Review of Lower Extremity Function Following SEMLS in Children with Cerebral Palsy

The orthopaedic aspect of spastic cerebral palsy

“…26 Through a systematic review of 24 studies with three-dimensional gait analysis data, Lamberts et al concluded that there is a significant tendency to improve the angular displacements and temporospatial parameters of gait. 30 Similar conclusions have emerged from a recent systematic review of 16 studies by Mullerpatan et al, 43 who confirmed clinically significant improvements in gait (three-dimensional gait analysis), functional mobility (FMS) and self-care (Paediatric Evaluation of Disability Inventory [PEDI]), but also non-significant differences in quality of life (questionnaires) following multilevel surgery. Additionally, a recent pooled analysis of 73 cohort studies by Amirmudin et al 52 has shown that multilevel surgery does not significantly improve gross motor function, does not significantly alter gait speed and muscle strength, but reduces spasticity and improves gait function.…”

“…A large portion of experts 5,31,43 believe that the age of 6-12 years is the optimal period for multilevel surgery in children with bilateral spastic CP, as this prevents the risk of both recurrence and overcorrection. It also ensures fewer and more definitive orthopaedic surgeries are allowed.…”

“…57,58 In conclusion, reviewing the effectiveness studies of orthopaedic surgery (on bone and soft tissue or exclusively on soft tissue) in children with CP, it is found that multilevel surgery is mainly supported by noncomparative studies and only from one pilot RCT. 31 Therefore, orthopaedic surgery in CP is characterised by a lack of a sufficient number of high methodological quality studies, revealing its low level of evidence, 26,43 and, consequently, the inability to prove to be the most appropriate modality to promote mobility. 52 The difficulty for researchers to design robust methodological studies lies in (1) ethical issues of consensus on non-surgical treatment of contractures and deformities, (2) difficulty of recruiting patients due to the relatively small number of children that undergo multilevel surgery per year and (3) difficulties in obtaining funding for a multicenter study with sufficient duration of follow-up to assess the effect of multilevel surgery.…”

Pediatric Outcomes Data Collection Instrument Scores Within Gross Motor Function Classification Scale Levels and Functional Mobility Scale Ratings in Individuals With Cerebral Palsy

“…The PODCI has been widely used as a method to evaluate patient outcomes following orthopaedic intervention or single-event multilevel surgery (SEMLS). 28,[36][37][38] Research has shown that the PODCI is able to detect improvements following orthopaedic surgery in patients at GMFCS levels I-III, with improvements postoperatively being of similar magnitude for each GMFCS level. 37 Future research should examine if this is also the case for patients functioning at GMFCS level IV, providing additional information for their health care providers to determine the impact of intervention and other areas of need.…”

Η Αποτελεσματικότητα Ενός Συνδυασμένου Προγράμματος Λειτουργικής Φυσικοθεραπείας Και Ελάχιστης Επεμβατικής Ορθοπαιδικής Χειρουργικής Στην Αδρή Κινητική Λειτουργία Παιδιών Με Εγκεφαλική Παράλυση

“…Εντούτοις, υπάρχει μία αμφιλογία και σύγχυση ανάμεσα στους επιστήμονες ως προς την ιδανική ηλικιακή περίοδο εφαρμογής των ορθοπαιδικών επεμβάσεων στα παιδιά με Ε.Π [394]284,395] αποτελεί την καλύτερη δυνατή περίοδο για να υποβληθούν τα παιδιά με αμφοτερόπλευρη σπαστική Ε.Π. σε πολυεπίπεδη χειρουργική επέμβαση, καθώς έτσι αποτρέπεται ο κίνδυνος υποτροπής και υπερβολικής διόρθωσης[24] και, επίσης, επιτρέπονται λιγότερες και πιο οριστικές ορθοπαιδικές επεμβάσεις[396].…”