GDT demonstrated clear gains for children with cerebral palsy in everyday activities and gross motor function in comparison to AT.

ABBREVIATIONSBoNT-A Botulinum toxin type A MAS Modified Ashworth Scale ROM Range of motion SDR Selective dorsal rhizotomy AIM The aim of this study was to evaluate the long-term effects of selective dorsal rhizotomy (SDR) in children with cerebral palsy (CP).METHOD Nineteen children (four females, 15 males; mean age 4y 7mo, SD 1y 7mo) with bilateral spastic CP, were prospectively assessed at baseline and 18 months, 3 years, and 10 years after SDR. Assessments included the Modified Ashworth Scale for spasticity, the Gross Motor Function Measure 88 (GMFM-88) and the Wilson gait scale for ambulation, neurological investigations, and passive joint range of motion assessment. A 10-year retrospective chart review was added for orthopaedic surgery after SDR. RESULTSBaseline muscle tone at the hip, knee, and ankle level displayed a high degree of spasticity that normalized after SDR. After 10 years there was a slight recurrence of spasticity at the knee and ankle. Joint range of motion declined from a maximum at 3 years after SDR to the 10-year follow-up. Median ambulatory status was best 3 years after SDR and then declined. The GMFM-88 score increased from the median baseline value of 51 to 66 (p=0.002) and 76 (p<0.001) at the initial follow-ups. After 10 years there was a decline in gross motor function with a reduction in the GMFM-88 score to 62 (p=0.022). Within 10 years, 16 out of 19 patients had a mean of three orthopaedic surgeries (SD 2.8), soft tissue surgery being the most common. INTERPRETATIONThe spasticity-reducing effect of SDR, although pronounced, did not seem to improve long-term functioning or prevent contractures. This suggests that contracture development in CP is not mediated by spasticity alone.In children with cerebral palsy (CP), spasticity has often been assumed to be the main reason for functional limitations and development of contractures. Accordingly, many treatments are aimed at reducing spasticity. Interventions used to reduce spasticity are injections with botulinum toxin type A (BoNT-A), intrathecal baclofen therapy, oral drugs, orthopaedic surgery, and physiotherapy. 1 Selective dorsal rhizotomy (SDR) is a neurosurgical procedure where afferent excitatory nerve fibres emerging from the proprioceptors in the muscle spindles are cut where they enter the posterior root of the spinal cord, thereby reducing efferent excitation. The aim is to reduce spasticity and improve function. Reduction in spasticity has been shown for up to 5 years after SDR. 2There is conflicting evidence when tone-reducing therapies have been evaluated from a functional perspective, typically using gait or various assessments of gross motor function. 3,4 Thus studies have found moderate functional gains [5][6][7][8][9][10][11] or no positive functional outcomes. [12][13][14][15][16] However, only a subgroup of the studies has analysed in depth the possible correlation between a reduction in spasticity and improved function. Of these studies, only Love et al. 6 investigated this relationship and demonstrated a positive...

ROMRange of motion SDR Selective dorsal rhizotomy AIM The aim of this study is to evaluate the long-term effects of selective dorsal rhizotomy (SDR), 15 to 20 years after surgery in patients with cerebral palsy.METHOD Eighteen children (four females, 14 males; mean age at SDR 4y 7mo, SD 1y 7mo) with bilateral spastic cerebral palsy (CP), were prospectively assessed after SDR. This study focuses on the outcome 15 to 20 years after the procedure. The assessments include the Modified Ashworth Scale for spasticity, the Gross Motor Function Measure (GMFM-88), the Wilson Mobility Scale, The Health-Related Quality of Life Health Survey, SF-36v2, and the Brief Pain Inventory. RESULTSThe effect of normalized muscle tone in lower extremities after SDR was sustained after a median of 17 years. The best gross motor function capacity, according to the GMFM score, was seen at the 3-year follow-up, thereafter a gradual decline followed. Half of the individuals reported low intensity pain and interference. Compared to a norm sample the physical health component of SF-36v2 was slightly lower and the mental health component slightly higher. INTERPRETATIONThe spasticity-reducing effect of SDR does not improve long-term functioning, nor prevent contractures, but it can possibly reduce the pain often experienced by individuals with CP.Selective dorsal rhizotomy (SDR) has been regularly used for more than two decades in order to alleviate lower limb spasticity in children with cerebral palsy (CP). Results have displayed a reduction in both short-and long-term spasticity (i.e. beneficial effects at the body function/structure domain when the International Classification of Functioning, Disability and Health [ICF] 1 is used as a frame of reference).2-4 The muscle tone decrease has been shown to be stable for up to 10 years. [5][6][7][8] Nonetheless, there is currently no evidence that SDR has any positive long-term effects on the ICF activity and participation domains where changes in, for example, gross motor function will be assigned. 2,3,9 Other than spasticity (which is commonly evaluated in SDR studies) earlier studies have focused on evaluating a limited number of factors; ROM, gait, gross motor function and the need of orthopaedic surgery. There is a possibility that spasticity reduction after SDR might affect other features such as physical activity, health-related quality of life, and pain.We have previously published a report where 19 children were followed up for 10 years after SDR. 8 We concluded that 10 years after SDR, the spasticity-reducing effect was maintained, but this did not seem to improve long-term functioning or prevent contractures in this group of children with spastic diplegic CP. This suggests that contractures development in CP is not only mediated by spasticity'. We also proposed that other possible effects of spasticity reduction should be addressed in future research.Our present study evaluates the same cohort of young persons with CP with the aim to establish if the spasticity reduction was still pres...

AIM The aim of this study was to investigate the acquisition of self-care and mobility skills in children with cerebral palsy (CP) in relation to their manual ability and gross motor function.METHOD Data from the Pediatric Evaluation of Disability Inventory (PEDI) self-care and mobility functional skill scales, the Manual Ability Classification System (MACS), and the Gross Motor Function Classification System (GMFCS) were collected from 195 children with CP (73 females, 122 males; mean age 8y 1mo; SD 3y 11mo; range 3-15y); 51% had spastic bilateral CP, 36% spastic unilateral CP, 8% dyskinetic CP, and 3% ataxic CP. The percentage of children classified as MACS levels I to V was 28%, 34%, 17%, 7%, and 14% respectively, and classified as GMFCS levels I to V was 46%, 16%, 15%, 11%, and 12% respectively. RESULTS Children classified as MACS and GMFCS levels I or II scored higher than children inMACS and GMFCS levels III to V on both the self-care and mobility domains of the PEDI, with significant differences between all classification levels (p<0.001). The stepwise multiple regression analysis verified that MACS was the strongest predictor of self-care skills (66%) and that GMFCS was the strongest predictor of mobility skills (76%). A strong correlation between age and self-care ability was found among children classified as MACS level I or II and between age and mobility among children classified as GMFCS level I. Many of these children achieved independence, but at a later age than typically developing children. Children at other MACS and GMFCS levels demonstrated minimal progress with age.