Aprendizaje motor durante la realización de una tarea motora medido con resonancia magnética: una revisión sistemática / Motor learning while performing a motor task measured by magnetic resonance imaging: a systematic review

Introducción: Distintas variables, como la repetición y la carga cognitiva, pueden explicar las diferencias neurofisiológicas que se observan en el aprendizaje motor entre una tarea u otra. Este aprendizaje se puede medir con resonancia magnética funcional. Objetivo: El objetivo de esta revisión sistemática fue documentar el aprendizaje motor mediante resonancia magnética funcional durante la realización de distintas tareas motoras simples o complejas en sujetos sanos. Material y métodos. La búsqueda de artículos se realizó en las bases de datos MEDLINE, PEDro, CINHAL y EBSCO en mayo de 2020. Para realizar la revisión sistemática se siguieron los criterios PRISMA. Resultados: Se seleccionaron nueve estudios para realizar su análisis cualitativo. La calidad de los estudios osciló entre los 5 y los 7 puntos según la escala PEDro. El análisis cualitativo muestra evidencia fuerte de que tras la repetición de una tarea motora se genera un proceso de aprendizaje motor. Existe evidencia fuerte y moderada de que la observación de acciones y la restricción del sueño intervienen en el aprendizaje motor. Los resultados acerca del entrenamiento de discriminación sensorial fueron controvertidos. Conclusiones: Los resultados muestran con una calidad de la evidencia fuerte que la repetición de una tarea motora está relacionada con el proceso de aprendizaje, lo que parece guardar relación con un engrosamiento de la corteza motora tras la intervención medido con resonancia magnética funcional. Estos resultados no son concluyentes, debido a los factores limitantes de esta revisión sistemática.(AU)

Introduction: Different variables, such as repetition and cognitive load, may explain the neurophysiological differences observed from one task to another in motor learning. This learning can be measured with functional magnetic resonance imaging. Aim: The aim of this systematic review was to document motor learning by functional magnetic resonance imaging during the performance of different simple or complex motor tasks in healthy subjects. Material and methods: The search for articles was carried out in the MEDLINE, PEDro, CINHAL and EBSCO databases in May 2020. The systematic review followed the PRISMA criteria. Results: Nine studies were selected for a qualitative analysis. The quality of the studies ranged from 5 to 7 points on the PEDro scale. The qualitative analysis shows strong evidence that after repeating a motor task a motor learning process is generated. There is both strong and moderate evidence to show that action observation and sleep restriction are involved in motor learning. The results on sensory discrimination training were controversial. Conclusions: The results show, with high quality evidence, that repetition of a motor task is associated with the learning process, which seems to be related to a thickening of the motor cortex after the intervention measured with functional magnetic resonance imaging. These results are not conclusive, owing to the limiting factors of this systematic review.(AU)

[Motor learning while performing a motor task measured by magnetic resonance imaging: a systematic review]. / Aprendizaje motor durante la realización de una tarea motora medido con resonancia magnética: una revisión sistemática.

INTRODUCTION: Different variables, such as repetition and cognitive load, may explain the neurophysiological differences observed from one task to another in motor learning. This learning can be measured with functional magnetic resonance imaging. AIM: The aim of this systematic review was to document motor learning by functional magnetic resonance imaging during the performance of different simple or complex motor tasks in healthy subjects. MATERIAL AND METHODS: The search for articles was carried out in the MEDLINE, PEDro, CINHAL and EBSCO databases in May 2020. The systematic review followed the PRISMA criteria. RESULTS: Nine studies were selected for a qualitative analysis. The quality of the studies ranged from 5 to 7 points on the PEDro scale. The qualitative analysis shows strong evidence that after repeating a motor task a motor learning process is generated. There is both strong and moderate evidence to show that action observation and sleep restriction are involved in motor learning. The results on sensory discrimination training were controversial. CONCLUSIONS: The results show, with high quality evidence, that repetition of a motor task is associated with the learning process, which seems to be related to a thickening of the motor cortex after the intervention measured with functional magnetic resonance imaging. These results are not conclusive, owing to the limiting factors of this systematic review.

