Long-term results of multilevel surgery in adults with cerebral palsy

Putz, Cornelia; Blessing, Ann Kathrin; Erhard, Sarah; Fiethen, Katharina; Geisbüsch, Andreas; Niklasch, Mirjam; Döderlein, Leonhard; Wolf, Sebastian I.; Dreher, Thomas

doi:10.1007/s00264-018-4023-7

Cited by 5 publications

(5 citation statements)

References 24 publications

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“…This does demonstrate that a small number of adults, after maturity, may develop symptomatic deformities that are primarily related to planovalgus feet and hallux valgus. Although there are reports of surgical correction of gait deformities in adults with CP having a good outcome, these studies do not report if deformity onset was in adulthood or childhood 28,30. Identification of foot deformities as the major residual deformity and the deformity most likely to progress in adulthood has not been previously reported in patients with CP.…”

Section: Discussionmentioning

confidence: 94%

Residual Deformity and Outcome of Ambulatory Adults With Cerebral Palsy: A Long-term Longitudinal Assessment

Saisongcroh¹,

Shrader²,

Lennon³

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Advances in pediatric orthopaedic care have improved mobility and function for children with cerebral palsy (CP) as mobility declines from adolescence into adulthood. The long-term effectiveness of modern orthopaedic care is not widely reported. This study aimed to report the pediatric orthopaedic surgical burden, residual deformities, and outcomes using objective evidence of mobility in ambulatory adults with CP. Methods: An institutional review board–approved prospective cohort study was performed in ambulatory adults with CP between 25 and 45 years, who had an adolescent gait analysis. Orthopaedic interventions were reviewed, and adolescent and adult gait analyses were compared using paired 2-tailed t tests. Adults were categorized by the presence of no, mild, or severe residual deformities in rotation, crouch, stiff knee, equinus, and foot deformity. Results: Of 106 adults with CP, Gross Motor Function Classification System (GMFCS) distribution was grade I (22%), II (50%), III (23%), and IV (5%). Sixty-one males and 45 females were tested. The average age was 30±4 years with follow-up of 13±4 years since previous analysis; 279 surgical events (1165 procedures) were performed with a mean per patient of 2.6 events and 11 procedures. Comm on procedures were gastrocsoleus complex (88%) and hamstring lengthening (79%). The mean gait deviation index at adolescent and adult visit were 72.7±13 and 72.3±13 (P=0.78). Mean gait velocity at the adolescent visit was 85±27 and 79±31 cm/s at adult visit (P=0.02). Both gait deviation index and gait velocity change were clinically insignificant. Fifty-seven adults (81 limbs, 54%) had mild residual deformities. Residual hip internal rotation, pes planovalgus, and crouch gait were common. Severe deformities impacting function or causing pain were present in 11 participants (14 limbs, 10%). Seven of the 11 adults with severe deformities were worse compared with their adolescent evaluation; 4 were unchanged. Conclusions: Correcting deformities before adulthood has lasting stability with little functional loss in most ambulatory young adults with CP. Increasing deformity after adolescence can occur in young adults but is uncommon. Level of Evidence: Level III.

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Section: Discussionmentioning

confidence: 94%

Residual Deformity and Outcome of Ambulatory Adults With Cerebral Palsy: A Long-term Longitudinal Assessment

Saisongcroh¹,

Shrader²,

Lennon³

et al. 2022

Journal of Pediatric Orthopaedics

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“…37 It is thus interesting to observe that different types of procedure do not have the same impacts on long-term gait evolution. 38 In their study on long-term evolution (10.9 years) in adults (mean age at baseline: 24.8 (sd 7.6)), Putz et al 39 showed that patients with bilateral CP who underwent SEMLS had an improved gait score (GPS) over time. Thus, SEMLS is an important treatment for managing CP impairments between childhood and young adulthood, but also during the adult period.…”

Section: Discussionmentioning

confidence: 99%

Follow-up of walking quality after end of growth in 28 children with bilateral cerebral palsy

