A Systematic Review of the Effects of Single-Event Multilevel Surgery on Gait Parameters in Children with Spastic Cerebral Palsy

Lamberts, Robert P.; Burger, Marlette; Eken, Maaike M.; Langerak, Nelleke G.

doi:10.1371/journal.pone.0164686

Cited by 59 publications

(57 citation statements)

References 35 publications

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“…Biomechanically, all joints in the lower limb work together in gait, meaning surgical lengthening of muscles at one joint impacts available range and control at other joints. Therefore, single-event multi-level surgery is a powerful intervention to simultaneously address the biomechanics of gait and minimize repeat surgeries (yellow light) [216,217]. Our review has shown that traditional interventions for contracture management, including neurodevelopmental therapy [3•] (red light) and passive stretching in isolation [155] (yellow light), appear ineffective and the panel assigned negative recommendations since effective substitutes exist.…”

Section: Contracture Prevention and Managementmentioning

confidence: 99%

State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

Novak

Morgan

Fahey

et al. 2020

Curr Neurol Neurosci Rep

546

611

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Purpose of Review Cerebral palsy is the most common physical disability of childhood, but the rate is falling, and severity is lessening. We conducted a systematic overview of best available evidence (2012-2019), appraising evidence using GRADE and the Evidence Alert Traffic Light System and then aggregated the new findings with our previous 2013 findings. This article summarizes the best available evidence interventions for preventing and managing cerebral palsy in 2019. Recent Findings Effective prevention strategies include antenatal corticosteroids, magnesium sulfate, caffeine, and neonatal hypothermia. Effective allied health interventions include acceptance and commitment therapy, action observations, bimanual training, casting, constraint-induced movement therapy, environmental enrichment, fitness training, goal-directed training, hippotherapy, home programs, literacy interventions, mobility training, oral sensorimotor, oral sensorimotor plus electrical stimulation, pressure care, stepping stones triple P, strength training, task-specific training, treadmill training, partial body weight support treadmill training, and weight-bearing. Effective medical and surgical interventions include anti-convulsants, bisphosphonates, botulinum toxin, botulinum toxin plus occupational therapy, botulinum toxin plus casting, diazepam, dentistry, hip surveillance, intrathecal baclofen, scoliosis correction, selective dorsal rhizotomy, and umbilical cord blood cell therapy. Summary We have provided guidance about what works and what does not to inform decision-making, and highlighted areas for more research.

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Section: Contracture Prevention and Managementmentioning

confidence: 99%

State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

Novak

Morgan

Fahey

et al. 2020

Curr Neurol Neurosci Rep

546

611

View full text Add to dashboard Cite

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“…According to the literature, the method of Clinical Gait Analysis (CGA) has a significant impact on orthopedic decision-making [16,17,18] and modifies surgical planning in more than half of cases [19,20,21], revealing clinically significant differences in the quality of threshold values [22]. When CGA data are used for planning the operations, early relapses (up to 21 months after surgery) were reported in 15 % of cases.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the causes of pathological patterns of the kinematic locomotor profile based on the findings of computer gait analysis in children with spastic CP types

Chibirov¹,

Долганова²,

Долганов³

et al. 2019

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To interpret the clinical gait analysis (CGA), it is necessary to associate changes in gait with clinical impairment and differentiate the primary deviations in the gait stereotype from compensatory adaptive changes. Purpose To assess the pathological elements of the locomotor profile according to video gait analysis and clinical examination of patients; to compare the abnormalities identified in gait kinematics with the probable clinical causes of these abnormalities. Materials and methods Clinical examination and assessment of the locomotor profile with video gait analysis (CGA) were performed in 46 children (92 limbs) with bilateral spastic types of cerebral palsy (25 boys, 21 girls). We used 6 Qualisys Oqus cameras and one AMTI dynamometric platform (Advanced Mechanical Technology Inc., Watertown, MA, USA) with passive marker video capture technology. The IOR model was used for installing markers. The patterns of the locomotor profile adopted by the Delphic Convention were analyzed. The assessment of diagnostic coincidences or discrepancies was evaluated as percentage rates. Results The portion of the pathological elements of the locomotor profile identified according to the video gait analysis and clinical examination of patients is presented in the tables. The positive ratio of the pathological elements of the locomotor profile identified according to the video gait analysis and clinical examination of patients averaged 66.7 %. The lowest error rate: when assessing the limitation of the range of motion of the ankle joint and hip joint there were 82.6% and 81.8% of positive results, respectively. Discussion Clinical gait analysis (CGA) is crucial in controversial situations regarding detorsion osteotomies in multilevel operations. Conclusions Muscle retraction is the main (primary) clinical sign leading to positional kinematic deviations in joints and segments. The limitation of the range of motion in the knee and ankle joints due to muscle retraction results in secondary contractures of these joints.

