Analysis of Three-Dimensional Gait Characteristics before and after FSPR Surgery of Patients with Spastic Cerebral Palsy / 医用生物力学

Objective To analyze gait characteristics of patients with spastic cerebral palsy (CP) before and after functional selective posterior rhizotomy (FSPR) surgery, so as to evaluate curative effects of the surgery objective ly. MethodsFifteen patients with spastic CP to be treated by FSPR were selected. The VICON three-dimensional (3D) motion analysis system and AMTI 3D force plates were used to collect and analyze the spatiotemporal gait parameters, kinematic and dynamic parameters before and after FSPR surgery. Results After the surgery, the left and right support phases were longer,and the left-side step length was significantly larger. The step height, velocity and the max displacement of center of gravity (COG) in coronal plane were smaller than those before surgery.The sagittal plane angle (flexion and extension angle) of the knee during initial landing was significantly increased, while no significant differences were found in that of the hip and ankle.The range of motion (ROM) of the left/right hip, knee and ankle in sagittal plane was increased to some extent during walking, with statistical differences. The ROM of right ankle in coronal plane was also increased obviously. The minimum flexion angle of the right knee and the maximum plantar flexion angle of the left/right ankle were significantly reduced. The maximum vertical forces of left and right support phases were significantly increased, while no significant differences were found in torque of lower limbs. Conclusions The 3D gait analysis can be used to evaluate the effect of FSPR on patients with spastic CP. The spasticity of patients with spastic CP is relieved after FSPR surgery, and the spatiotemporal gait parameters and kinematics parameters are improved significantly. But the improvement of dynamic parameters was not obvious, and further rehabilitation treatment is needed.

Advances on selective posterior rhizotomy for lower limb function in patients with cerebral palsy / 中国骨伤

Cerebral palsy is a common clinical syndrome of neurological disability in childhood, which seriously affects the quality of life of children and their families, and brings a heavy economic burden to the society. Domestic and foreign scholars had a long history of the application of selective posterior rhizotomy for the treatment of spastic cerebral palsy or mixed cerebral palsy with limb paralysis. It is effective in improving the lower extremity spasm of patients with cerebral palsy, and there are few cases with recurrences. After rehabilitation therapy, the muscle strength of patients with cerebral palsy was significantly improved compared with the previous one. The range of motion was significantly improved after operation, and there is no rebounded in aspect of joint activety in the long-term follow-up. The overall gait of the patient was significant improved. The author thought that selective posterior rhizotomy is effective in improving the motor function of lower limbs in patients with cerebral palsy, and it is worth being spread. However, it has to follow the principle of selecting appropriate cases before surgery, precise operation during operation, and timely and effective rehabilitation treatment after surgery, in order to achieve a better curative effect.

Efficacy analysis of selective posterior rhizotomy at medullary conus for treatment of double lower extremities spastic cerebral palsy / 中华实用儿科临床杂志

Objective To investigate the clinical efficacy of L1 -S1 selective posterior rhizotomy (SPR)at the medullary conus level for the treatment of double lower extremities spastic cerebral palsy(CP).Methods A total of 1 09 double lower extremities spastic CP children underwent SPR at the level of medullary consul were selected in the Second Affiliated Hospital of Xinjiang Medical University from October 201 0 to May 201 4.The 4 groups were analyzed in terms of muscle tension and gross motor function of the lower limbs 6 months before and after operation,retrospective-ly.The SPSS 1 7.0 software was used for statistical analysis.Results Patients had different degrees of improvement in gross motor function and reduction of spasticity in all muscle groups of lower limbs after operation.Six months after the operation,the muscular tension of hip flexor,hip adductor,knee flexor and plantar flexors (modified Ashworth spastic scale score)were all improved compared with preoperation (t =1 6.635,27.41 1 ,31 .362,38.81 9,all P <0.01 ).Gross motor function of lower limbs (Gross Motor Function Measure)at 6 months after the operation was significantly im-proved compared with preoperation (51 .97 ±1 2.92 vs 41 .01 ±1 1 .46),and the difference was significant(t =26.67, P <0.01 ).The postoperative complications:intracranial hypotension headache (5 cases,4.59%),postoperative high fever (2 cases,1 .83%),incision fat liquefaction (2 cases,1 .83%),sensory barriers of lower limbs (1 case, 0.92%),and urine obstacles (1 case,0.92%).Conclusions SPR at the level of medullary conus has the advantages of minimal injury,rapid recovery and little influence on the stability of the spine.In addition,the procedure can relieve the spasticity of lower limbs of the CP patients effectively.

