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Changes in gait which occur before and during the adolescent growth spurt in children treated by selective dorsal rhizotomy.

McFall, J.; Stewart, C.; Kidgell, V.; Postans, N.; Jarvis, S.; Freeman, R.; Roberts, A.

Changes in gait which occur before and during the adolescent growth spurt in children treated by selective dorsal rhizotomy. Thumbnail


Authors

J. McFall

V. Kidgell

N. Postans

S. Jarvis

R. Freeman

A. Roberts



Abstract

This paper presents long term follow up results from 17 children (6 girls, 11 boys, GMFCS levels II-IV), treated by means of selective dorsal rhizotomy (SDR). The particular focus is on the effect of the adolescent growth spurt on patients who had previously undergone SDR. The children were all assessed using 3D gait analysis, in combination with clinical examination at three time points-before SDR surgery (PRE), after SDR surgery when pre-adolescent (POST1) and post-adolescence (POST2). The total follow up period to POST2 was 8 years 6 months for girls and 9 years 5 months for boys. All children maintained or improved their GMFCS level. Positive changes in ranges of motion and gait were observed at POST1 and these were generally maintained over adolescence to POST2. The mean Gait Profile Score (GPS) had improved by 3.2 points (14.7-11.5) at POST1, with a non-significant deterioration of 0.3 over the adolescent growth spurt. These positive results reflect the total package of care for the children, involving careful pre-operative selection by a multidisciplinary team and post-operative management including intensive physiotherapy and maintenance in tuned ankle foot orthoses. Fifty-nine per cent of children had some additional orthopaedic surgery, mostly bony procedures. The overall benefits arising from their management need to be considered in the light of the likely deterioration experienced by this patient group. The results of this study support the use of SDR as part of a management strategy for carefully selected children with cerebral palsy with the aim of optimizing gait at skeletal maturity.

Journal Article Type Article
Acceptance Date Jun 20, 2015
Online Publication Date Jun 29, 2015
Publication Date 2015-09
Publicly Available Date Mar 29, 2024
Journal Gait and Posture
Print ISSN 0966-6362
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 42
Issue 3
Pages 317 - 322
DOI https://doi.org/10.1016/j.gaitpost.2015.06.187
Keywords Cerebral palsy; Selective dorsal rhizotomy; Gait; Adolescence
Publisher URL http://www.sciencedirect.com/science/article/pii/S096663621500689X

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