1
|
Makoshi Z, Islam M, McKinney J, Leonard J. Postoperative outcomes and stimulation responses for sectioned nerve roots during selective dorsal rhizotomy in cerebral palsy. Acta Neurochir (Wien) 2024; 166:308. [PMID: 39078485 PMCID: PMC11289343 DOI: 10.1007/s00701-024-06187-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/28/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND Cerebral palsy (CP) is the most cause of motor dysfunction in children. Selective dorsal rhizotomy (SDR) plays a major role in long term spasticity control. However, limited data exists on the effect of SDR on postoperative spasticity treatment requirements and supraspinal effects, and the stimulation responses of dorsal nerve roots in those with CP. METHODS The current study included the outcome for 35 individuals undergoing SDR for motor functional outcome, spasticity, baclofen dose changes, botulinum toxin injection frequency, and spasticity related orthopedic procedures. We also report on the stimulation responses in 112 individuals who underwent SDR at our institution. RESULTS There was a significant difference in gross motor function measures (GMFM)-66 scores at last follow up that remained present when considering only ambulatory children but not with non-ambulatory children. Ashworth scores were significantly decreased for both upper and lower extremities after SDR at all follow up points. There was a significant decrease in Baclofen dose and botulinum toxin injections requirements after SDR, but no significant difference in the need for orthopedic intervention. A total of 5502 dorsal nerve roots were tested showing a decrease in stimulation intensity and increase in grade on the right side and for descending lumbosacral levels. CONCLUSIONS SDR improves gross motor scores during short term follow up but has additional benefits in decreasing baclofen dosing and botulinum toxin injections requirements after surgery. They stimulation responses of sectioned dorsal nerve roots adds to the limited available data and our understanding of the pathological changes that occur in CP.
Collapse
Affiliation(s)
- Ziyad Makoshi
- Neurosciences Department, El Paso Children's Hospital, El Paso, TX, USA
- Department of Surgery, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Monica Islam
- Division of Pediatric Neurology, Department of Pediatrics, The Ohio State College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jennifer McKinney
- Division of Pediatric Neurology, Department of Pediatrics, The Ohio State College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jeffrey Leonard
- Department of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, OH, USA.
- The Ohio State University Wexner Medical Center, The Ohio State University College of Medicine, Columbus, OH, USA.
| |
Collapse
|
2
|
Gravholt A, Fernandez B, Bessaguet H, Millet GY, Buizer AI, Lapole T. Motor function and gait decline in individuals with cerebral palsy during adulthood: a narrative review of potential physiological determinants. Eur J Appl Physiol 2024:10.1007/s00421-024-05550-y. [PMID: 39042142 DOI: 10.1007/s00421-024-05550-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 07/06/2024] [Indexed: 07/24/2024]
Abstract
Cerebral palsy (CP) is the most common childhood-onset disability. The evolution of gait according to severity is well known amongst children and thought to peak between 8 and 12 years of age among those walking without assistive devices. However, among adults, clinical experience as well as scientific studies report, through clinical assessments, questionnaires and interviews, increasing walking difficulties leading to an increased dependency of assistive devices in everyday ambulation. For many individuals with CP, this change will occur around 30-40 years, with the risk of losing mobility increasing with age. This narrative review aims to first provide objective evidence of motor function and gait decline in adults with CP when ageing, and then to offer mechanistic hypotheses to explain those alterations. Many studies have compared individuals with CP to the typically developing population, yet the evolution with ageing has largely been understudied. Comorbid diagnoses comprise one of the potential determinants of motor function and gait decline with ageing in people with CP, with the first manifestations happening at an early age and worsening with ageing. Similarly, ageing appears to cause alterations to the neuromuscular and cardiovascular systems at an earlier age than their typically developing (TD) peers. Future studies should, however, try to better understand how the physiological particularities of CP change with ageing that could pave the way for better strategies for maintaining function and quality of life in people with CP.
Collapse
Affiliation(s)
- Anders Gravholt
- Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Laboratoire Interuniversitaire de Biologie de La Motricité, 42023, Saint-Etienne, France
| | - Bruno Fernandez
- Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Laboratoire Interuniversitaire de Biologie de La Motricité, 42023, Saint-Etienne, France
| | - Hugo Bessaguet
- Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Laboratoire Interuniversitaire de Biologie de La Motricité, 42023, Saint-Etienne, France
| | - Guillaume Y Millet
- Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Laboratoire Interuniversitaire de Biologie de La Motricité, 42023, Saint-Etienne, France
- Institut Universitaire de France (IUF), Paris, France
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, Netherlands
- Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Thomas Lapole
- Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Laboratoire Interuniversitaire de Biologie de La Motricité, 42023, Saint-Etienne, France.