Clinic research into the effects of SPR on the sensory function of lower extremities / 中华显微外科杂志

Objective To explore the reason why the SPR could make the changes of Sensory Function of Lower extremities,and the clinical significance of these changes.Methods From February,2012 to August,2014,24 patients with spastic cerebral palsy who were consistent with the indications of SPR,had normal intelligence development,and express competence,and could cooperate with the test.To test the changes of Sensory Function of lower extremities preoperatively,1 week after SPR,such as haptics,superficial algaesthesis,temperature sensation,cinaesthesia,topesthesia,pallesthesia,deep pain sense,tactile localization sense,two point discrimination and pattern sense.Results There were 6 patients who present with skin paresthesia of lower extremities among the 24 patients after the SPR.Of the 6 patients,4 became normal 2 weeks later,1 became normal 3 weeks later,and the longest 1 became normal 6 weeks later.No instances with permanent sensory deprivation and anaesthesia were found.The proportions of the excised root of spinal nerves during the SPR in the groups with skin anaesthesia of lower extremities and without skin anaesthesia of lower extremities were 0.268 ± 0.049 and 0.193 ± 0.074 (P ＜ 0.05 respectively).The former was significantly higher than the latter.The changes of haptics,cinaesthesia,topesthesia,deep pain sense,tactile localization sense,two point discrimination,pallesthesia preoperatively,1 week after SPR were not significantly different (P ＞ 0.05).There were significant differences in the superficial algaesthesis,pattern sense and temperature sensation preoperatively and postoperatively (P ＜ 0.05).Both of them decreased compared with those of 1 week after SPR.Conclusion The slight damage to sensory function of lower extremities resulted from SPR may not affect the protectant sensory function of the body.The skin anaesthesia of lower extremities is probably concerned with the proportion of the excised root of spinal nerves during the SPR,but not associated with the age.The impaired symptoms of the sensory function of lower extremities resulted from SPR can spontaneous recover in 2-6 weeks after SPR.SPR is safely with the clinic research on the sensory function of lower extremities.

Effect of Grade of Gross Motor Function Classification System on Outcome of Selective Posterior Rhizotomy for Children with Cerebral Palsy / 中国康复理论与实践

@#Objective To observe the outcome of selective posterior rhizotomy (SPR) for cerebral palsy children with different gross motor function before operation. Methods 132 cases accepted SPR were grouped with their grades of Gross Motor Function Classification System (GMFCS), and their outcomes were compared. Results The muscle tension, gross motor function and activities of daily living improved in all the groups after SPR (P<0.01). The muscle tone decreased the most in grade I (P<0.01). The gross motor ability improved the most in grade II(P<0.001). The activiti es of daily living improved the most in grades I and IV (P<0.05). Conclusion The outcome of SPR for children with cerebral palsy is various with the gross motor function before operation.

Effect of Enhanced Physical Therapy with Integrated Traditional and Western Medicine on Muscular Weakness after Selective Posterior Rhizotomy / 中国康复理论与实践

@#Objective To explore the effect of enhanced physical therapy with integrated traditional and western medicine on muscularweakness after selective posterior rhizotomy. Methods 44 children with muscular weakness after selective posterior rhizotomy were dividedinto the treatment group (n=28) and the control group (n=16). Exercise therapy, physical therapy, electroacupuncture and Chinese massagewere applied to the treatment group, while exercise therapy was applied to the control group only. The muscle strength of the leg of childrenwere compared right after the surgery and 2 weeks after the surgery. Results The muscle strength of the leg of children in treatment group recoveredbetter than the control group 2 weeks after the surgery (P<0.05), and it was almost at the same level with that before surgery (P<0.05). Conclusion The enhanced physical therapy with integrated traditional and western medicine method could rapidly recover the musclestrength of the leg of children after SPR.

