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Changes in the Status of Spastic Diplegic Children in Terms of Gross Motor Function Classification System and
Laxmish R1, Vikas Gupta1, Nitu Mishra2,3
1Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND.
Insights
Surgical interventions improve functional outcomes in children with spastic cerebral palsy (CP), as indicated by Functional Mobility Scale (FMS) scores. While Gross Motor Function Classification System (GMFCS) levels remain stable, parents should be informed about potential score worsening post-surgery.
Area of Science:
- Pediatric Orthopedics
- Rehabilitation Medicine
- Developmental Pediatrics
Background:
- Comprehensive instrumented gait analysis (IGA) is often unavailable in low- to mid-income countries (LMICs) for assessing surgical outcomes in spastic diplegia.
- Gross Motor Function Classification System (GMFCS) levels and Functional Mobility Scale (FMS) scores are potential indirect indicators of functional status changes after surgery.
Purpose of the Study:
- To evaluate changes in GMFCS levels and FMS scores post-surgery in children with spastic diplegia.
- To determine if GMFCS and FMS scores can serve as indirect measures of functional improvement.
- To assess the impact of age at surgery on the temporal changes in these scores.
Main Methods:
- Prospective study involving 25 children with spastic diplegia undergoing surgical intervention.
- GMFCS levels and FMS scores were recorded pre-surgery and at follow-up visits up to two years post-surgery.
- Analysis included changes from baseline and between visits, and the effect of age at surgery.
Main Results:
- Both GMFCS levels and FMS scores showed improvement from 3 months to 1 year post-surgery.
- A subset of patients experienced a worsening of scores at the two-year follow-up.
- Age at surgery did not significantly affect the pattern of score changes.
Conclusions:
- Surgical interventions enhance functional outcomes in spastic CP, evidenced by improved FMS scores and stable GMFCS levels.
- Peak functional improvement is typically observed one year post-surgery, with a possibility of later decline.
- Informed parental consent and emphasis on postoperative physical therapy are crucial for managing expectations and optimizing outcomes.
Abstract:
Introduction Most centers in low- to mid-income countries (LMICs) lack facilities for a comprehensive instrumented gait analysis (IGA) which is often considered the preferred method for assessment of the functional results of surgery in children with spastic diplegia. We aimed to study if there were any changes in the Gross Motor Function Classification System (GMFCS) levels and Functional Mobility Scale (FMS) scores after surgery and whether they can be used as an indirect indicator of change in the functional status of a child. Methods This prospective study was conducted at the Pediatric Orthopedic unit of a teaching hospital on spastic diplegic children requiring surgical intervention. GMFCS levels and FMS scores were recorded before the surgery and at each follow-up visit, with the latest record being two years post-surgery. The change in the scores was indicated as an improvement, deterioration, or no change from the baseline and compared to the score of the preceding visit. In addition, it was examined whether the age at surgery had any effect on the temporal change in the scores. Results A total of 25 children were included for analysis after excluding those who failed to fulfill the predefined inclusion and exclusion criteria. Both the GMFCS levels and FMS scores improved from the third month to one-year post-surgery, after which a few patients had a worsening of their scores at the two years follow-up visit. The age at which surgery was performed had no significant effect on the pattern of change in the scores. Most children sought consultations with the physical therapy department only when they visited the surgical team for follow-up. Conclusion This study shows that surgical interventions do improve the functional outcomes in children with spastic CP when assessed using FMS scores while maintaining an undeteriorated GMFCS level in most children. While a peak improvement can be expected one year after surgery in most patients, possible of worsening from baseline scores do exist, and the parents must be informed of the same. Any decision for surgery must involve the parents, and the usefulness of postoperative physical therapy must be impressed upon them before the surgery and during each follow-up visit too.
