Selective dorsal rhizotomy for spasticity associated with spinal cord injury sustained during surgery for spinal lipomatous malformation: A case report.

Selective dorsal rhizotomy (SDR) was used to treat lower extremity spasticity in an ambulatory 7-year-old girl with a history of a T10 spinal lipoma. The spasticity was the result of an AIS D spinal cord injury (SCI) suffered during untethering surgery at age 2 years. After SDR and a course of intensive inpatient rehabilitation, the patient's gait improved markedly. To the authors' knowledge, this is the first published case of SDR as a treatment for spasticity in a patient with a spinal lipomatous malformation.

Instrumented gait analysis for management of gait disorders in children with cerebral palsy: A scoping review.

BACKGROUND: The use of Instrumented Gait Analysis (IGA) for the clinical management of individuals with cerebral palsy (CP) has increased in recent years. Previous systematic reviews have been completed to evaluate and summarize the evidence related to the efficacy of IGA in general. However, a focused summary of research studies on IGA for children with CP related gait disorders is needed. RESEARCH QUESTION: The purpose of the current work was to perform a scoping review to describe and categorize the range of existing literature about IGA as applied to the clinical management of children with CP related gait disorders. METHOD: A health sciences librarian developed a search strategy to include four key inclusion criteria of original research study, population included children with CP, study employed IGA, available in English. The available literature was organized into six study categories: reliability and validity, documentation of subgroups or model development, IGA for clinical decision making, effectiveness of treatments that depend on IGA, cost effectiveness, IGA used to evaluate the outcome of surgical, medical or rehabilitation treatment. RESULTS: 909 studies met the inclusion criteria and were placed into the six study categories. 14 % of studies were in reliability and validity, 33 % in subgroups or modeling, 2% in IGA for clinical decision making, 2% in treatments that depend on IGA, 1% in cost effectiveness, and 49 % of studies had IGA used as an outcome measure for treatment. SIGNIFICANCE: This scoping review has documented the wide range, diversity and extent of original research studies investigating the use of IGA for the clinical management of children with CP related gait disorders. The large volume of studies provides a basis for future work to develop a CPG about the use of IGA for the clinical management of children with CP related gait disorders.

Short-burst interval treadmill training walking capacity and performance in cerebral palsy: a pilot study.

PURPOSE: To examine the effect of short-burst interval locomotor treadmill training (SBLTT) on walking capacity and performance in cerebral palsy (CP). METHODS: Twelve children with spastic diplegic CP (average 8.6 years) across Gross Motor Function Classification System levels II (8) and III (4) were randomized to 20 SBLTT sessions over 4 or 10 weeks. SBLTT consisted of alternating 30 seconds of slow and fast walking for 30 minutes/session. Outcomes included the 10 m walk test, one-minute walk test (1MWT), and timed-up-and go (TUG) (capacity) and StepWatch (performance) collected at baseline, post, and 6 weeks post. RESULTS: Fast speed (+.11, p = .04; +.11 m/s, p = .006), 1MWT (+11.2; +11.7 m, p = .006) and TUG (-1.7; -1.9 seconds, p = .006) improved post SBLTT and 6 weeks, respectively. Walking performance increased: average strides/day (+948; +1712, p < .001) and percent time in high strides rates (+0.4, p = 0.07; +0.2, p = .008). CONCLUSIONS: Pilot study suggests SBLTT may improve short-term walking capacity and performance.

Effectiveness of Rehabilitation Interventions to Improve Gait Speed in Children With Cerebral Palsy: Systematic Review and Meta-analysis.