| |
Collapse
|
3
|
Faccioli S, Pagliano E, Ferrari A, Maghini C, Siani MF, Sgherri G, Cappetta G, Borelli G, Farella GM, Foscan M, Viganò M, Sghedoni S, Perazza S, Sassi S. Evidence-based management and motor rehabilitation of cerebral palsy children and adolescents: a systematic review. Front Neurol 2023; 14:1171224. [PMID: 37305763 PMCID: PMC10248244 DOI: 10.3389/fneur.2023.1171224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023] Open
Abstract
Background Evidence regarding the management of several aspects of cerebral palsy improved in recent years. Still, discrepancies are reported in clinical practice. Italian professionals and stakeholders expressed the need of setting up updated, evidenced-based, shared statements, to address clinical practice in cerebral palsy rehabilitation. The objective of the present study was to provide an updated overview of the state of knowledge, regarding the management and motor rehabilitation of children and young people with cerebral palsy, as the framework to develop evidence-based recommendations on this topic. Methods Guidelines and systematic reviews were searched, relative to evidence-based management and motor treatment, aimed at improving gross motor and manual function and activities, in subjects with cerebral palsy, aged 2-18 years. A systematic search according to the Patients Intervention Control Outcome framework was executed on multiple sites. Independent evaluators provided selection and quality assessment of the studies and extraction of data. Results Four guidelines, 43 systematic reviews, and three primary studies were included. Agreement among guidelines was reported relative to the general requirements of management and motor treatment. Considering the subject's multidimensional profile, age and developmentally appropriate activities were recommended to set individual goals and interventions. Only a few approaches were supported by high-level evidence (i.e., bimanual therapy and constraint-induced movement therapy to enhance manual performance). Several task-specific active approaches, to improve gross motor function and gait, were reported (mobility and gait training, cycling, backward gait, and treadmill), based on low-level evidence. Increasing daily physical activity and countering sedentary behavior were advised. Based on the available evidence, non-invasive brain stimulation, virtual reality, action-observation therapy, hydrotherapy, and hippotherapy might be complementary to task or goal-oriented physical therapy programs. Conclusion A multiple-disciplinary family-centered evidence-based management is recommended. All motor rehabilitation approaches to minors affected by cerebral palsy must share the following fundamental characteristics: engaging active involvement of the subject, individualized, age and developmentally appropriate, goal-directed, skill-based, and preferably intensive and time-limited, but suitable for the needs and preferences of the child or young person and their family, and feasible considering the implications for themselves and possible contextual limitations.
Collapse
Affiliation(s)
- Silvia Faccioli
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Ph.D. Program in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Emanuela Pagliano
- Neurodevelopmental Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Adriano Ferrari
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cristina Maghini
- Functional Rehabilitation Unit, IRCCS E. Medea, Associazione La Nostra Famiglia, Bosisio Parini, Italy
| | - Maria F. Siani
- Physical Medicine and Rehabilitation Unit, S. Maria delle Croci Hospital, Azienda Unità Sanitaria Locale Romagna, Ravenna, Italy
| | - Giada Sgherri
- Developmental Neuroscience Clinical Department, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Gina Cappetta
- Physical Medicine and Rehabilitation Unit, Infermi Hospital, Azienda Unità Sanitaria Locale Romagna, Rimini, Italy
| | - Giulia Borelli
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppina M. Farella
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Foscan
- Neurodevelopmental Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marta Viganò
- Neurodevelopmental Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Silvia Sghedoni
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Perazza
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Sassi
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| |
Collapse
|
4
|
Relative contribution of sensory and motor impairments to mobility limitations in children with cerebral palsy: an observational study. Sci Rep 2023; 13:3229. [PMID: 36828863 PMCID: PMC9957987 DOI: 10.1038/s41598-023-30293-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/21/2023] [Indexed: 02/26/2023] Open
Abstract
The purpose of this study was to determine the relative contribution of sensory and motor impairments to mobility limitations in cerebral palsy. An observational study was carried out in 83 children with all types of cerebral palsy with a mean age of 10.8 years (SD 1.2). Five impairments (coordination, strength, spasticity, contracture, proprioception) and three aspects of mobility (standing up from a chair, short and long distance walking) were measured. Standard multiple regression was used to determine the relative contribution of impairments to mobility as well as the relative contribution of strength of individual muscle groups (dorsiflexors, plantarflexors, knee extensors, hip abductors and hip extensors) to mobility. Five impairments accounted for 48% of the variance in overall mobility (p < 0.001): coordination independently accounted for 9%, contracture for 4% and strength for 3% of the variance. Five muscle groups accounted for 53% of the variance in overall mobility (p < 0.001): hip extensors independently accounted for 9%, knee extensors for 4%, dorsiflexors for 4% and plantarflexors for 3% of the variance. Our findings demonstrate that the impairments making a significant independent contribution to mobility in pre-adolescent cerebral palsy were loss of coordination, loss of strength and contracture.