TITLE: Aprendizaje motor durante la realización de una tarea motora medido con resonancia magnética: una revisión sistemática.Introducción. Distintas variables, como la repetición y la carga cognitiva, pueden explicar las diferencias neurofisiológicas que se observan en el aprendizaje motor entre una tarea u otra. Este aprendizaje se puede medir con resonancia magnética funcional. Objetivo. El objetivo de esta revisión sistemática fue documentar el aprendizaje motor mediante resonancia magnética funcional durante la realización de distintas tareas motoras simples o complejas en sujetos sanos. Material y métodos. La búsqueda de artículos se realizó en las bases de datos MEDLINE, PEDro, CINHAL y EBSCO en mayo de 2020. Para realizar la revisión sistemática se siguieron los criterios PRISMA. Resultados. Se seleccionaron nueve estudios para realizar su análisis cualitativo. La calidad de los estudios osciló entre los 5 y los 7 puntos según la escala PEDro. El análisis cualitativo muestra evidencia fuerte de que tras la repetición de una tarea motora se genera un proceso de aprendizaje motor. Existe evidencia fuerte y moderada de que la observación de acciones y la restricción del sueño intervienen en el aprendizaje motor. Los resultados acerca del entrenamiento de discriminación sensorial fueron controvertidos. Conclusiones. Los resultados muestran con una calidad de la evidencia fuerte que la repetición de una tarea motora está relacionada con el proceso de aprendizaje, lo que parece guardar relación con un engrosamiento de la corteza motora tras la intervención medido con resonancia magnética funcional. Estos resultados no son concluyentes, debido a los factores limitantes de esta revisión sistemática.

Fiabilidad intra e interevaluador de un sensor inercial para el rango de movimiento de la rodilla en sujetos asintomáticos / Intra- and inter-reliability of an inertial sensor for knee range of motion in asymptomatic subjects

Introducción: La cuantificación del rango de movimiento de la rodilla es una medida clínicamente relevante en el ámbito sanitario, ya que su disminución puede alterar las actividades de la vida diaria. La obtención de una medida fiable del rango de movimiento nos permite valorar la eficacia de las intervenciones, así como la gravedad de la enfermedad. Por esto, el objetivo de este estudio fue conocer la fiabilidad intra e interevaluador de un protocolo para el rango de movimiento articular de la rodilla llevado a cabo con un sensor inercial en sujetos asintomáticos. Métodos: Se midió el rango de movimiento de 32 rodillas en sujetos asintomáticos, se realizaron 2 sesiones de medición, una por evaluador, en el mismo día. En cada sesión se hicieron un total de 8 mediciones (2 medidas para flexión en decúbito supino, 2 medidas para extensión en decúbito supino, 2 medidas para flexión en bipedestación y 2 para la extensión en bipedestación). Resultados: Para la fiabilidad interevaluador se consiguieron buenos resultados con un ICC superior a 0,79 para todos los movimientos. Los datos obtenidos para la fiabilidad intraevaluador en todos los movimientos fueron excelentes (ICC > 0,88). Conclusión: Este estudio obtuvo una excelente fiabilidad interevaluador e intraevaluador para los sujetos sanos midiendo con sensores inerciales

Introduction: The quantification of knee range of motion is a clinically relevant measurement in the healthcare setting, as its decrease can alter activities of daily living. Collecting reliable measurements of the range of motion allows us to evaluate the reliability of interventions, or the severity of the pathology. The objective of this study was to obtain the intra- and inter- rater reliability of a protocol for the knee the range of joint motion, measured with an inertial sensor in asymptomatic subjects. Methods: The range of motion of 32 asymptomatic knees was measured. Two measurement sessions were performed by two different evaluators. A total of 8 measurements were made in each session: 2 measurements for flexion in supine decubitus position, 2 measurements for extension in supine decubitus, 2 measurements for flexion in standing position and 2 measurements for extension in standing position. Results: For inter-rater reliability, good results were achieved, with an ICC > 0.79 for all movements. The obtained data for intra-rater reliability in all the movements was excellent, with an ICC > 0.88. Conclusion: This study obtained excellent inter-rater and intra-rater reliability for healthy subjects

