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Selective dorsal rhizotomy in Hong Kong: multidimensional outcome measures
Sophelia Hoi-Shan Chan1, Kwong Yiu Yam, Beverley Pui-Heung Yiu-Lau
1Child Assessment Service, Department of Health, Central Kowloon Child Assessment Centre, Kowloon, Hong Kong. sophe@netvigator.com
Insights
Selective dorsal rhizotomy combined with physiotherapy significantly reduces spasticity and improves mobility and self-care in children with spastic cerebral palsy.
Area of Science:
- Neurology
- Orthopedics
- Pediatric Rehabilitation
Background:
- Spastic cerebral palsy (CP) is a common childhood motor disorder characterized by increased muscle tone and stiffness.
- Selective dorsal rhizotomy (SDR) is a surgical procedure aimed at reducing spasticity by selectively cutting specific nerve roots.
- Physiotherapy is crucial for maximizing functional outcomes post-SDR.
Purpose of the Study:
- To evaluate the short-term effectiveness of selective dorsal rhizotomy (SDR) combined with physiotherapy in children with spastic cerebral palsy.
- To assess the impact of SDR on spasticity, motor function, and participation.
Main Methods:
- A prospective case series study involving 20 children with spastic CP (mean age 8.57 years).
- Assessments included the Modified Ashworth Scale, range of motion, Gross Motor Function Measure (GMFM), Pediatric Evaluation of Disability Inventory (PEDI), Canadian Occupational Performance Measure (COPM), and 3D gait analysis.
- Measurements were taken pre-operatively and at 6 and 12 months post-SDR.
Main Results:
- Statistically significant reductions in spasticity (Modified Ashworth Scale) and improvements in passive joint range of motion.
- Functional gains observed in mobility and self-care (PEDI), with notable improvements in social participation (COPM).
- GMFM effectively documented motor changes, except in Gross Motor Function Classification System (GMFCS) level I. 3D gait analysis confirmed improved gait kinematics and kinetics.
Conclusions:
- Selective dorsal rhizotomy plus physiotherapy is an effective short-term treatment for reducing spasticity and enhancing functional outcomes in children with spastic CP, particularly those in GMFCS levels I-III.
- The combination of SDR and physiotherapy leads to significant improvements in mobility, self-care, and social participation.
- Objective measures like 3D gait analysis and subjective measures like COPM provide valuable insights into treatment efficacy.
Abstract:
We prospectively case series study evaluated the short-term effectiveness of selective dorsal rhizotomy plus physiotherapy. Twenty children with spastic cerebral palsy, selected for selective dorsal rhizotomy (mean age, 8.57 years; range, 5.96-11.18 years), were assessed before, and 6 and 12 months after, selective dorsal rhizotomy. Main outcome measures included the Modified Ashworth Scale, passive range of joint movement, the Gross Motor Function Measure, the Pediatric Evaluation of Disability Inventory, the Canadian Occupational Performance Measure, and three-dimensional gait analysis. The results confirmed that selective dorsal rhizotomy plus physiotherapy provided a statistically significant reduction of spasticity, functional improvements in mobility and self-care performance, and increased participation in social situations in our study group (85% exhibited normal intelligence, and 90% belonged to Gross Motor Function Classification System levels I-III). The Gross Motor Function Measure proved to be sensitive in documenting motor functional changes, except for children at Gross Motor Function Classification System level I. Instrumental three-dimensional gait analysis with kinematics and kinetics data analysis confirmed gait improvements in children of higher motor function. The Canadian Occupational Performance Measure indicated improvements in social participation.
