Wright FV et al
TITLE - Evaluation of selective dorsal rhizotomy for the reduction of spasticity in cerebral palsy: a randomized controlled trial
ABSTRACT - Selective dorsal rhizotomy (SDR) is widely used to treat spasticity in children with diplegic cerebral palsy (CP) but has never been shown conclusively to improve functional outcome. The study was designed to measure changes in gross motor function in children 1 year following rhizotomy compared with a control group receiving equivalent physiotherapy (PT) and occupational therapy (OT) with the exception that the rhizotomy group initially underwent a 6-week postoperative in-patient therapy program. Twenty-four children (mean age 58 months) with mild to moderate CP with spastic diplegia were randomly assigned to a therapy-only control group (CG) (N=12) or rhizotomy and therapy group (RG) (N=12).
The Gross Motor Function Measure (GMFM) was administered at the baseline, 6-, and 12-month assessments. Extremity tone, range of motion (ROM), biomechanics of the ankle-stretch reflex, isometric contraction, and temporal gait components were also evaluated. GMFM scores in the RG improved by 12.1 percentage points versus 4.4 percentage points in the CG (P<0.02). RG knee and ankle tone was significantly reduced (P<0.005), associated with increased passive ankle ROM (P<0.001), and decreased soleus EMG reflex activity on forced dorsiflexion (P<0.008). Foot-floor contact pattern improved in the RG compared with the CG (P<0.05). In conclusion, SDR combined with PT and OT leads to significantly greater functional motor improvement at 1 year following surgery compared with PT and OT alone. This was achieved in part through reduced knee and ankle tone, increased ankle dorsiflexion ROM, and more normal foot-floor contact during walking.
SOURCE - Dev Med Child Neurol 1998 Apr; 40(4):239-47
Engsberg JR et al
TITLE - Changes in ankle spasticity and strength following selective dorsal rhizotomy and physical therapy for spastic cerebral palsy.
ABSTRACT - OBJECT: In this investigation the authors quantified changes in ankle plantarflexor spasticity and strength following selective dorsal rhizotomy (SDR) and intensive physical therapy in patients with cerebral palsy (CP). METHODS: Twenty-five patients with cerebral palsy (CP group) and 12 able-bodied volunteers (AB controls) were tested with a dynamometer. For the spasticity measure, the dynamometer was used to measure the resistive torque of the plantarflexors during passive ankle dorsiflexion at five different speeds. Data were processed to yield a single value that simultaneously encompassed the three key elements associated with spasticity: velocity, resistance, and stretch. For the strength test, the dynamometer rotated the ankle from full dorsiflexion to full plantarflexion while a maximum concentric contraction of the plantarflexors was performed. Torque angle data were processed to include the work done by the patient or volunteer on the machine. Plantarflexor spasticity values for the CP group were significantly greater than similar values for the AB control group prior to surgery but not significantly different after surgery. Plantarflexor strength values of the CP group were significantly less than those of the AB control group pre- and postsurgery. Postsurgery strength values did not change relative to presurgery values.CONCLUSIONS: The spasticity results of the present investigation agreed with those of previous studies indicating a reduction in spasticity for the CP group. The strength results did not agree with the findings of most previous related literature, which indicated that a decrease in strength should have occurred. The strength results agreed with a previous investigation in which knee flexor strength was objectively examined, indicating that strength did not decrease as a consequence of an SDR. The methods of this investigation could be used to improve SDR patient selection.
SOURCE - J Neurosurg 1999 Nov; 91(5):727-32
McLaughlin JF et al
TITLE - Selective dorsal rhizotomy: efficacy and safety in an investigator-masked randomized clinical trial [see comments]
ABSTRACT - The objective of this single-center investigator-masked randomized clinical trial was to investigate the efficacy and safety of selective dorsal rhizotomy (SDR) in children with spastic diplegia. Forty-three children with spastic diplegia were randomly assigned on an intention-to-treat basis to receive SDR plus physical therapy (PT), or PT alone. Thirty-eight children completed follow-up through 24 months. Twenty-one children received SDR (SDR+PT group)and 17 received PT (PT Only group). SDR was guided with electrophysiological monitoring and performed by one experienced neurosurgeon. All subjects received equivalent PT. Spasticity was quantified with an electromechanical torque measurement device (spasticity measurement system [SMS]). The Gross Motor Function Measure (GMFM) was used to document changes in functional mobility. Primary outcome measures were collected at baseline, 6, 12, and 24 months by evaluators masked to treatment. At 24 months, the SDR+PT group exceeded the PT Only group in mean reduction of spasticity by SMS measurement (-8.2 versus +5.1 newton meters/radian, P=0.02). The SDR+PT group and the PT Only group demonstrated similar improvements in independent mobility on the GMFM (7.0 versus 7.2 total percent score, P=0.94). Outcomes on secondary variables were consistent with primary outcomes. There were no serious adverse events. We conclude that SDR is safe and reduces spasticity in children with spastic diplegia. SDR plus PT and equivalent PT without SDR result in equal improvements in independent mobility at 24 months. SDR may not be an efficacious treatment for children with mild spastic diplegia.
