Reactive Balance Control Following Selective Dorsal Rhizotomy in Child With Diplegic Cerebral Palsy

Area of Science:

• Neurology
• Pediatrics
• Rehabilitation Medicine

Background:

• Cerebral palsy (CP) is a leading cause of childhood motor disability, marked by impaired motor control and increased fall risk.
• Children with CP often show delayed muscle activation, impacting reactive balance during unexpected movements.
• Selective dorsal rhizotomy (SDR) is a surgical intervention aimed at reducing lower extremity spasticity in CP.

Purpose of the Study:

• To investigate the effects of SDR on reactive balance control in a child with spastic diplegic cerebral palsy.
• To quantify changes in balance responses to perturbations using computerized dynamic posturography post-SDR.
• To identify limitations and areas for improvement in balance control following SDR surgery.

Main Methods:

• A case report involving a 7-year-old girl with spastic diplegic CP (GMFCS II).
• Utilized clinical evaluations and computerized dynamic posturography, including the Motor Control Test and Adaptation Test.
• Assessed reactive balance control by simulating unexpected external perturbations pre- and post-SDR.

Main Results:

• Post-SDR, improved symmetry in lower extremity weight bearing was observed, especially during forward perturbations.
• The participant no longer experienced falls in conditions that previously induced imbalance.
• However, response latencies were prolonged compared to typically developing peers, and force to overcome sway was greater.

Conclusions:

• SDR effectively reduced spasticity but did not resolve other contributing factors to balance deficits in CP, such as contractures and weakness.
• This case highlights the need for comprehensive clinical assessments and targeted interventions for reactive balance post-SDR.
• Further development of effective measurement tools for reactive balance in children with CP is crucial.