Short‐term outcome of multilevel surgical intervention in spastic diplegic cerebral palsy compared with the natural history

Abstract

Outcome in 24 ambulant children with spastic diplegic cerebral palsy, in whom multilevel surgical intervention was recommended following gait analysis, is reviewed. Twelve children had surgical intervention (treatment group; eight males, four females; mean age 9 years 10 months, SD 3 years 4 months) while the other 12 did not (control group; five males, seven females; mean age 10 years 1 month, SD 2 years 11 months). All children had interval three‐dimensional gait analyses (mean time between analyses: control group, 14.1 months; treatment group, 17.9 months). At follow‐up the control group (mean age 11 years 9 months) showed a significant increase in minimum hip and knee flexion in stance which was not related to age, the interval between analyses, changes in the passive joint range of motion, nor changes in anthropometric measurements. The treatment group (mean age at follow‐up 11 years 3 months) showed a significant improvement in minimum knee flexion and in ankle dorsiflexion in stance. Parents of nine children said their child's walking distance had increased following intervention. Of five children using posterior walkers preoperatively, two continued to use them postoperatively; two were using crutches or sticks and the remaining child walked independently. Two children who walked independently preoperatively used sticks postoperatively for community ambulation. The deterioration seen in the kinematics of the control group suggests that previous outcome studies comparing postoperative gait with preoperative gait have underestimated the immediate effects of surgery. It also raises concerns about the long‐term effects of surgical intervention.

Effects of a static bicycling programme on the functional ability of young people with cerebral palsy who are non‐ambulant

“…This indicates that no underlying change was occurring to the functional ability of the participants that may have accounted for improvements found in the exercise period (although routine therapy was continued throughout the baseline, exercise, and follow-up periods). This concurs with Gough et al 22 and Bottos et al, 7 who suggest that function does not improve and, in fact, may deteriorate in children and adolescents.…”

Surgical correction of equinus deformity in children with cerebral palsy: A systematic review

“…Some studies focused on a single operative procedure [25,30,37], others on a comparison of multiple procedures [17,33,40], and some in the setting of SEMLS [2,11,14,20,23,24,27,29,35,37,38,41,45]. The reason for the choice of various procedures was often surgeon preference or frequently not clearly stated.…”

“…The outcome measures reported included clinical examination and rating scales [2,11,, gait rating scales [2, 14, 16-18, 20-22, 24, 25, 27, 29, 30, 32, 33, 36, 39, 42], goniometry [2,14,17,21,25,36,44], three-dimensional gait analysis [2, 11, 14, 15, 17, 21-24, 28, 29, 31, 32, 35, 37-39, 41, 44, 46], the modified Ashworth scale (spasticity) [2,11,36,37], radiographs [17,32,45], electromyography [11,15,23,24,35,38], the Gross Motor Function Measure (GMFM) [14,21] and the need for floor reaction AFOs to manage crouch gait [20,26]. Such measures were used to derive an outcome scale, which rated the overall result from good to poor.…”

Lower extremity soft tissue surgery in spastic cerebral palsy: experience from a government rehabilitation unit

“…The treatment group on the other hand showed a significant improvement in minimum knee flexion and in ankle dorsiflexion in stance suggesting positive outcomes in gait immediately after surgery. 8 Thomson et al studied the effects of SEMLS in 19 children with bilateral spastic CP through a prospective cohort study to determine if improvements in gait and function would be maintained at 5 years post follow up. were not significant indicating that improvements in gait and gross motor function were stable over time.…”

“…Corrective surgery is indicated when the contractures are static and severe enough to interfere with movements and locomotion. 8 Surgical procedures for lower extremity soft tissue such as tenotomy, tendon transfers, fractional or Z lengthening of the tendon can be performed to correct contractures and deformities of the joint to lengthen the spastic muscle. 9 SEMLS which has replaced the previous concept of single level surgery, has shown improved long term gait outcomes in both prospective and retrospective studies in bilateral CP.…”