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Spasticity and strength changes as a function of selective dorsal rhizotomy
J R Engsberg1, K S Olree, S A Ross
1Human Performance Laboratory, Barnes-Jewish and St. Louis Children's Hospitals, Missouri 63108, USA. jre6264@bjcmail.carenet.org
Insights
Selective dorsal rhizotomy reduced hamstring spasticity in children with cerebral palsy (CP). However, hamstring strength in the CP group significantly increased post-surgery, contrary to previous findings.
Area of Science:
- Neurology
- Pediatrics
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) often involves hamstring muscle spasticity.
- Selective dorsal rhizotomy (SDR) is a surgical intervention for CP.
- The impact of SDR on hamstring spasticity and strength requires further quantification.
Purpose of the Study:
- To quantify changes in hamstring muscle spasticity and strength in children with CP after SDR.
- To compare spasticity and strength measures between children with CP and able-bodied (AB) children.
Main Methods:
- Nineteen children with CP and six AB children were assessed using a dynamometer.
- Spasticity was measured by calculating the slope of work-velocity data during passive knee extension.
- Strength was measured by the work done during maximum concentric hamstring contractions.
Main Results:
- Pre-surgery, children with CP had significantly greater hamstring spasticity than AB children.
- Post-surgery, hamstring spasticity in the CP group was not significantly different from the AB group.
- Hamstring strength in the CP group significantly increased post-surgery but remained lower than in the AB group.
Conclusions:
- SDR effectively reduces hamstring spasticity in children with CP.
- Contrary to prior literature, SDR led to a significant increase in hamstring strength in this CP cohort.
Object:
The goal of this investigation was to quantify changes in hamstring muscle spasticity and strength in children with cerebral palsy (CP) as a function of their having undergone a selective dorsal rhizotomy.
Methods:
Nineteen children with CP (CP group) and six children with able bodies (AB group) underwent testing with a dynamometer. For the spasticity measure, the dynamometer measured the resistive torque of the hamstring muscles during passive knee extension at four different speeds. Torque-angle data were processed to calculate the work done by the machine to extend the knee for each speed. Linear regression was used to calculate the slope of the line of best fit for the work-velocity data. The slope simultaneously encompassed three key elements associated with spasticity (velocity, resistance, and stretch) and was considered the measure of spasticity. For the strength test, the dynamometer moved the leg from full knee extension to flexion while a maximum concentric contraction of the hamstring muscles was performed. Torque-angle data were processed to calculate the work done on the machine by the child. Hamstring spasticity values for the CP group were significantly greater than similar values for the AB group prior to surgery; however, they were not significantly different after surgery. Hamstring strength values for the CP group remained significantly less than those for the AB group after surgery, but were significantly increased relative to their presurgery values.
Conclusions:
The results of spasticity testing in the present investigation agreed with those of previous studies, indicating a reduction in spasticity for the CP group. The results of strength testing did not agree with those in the previous literature; a significant increase in strength was observed for the CP group.