Effect of Neostigmine on Cardiovascular Response from Neuromuscular Electrical Stimulation in Selective Posterior Rhizotomy for Patients with Cerebral Palsy / 中国康复理论与实践

@#Objective To observe the effect of intravenous pre-injection of neostigmine on cardiovascular response(CVR) caused by neuromuscular electrical stimulation(NMES) in selective posterior rhizotomy(SPR) for patients with cerebral palsy.Methods 56 patients with cerebral palsy undergoing SPR at lumbarsacral segments under general anesthesia were randomly assigned to 2 groups: intravenous neostigmine 0.04 mg/kg(no more than 1 mg in total) and intravenous atropine 0.02 mg/kg(no more than 0.5 mg in total) 5 min before NMES in group N,and intravenous normal saline 0.12 ml/kg instead in group C.The systolic blood pressure(SBP) and heart rate(HR) at following time points: before skin incision(T1),before intravenous neostigmine/atropine or normal saline injection(T2),1 min after NMES(T3),and 10 min after NMES(T4).Results SBP and HR at T3 in group N were significantly lower than those in group C(P<0.01).No significant difference was found at T1,T2 and T4 between two groups(P>0.05).Cases who needed extra dose of fentanyl during NMES in group N were significantly lower than those in group C(P<0.01).Conclusion Intravenous pre-injection of neostigmine before NMES can effectively decrease the CVR caused by NMES.

Rizotomia seletiva posterior ou tratamento neuroevolutivo bobath para a criança com disfunção neuromotora espástica? / Selective posterior rhizotomy or bobath neuro-developmental treatment for the child with spastic neuromotor dysfunction?

A espasticidade encontra-se geralmente presente em crianças com Disfunção Neuromotora. Neste estudo, abordamos duas formas de tratamento que atuam na normalização do tônus, sendo uma cirúrgica e outra conservadora. A Rizotomia Seletiva Posterior caracteriza-se pela secção parcial das raízes aferentes lombo-sacrais. Já o Tratamento Neuroevolutivo Bobath utiliza técnicas manuais para adequar o tônus e, concomitantemente, proporcionar funcionalidade a criança. O objetivo do trabalho consiste na análise criteriosa das duas terapias, visando avaliar a necessidade de submeter o paciente a um procedimento invasivo. Pretendemos, desta forma, ampliar os conhecimentos dos profissionais que constituem uma equipe multidisciplinar, no sentido de facilitar a escolha do tratamento adequado para estas crianças com Disfunção Neuromotora. Independentemente do método eleito, é importante ressaltar que a qualidade de vida deve ser sempre priorizada. Portanto, o paciente precisa ser tratado como um todo, adequando o tônus e permitindo-lhe função. E de extrema importância a avaliação criteriosa individualizada, uma vez que a Rizotomia Seletiva Posterior pode atuar come complemento a reabilitação, na promoção de melhores resultados.

Spasticity is generally found in children with Neuromotor Dysfunction. In this study, we approach two forms of treatment that act in the normalization of the tone: one surgical and other conservative. The Selective Posterior Rhizotomy is characterized by the partial section of the afferent lombosacral roots. As for the Bobath Neuro-developmental treatment, some manual techniques are used to adequate the tone, and accordingly, to allow the children to make use of their functions. The objective of this paper is to analyze carefully both therapies, aiming at evaluating the need to submit the patient to surgery. We intend to enlarge the knowledge of professionals taking part of a Multidiscipline team, to facilitate the choice of the best treatment for children with Neuromotor Dysfunction. Regardless of the method chosen it is important to remark that the quality of life must be a priority. Therefore, the patients have to be treated as a whole, enabling them to adequate tone and allowing them to use the function. It is extremely important to have a very careful individual evaluation, once the Selective Posterior Rhizotomy can be a complement to rehabilitation for a better outcome.

