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Repeated Transcranial Magnetic Stimulation Combined with Action Observation Training in Children with Spastic Cerebral Palsy
Published on: August 9, 2024
Combined Gastrocnemius Release with Gracilis and Toe Flexor Release Offers a Targeted Multi-Level Approach within
Santoshkumar J Hankare1, Saurabh Gajanan Fate1, Abhishek Milind Ganacharya1
1Department of Orthopaedics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India.
Introduction:
Spastic hemiplegic cerebral palsy (CP) often causes multi-level lower limb deformities, impairing gait and mobility. Single-level surgeries yield suboptimal results due to persistent spasticity elsewhere.
Case Series:
We report outcomes in 15 ambulatory patients (aged 4-18 years, gross motor function classification system [GMFCS] I-III) undergoing combined gastrocnemius release, gracilis release, and toe flexor lengthening as part of single-event multi-level surgery (SEMLS) in spastic hemiplegic CP.
Results:
Ankle dorsiflexion improved from -10° to +10° (P < 0.05), knee flexion reduced from 24° to 6° (P < 0.05), and toe clawing resolved in all. Gait symmetry, step length, and GMFCS levels were enhanced; complications were minimal (overcorrection in 1, weakness in 1).
Conclusion:
This multi-level soft-tissue release effectively restores biomechanics with low recurrence, supporting SEMLS principles. Gastrocnemius, gracilis, and toe flexor release is a safe and effective SEMLS strategy significantly improving gait, functional mobility, and quality of life.
Study Design:
Case Series (Level of Evidence: Level IV).