SOURCE - Dev Med Child Neurol 1998 Apr; 40(4):220-32
Gul SM et al
TITLE - Long-term outcome after selective posterior rhizotomy in children with spastic cerebral palsy.
ABSTRACT - A retrospective analysis of data collected prospectively was performed to determine the long-term outcome of lumbosacral selective posterior rhizotomy (SPR) in children with spastic cerebral palsy (CP). The study population comprised children with spastic CP, who had SPR more than 4 years prior to the time of the study and had quantitative standardized assessments of lower limb spasticity (Ashworth scale), range of motion measured goniometrically, muscle strength (MRC scale) and ambulatory function, both preoperatively and at 1 year after SPR. Children meeting these criteria were reassessed at 5 years after SPR using the same measures.Hip adductor spasticity, hip abduction range of motion and quadriceps strength were chosen as the primary outcome measures for statistical analysis. Of 80 patients who met the entry criteria for the study, 33 completed the 5-year assessments. Significant improvements in spasticity, range of motion and muscle strength were noted both at 1 year and at 5 years after SPR. The preoperative, 1-year and 5-year values were as follows: hip adductor spasticity (Ashworth scale) = 4.1, 2.1, 2.2; hip abduction range of motion (degrees) = 20.4, 39.9, 31.7, and quadriceps strength (MRC scale) = 3.6, 4.0, 4.1. Ambulatory function seemed to be better at 1 and 5 years compared to baseline, but no statistical analysis was done for this secondary outcome measure. It was concluded that improvements in lower limb motor outcome are present at 1 year after SPR, and that these improvements are generally maintained at 5 years.Copyright Copyright 1999 S. Karger AG, Basel
SOURCE - Pediatr Neurosurg 1999 Aug; 31(2):84-95
Loewen P et al
TITLE - Upper extremity performance and self-care skill changes in children with spastic cerebral palsy following selective posterior rhizotomy.
ABSTRACT - Changes in upper extremity and self-care performance following selective posterior rhizotomy (SPR) are reported frequently,but rarely quantified. In this study, 36 children with spastic cerebral palsy were assessed preoperatively and 1 year following SPR using the Quality of Upper Extremity Skills Test (QUEST). Twenty-six children were assessed at similar intervals using the Functional Independence Measure for Children (WeeFIM) as a measure of self-care performance. Wilcoxon matched-pair signed-rank tests were used to compare the QUEST total scores and the WeeFIM motor,cognitive, and total scores before and after SPR. One year after SPR, the total QUEST scores were significantly better (median improvement = 3.2%, p < 0.0001), as were the WeeFIM motor (median improvement = 9.5, p < 0. 0001), cognitive (median improvement = 1.0, p < 0.008), and total (median improvement = 11.0, p < 0.0001) scores. The results indicate quantifiable improvements in upper extremity function, and motor and cognitive self-care skills in children 1 year after SPR.
SOURCE - Pediatr Neurosurg 1998 Oct; 29(4):191-8
Engsberg JR et al
TITLE - Spasticity and strength changes as a function of selective dorsal rhizotomy.
ABSTRACT - OBJECT: The goal of this investigation was to quantify changes in hamstring muscle spasticity and strength in children with cerebral palsy (CP) as a function of their having undergone a selective dorsal rhizotomy. METHODS:Nineteen children with CP (CP group) and six children with able bodies (AB group) underwent testing with a dynamometer.For the spasticity measure, the dynamometer measured the resistive torque of the hamstring muscles during passive knee extension at four different speeds. Torque-angle data were processed to calculate the work done by the machine to extend the knee for each speed. Linear regression was used to calculate the slope of the line of best fit for the work-velocity data. The slope simultaneously encompassed three key elements associated with spasticity (velocity,resistance, and stretch) and was considered the measure of spasticity. For the strength test, the dynamometer moved the leg from full knee extension to flexion while a maximum concentric contraction of the hamstring muscles was performed.Torque-angle data were processed to calculate the work done on the machine by the child. Hamstring spasticity values for the CP group were significantly greater than similar values for the AB group prior to surgery; however,they were not significantly different after surgery. Hamstring strength values for the CP group remained significantly less than those for the AB group after surgery, but were significantly increased relative to their presurgery values.CONCLUSIONS: The results of spasticity testing in the present investigation agreed with those of previous studies, indicating a reduction in spasticity for the CP group. The results of strength testing did not agree with those in the previous literature; a significant increase in strength was observed for the CP group.
