Rizotomia Dorsal Seletiva Na Paralisia Cerebral: Critérios De Indicação E Protocolos De Reabilitação Fisioterapêutica Pós-Operatória

Abstract

Objective: To identify selection criteria for selective dorsal rhizotomy (SDR) in cerebral palsy, to analyze the instruments used for evaluation, and to describe the characteristics of physical therapy in postoperative protocols.Data sources: Integrative review performed in the following databases: SciELO, PEDro, Cochrane Library, and PubMed. The terms in both Portuguese and English for “cerebral palsy”, “selective dorsal rhizotomy”, and “physical therapy” were used in the search. Studies whose samples enrolled individuals with cerebral palsy who had attended physical therapy sessions for selective dorsal rhizotomy according to protocols and describing such protocols’ characteristics were included. Literature reviews were excluded and there was no restriction as to period of publication.Data synthesis: Eighteen papers were selected, most of them being prospective cohort studies with eight-month to ten-year follow-ups. In most studies, the instruments of assessment encompassed the domains of functions, body structure, and activity. The percentage of posterior root sections was close to 50%. Primary indications for SDR included ambulatory spastic diplegia, presence of spasticity that interfered with mobility, good strength of lower limbs and trunk muscles, no musculoskeletal deformities, dystonia, ataxia or athetosis, and good cognitive function. Postoperative physical therapy is part of SDR treatment protocols and should be intensive and specific, being given special emphasis in the first year.Conclusions: The studies underline the importance of appropriate patient selection to obatin success in the SDR. Postoperative physical therapy should be intensive and long-term, and must necessarily include strategies to modify the patient’s former motor pattern.

Predicting Gross Motor Function in Children and Adolescents with Cerebral Palsy Applying Artificial Intelligence Using Data on Assistive Devices

“…It is conceivable that using the MDSC, therapies can be retrospectively analyzed; not only longitudinally, but also across interventions comparing data sets including information about medical devices, but lack information about the severity of motor function skills such as a GMFM-66 score. To give an example, selective dorsal rhizotomy (SDR) could be considered: this is a surgical procedure on the posterior root of the lumbar spinal cord to reduce leg spasticity [ 28 ]. It would be possible to compare the MDS of children with SDR, calculated with the data of the health insurance companies, before surgery and, e.g., 2 years after surgery with a control group, which are of similar age and have a similar MDS at the beginning, in the sense of a case-control study.…”

Selective Dorsal Rhizotomy: Analysis of two rootlet sectioning techniques

“…A wide range of percentages of dorsal rootlet to be transected during SDR has been reported. In some centers, a rate of 50-70% is used [23]. The argument in favor of a higher rate of sectioning is a better reduction of spasticity.…”

The short-term effects of selective dorsal rhizotomy on gait compared to matched cerebral palsy control groups

“…ambulatory spastic diplegia, presence of significant spasticity interfering with mobility, good strength of lower limbs and trunk, no significant fixed contractures, good cognitive function and family support and no other movement disorders such as dystonia, ataxia or athetosis. [1, 9, 10]. However, a number of families’ self-funded travel to a centre in the United States for SDR and some of these patients at least may not have met these more widely accepted selection criteria.…”

“…SDR is currently not available in Ireland. However, recently children who meet recognised selection criteria [1, 9, 10] may be reviewed for suitability for this intervention. If felt appropriate they are referred to be assessed for SDR in a neighbouring country and a limited number then elect to proceed with surgery.…”