Collapse
|
5
|
Hickey L, Kuyucak O, Clausen L, Imms C. Mapping the focus of research conducted with adults with cerebral palsy: an overview of systematic reviews. Disabil Rehabil 2023; 45:185-208. [PMID: 35114857 DOI: 10.1080/09638288.2022.2032412] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE To map research conducted with adults with cerebral palsy (CP) to the International Classification of Functioning, Disability and Health (ICF) to understand the array of research available, identify key clinical messages and inform future research. MATERIALS AND METHODS An overview of systematic reviews was conducted. Comprehensive searches (to December 2021) were conducted in PsycINFO, Web of Science, MEDLINE, CINAHL, Cochrane, JBI, and EMBASE. Eligible studies were systematic reviews that included primary studies of adults with CP. Included reviews were assessed for study quality and mapped to the ICF components and chapters. A narrative synthesis of commonly reported outcomes within the component/s and chapter/s was conducted. RESULTS All 24 included reviews were published since 2010. Thirteen focused on body functions: movement related functions and cardiovascular and respiratory systems. Although nine reviews focused on gait and mobility, considerable overlap of included studies limited the volume of evidence and variability in review quality limited generalisability of findings. CONCLUSIONS Research involving adults with CP is growing; however, this overview of reviews found a predominant focus on mobility and gait. Future research, informed by consumer priorities, is needed to address a broader range of key health and participation outcomes.Implications for rehabilitationFitness, mobility, and gait were the most common research topics found in these systematic reviews suggesting a narrow research focus in adults with CP.There are significant gaps in our knowledge to inform clinical messages for practice about broad long-term outcomes of CP and how best to support their activity performance and participation.There is very limited evidence with which to guide and support rehabilitation professionals working in this field.
Collapse
Affiliation(s)
- Lyndal Hickey
- Department of Social Work, Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Osman Kuyucak
- Department of Social Work, Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Lukas Clausen
- Department of Social Work, Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Christine Imms
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
6
|
Baird G, Chandler S, Shortland A, Will E, Simonoff E, Scrutton D, Fairhurst C. Acquisition and loss of best walking skills in children and young people with bilateral cerebral palsy. Dev Med Child Neurol 2022; 64:235-242. [PMID: 34410016 DOI: 10.1111/dmcn.15015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 03/24/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
AIM To explore factors predicting acquisition and loss of best walking ability in young people with bilateral cerebral palsy (CP). METHOD In our population cohort (Study of Hips And Physical Experience) of 338 children (201 males, 137 females) with bilateral CP, age at achieving walking was recorded and walking ability predicted from early motor milestones. Walking was assessed at 5 to 8 years (mean 7y) and in 228 of 278 survivors at 13 to 19 years (mean 16y). Parent carers reported their view of any loss of best achieved walking. Factors potentially associated with loss of best achieved walking were explored: severity and type of motor disorder; intellect and communication; manipulative skill; general health and comorbidity; pain; orthopaedic surgery; musculoskeletal spine and lower limb deformity; weight; fatigue; mood; and presence of regular exercise regime. RESULTS The ability to walk independently was reliably predicted by the motor milestone 'getting to sit and maintain sitting' by the age of 36 months (without aids) and 55 months (with aids). Forty-five per cent of the cohort never walked 10 steps independently. Not all who achieved walking without aids were still doing so by a mean age of 16 years, which was associated with later age at achieving walking and the degree of musculoskeletal deformity, as was the parent carers' report of loss of best walking. INTERPRETATION In this study, development of musculoskeletal deformity was a significant factor in not maintaining best achieved walking by mean age 16 years, which is most likely to occur in young people whose walking ability is with aids over short distances or in therapy only. Prediction of future walking ability in a child with bilateral CP can be made from early motor milestones.
Collapse
Affiliation(s)
- Gillian Baird
- Newcomen Neurodevelopmental Service, Paediatric Neurosciences, Guy's & St Thomas' NHS Trust, King's Health Partners, Evelina London Children's Hospital, London, UK
| | - Susie Chandler
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Adam Shortland
- Biomedical Engineering & Imaging Science, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Elspeth Will
- Newcomen Neurodevelopmental Service, Paediatric Neurosciences, Guy's & St Thomas' NHS Trust, King's Health Partners, Evelina London Children's Hospital, London, UK
| | - Emily Simonoff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - David Scrutton
- Newcomen Neurodevelopmental Service, Paediatric Neurosciences, Guy's & St Thomas' NHS Trust, King's Health Partners, Evelina London Children's Hospital, London, UK
| | - Charlie Fairhurst
- Newcomen Neurodevelopmental Service, Paediatric Neurosciences, Guy's & St Thomas' NHS Trust, King's Health Partners, Evelina London Children's Hospital, London, UK
| |
Collapse
|