SOURCE - J Neurosurg 1998 Jun; 88(6):1020-6
TITLE - [The effect of electromyostimulation on the clinico-electroencephalographic indices in the rehabilitation of patients with spastic forms of infantile cerebral palsy]
ABSTRACT - In a series of paediatric patient population, thirty children presenting with spastic forms of cerebral palsy demonstrated certain differences in the brain bioelectrical activity. In hemiparesis patients, there was an unusual frequency of alpha-rhythm and slow-wave activity as per EEG recordings. Following applied electrical stimulation an increase was noted in brain electrogenesis rate as was improvement of corticosubcortical relationships. In patients presenting with hemiparetic form, changes in brain electrogenesis were believed to suggest activation of cortical mechanisms against the background of reduction in the activity in subcortical structures.
SOURCE - Lik Sprava 1998 Oct; (7):150-2
Scheker LR et al
TITLE - Neuromuscular electrical stimulation and dynamic bracing as a treatment for upper-extremity spasticity in children with cerebral palsy.
ABSTRACT - We have investigated a therapeutic regimen using neuromuscular electrical stimulation (NMES) and dynamic bracing to assess their effectiveness in reducing upper-extremity spasticity in children with cerebral palsy. Nineteen patients between 4 and 21 years of age with documented diagnoses of spastic cerebral palsy were treated. The patients included in the study followed a regimen of two 30-minute sessions of NMES of the antagonist extensors combined with dynamic orthotic traction during the day. A static brace was used at night.Spasticity of the wrist and fingers was assessed periodically using the Zancolli classification. Treatment ranged from 3 to 43 months. After treatment with electrical stimulation and dynamic bracing, all the patients moved up 1 to 3 levels in the Zancolli classification and showed a marked improvement in upper-extremity function. These results show that combining NMES and dynamic orthotic traction dramatically decreases spasticity of the upper extremity in young patients with cerebral palsy.
SOURCE - J Hand Surg [Br] 1999 Apr; 24(2):226-32
Chad KE et al
TITLE - The effect of a weight-bearing physical activity program on bone mineral content and estimated volumetric density in children with spastic cerebral palsy.
ABSTRACT - After an 8-month physical activity intervention in children with cerebral palsy, increases in femoral neck bone mineral content (BMC) (9.6%), volumetric bone mineral density (v BMD) (5.6%), and total proximal femur BMC (11.5%) were observed in the intervention group (n = 9) compared with control subjects (n = 9; femoral neck BMC, -5. 8%; v BMD,-6.3%; total proximal femur BMC, 3.5%).
SOURCE - J Pediatr 1999 Jul; 135(1):115-7
Damiano DL et al
TITLE - Functional outcomes of strength training in spastic cerebral palsy.
ABSTRACT - OBJECTIVE: To determine clinical effectiveness of strength training in children with spastic cerebral palsy. DESIGN:Prospective before and after trial in which subjects participated in a 6-week strength training program. All received before and after isometric strength evaluation of eight muscle groups in both lower extremities with a hand-held dynamometer,3-D gait analysis at free and fast speeds, administration of the Gross Motor Function Measure (GMFM), and assessment of energy expenditure during gait. SETTING: Pediatric rehabilitation center at a tertiary care hospital. PATIENTS: Eleven children met inclusion criteria for participation. Six had spastic diplegia, were limited community ambulators, and demonstrated less than 50% of normal muscle strength. Five had spastic hemiplegia and demonstrated a 20% strength asymmetry in at least two muscles across extremities. RESULTS: Each group had significant strength gains in the muscles targeted.The entire cohort had higher gait velocity primarily as a result of increased cadence, with greater capacity to walk faster. GMFM Dimension 5 also improved, with no change in energy expenditure. Asymmetry in strength improved in hemiplegia, with no change in asymmetry in support times or joint motion across extremities. CONCLUSIONS: This study reinforced the relationship of strength to motor function in cerebral palsy and further demonstrated the effectiveness of strengthening in this population.