Change of glucose in plasma in selective posterior rhizotomy at lumbar and sacral regions on cerebral palsy children / 中国康复理论与实践

@#Objective To investigate the carbohydrate metabolism during selective posterior rhizotomy (PCR) at lumbar and sacral regions on cerebral palsy children (CPC).Methods62 CPC who received SPR at lumbar and sacral regions under combined intravenous and inhalation anesthesia were tested with the level of glucose (Glu) in plasma at different time during the operation.Results and ConclusionThere is no significant difference of Glu at different time during the operation, however, the Glu level shows an elevating trend at 3 and 10 minutes after posterior root electric stimulation.

Effect of muscle stimulating instrument on patients with spasticity of lower limbs after surgical treatment / 中国康复理论与实践

@#ObjectiveTo observe the effect of muscle stimulating instrument on patients with spasticity of lower limbs after surgical treatment.Methods49 adults with spasticity of lower limbs after surgical treatment were divided into the treatment group (21 cases) and the control group (28 cases). Patients of two groups were treated with routien rehabilitation training, but muscle stimulating instruments treatment was added to patients of the treatment group. The muscle strength and motor ability of patients of two groups were followed up and compared.ResultsThe muscle strength and motor ability of the treatment group were better than that of the control group during follow-up period (P<0.05,P<0.01).ConclusionMuscle stimulating instrument can accelerate the recovery of muscle strength and motor ability in adults with spasticity of lower limbs after surgical treatment.

Effect of Both Limited Selective Posterior Rhizotomy and Limited Selective Soft Tissue Release Treating Spasmo-Cerebral Palsy in Both Legs / 实用儿科临床杂志

Objective To analyze the effect of both limited selective posterior rhizotomy(LSPR)and limited selective soft tissue release(LSTR)on healing motor function related to spasmo-cerebral palsy in both legs.Methods Thirty-eight cases CP with LSPR and LSTR were collected in the past 3 years;21 males,17 females;aged 3.0-8.11 years old,on the average of 5.11 years old.Perioperative motor function were evaluated according to motor function scores.Results LSPR and LSTR played a role in improving motor function obviously,and had little difference in orthomorphia after SPR for 6 months.Conclusion LSPR and LSTR may improve cramp and abnormality in both legs,and enhance motor function,so the secondary operation agony can be avoided,and the family economic burden relived.

Kinematic Gait Analysis in Children with Spastic Diplegic Cerebral Palsy after Selective Posterior Rhizotomy: Long Term Follow Up

OBJECTIVE: To evaluate the changes of kinematic gait patterns at long-term follow up study after selective posterior rhizotomy (SPR) in children with spastic diplegic cerebral palsy. METHOD: Eighteen children with spastic diplegic cerebral palsy participated in this study. Gait patterns on sagittal plane were studied before and at average 3.5 years after SPR. Kinematic and temporospatial data were obtained by the VICON 370 system. RESULTS: The spasticity of hip adductor and ankle plantar flexor were improved significantly after SPR. The maximal angle of pelvic tilt, ankle dorsiflexion angle at initial contact, peak ankle dorsiflexion angle during stance phase, at toe-off and during swing phase, mid-range point of flexion-extension motion on ankle were significantly improved after SPR. The temporospatial data tended to improve after SPR at long-term follow up. CONCLUSION: The SPR reduced spasticity and the gait pat terns were improved in children with spastic diplegic cere bral palsy at long-term follow up.

Effect of muscle stimulating instrument on muscle stone of children with cerebral palsy after selective posterior rhizotomy / 中国康复理论与实践

@# ObjectiveTo observe the effect of muscle stimulating instrument in enforcing muscle stone of children with cerebral palsy after selective posterior rhizotomy(SPR).Methods106 patients were divided into two groups,treatment group(n=51) and control group(n=55).Two groups received routine rehabilitation therapy,otherwise,treatmwnt group were treated with the muscle stimulating instrument after SPR.Pretreatment and 30d,60d,180d after treatment,muscle stone of two groups was measured and compared.ResultsImprovement of treatment group in muscle stone was better than that of control group(P<0.01).ConclusionMuscle stimulating instrument is effective to improve muscle tone of children with cerebral palsy after SPR.

