1
|
Fong MM, Gibson N, Williams SA, Jensen L. Clinical functional outcome measures for children with cerebral palsy after gait corrective orthopaedic surgery: A scoping review. Dev Med Child Neurol 2023; 65:1573-1586. [PMID: 37147852 DOI: 10.1111/dmcn.15622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 05/07/2023]
Abstract
AIM To identify the most frequently reported non-instrumented measures of gait, activity, and participation in children with cerebral palsy (CP) after undergoing gait corrective orthopaedic surgery. METHOD Four databases were searched from database inception to the 9th December 2021 for studies that evaluated functional outcomes for children with CP under 18 years undergoing gait corrective orthopaedic surgery. RESULTS Of 547 citations, 44 publications (n = 3535 participants, n = 1789 males, mean age 10 years 5 months [SD = 3 years 3 months], Gross Motor Function Classification System levels I-III at the time of surgery) were eligible for inclusion. Fourteen different outcome measures were used: one measure of gait, 10 measures of activity, and three measures of participation. Gait was measured with the Edinburgh Visual Gait Scale (EVGS; 4 out of 44). The most common activity and participation measures were the Functional Mobility Scale (FMS; 15 out of 44) and Pediatric Outcomes Data Collection Instrument (11 out of 44) respectively. No studies reported a combination of gait, activity, and participation measures. INTERPRETATION The EVGS and FMS should be considered as core outcome measures in gait corrective orthopaedic surgery, while a measure of participation is unclear. Additional considerations for developing a comprehensive suite of outcomes include identifying a combination of clinical measures and performance-reflective questionnaires that are standardized for children with CP undergoing surgery and meaningful to clinicians and families.
Collapse
Affiliation(s)
- Maxine M Fong
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Department of Physiotherapy, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Noula Gibson
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Department of Physiotherapy, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Kids Rehab WA, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Sian A Williams
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Lynn Jensen
- Department of Physiotherapy, Perth Children's Hospital, Nedlands, Western Australia, Australia
| |
Collapse
|
2
|
Bertucco M, Nardon M, Mueske N, Sandhu S, Rethlefsen SA, Wren TAL, Sanger TD. The Effects of Prolonged Vibrotactile EMG-Based Biofeedback on Ankle Joint Range of Motion During Gait in Children with Spastic Cerebral Palsy: A Case Series. Phys Occup Ther Pediatr 2022; 43:351-366. [PMID: 36446743 DOI: 10.1080/01942638.2022.2151391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
AIMS The objective of this case series was to examine the feasibility of vibrotactile EMG-based biofeedback (BF) as a home-based intervention tool to enhance sensory information during everyday motor activities and to explore its effectiveness to induce changes in active ankle range of motion during gait in children with spastic cerebral palsy (CP). METHODS Ten children ages 6 to 13 years with spastic CP were recruited. Participants wore two EMG-based vibro-tactile BF devices for at least 4 hours per day for 1-month on the ankle and knee joints muscles. The device computed the amplitude of the EMG signal of the target muscle and actuated a silent vibration motor proportional to the magnitude of the EMG. RESULTS Our results demonstrated the feasibility of the augmented sensory information of muscle activity to induce changes of the active ankle range of motion during gait for 6 children with an increase ranging from 8.9 to 51.6% compared to a one-month period without treatment. CONCLUSIONS Preliminary findings of this case series demonstrate the feasibility of vibrotactile EMG-based BF and suggest potential effectiveness to increase active ankle range of motion, therefore serving as a promising therapeutic tool to improve gait in children with spastic CP.