SOURCE - Arch Phys Med Rehabil 1998 Feb; 79(2):119-25
Valvano J et al
TITLE - Practice of a precision isometric grip-force task by children with spastic cerebral palsy.
ABSTRACT - The ability to produce and sustain a criterion level of precision isometric grip force was studied in a group of 7- to 12-year-old children with cerebral palsy (CP) and in a control group. On-line visual feedback of the forces produced relative to a stationary target was provided for each 5-second trial. Subjects practised 48 trials on each of 3 consecutive days. Measures of accuracy and variability revealed significantly reduced accuracy and increased variability in isometric force production for the group with CP. Both groups demonstrated improvement with practice, with the significantly greater change in the control subjects. There was substantial variability in performance among subjects with CP. Gains associated with practice were sustained over a 5-day retention interval for both groups. The requirement to control proximal segments of the upper extremity was not associated with increased error in grip-force production of the group with CP.
SOURCE - Dev Med Child Neurol 1998 Jul; 40(7):464-73
Kuczynski M et al
TITLE - Influence of artificial saddle riding on postural stability in children with cerebral palsy.
ABSTRACT - Stability of quiet upright stance was investigated in 25 children with cerebral palsy at the beginning and the end of a 3-month period of therapy involving 20 min microprocessor-controlled saddle riding, performed twice a week. The traditional parameters of postural sway based on the centre-of-pressure analysis (range, standard deviation, mean speed and mean radius) dropped significantly over time confirming advantageous influence of this treatment. As a complementary tool, an autoregressive modelling technique was used allowing us to establish after each single ride considerable decreases in the frequency of the feet adjustments, which represent the control variable of the postural system in sagittal plane. These changes reflect diminished ankle joints stiffness resulting from a single session, and are supposedly a basic reason for substantial progress of the patients. The autoregressive approach proved to be a powerful method, which corroborates and reinforces stabilographic investigations. The findings confirm that the therapy led to a noteworthy improvement in the postural performance of the CP children in sagittal as well in frontal planes. Moreover, they let us to infer about biomechanical properties of joints involved in maintaining posture, thus giving more insight into the operation of the neuro-muscular system and allowing us to better understand the reason of progress in motor control of posture.
SOURCE - Gait Posture 1999 Oct; 10(2):154-60
TITLE - A preliminary report on the effectiveness of trunk targeting in achieving independent sitting balance in children with cerebral palsy.
ABSTRACT - OBJECTIVE: To assess the potential of Targeted Training in initiating or accelerating improved movement control of the trunk and hip joints in children with cerebral palsy so that independent sitting balance without specialized seating could be achieved. DESIGN: Six single case studies.SETTING: Assessment and review were undertaken in a specialized centre with intervention in the subjects' home or school.SUBJECTS: Children between the ages of two years five months and seven years five months (mean four years seven months)with an established diagnosis of cerebral palsy. None had independent sitting balance at the start of the study. INTERVENTION: Targeted Training using specialized equipment was directed at the appropriate few joints of the trunk as determined by initial testing and progressed when control at those joints had become automatic. The equipment provided support and challenged control learning. Periods of no intervention and placebo intervention, when the equipment was inappropriately set up, were also used. Two of the children ceased their traditional physiotherapy input while Targeted Training or placebo training took place. MAIN OUTCOME MEASURE: A new test was devised and validated to determine the most caudal extent of control of the vertical posture. In addition, a functional test of independent sitting balance was defined. RESULTS: All six children showed an increase in movement control and all gained independent sitting balance within 12-25 weeks (mean 16 weeks). This was irrespective of the continuation or cessation of traditional physiotherapy. CONCLUSION: These preliminary findings suggest that Targeted Training may be an effective means of promoting movement control and functional ability. Confirmation of these findings by other investigators would be of value.
SOURCE - Clin Rehabil 1998 Aug; 12(4):281-93
Reid D et al
TITLE - Functional impact of a rigid pelvic stabilizer on children with cerebral palsy who use wheelchairs: users' and caregivers'perceptions.
