Enhancement of postural control and upper limb function following selective dorsal rhizotomy: a retrospectively
Pasquale Cardellicchio1, Marta Bertamino2, Anna Bruna Ronchetti2
1Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy. pasquale.cardellicchio@gaslini.org.
Insights
Selective dorsal rhizotomy (SDR) surgery significantly improves neck, trunk, and upper limb function in children with cerebral palsy, with early gains noted within three months post-operation. This neurosurgical intervention aids in reducing spasticity and enhancing motor control.
Area of Science:
- Neurosurgery
- Pediatric Rehabilitation
- Movement Disorders
Background:
- Cerebral palsy (CP) is a leading cause of pediatric disability, impacting movement and posture.
- Selective Dorsal Rhizotomy (SDR) is a neurosurgical option for CP, primarily targeting lower limb spasticity.
- Limited research exists on SDR's effects on upper limb function and trunk control in CP.
Purpose of the Study:
- To systematically evaluate changes in neck, trunk, and upper limb functionality after SDR in children with CP.
- To identify the timeline of functional improvements and recovery post-SDR.
- To investigate the influence of age at surgery on upper limb motor improvements.
Main Methods:
- Systematic assessment of neck, trunk, and upper limb function following SDR.
- Analysis of functional changes and recovery timelines.
- Exploration of the correlation between age at surgery and short-term upper limb improvements.
Main Results:
- SDR leads to significant functional improvements, particularly in the early post-surgical phase (detectable within three months).
- Improvements were observed in upper limb function and trunk control, alongside a reduction in trunk misalignment.
- Age at surgery was found to impact short-term improvements in upper limb movements.
Conclusions:
- SDR offers significant functional benefits for children with cerebral palsy, especially in the initial post-operative period.
- The findings underscore the importance of tailored rehabilitation protocols based on individual recovery timelines and age.
- Further research can optimize post-SDR outcomes by refining rehabilitation strategies.
Abstract:
Cerebral palsy is the most common pediatric disability, characterized by a spectrum of permanent disorders that hinder movement, posture, and overall activity, causing long-term functional limitations. For those unresponsive or unsuitable to conventional treatments, neurosurgical interventions such as selective dorsal rhizotomy or intrathecal baclofen may be considered. Selective dorsal rhizotomy (SDR) aims to reduce lower limb spasticity while preserving sensory and sphincteric functions. Despite its established effectiveness in the control of lower limb increased muscle tone, its impacts on the upper limb motor performance and the trunk control require further investigations. This study aims to systematically assess changes in neck, trunk, and upper limb functionality following Selective Dorsal Rhizotomy in children with cerebral palsy, highlighting the improvements and the timeline of recovery after surgery.
Conclusions:
Selective dorsal rhizotomy improvements achieved are significant especially in the early post-surgical phase and already detectable three months after surgery and involved also a reduction in both upper limb function and trunk misalignment. Determining post-operative improvements and recovery times can help maximize post-operative outcomes through appropriate rehabilitation therapies.
What Is Known:
• Selective dorsal rhizotomy (SDR) aims to reduce lower limb spasticity while preserving sensory and sphincteric functions, but limited research exists regarding the impact of SDR on the improvement of upper limb function and trunk control.
What Is New:
• This study reveals key insights into changes in neck, trunk, and upper limb function post-SDR in children with CP, identifying which parameters improve, and the timeline of these improvements. Our findings suggest how age at surgery have an impact on the short-term improvement on the upper-limb movements, shedding new light on the importance of fine-tuning appropriate rehabilitation protocols.
