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Does loss of spasticity matter? A 10‐year follow‐up after selective dorsal rhizotomy in cerebral palsy
Author(s) -
TEDROFF KRISTINA,
LÖWING KRISTINA,
JACOBSON DAN N O,
ÅSTRÖM EVA
Publication year - 2011
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/j.1469-8749.2011.03969.x
Subject(s) - spasticity , rhizotomy , cerebral palsy , gross motor function classification system , ankle , medicine , range of motion , modified ashworth scale , spastic cerebral palsy , muscle tone , spastic , ambulatory , physical therapy , anesthesia , surgery , physical medicine and rehabilitation , dorsum , anatomy
Aim The aim of this study was to evaluate the long‐term effects of selective dorsal rhizotomy (SDR) in children with cerebral palsy (CP). Method Nineteen children (four females, 15 males; mean age 4y 7mo, SD 1y 7mo) with bilateral spastic CP, were prospectively assessed at baseline and 18 months, 3 years, and 10 years after SDR. Assessments included the Modified Ashworth Scale for spasticity, the Gross Motor Function Measure 88 (GMFM‐88) and the Wilson gait scale for ambulation, neurological investigations, and passive joint range of motion assessment. A 10‐year retrospective chart review was added for orthopaedic surgery after SDR. Results Baseline muscle tone at the hip, knee, and ankle level displayed a high degree of spasticity that normalized after SDR. After 10 years there was a slight recurrence of spasticity at the knee and ankle. Joint range of motion declined from a maximum at 3 years after SDR to the 10‐year follow‐up. Median ambulatory status was best 3 years after SDR and then declined. The GMFM‐88 score increased from the median baseline value of 51 to 66 ( p =0.002) and 76 ( p <0.001) at the initial follow‐ups. After 10 years there was a decline in gross motor function with a reduction in the GMFM‐88 score to 62 ( p =0.022). Within 10 years, 16 out of 19 patients had a mean of three orthopaedic surgeries (SD 2.8), soft tissue surgery being the most common. Interpretation The spasticity‐reducing effect of SDR, although pronounced, did not seem to improve long‐term functioning or prevent contractures. This suggests that contracture development in CP is not mediated by spasticity alone.