Outcome of childhood leukaemia survivors and necrosis of the femoral head treated with autologous mesenchymal stem cells

Purpose. Corticoid-induced osteonecrosis (ON) of femoral head can lead to severe hip joint impairment and hip replacement, with negative impact in young survivors of acute lymphoblastic leukaemia (ALL) with long life expectancy. We aim to improve quality of life in these patients with a novel approach. Methods/patients. Based on the regenerative capacities of mesenchymal stem cells (MSCs), we performed locally implanted autologous cell therapy in two adolescents suffering of bilateral femoral ON. This required a simple, minimally invasive surgical procedure. Results. Both patients experienced significant pain relief and restoration of gait kinematic values. Radiographic evaluation showed cessation of hip collapse. No toxicities/complications were observed after a 4-year follow-up. Conclusions. Our preliminary results suggest that autologous MSCs can be considered as a novel treatment for children and young adults with ON after overcoming ALL. It may avoid hip replacement and improve quality of life of leukaemia survivors

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Análisis bioconductual del sistema vestibular y el control postural en pacientes con mareo cervicogénico. Estudio observacional transversal / Biobehavioural analysis of the vestibular system and posture control in patients with cervicogenic dizziness. A cross-sectional study

Introducción: El mareo cervicogénico es una afección que se caracteriza por mareos y desequilibrio que se asocia a dolor de cuello. La fisiopatología no está clara, y es necesario conocer la base neurofisiológica del trastorno. El objetivo de estudio es comparar la actividad del reflejo vestíbulo-ocular y el control postural entre pacientes que presentan mareo cervicogénico y sujetos asintomáticos; además, se pretende evaluar la asociación entre la discapacidad por mareo con otras variables psicosociales. Material y métodos: Se seleccionaron un total de 20 pacientes y 22 sujetos asintomáticos, a los que se realizó una valoración del reflejo vestíbulo-ocular con el test del impulso cefálico y una valoración del control postural mediante posturografía dinámica y el test de organización sensorial, además se evaluaron mediante autoinforme la discapacidad por mareo, la discapacidad cervical, el miedo al movimiento y el estado de ansiedad y depresión. Resultados: No se encontraron diferencias en la actividad del reflejo vestíbulo-ocular (p > 0,05); a nivel del control postural se encontraron diferencias con un tamaño del efecto mediano-grande (d > 0,60) en variables relacionadas con la propiocepción e integración de la información visual, asociándose esta variable a la discapacidad por mareo. La discapacidad por mareo presentó asociaciones moderadas-fuertes con la discapacidad cervical, el miedo al movimiento y la ansiedad. Conclusión: Los resultados obtenidos descartan una alteración del sistema vestibular en el mareo cervicogénico, aunque sí se comprueba la existencia de una alteración propioceptiva. La asociación de la discapacidad por mareo con otras variables psicosociales a la vista de nuestros resultados debe tomarse en cuenta en la clínica y en futuras investigaciones (AU)