Collapse
Affiliation(s)
- Matteo Bertucco
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mauro Nardon
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nicole Mueske
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Sukhveer Sandhu
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | | | - Tishya A L Wren
- Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Terence D Sanger
- School of Engineering, University of California, Irvine, CA, USA.,School of Medicine, University of California, Irvine, CA, USA.,Children's Hospital of Orange County, Orange, CA, USA
| |
Collapse
|
3
|
Kay RM, McCarthy J, Narayanan U, Rhodes J, Rutz E, Shilt J, Shore BJ, Veerkamp M, Shrader MW, Theologis T, Van Campenhout A, Pierz K, Chambers H, Davids JR, Dreher T, Novacheck TF, Graham K. Finding consensus for hamstring surgery in ambulatory children with cerebral palsy using the Delphi method. J Child Orthop 2022; 16:55-64. [PMID: 35615393 PMCID: PMC9124912 DOI: 10.1177/18632521221080474] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 01/15/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE There is marked variation in indications and techniques for hamstring surgery in children with cerebral palsy. There is particular uncertainty regarding the indications for hamstring transfer compared to traditional hamstring lengthening. The purpose of this study was for an international panel of experts to use the Delphi method to establish consensus indications for hamstring surgery in ambulatory children with cerebral palsy. METHODS The panel used a five-level Likert-type scale to record agreement or disagreement with statements regarding hamstring surgery, including surgical indications and techniques, post-operative care, and outcome measures. Consensus was defined as at least 80% of responses being in the highest or lowest two of the five Likert-type ratings. General agreement was defined as 60%-79% falling into the highest or lowest two ratings. There was no agreement if neither of these thresholds was reached. RESULTS The panel reached consensus or general agreement for 38 (84%) of 45 statements regarding hamstring surgery. The panel noted the importance of assessing pelvic tilt during gait when considering hamstring surgery, and also that lateral hamstring lengthening is rarely needed, particularly at the index surgery. They noted that repeat hamstring lengthening often has poor outcomes. The panel was divided regarding hamstring transfer surgery, with only half performing such surgery. CONCLUSION The results of this study can help pediatric orthopedic surgeons optimize decision-making in their choice and practice of hamstring surgery for ambulatory children with cerebral palsy. This has the potential to reduce practice variation and significantly improve outcomes for ambulatory children with cerebral palsy. LEVEL OF EVIDENCE level V.
Collapse
Affiliation(s)
- Robert M Kay
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA,Robert M Kay, Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Blvd., #69, Los Angeles, CA 90027, USA.
| | - James McCarthy
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | | | - Erich Rutz
- The Royal Children’s Hospital Melbourne, Parkville, VIC, Australia
| | | | | | - Matthew Veerkamp
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - M Wade Shrader
- Nemours Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | | | | | | | | | - Jon R Davids
- Shriners Hospitals for Children – Northern California, Sacramento, CA, USA
| | | | - Tom F Novacheck
- Gillette Children’s Specialty Healthcare, Saint Paul, MN, USA
| | - Kerr Graham
- The Royal Children’s Hospital Melbourne, Parkville, VIC, Australia
| |
Collapse
|
4
|
Rehbein I, Teske V, Pagano I, Cúneo A, Pérez ME, von Heideken J. Analysis of orthopedic surgical procedures in children with cerebral palsy. World J Orthop 2020; 11:222-231. [PMID: 32405471 PMCID: PMC7206198 DOI: 10.5312/wjo.v11.i4.222] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/21/2020] [Accepted: 03/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Orthopedic surgery in children with cerebral palsy (CP) aims to improve function and prevent deformities. Each child’s condition in CP is unique and many co-variables influence surgical decision-making including a patient's age and their functional level. Little is known about the frequency of different types of orthopedic surgery in children with CP who have varied functional levels, particularly in countries from Latin America.
AIM To assess the type of orthopedic surgical procedures in relation to age and gross motor function in children with CP.
METHODS This retrospective study included all children with CP (n = 245) treated with elective orthopedic surgery at a Uruguayan university hospital between October 2010 and May 2016 identified from a surgical database. Eighteen children (7%) were lost to follow-up due to missing medical charts. Demographics, gross motor function classification (GMFCS), and orthopedic surgeries were obtained from the medical records of 227 children. Chi-squared tests and analysis of variance were used to assess the frequency of surgery, accounting for GMFCS levels. Mean age for soft tissue vs bone surgery was compared with the independent samples t-test.
RESULTS A total of 711 surgical procedures were performed between 1998 and 2016. On average, children had 3.1 surgical procedures and the mean age at first surgery was 8.0 years. There were no significant differences in age at first surgery among GMFCS levels (P = 0.47). The most common procedures were lower leg soft tissue surgery (n = 189, 27%), hip tenotomy (n = 135, 19%), and hamstring tenotomy (n = 104, 14%). For children with GMFCS level I, the mean number of surgeries per child [1.8 (range 1-9)] differed significantly at P < 0.05 in children with GMFCS levels II [3.2 (1-12)], III [3.2 (1-8)], IV [3.3 (1-13)], and V [3.6 (1-11)]. Within II, III, IV, and V, there was no significant difference in mean number of surgeries per child when comparing across the groups. The proportion of soft tissue surgery vs bone surgery was higher in GMFCS levels I-III (80%-85%) compared to levels IV (68%) and V (55%) (P < 0.05).
