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

Abstract

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.

Functional outcome after selective dorsal rhizotomy: a retrospective case control study

“…For functional capacity, no between-group difference in the distance covered in 6MWT, (which measures e ciency in walking), and level of VO 2peak at the end of 6MWT (which measures energy consumption) were observed in our patients with and without SDR. The ndings were in line with a previous report [22] which suggested that reduction in spasticity by SDR have no obvious lasting effect in exercise capacity.…”

Selective dorsal rhizotomy and energy consumption in children with cerebral palsy: the importance of publishing unpopular results

“…Most clinicians assume these changes are due to the increased metabolism of the spastic muscles, especially during gross motor movements such as walking. I commend Zaino et al 3 for their efforts as well as their boldness in publishing a study that challenges previous publications, 4,5 commonly held notions, as well as their own study hypothesis.…”