Selective posterior rhizotomy and procedural treatment on spastic cerebal palsy / 中国康复理论与实践

@#ObjectiveTo evaluate the effect of selective posterior rhizotomy(SPR),local corrective surgery and the training of rehabilitation on the relief of limb spasm secondary to cerebral palsy.MethodsThe "open window" of bilateral vertebral lamina resection, the the posterior roots of L2-S1 were separated from anterior roots and splited into rootlets. The rootlets sensitive to lower threshold of electrical stimulation were sectioned. The ratios of cut root,acorrding to muscle tension, myodynamia, body weight, muscle function,were estimated and all of them <30%. The local plastic operation was performed for nonimprovement of lower limb spasm and the training of rehabilitation began at postoperation. ResultsThe SPR have been performed on 28 cases. The rate of spasticity relief was 90% and the rate of functional improvement was 80% with follow-up. ConclusionsIt is a successful way to treat spastic cerebral palsy with SPR and procedural method.

Muscle stimulating instrument on children with cerebral palsy after seletive posterior rhizotomy / 中国康复理论与实践

@#ObjectiveTo observe the effect of Muscle Stimulating Instrument in enforcing the strength of weaken muscles after selective posterior rhizotomy (SPR). MethodsA group of 27 patients with spastic cerebral palsy aging from 3 to 10 years at the average of 5.7 years were treated with the instrument after SPR. A control group of 36 cases was adopted. Muscle strength, gait and motor function amelioration were compared between two groups. ResultsResults of treatment group in both muscle strength and motor function are better than those of the control group (P<0.05).ConclusionsMuscle stimulating instrument is effective to tone up the muscles which patients felt weak after SPR, and to accelerate the course of rehabilitation.

The Effect of Selective Posterior Rhizotomy and Rehabilitation Therapy on Motor Function of Patients with Spastic Cerebral Palsy / 中国康复理论与实践

@#Objects:To observe the effort of rehabilitation therapy after SPR.Methods:Twenty CP patients with spasticity were operated from December 1996 to October 1997.Occupational therapy was used in conjunction with Bobath method which formed the base of PT.Results:All values of muscle tone before and after operation were significantly different.Strength of many muscular groups was lower than normal level before operation and decreased further postoperatively.Sitting,kneeling and standing posture improved after operation and rehabilitation.There were 9 independent walk cases improved stride length,heel contact pattern and they had no scissors gait after rehabilitation.Conclusion:The goals of rehabilitation training focused on building muscle strength,stretching contractures and building up right posture control,inhibiting abnormal movement pattern,and gradually forming nornmal movement pattern.

Changes of Dermatomal Somatosensory Evoked Potentials in the Children with Spastic Cerebral Palsy after Selective Posterior Rhizotomy

OBJECTIVE: To evaluate the changes of dermatomal SEP (DSEP) in children with a spastic cerebral palsy (CP) after the selective posterior rhizotomy (SPR). METHOD: The subjects were 14 spastic CP children, with the age from 3 to 6 years old, who underwent SPR. DSEPs were studied at the L2-3, L4, L5, S1 dermatomes bilaterally, pre and postoperatively. Postoperative DSEPs were interpreted by the changes of latency, amplitude and waveforms. RESULTS: 1) All children were spastic diplegia except one who was a spastic hemiplegia. 2) Preoperative DSEPs were flat or severely distorted in 40 of 112 waveforms (34.5%). 3) Postoperative DSEP latencies were no change in 39.3%, improved in 17.9%, and worsened in 25.6% respectively. Amplitudes were no change in 30.8%, improved in 38.5%, and worsened in 13.7% respectively. Waveforms were no change in 64.1%, improved in 22.2%, and worsened in 8.5% respectively. There was no statistical difference of postoperative changes of the 3 categories according to the root levels. CONCLUSION: The results showed that the preoperative DSEPs were abnormal in 34.5% suggestive the lesions of CP being more widespread than strictly involving the motor system. This study confirmed that the most SEPs unchanged by the SPR. A further study for the relationship of postoperative DSEP changes and clinical findings such as functional impairment would be needed.