CONCLUSION The frequency of surgical procedures per child did not increase with higher GMFCS level after level I. However, the proportion of bone surgery was higher in GMFCS levels IV-V compared to I-III.
Collapse
Affiliation(s)
- Ignacio Rehbein
- Clínica de Traumatología y Ortopedia Pediátrica, Facultad de Medicina, Universidad de la República, Montevideo 11200, Uruguay
| | - Viviana Teske
- Clínica de Traumatología y Ortopedia Pediátrica, Facultad de Medicina, Universidad de la República, Montevideo 11200, Uruguay
| | - Ignacio Pagano
- Clínica de Traumatología y Ortopedia Pediátrica, Facultad de Medicina, Universidad de la República, Montevideo 11200, Uruguay
| | - Alejandro Cúneo
- Clínica de Traumatología y Ortopedia Pediátrica, Facultad de Medicina, Universidad de la República, Montevideo 11200, Uruguay
| | - María Elena Pérez
- Clínica de Traumatología y Ortopedia Pediátrica, Facultad de Medicina, Universidad de la República, Montevideo 11200, Uruguay
| | - Johan von Heideken
- Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, Stockholm 17177, Sweden
| |
Collapse
|
5
|
Functional outcomes after selective dorsal rhizotomy followed by minimally invasive tendon lengthening procedures in children with spastic cerebral palsy. J Pediatr Orthop B 2020; 29:1-8. [PMID: 31305364 DOI: 10.1097/bpb.0000000000000642] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many surgical options have been proposed to improve the ambulatory status of children with spastic cerebral palsy (CP), but none have focused on addressing both spasticity and lower extremity tendon contractures. The purpose of this study is to evaluate the results of selective dorsal rhizotomy (SDR) followed by minimally invasive tendon lengthening allowing immediate return to ambulation. Two hundred fifty-five spastic CP patients (who received SDR procedure at an average age of 6.9±2.6 years and tendon lengthening procedure at an average age of 7.2±2.5 years) were retrospectively reviewed. Patients were grouped by the gross motor function classification system (GMFCS) 1-3 and 4-5. Kaplan-Meier analysis and Cox proportional hazard model using a requirement for additional tendon lengthening as an end point were conducted. Tendon lengthening followed SDR at an average of 4.3±10.7 months. On an average of 4.9±1.2 years after tendon lengthening, GMFCS was improved in 28 and maintained in 213 patients, respectively. There was no difference of variables and joint angles between the two GMFCS groups. A repeat tendon lengthening was required in 19 patients. The Kaplan-Meier analysis showed 81% success rate. Cox proportional hazard model identified age at tendon lengthening [hazards ratio (HR), 0.53; 95% confidence interval (CI), 0.37-0.76] and duration between SDR and tendon lengthening of more than 6 months (HR, 2.96; 95% CI, 1.05-8.33) associated with need for a repeat tendon lengthening procedure. Our novel approach of SDR/tendon lengthening results in improved joint angles as well as stable or improved GMFCS. Longer follow-up is necessary to determine if this approach could prolong ambulatory ability and reduced need for more invasive orthopedic surgeries.
Collapse
|
6
|
He X, Xu Y, Yang X. [Precise diagnosis and treatment of spastic cerebral palsy]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1584-1588. [PMID: 31823563 DOI: 10.7507/1002-1892.201903072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the advancement of precise diagnosis and treatment for spastic cerebral palsy in recent years. Methods The literature and own experiences were reviewed, and the surgical method, precise diagnosis, and personalized treatment of spastic cerebral palsy based on the classification of spastic cerebral palsy were summarized and analyzed. Results The common classification of spastic cerebral palsy are gross motor function classification system (GMFCS) and manual ability classification system (MACS). The surgical methods of spastic cerebral palsy can be divided into soft tissue surgery, nerve surgery, and bone and joint surgery. The precise diagnosis of spastic cerebral palsy includes qualitative diagnosis, localization diagnosis, and quantitative diagnosis. Based on precise diagnosis and classification, one or more corresponding surgical methods are selected for treatment. Conclusion The manifestations of spastic cerebral palsy are so diverse that it is necessary to select rational surgeries based on precise diagnosis to achieve individualized treatment.
