of PROMIS Pediatric Measures to Detect Change in Children With Cerebral Palsy Undergoing Musculoskeletal Surgery

New Clinical and Research Trends in Lower Extremity Management for Ambulatory Children with Cerebral Palsy

Is percutaneous medial hamstring myofascial lengthening as anatomically effective and safe as the open procedure?

Contact Info

Product

Resources

About