Functional performance in self‐care and mobility after selective dorsal rhizotomy: a 10‐year practice‐based follow‐up study

Abstract

AIM To explore changes in performance in daily activities (self-care and mobility) 10 years after selective dorsal rhizotomy (SDR).METHOD Twenty-four children with bilateral spastic cerebral palsy were followed; the median age at SDR was 4 years 1 month (range 2y 5mo-6y 4mo) and at 10-year follow-up was 14 years 6 months (range 12y 3mo-16y 9mo). The preoperative Gross Motor Function Classification System (GMFCS) levels were: I (n=1), II (n=7), III (n=4), IV (n=11), and V (n=1). The Pediatric Evaluation of Disability Inventory (PEDI) was used to assess performance in functional skills, caregiver assistance, and frequency of modifications and adaptive equipment (MAE) in self-care and mobility domains. Changes were analysed in relation to preoperative GMFCS levels, PEDI scores, and age at operation.RESULTS All scores improved significantly (p<0.01) during the first 5 years in patients assigned to GMFCS levels I-III and IV-V. Between 5 years and 10 years, changes were seen in patients grouped in GMFCS levels I-III in the functional skills, mobility (p=0.04), caregiver assistance self-care (p=0.03), and caregiver assistance mobility (p=0.03) domains. Those grouped in GMFCS levels IV-V showed small changes between 5 years and 10 years after surgery. Changes were dependent on the preoperative GMFCS levels in all domains; caregiver assistance, self-care and mobility changes were dependent on preoperative values. The use of MAE increased in participants in GMFCS levels IV-V.INTERPRETATION Children who underwent SDR and physiotherapy improved in functional performance in self-care and mobility and were more independent 10 years postoperatively.

Stability of the Gross Motor Function Classification System in children and adolescents with cerebral palsy: a retrospective cohort registry study

“…6 A high level of absolute agreement (96.8%) between the original and updated versions of the GMFCS has been shown. 7 Overall, the evidence supports that GMFCS levels remain stable over time, 4,[8][9][10][11][12] although the stability of the GMFCS in infants younger than 2 years is lower than at older ages. 13 For more than 20 years, children and adolescents with CP living in Sweden have participated in the Cerebral Palsy Follow-Up Programme (CPUP).…”

Single-level selective dorsal rhizotomy for spastic cerebral palsy

“…Peacock's original cohort has now been followed up for over 20 years and it is evident that the benefits they gained as children are still present (32). Nordmark et al and Josenby et al found that patients also had improvements in their Paediatric Evaluation of Disability Inventory (PEDI) scores, notably in the functional skills and mobility domains (27,31). Dudley et al found that these gains persisted to 15 years post-SDR (29).…”

Selective dorsal rhizotomy: an old treatment re-emerging

“…Similarly, there was significant improvement in passive range of movement in hip, knee and ankle joints, as well as significant improvements in GMFM. In a 10-year follow-up study of 24 children, undertaken by the same group, additional improvement was evident in the functional skills, mobility and caregiver assistance (both self-care and mobility) domains of the Paediatric Evaluation of Disability Inventory (PEDI) scores between 5 and 10 years after SDR 12. This was particularly evident in children in the GMFCS I to III subgroups.…”