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AUTHOR -
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
AUTHOR -
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
AUTHOR -
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
AUTHOR -
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
AUTHOR -
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
AUTHOR -
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
AUTHOR -
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
AUTHOR -
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
AUTHOR -
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
AUTHOR -
Butler PB
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
AUTHOR -
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
AUTHOR -
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
AUTHOR -
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
AUTHOR -
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
AUTHOR -
Stockert K
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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