Bonnefoy‐Mazure¹,

Coulon²,

Lascombes³

et al. 2020

Journal of Children's Orthopaedics

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Purpose Assessment of surgical treatments on gait in patients with bilateral cerebral palsy (CP) is often performed in short-term studies. The purpose of this study was to analyze the influence of single-event multilevel surgery (SEMLS) on long-term evolution of gait using gait deviation index (GDI) and walking speed. Methods In all, 28 patients with bilateral CP (Gross Motor Function Classification System I to III) with two clinical gait analyses (CGA) were included (mean age: 9.0 years (sd 2.9) at the first CGA, 19.6 years (sd 4.1) at the last, all of them at skeletal maturity). GDI, walking speed and their changes were calculated. Statistical analysis was performed to observe differences between baseline and follow-up CGA. Pearson’s correlations were conducted to evaluate the associations between GDI and walking speed changes with: GDI at baseline and walking speed at baseline. GDI and walking speed evolution have been analyzed for two groups of patients: with and without SEMLS. Results Regardless of the treatment, GDI was significantly higher at follow-up CGA (baseline: 73.1 (sd 13.1) versus follow-up: 80.1 (sd 13.2); p = 0.014). Significant negative correlations were found between GDI change and GDI at baseline (r = -0.52; p = 0.004) and between walking speed change and walking speed at the baseline (r = -0.70; p < 0.001). Regarding the group of patients with or without SEMLS, only significant improvement of GDI was found for patients with SEMLS (at baseline: 69.0 (sd 12.1) versus follow-up: 77.8 (sd 11.2); p < 0.05). Conclusion Analysis at skeletal maturity showed a gait quality maintained for patients without SEMLS and an improvement for patients with SEMLS. Level of evidence Level III

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“…Em geral, a m edia (DP) da percepc ßão subjetiva da marcha foi 7,5 (1,8), e foi significativamente mais alta em pacientes com Sistema de Classificac ßão da Func ßão Motora Grossa (GMFCS) n ıvel I (7,9 [1,5]) no que nos pacientes nos n ıveis GMFCS II e III (5,9 [2,0]). Correlac ßões positivas foram encontradas entre a percepc ßão subjetiva da marcha e os escores da marcha, velocidade da marcha, distância no TC6 e pontuac ßão SF-36.…”

Section: Resultsunclassified

“…These scores can be used to monitor gait quality evolution over time and after treatment. Indeed, several studies have reported post‐treatment gait outcomes (often based solely on gait quality) during childhood but with no consideration of how patients perceived their own walking abilities and capacities . However, patients’ subjective perceptions are important because they reflect how they value themselves with regards to their functional abilities, ideas of aesthetics, feelings of asymmetry, and self‐esteem .…”

mentioning

confidence: 99%

“…Indeed, several studies have reported post-treatment gait outcomes (often based solely on gait quality) during childhood but with no consideration of how patients perceived their own walking abilities and capacities. [5][6][7] However, patients' subjective perceptions are important because they reflect how they value themselves with regards to their functional abilities, ideas of aesthetics, feelings of asymmetry, and self-esteem. 8 Subjective perceptions of patients with CP can be influenced by factors such as sensory, perceptive, cognitive, communication, or behavioural disorders.…”

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confidence: 99%

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Self‐perceived gait quality in young adults with cerebral palsy

Bonnefoy‐Mazure

Coulon

Armand

2020

Develop Med Child Neuro

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Aim To explore how patients with cerebral palsy (CP) perceive their gait and evaluate associations between subjective gait perception and: objective gait parameters, endurance, pain, and fatigue. Method Sixty‐two patients (21 females and 41 males; mean [SD] age 20y [5y 1mo], range 15–29y) performed a clinical gait analysis. Self‐selected walking speed, Gait Profile Score, and Gait Variable Score were calculated. Subjective gait perception was assessed with a visual analogue scale using the question: ‘On a scale from 0 (worst) to 10 (optimal), how would you describe your walking today?’. A 6‐minute walk test (6MWT) measured endurance; the 36‐Item Short Form Health Survey (SF‐36) evaluated quality of life. T‐tests, Pearson correlations, and univariate and multiple linear regression models were used to compare and find associations between the data. Results Overall mean (SD) subjective gait perception was 7.5 (1.8) and was significantly higher for patients in Gross Motor Function Classification System (GMFCS) level I (7.9 [1.5]) than for patients in GMFCS levels II and III (5.9 [2.0]). Positive correlations were found between subjective gait perception and gait scores, walking speed, 6MWT distance, and SF‐36 score. Only walking speed was a significant predictor of subjective gait perception. Interpretation Subjective gait perception was influenced by GMFCS level and linked partially with the walking speed. The gait quality did not explain subjective gait perception. It is important to combine subjective and objective gait scores to develop personalized therapeutic goals. What this paper adds Subjective gait perception is influenced by the physical impairment levels of patients with cerebral palsy. Subjective gait perception and objective gait scores are associated. Walking speed is the only predictor of gait perception.

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Long-term results of multilevel surgery in adults with cerebral palsy

Abstract: Surgical treatment in adults with BSCP was feasible and effective in the long-term. Significant improvement of gait and function was maintained in the majority of patients, while some patients were prone to develop crouch gait, hip flexion contractures, or pain.

Cited by 5 publications

References 24 publications

Residual Deformity and Outcome of Ambulatory Adults With Cerebral Palsy: A Long-term Longitudinal Assessment

Residual Deformity and Outcome of Ambulatory Adults With Cerebral Palsy: A Long-term Longitudinal Assessment

Follow-up of walking quality after end of growth in 28 children with bilateral cerebral palsy

Self‐perceived gait quality in young adults with cerebral palsy

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