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“…Although MLS is the standard of care for ambulant children with BSCP, the evidence on its mid‐ to long‐term results is weak. Previous studies presented either short‐term or single‐centre data, therefore their results were unconvincing and not generalizable . Dreher et al.…”

mentioning

confidence: 94%

“…Undertaking a meaningful clinical trial of a non‐standardised intervention on a non‐homogeneous population represents a significant methodological problem. It is for this reason that prospective randomized trials in this area of clinical practice are scarce . Dreher et al.…”

mentioning

confidence: 99%

Results of multilevel surgery in diplegic cerebral palsy at skeletal maturity: new evidence

Theologis

2017

Develop Med Child Neuro

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as magnetic resonance imaging (MRI) or 3D ultrasound are costly, require specialist expertise, and take a long time to perform and process. These limitations may explain, in part, why the measurement of muscle volume has not yet transitioned into clinical practice or been included in large-scale clinical trials. To date, research studies of muscle volume in CP have low numbers of participants or are restricted to one or two muscles. Therefore, for larger research studies to be performed, and for muscle volume to become a routine clinical assessment, a new clinically feasible approach for measuring muscle volume is required.The work of Schless et al. 5 suggests that muscle volume may be estimated from measurements made using a standard two-dimensional (2D) ultrasound scanner. Schless et al. reported a strong linear relationship between muscle volume and the product of muscle length and cross-sectional area in the medial gastrocnemius. 5 This strong relationship has implications for the clinical feasibility of assessing muscle volume in this group. However, the work described is not a complete test of the utility and accuracy of estimating muscle volume by 2D ultrasound. The measurements of muscle length and anatomical cross-sectional area were made using a 3D ultrasound system. It cannot be assumed that by using a 2D method in isolation the relationship would be as strong as Schless et al. report. The authors identified the muscle insertion and musculo-tendinous junction from within a reconstructed 3D data set postdata collection. This has the advantage of allowing longitudinal reconstructions of the whole muscle length to be viewed, which greatly aids in identifying muscle end points. In practice, a 2D assessment would involve measurement of muscle length by tape measure guided by live 2D ultrasound imaging, and the identification of an optimal ultrasound image from which to estimate the anatomical cross-sectional area. Variation in probe location, orientation, and surface pressure are all likely to increase variability in the data set. Therefore, this 2D technique for estimating muscle volume is likely to have lower repeatability compared to MRI and 3D ultrasound techniques. However, accepting a suboptimal 2D technique that is simple, realistic, and feasible may be the way forward to enable large scale research studies to be performed and ultimately for a routine clinical assessment technique to be developed.The authors use an unconventional definition of the proximal origin of the medial gastrocnemius at the tibia, rather than utilising the real anatomical origin at the formal condyle. Although this limitation is unlikely to have a significant impact on the strength of the relationship between muscle volume and the product of muscle length and cross-sectional area, the regression equation developed by the authors is only valid for measurements made following the same definition. Furthermore, the findings of Schless et al. may not be generalisable to other muscles. Further investigation of the reliability of mu...

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A Systematic Review of the Effects of Single-Event Multilevel Surgery on Gait Parameters in Children with Spastic Cerebral Palsy

Cited by 59 publications

References 35 publications

State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

Analysis of the causes of pathological patterns of the kinematic locomotor profile based on the findings of computer gait analysis in children with spastic CP types

Results of multilevel surgery in diplegic cerebral palsy at skeletal maturity: new evidence

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