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Long‐term effect of selective dorsal rhizotomy on gross motor function in ambulant children with spastic bilateral cerebral palsy, compared with reference centiles
Author(s) -
Bolster Eline AM,
Schie Petra EM,
Becher Jules G,
Ouwerkerk Willem JR,
Strijers Rob LM,
Vermeulen R Jeroen
Publication year - 2013
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.12148
Subject(s) - rhizotomy , cerebral palsy , gross motor function classification system , medicine , spasticity , gross motor skill , spastic diplegia , spastic , physical therapy , spastic quadriplegia , physical medicine and rehabilitation , motor skill , dorsum , anatomy , psychiatry
Aim The aim of this study was to evaluate the long‐term effect of selective dorsal rhizotomy ( SDR ) on the gross motor function of ambulant children with spastic bilateral cerebral palsy ( CP ), compared with reference centiles. Method The study used a prospective cohort design and participants comprised 29 children classified using the Gross Motor Function Classification System ( GMFCS ) in level I ( n =7), II ( n =4), or III ( n =18; 18 males, 11 females; median age at time of surgery 6y 4mo; range 2y 10mo–12y 1mo), who were examined 5 years and 10 years after SDR . We used individual centiles based on Gross Motor Function Measure ( GMFM ‐66) scores and age, corresponding to the GMFCS levels. Individual improvement or deterioration was defined as a change of more than 20 centiles. Side effects experienced and additional treatment received after SDR were also recorded. Results Five years after SDR , 10 out of 28 children showed improvement, and 10 years after SDR 6 out of 20 children had improved. Spinal side effects were noted in two children and hip subluxation in three. Additional treatments included subtalar arthrodesis ( n =13), endorotational osteotomy of the tibia ( n =5), and botulinum toxin treatment ( n =13). Interpretation None of the children showed deterioration of gross motor function based on centile ranking. Five and 10 years after SDR , gross motor function in some children had improved more than would have been expected according to the reference centiles. This suggests, taking the limitations of this study into account, that the applied criteria for selection were adequate. However, the children still required additional treatment after SDR .