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Gait status 26-35 years after selective dorsal rhizotomy: A 9 year follow up study
Nelleke G Langerak1, Berendina E Veerbeek1, A Graham Fieggen1
1Neuroscience Institute and Division of Neurosurgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Background:
Although the short-term outcomes of selective dorsal rhizotomy (SDR) in children with cerebral palsy (CP) have been well documented, less is known about the long-term benefits of SDR, especially while aging.
Research Question:
Does the gait of adults with CP, who underwent SDR in childhood, change during a nine-year aging follow-up period? Do associations exists between the gait deviation index (GDI) and contextual factors at follow-up?
Methods:
Three-dimensional motion data was captured (Vicon system) of 26 adults (10 female) with CP and spastic diplegia at baseline (17-to-26 years post-SDR) and at nine-year follow-up (26-to-35 years post-SDR), as well as 41 matched typically developed (TD) adults used for reference data. Kinematic, non-dimensional temporal distance and GDI parameters were determined, and associations with contextual factors were studied.
Results:
At follow-up the adults with CP had a (median [interquartile ranges]) age of 35.8 [34.2-41.2] years and classified as Gross Motor Function Classification System (GMFCS) level I (n = 13), level II (n = 10) and level III (n = 3). Overall no clinically relevant change in gait quality (GDI) was detected over the nine-year follow-up period. However, small changes were found in hip and knee range of motion, peak knee flexion and walking speed. In line with the baseline study, a number of gait parameters were different to TD adults. The only association found was between GDI and GMFCS at follow-up (r = 0.64, p < 0.01).
Significance:
The overall walking pattern of the adults with CP who underwent SDR in childhood was characterised by mild crouch gait with minimal signs of spasticity, confirming former physical examination findings. Some small changes in certain gait parameters were determined, though clinically the gait quality remained stable during the nine-year aging period. This finding supports the stability of the gait pattern during mid-life in adults with CP, who met the strict SDR selection criteria.