Collapse
Affiliation(s)
- Xiaoqing He
- Institute of Trauma Orthopedic Surgery, the 920 Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032, P.R.China
| | - Yongqing Xu
- Institute of Trauma Orthopedic Surgery, the 920 Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032,
| | - Xi Yang
- Institute of Trauma Orthopedic Surgery, the 920 Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032, P.R.China
| |
Collapse
|
7
|
Quantitative Assessment of Muscle Strength Following "Slow" Surgical Lengthening of the Medial Hamstring Muscles in Children With Cerebral Palsy. J Pediatr Orthop 2019; 39:e373-e379. [PMID: 30570590 DOI: 10.1097/bpo.0000000000001313] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Classic teaching for surgical lengthening of muscle contractures in children with cerebral palsy (CP) has emphasized complete correction of the deformity acutely, with immobilization of the targeted muscles in the fully corrected position. Clinical experience has led to the impression that the muscles are invariably weakened by this approach. We have developed an alternative technique for correction of contractures called slow surgical lengthening (SSL). The goal of the study was to determine the physical examination, kinematic, and muscle strength outcomes following SSL of the medial hamstring muscles in children with CP. METHODS The study group included 41 children with CP who underwent SSL of the medial hamstring muscles as part of a comprehensive single-event multilevel surgery, who had preoperative and 1-year postoperative evaluations in our Motion Analysis Center, which included quantitative assessment of isometric and isokinetic muscle strength. RESULTS All subjects were Gross Motor Function Classification System I and II. Mean age at the time of surgery was 10.8 years. The mean popliteal angle improved by 16.2 degrees (P<0.001) following SSL of the medial hamstrings. Sagittal plane kinematics following SSL of the medial hamstrings showed improvement of knee extension at initial contact of 10.2 degrees (P<0.001), decrease of peak knee flexion in mid-swing of 3.6 degrees (P=0.014), improved minimum knee flexion in stance of 4.9 degrees (P=0.002), and no significant change in mean anterior pelvic tilt (P=0.123). Mean peak isometric knee flexion torque remained unchanged from preoperative to postoperative studies (P=0.154), whereas mean peak isokinetic knee flexion torque significantly increased by 0.076 Nm/kg (P=0.014) following medial hamstring SSL. DISCUSSION SSL was developed based upon clinical experience and improved understanding of the pathophysiology of skeletal muscle in children with CP. The SSL technique allows the tendinous tissue to separate spontaneously at the time of recession, but does not force further acute lengthening by intraoperative manipulation, thereby minimizing the damage to the underlying muscle. It is broadly believed that muscle weakness is inevitable following surgical lengthening. The current study shows that the SSL technique does not cause weakness. LEVEL OF EVIDENCE Level IV-therapeutic.
Collapse
|
8
|
Saleh E, Dahan-Oliel N, Montpetit K, Benaroch T, Yap R, Barakat N, Mulcahey MJ. Functional Gains in Children With Spastic Hemiplegia Following a Tendon Achilles Lengthening Using Computerized Adaptive Testing-A Pilot Study. Child Neurol Open 2018; 5:2329048X18811452. [PMID: 30456216 PMCID: PMC6238195 DOI: 10.1177/2329048x18811452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 08/30/2018] [Accepted: 10/14/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose: This pilot study evaluated the outcomes of tendon Achilles lengthening in 12 children (mean age: 11.2 years) with spastic hemiplegia. Methods: Cerebral Palsy Computer Adaptive Tests, the timed up-and-go, the Gross Motor Function Measure, the Gillette Functional Assessment Questionnaire, and the Pediatric Outcomes Data Collection Instrument were administered at baseline and at 6, 12, and 24 months postsurgery. Results: Significant improvement at the latest follow-up (12-24 months following surgery) was seen in all domains of the Cerebral Palsy Computer Adaptive Test: activity (P = .017), lower extremity (P = .005), global (P = .005), pain (P = .005), and fatigue (P = .028), as well as in the Gross Motor Function Measure-standing domain (P = .02) and the mobility domain of the Pediatric Outcomes Data Collection Instrument (P = .04). Conclusion: These findings indicate that the tendon Achilles lengthening improved functional outcome in these children as measured by tests of physical function, walking speed, and activity performance.