Hip Migration after Selective Posterior Rhizotomy in Cerebral Palsy / 대한정형외과학회잡지

Hip subluxation and dislocation are common orthopaedic problems in children with cerebral palsy. Selective posterior rhizotomy(SPR) is a neurologic procedure aimed in reducing spasticity. Several recent studies have indicated a decrease in spasticity and functional improvement after SPR, and also decrease the tendency toward hip subluxation in children with cerebral palsy. This is a retrospective study to examine whether SPR halts hip subluxation. Between May 1994 and July 1996, 22 children below age of 5 underwent SPR. Twenty children were spastic diplegic types and 2 were mixed type and quadriplegic type respectively. Approximately 50-80% of L2-Sl level dorsal roots was cut, and 13 children had 50% of both Ll roots cut. Migration percentage score (MP) was used to determine progression of hip subluxation during the follow up period (12 36 mos.; Average 15 mos.). Of the total 44 hips in 22 patients, 45.5% (20 hips) improved, 34% (15 hips) remained unchanged, and 20.5% (9 hips) were worsened after SPR. Radiographic stability was achieved in 79.5%. Ll root cut rate (Ll SPR) was 55.5% for improved hips, 67% for unchanged hips, and 50% for worsened hips. Two patients had undergone orthopaedic procedure for progressive hip migration. Most patients experienced postoperative hip stability after SPR, but 20.5% were worsened and 2 patients had orthopaedic procedure. Also it is unlikely that Ll root involvement prevents progression of hip migration.

The Effectiveness of Selective Posterior Rhizotomy for the Rehabilitation in Children with Cerebral Palsy

Selective posterior rhizotomy (SPR) is a neurosurgical procedure designed to alleviate spasticity and has been successfully used for children with spastic cerebral palsy. We evaluated eleven children who had follow up over 6 months after SPR among sixteen children who underwent SPR from August 1995 to July 1996. The authors have analyzed the status of the children with spastic cerebral palsy before and after operation to determine the effects of this therapy on muscle tone, functional grade, gross motor function and gait pattern. Gross motor function was measured by gross motor function measure(GMFM) scale. Postoperative tests showed reduction in muscle tone in all cases compared with preoperative assessments. Functional grade was increased in 90% of the cases more than one grade. The total gross motor mean score change between the preoperative and 6 months postoperative score was 16. Gross motor scores were analysed in each of 5 dimensions(88 conditions), i.e., lying and rolling, sitting, crawling and kneeling, standing, and walking, running, jumping. Gross motor score for each dimension improved in all cases. The greatest improvement was seen in sitting scores. The results of gait analysis of 2 ambulatory patients showed increased range of motion of hip and knee joints throughout the gait cycle and increased ankle dorsiflexion during swing phase. These results showed that SPR combined with intensive postoperative rehabilitation for children with spastic cerebral palsy had a significant positive effect on gross motor function.

Analysis of factors affecting stress in selective posterior rhizotomy / 中国康复理论与实践

@#用秩和比法对37例脑瘫患者施行SPR术中影响应激反应的诸因素进行分析。结果显示：3—6岁小儿、切断后根小束大于50％者、电刺激量平均为5．1—10mA者、芬太尼量大于3μg／kg·h者和于腰骶部行SPR者应激反应最强。3、4级痉挛者、芬太尼量为2．1—3μg／kg·h者、7—13岁儿童、切断后根小束41—50％者和电刺激量平均大于10mA者应激反应较强。5级痉挛、14岁以上青成年和电刺激量平均小于5mA者，应激反应较弱。而芬太尼量小于2μg／kg·h、切断后根小束少于40％和行颈胸段SPR者应激反应最弱。经临床分析，作者提出：SPR中应特别注意6岁前小儿及切断后根小束超过50％的脑瘫患者的应激反应。