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Published on: August 9, 2024
Short-term selective dorsal rhizotomy responders among children with bilateral cerebral palsy
Eirini Papageorgiou1,2, Laure Everaert1,2, Guy Molenaers3,4
1Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
Insights
Selective dorsal rhizotomy (SDR) shows short-term gait improvements in children with cerebral palsy (CP), particularly in jump gait patterns. While spasticity decreased, strength and selectivity were maintained, suggesting potential for tailored treatments.
Area of Science:
- Orthopedics
- Pediatric Neurology
- Rehabilitation Medicine
Background:
- Bilateral spastic cerebral palsy (CP) significantly impacts children's gait and motor function.
- Selective dorsal rhizotomy (SDR) is a surgical intervention aimed at reducing spasticity in CP.
- Understanding the short-term effects of SDR on specific gait patterns is crucial for treatment planning.
Purpose of the Study:
- To evaluate the immediate effects of SDR on gait kinematics and clinical impairments in children with bilateral spastic CP.
- To analyze these effects across different baseline gait patterns.
- To compare post-SDR outcomes with typically developing children's gait.
Main Methods:
- Eighty-nine children with bilateral spastic CP underwent 3D gait analysis pre- and post-SDR (1-year follow-up).
- Participants were classified by baseline gait patterns (e.g., jump, equinus, crouch).
- Analyses included kinematic waveforms, Gait Profile Score, spatiotemporal parameters, and impairment scores (spasticity, strength, selectivity).
Main Results:
- Overall, distal kinematics improved, while proximal kinematics deteriorated, particularly in genu recurvatum and crouch gait.
- Jump gait demonstrated the most significant improvements, followed by apparent equinus and crouch gait.
- SDR effectively reduced spasticity without compromising muscle strength or selectivity.
Conclusions:
- Short-term SDR intervention shows varied effects on gait kinematics, with notable improvements in specific patterns like jump gait.
- The findings highlight the importance of considering baseline gait patterns for personalized SDR treatment strategies.
- SDR can be a valuable tool for managing spasticity in CP without adverse effects on strength or selectivity.
Aim:
To identify the short-term effects of selective dorsal rhizotomy (SDR) on gait and clinical impairments in children with bilateral spastic cerebral palsy (CP) and subgroups based on baseline gait patterns.
Method:
Eighty-nine children with bilateral spastic CP (55 males, mean age [SD] before SDR: 9 years 5 months [2 years 3 months]; Gross Motor Function Classification System level I: 18; II: 54; III: 17) received three-dimensional gait analyses at two time points (baseline and 1 year after SDR); their baseline gait patterns were classified. The analysis included the comparisons of (1) sagittal plane kinematic waveforms, the Gait Profile Score, and non-dimensional spatiotemporal parameters between the two time points, (2) the kinematic waveforms of both time points to those of typically developing children, and (3) composite impairment scores of spasticity, weakness, and selectivity between the two time points.
Results:
Overall, kinematics improved distally but deteriorated proximally in the entire sample, especially in genu recurvatum and crouch gait patterns. Jump gait showed the most improvements after SDR, followed by apparent equinus and crouch gait. Spasticity was reduced after SDR, but not at the expense of strength or selectivity.
Interpretation:
The potential merit of investigating short-term SDR effects on gait according to baseline gait patterns was shown, with an overview of changes after SDR that may facilitate patient-tailored treatment.
