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Developmental skills of children with spastic diplegia: functional and qualitative changes after selective dorsal
C E Buckon1, S Thomas, R Pierce
1Shriners Hospital for Children, Oregon Health Sciences University, Portland, USA.
Insights
Selective dorsal rhizotomy (SDR) reduced spasticity and improved range of motion in children with spastic diplegia. Gains in stability and developmental positions were noted at 6 months, with improved transitional movements by 1 year.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Spastic diplegia is a common form of cerebral palsy affecting lower limb function.
- Selective dorsal rhizotomy (SDR) is a surgical procedure aimed at reducing spasticity.
- Understanding the functional outcomes of SDR is crucial for pediatric rehabilitation.
Purpose of the Study:
- To evaluate changes in muscle tone, passive range of motion, stability, and mobility after SDR.
- To assess developmental skill progression at 6 months and 1 year post-surgery.
Main Methods:
- Prospective outcome study design.
- Consecutive sample of 26 children with spastic diplegia.
- Assessment of muscle tone, range of motion, and functional skills.
Main Results:
- Reduced spasticity observed at 6 months, sustained at 1 year.
- Increased passive range of motion in hips and ankles by 6 months.
- Improved ability to assume developmental positions and stability by 6 months, with enhanced transitional movements by 1 year.
Conclusions:
- SDR effectively decreases spasticity and enhances lower extremity range of motion in children with spastic diplegia.
- The procedure is associated with improved developmental positioning and stability.
- Functional gains in transitional movements at 1 year likely result from SDR, maturation, and therapy.
Objective:
This study examined changes in muscle tone, passive range of motion, stability, and mobility in developmental skills at 6 months and 1 year after selective dorsal rhizotomy (SDR).
Design:
Prospective outcome study of a consecutive sample.
Setting:
Private children's hospital.
Patients:
Twenty-six children with spastic diplegia: 13 independent and 13 dependent ambulators (assistive devices).
Results:
A decrease in spasticity was seen at 6 months after SDR, with no further decrease at 1 year. Increases in passive range of motion of the hip and ankle were seen at 6 months after SDR. The ability to assume and maintain developmental positions with improved alignment and stability was seen more frequently at 6 months after SDR, whereas an improvement in the ability to perform transitional movements was seen more frequently at 1 year after SDR.
Conclusion:
SDR decreases spasticity and increases lower extremity range of motion in children with spastic diplegia and appears to be associated with the ability to assume a greater variety of developmental positions with improved alignment, thus greater stability. Improvements in the ability to perform difficult transitional movements at 1 year after SDR are most likely the result of the combined effect of maturation, SDR, and intensive therapeutic intervention.