Collapse
Affiliation(s)
- Eli Saleh
- Université de Montréal, Montreal, Quebec, Canada
| | - Noémi Dahan-Oliel
- Shriners Hospital for Children, School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | | | | | - Rita Yap
- Shriners Hospital for Children, Montreal, Quebec, Canada
| | - Nadia Barakat
- Shriners Hospitals for Children, Philadelphia, PA, USA
| | - M J Mulcahey
- Shriners Hospitals for Children, Jefferson School of Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
9
|
van Vulpen LF, de Groot S, Rameckers EA, Becher JG, Dallmeijer AJ. Improved parent-reported mobility and achievement of individual goals on activity and participation level after functional power-training in young children with cerebral palsy: a double-baseline controlled trial. Eur J Phys Rehabil Med 2018. [DOI: 10.23736/s1973-9087.18.04921-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
10
|
Houdek MT, Watts CD, Wyles CC, Trousdale RT, Milbrandt TA, Taunton MJ. Total Hip Arthroplasty in Patients with Cerebral Palsy: A Cohort Study Matched to Patients with Osteoarthritis. J Bone Joint Surg Am 2017; 99:488-493. [PMID: 28291181 DOI: 10.2106/jbjs.16.00528] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The spasticity and increased muscle tone observed in patients with cerebral palsy can lead to hip degeneration, subluxation, and pain. Currently, there is hesitation to perform total hip arthroplasty in patients with cerebral palsy because of fears of early wear and dislocation. The purpose of this study was to review the outcomes of total hip arthroplasty in patients with cerebral palsy and to compare outcomes with those of matched patients with a diagnosis of osteoarthritis. METHODS Over a 24-year period, 39 patients undergoing a total hip arthroplasty with a diagnosis of cerebral palsy were identified. The cohort included 26 male patients (67%), and the mean patient age was 49 years. The mean follow-up was 7 years. Patients with cerebral palsy were matched 1:2 with a group of patients undergoing total hip arthroplasty for osteoarthritis. RESULTS There was no difference in the rate of reoperation, implant survival, or complications, specifically dislocation. Prior to the surgical procedure, all patients had severe or moderate pain, and postoperatively no patient had moderate or severe pain. Twenty-three patients had an improvement in their ability to independently walk, and all preoperative hip flexion contractures were corrected (n = 9). There was also a significant improvement (p < 0.0001) in functional Harris hip scores. CONCLUSIONS This study refutes previous evidence showing increased risk of complications following total hip arthroplasty in patients with cerebral palsy. Total hip arthroplasty is a durable treatment option and provides clinically important pain relief and functional improvement in patients with cerebral palsy. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Matthew T Houdek
- 1Department of Orthopedic Surgery, Mayo Medical School, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | | |
Collapse
|
11
|
Abstract
BACKGROUND AND PURPOSE Instrumented 3-D gait analyses (GA) in children with cerebral palsy (CP) have shown improved gait function 1 year postoperatively. Using GA, we assessed the outcome after 5 years and evaluated parental satisfaction with the surgery and the need for additional surgery. PATIENTS AND METHODS 34 ambulatory children with spastic diplegia had preoperative GA. Based on this GA, the children underwent 195 orthopedic procedures on their lower limbs at a mean age of 11.6 (6-19) years. On average, 5.7 (1-11) procedures per child were performed. Outcome measures were evaluation of gait quality using the gait profile score (GPS) and selected kinematic parameters, functional level using the functional mobility scale (FMS), and the degree of parental satisfaction. RESULTS The mean GPS improved from 20.7° (95% CI: 19-23) preoperatively to 15.4° (95% CI: 14-17) 5 years postoperatively. There was no significant change in GPS between 1 and 5 years. The individual kinematic parameters at the ankle, knee, and hip improved statistically significantly, as did gait function (FMS). The mean parental satisfaction, on a scale from 0 to 10, was 7.7 (2-10) points. There was a need for additional surgical procedures in 14 children; this was more frequent in those who had the index operation at an early age. INTERPRETATION The main finding was that orthopedic surgery based on preoperative GA gave marked improvements in gait function and quality, which were stable over a 5-year period. Nevertheless, additional orthopedic procedures were necessary in almost half of the children and further follow-up with GA for more than 1 year postoperatively is recommended in children with risk factors for such surgery.
Collapse
Affiliation(s)
| | | | - Ingrid Skaaret
- Oslo Movement Laboratory, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| |
Collapse
|