The purpose of this study was to determine the effectiveness of muscle-release surgery for children with cerebral palsy (CP) using longitudinal and stratified analysis. Twenty-five children with CP (15 females, 10 males; age range 4 to 16 years; mean age 8 years 2 months, SD 3 years 2 months) were selected from five treatment centres in Japan. Twenty-two children had spastic diplegia, two had spastic quadriplegia, and one had athetospastic quadriplegia. Motor function for each child was assessed using the Gross Motor Function Measure (GMFM). Assessment was conducted on eight separate occasions: 1 month and 1 week before surgery, and 1, 2, 4, 6, 9, and 12 months after surgery. Participants' motor function before surgery was classified using the Gross Motor Function Classification System (GMFCS). Six children were classified at level I, three at level II, six at level III, and 10 at level IV. A significant difference was found after surgery in the GMFCS levels III and IV groups (p<0.05). Improvement in GMFM scores between 1 week before surgery and 12 months after surgery were 1, 5, 8.5, and 8.5 for GMFCS levels I to IV respectively. Results indicate that this treatment is advantageous for improving motor function in children within GMFCS levels III and IV.
[Purpose] The aim of this study was to quantify the resistance to passive movement by
measuring changes in muscle-tendon length and joint range of motion (ROM), before and
after applying a standardized 5-kilogram tension force, and to correlate and compare these
changes to muscle tone. [Subjects and Methods] Children with cerebral palsy (n=29) and
typically developed children (n=12) participated in this observational study. The modified
Ashworth scale (MAS) was used to assess tone in the right plantarflexor muscle. An
ultrasound-imaging device was used to measure Δmuscle-tendon length in the right medial
gastrocnemius muscle, and a goniometer was used to measure right ankle ΔROM. [Results]
Compared with the MAS, the results showed that ΔROM had the highest construct validity
(convergent and discriminant) followed by Δmuscle-tendon unit length. Therefore, these
parameters may be better alternatives to the MAS for the quantitative assessment of
resistance to passive movement in patients with increased tone. [Conclusion] This study
demonstrated that measuring the change in the passive properties of the muscle-tendon
unit, as well as the corresponding change in ROM, might provide better options for
assessing resistance to passive movement or muscle tone.
BackgroundIt has already been more than 50 years since the Pavlik harness was introduced in Japan, and today the Pavlik harness is widely recognized as the standard initial treatment modality for developmental dysplasia of the hip. We performed a multicenter nationwide questionnaire study concerning the results of Pavlik harness treatment twice in 1994 and 2008.MethodsIn 1994 and in 2008, we sent questionnaires to 12 institutes in Japan specializing mainly in pediatric orthopedics. We compare the results of these two studies and discuss differences in reduction rates, incidence of avascular necrosis in the femoral epiphysis and the percentage of joints with acceptable morphology (Severin grade I + II/total) at skeletal maturity. We statistically assessed these results to see whether there were changes in the treatment outcomes over this 14-year period.ResultsReduction of the dislocated hips was obtained by the Pavlik harness in 80.2 % (1990/2481 hips; 1994) and 81.9 % (1248/1523 hips; 2008). The incidences of avascular necrosis of the proximal femoral epiphysis in the dysplastic hips were 14.3 % (119/835 hips; 1994) and 11.5 % (76/663 hips; 2008). The type of avascular necrosis in hips from the 2008 study was determined according to the classification of Kalamchi and MacEwen: 24/69 hips (34.8 %) were classified as group I; 20/69 hips (29.0 %) as group II; 11/69 hips (15.9 %) as group Ill; 14/69 hips (20.3 %) as group IV. The percentages of hips with acceptable outcomes at skeletal maturity discerned from Severin X-ray changes (grade I + II/total) were 72.3 % (604/835 hips; 1994) and 77.7 % (488/628 hips; 2008).ConclusionReduction rates and the incidence of avascular necrosis in 2008 were statistically similar to the results in 1994. The rate of acceptable outcome (Severin grade I + II/total) in 2008 was statistically higher than that of 1994.
Postoperative long-term follow-up survey in patients with p-TCS indicated significant improvement of urological symptoms. However, 55% of patients had some lower urinary tract dysfunction that affected their activities in daily life.
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