ABSTRACT - A within-subject ABA design was used to assess the functional impact of a novel wheelchair mounted rigid pelvic stabilizer (RPS) compared with a traditional wheelchair lap belt in a group of six children with cerebral palsy (mean age 10.4 years). The lap belt was worn during the two baseline phases which were each 3 weeks in duration. During a 5 week treatment phase the lap belt was replaced with the RPS device. Using the Canadian Occupational Performance Measure (COPM) each subject's self-evaluated performance ability and satisfaction with performance for five key tasks was measured at the end of each study phase. In addition,a structured weekly interview was conducted with the primary caregivers to assess perceived changes in their child's functional performance with each task. Results of repeated measures ANOVAs were statistically significant, indicating that the RPS as compared to the lap belt is a more effective device. The RPS allowed significantly better occupational performance and satisfaction with performance as measured by the COPM. Single-subject data analyses showed clinically significant changes in task performance and satisfaction with performance when the RPS was worn as compared to the lap belt for all subjects. Caregivers' perception of functional change ratings closely corresponded to subjects' self-rated performance on specific tasks. Visual inspection of subject data also showed that, overall, the increased performance ratings for different tasks during the treatment phase decreased in the second baseline phase, when the RPS was removed, however, performance did not return to initial baseline levels. This suggests that the RPS has a facilitating effect for increasing physical functioning. These results are further discussed in terms of implications for practice,and future research.
SOURCE - Pediatr Rehabil 1999 Jul; 3(3):101-18
Ketelaar M et al
TITLE - Functional motor abilities of children with cerebral palsy:a systematic literature review of assessment measures.
ABSTRACT - OBJECTIVE: To provide an overview of functional assessment measures for children with cerebral palsy, supporting the selection of measures and the interpretation of results from measures. METHODS: Instruments were selected on the basis of a literature search of the Medline, Sportdisk and PsychLIT databases. ISSUES REVIEWED: Instruments were reviewed with respect to target group, purpose, nature,type and psychometric properties. RESULTS: In the literature 17 instruments that are used in paediatric rehabilitation and paediatric physical therapy to assess the functional motor abilities of children with cerebral palsy were found.While there is an urgent need for measures that can evaluate change in functional abilities, it was found that most measures are developed and validated for discriminative purposes. CONCLUSIONS: Although instruments developed within the last decade meet psychometric criteria more adequately than those developed previously, it is concluded that only two evaluative assessment measures, the Gross Motor Function Measure (GMFM) and the Pediatric Evaluation of Disability Inventory (PEDI), fulfil the criteria of reliability and validity with respect to responsiveness to change.
SOURCE - Clin Rehabil 1998 Oct; 12(5):369-80
McGibbon NH et al
TITLE - Effect of an equine-movement therapy program on gait, energy expenditure, and motor function in children with spastic cerebral palsy: a pilot study.
ABSTRACT - The purpose of this study was to evaluate the effects of an 8-week program of hippotherapy on energy expenditure during walking; on the gait dimensions of stride length,velocity, and cadence; and on performance on the Gross Motor Function Measure (GMFM) in five children with spastic cerebral palsy (CP). A repeated-measures within-subjects design was used consisting of two baseline measurements taken 8 weeks apart, followed by an 8-week intervention period, then a posttest. After hippotherapy, all five children showed a significant decrease (X2(r)=7.6, P<0.05) in energy expenditure during walking and a significant increase (X2(r)=7.6, P<0.05) in scores on Dimension E (Walking, Running,and Jumping) of the GMFM. A trend toward increased stride length and decreased cadence was observed. This study suggests that hippotherapy may improve energy expenditure during walking and gross motor function in children with CP.
SOURCE - Dev Med Child Neurol 1998 Nov; 40(11):754-62
Dubovtseva OA et al
TITLE - [New approaches in the treatment of speech disorders in children with an organic brain lesion]
ABSTRACT - Speech disorders encountered in children presenting with neurological pathology make their medical and social rehabilitation a real challenge. Overall sixty children were examined.Of these, 38 had infantile cerebral paralysis, 22 that being presented with sequelae of the hypoxic affection of the brain in ante- and perinatal period, who exhibited speech disorders (alalia, dysarthria, retarded speech development). Described in the paper are features of bloodflow disorders in intracranial and vertebral arteries as evidenced by ultrasonic Doppler technique and changes in brain bioelectrical activity according to findings from electroencephalomapping.In 53 patients, a positive effect was obtained as a result of therapy conducted in accordance with the stimulation type techniques (electroscalp therapy against the background of intramuscular administration of nicotinic acid plus laser therapy, transcutaneous electrostimulation, employment of such drug preparations as cogitum, nero-force, sirdalud).
SOURCE - Lik Sprava 1999 Apr; (3):121-4
TITLE - [Acupuncture and Vojta therapy in infantile cerebral palsy--a comparison of the effects]
ABSTRACT - Acupuncture and Vojta therapy are using more or less identical points and identical muscle chains for the treatment of infantile cerebral palsy. Therefore a common utilization seems to be sensible.
SOURCE - Wien Med Wochenschr 1998; 148(19):434-8
Last revised November 5, 2005
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