BACKGROUND: Children with cerebral palsy (CP) have decreased gait speeds, which can negatively affect their community participation and quality of life. However, evidence for effective rehabilitation interventions to improve gait speed remains unclear. PURPOSE: The purpose of this study was to determine the effectiveness of interventions for improving gait speed in ambulatory children with CP. DATA SOURCES: MEDLINE/PubMed, CINAHL, ERIC, and PEDro were searched from inception through April 2014. STUDY SELECTION: The selected studies were randomized controlled trials or had experimental designs with a comparison group, included a physical therapy or rehabilitation intervention for children with CP, and reported gait speed as an outcome measure. DATA EXTRACTION: Methodological quality was assessed by PEDro scores. Means, standard deviations, and change scores for gait speed were extracted. General study information and dosing parameters (frequency, duration, intensity, and volume) of the intervention were recorded. DATA SYNTHESIS: Twenty-four studies were included. Three categories of interventions were identified: gait training (n=8), resistance training (n=9), and miscellaneous (n=7). Meta-analysis showed that gait training was effective in increasing gait speed, with a standardized effect size of 0.92 (95% confidence interval=0.19, 1.66; P=.01), whereas resistance training was shown to have a negligible effect (effect size=0.06; 95% confidence interval=-0.12, 0.25; P=.51). Effect sizes from negative to large were reported for studies in the miscellaneous category. LIMITATIONS: Gait speed was the only outcome measure analyzed. CONCLUSIONS: Gait training was the most effective intervention in improving gait speed for ambulatory children with CP. Strength training, even if properly dosed, was not shown to be effective in improving gait speed. Velocity training, electromyographic biofeedback training, and whole-body vibration were effective in improving gait speed in individual studies and warrant further investigation.

A longitudinal study of outcome measures for children receiving early intervention services.

PURPOSE: The purpose of this study was to compare the Pediatric Evaluation of Disability Inventory (PEDI) and the Mullen Scales of Early Learning (MSEL) as measures of change in children who received early intervention services. METHODS: Thirty-four children were stratified into 2 groups according to the presence of gross motor delay. The PEDI and MSEL were administered 3 times: at an average age of 18, 31, and 53 months of age. Data were analyzed using a repeated-measures multivariate analysis of variance. RESULTS: The findings suggest that PEDI Functional Skills Scaled Scores were capable of measuring change in both groups of children. The standard scores on the PEDI Functional Skills Social Scale were found to be more sensitive to change than the MSEL Receptive and Expressive Language scores for children with motor delays. CONCLUSION: Using PEDI scaled scores may be an effective strategy for measuring change in children receiving early intervention services.

Treadmill training for an infant born preterm with a grade III intraventricular hemorrhage.

BACKGROUND AND PURPOSE: Research has documented the feasibility and benefit of treadmill training in children with cerebral palsy and Down syndrome. The purposes of this case report are: (1) to determine the feasibility of treadmill training in an infant at high risk for neuromotor dysfunction and (2) to describe the child's treadmill stepping patterns following treadmill training. CASE DESCRIPTION: The male infant, who had a grade III intraventricular hemorrhage following premature birth, began physical therapy and treadmill training at 51/4 months corrected age. Treadmill training was conducted 3 times weekly and videotaped weekly. Videotape analysis determined number of steps, step type, and foot position. OUTCOMES: Except for foot position, trends in treadmill stepping were similar to those of studies with infants not at high risk for neuromotor disabilities. DISCUSSION: This case report shows that treadmill training is feasible for an infant at high risk for neuromotor disabilities and may be associated with more mature stepping characteristics. Future research should evaluate optimum treadmill training parameters and long-term developmental outcomes.

Reliability and validity of the gross motor function classification system for cerebral palsy.

PURPOSE: The purposes of this study were to evaluate interrater reliability using videotapes and criterion-related and construct validity of the Gross Motor Function Classification System (GMFCS), aspects of reliability and validity not previously published. METHODS: Two experienced pediatric physical therapists rated 30 videotapes of children with cerebral palsy (CP) or Down syndrome (DS) to test interrater reliability. Criterion-related validity was evaluated by comparing GMFCS levels with tests of motor and nonmotor development. Construct validity was assessed by comparing GMFCS trends over time in children with CP and DS. RESULTS: Interrater reliability was 0.84. Correlation was higher between GMFCS level and tests of motor development than GMFCS level and tests of nonmotor development. The GMFCS level remained relatively stable in children with CP but tended to improve in children with DS. CONCLUSIONS: This study extends reliability and validity of the GMFCS, supporting its use in clinical practice and research.