Background: Cervicogenic dizziness is a musculoskeletal disorder mainly characterised by dizziness and disequilibrium associated with neck pain. The pathophysiology is unclear and the neurophysiological basis remains to be ascertained. The aim of this study is to compare the vestibulo-ocular reflex and postural control between patients with cervicogenic dizziness and asymptomatic subjects, and to assess the association between debilitating dizziness and other psychosocial variables. Materials and methods: A total of 20 patients and 22 asymptomatic subjects were selected. Vestibulo-ocular reflex was assessed by performing the head impulse test. Computerised dynamic posturography was used to evaluate the postural control by means of the sensory organisation test. In addition, subjects self-reported their degree of disability due to dizziness, cervical disability, kinesiophobia, and state of anxiety and depression. Results: There were no differences in the vestibulo-ocular reflex (P > .05). However, we found differences with a medium-to-large effect size (d > 0.60) in variables related to proprioception and visual information integration; the former variable set was related to disability due to dizziness. Disability due to dizziness presents strong-to-moderate associations with cervical disability, kinesiophobia, and anxiety. Conclusion: Our data rule out changes in the vestibular system in cervicogenic dizziness, but they do point to proprioceptive impairment. According to our results, the association between dizziness-related disability and other psychosocial factors in cervicogenic dizziness is very relevant for clinical medicine and for future research projects (AU)

Outcome of childhood leukaemia survivors and necrosis of the femoral head treated with autologous mesenchymal stem cells.

PURPOSE: Corticoid-induced osteonecrosis (ON) of femoral head can lead to severe hip joint impairment and hip replacement, with negative impact in young survivors of acute lymphoblastic leukaemia (ALL) with long life expectancy. We aim to improve quality of life in these patients with a novel approach. METHODS/PATIENTS: Based on the regenerative capacities of mesenchymal stem cells (MSCs), we performed locally implanted autologous cell therapy in two adolescents suffering of bilateral femoral ON. This required a simple, minimally invasive surgical procedure. RESULTS: Both patients experienced significant pain relief and restoration of gait kinematic values. Radiographic evaluation showed cessation of hip collapse. No toxicities/complications were observed after a 4-year follow-up. CONCLUSIONS: Our preliminary results suggest that autologous MSCs can be considered as a novel treatment for children and young adults with ON after overcoming ALL. It may avoid hip replacement and improve quality of life of leukaemia survivors.

Biobehavioural analysis of the vestibular system and posture control in patients with cervicogenic dizziness. A cross-sectional study. / Análisis bioconductual del sistema vestibular y el control postural en pacientes con mareo cervicogénico. Estudio observacional transversal.

BACKGROUND: Cervicogenic dizziness is a musculoskeletal disorder mainly characterised by dizziness and disequilibrium associated with neck pain. The pathophysiology is unclear and the neurophysiological basis remains to be ascertained. The aim of this study is to compare the vestibulo-ocular reflex and postural control between patients with cervicogenic dizziness and asymptomatic subjects, and to assess the association between debilitating dizziness and other psychosocial variables. MATERIALS AND METHODS: A total of 20 patients and 22 asymptomatic subjects were selected. Vestibulo-ocular reflex was assessed by performing the head impulse test. Computerised dynamic posturography was used to evaluate the postural control by means of the sensory organisation test. In addition, subjects self-reported their degree of disability due to dizziness, cervical disability, kinesiophobia, and state of anxiety and depression. RESULTS: There were no differences in the vestibulo-ocular reflex (P>.05). However, we found differences with a medium-to-large effect size (d>0.60) in variables related to proprioception and visual information integration; the former variable set was related to disability due to dizziness. Disability due to dizziness presents strong-to-moderate associations with cervical disability, kinesiophobia, and anxiety. CONCLUSION: Our data rule out changes in the vestibular system in cervicogenic dizziness, but they do point to proprioceptive impairment. According to our results, the association between dizziness-related disability and other psychosocial factors in cervicogenic dizziness is very relevant for clinical medicine and for future research projects.

European consensus on the concepts and measurement of the pathophysiological neuromuscular responses to passive muscle stretch.

BACKGROUND AND PURPOSE: To support clinical decision-making in central neurological disorders, a physical examination is used to assess responses to passive muscle stretch. However, what exactly is being assessed is expressed and interpreted in different ways. A clear diagnostic framework is lacking. Therefore, the aim was to arrive at unambiguous terminology about the concepts and measurement around pathophysiological neuromuscular response to passive muscle stretch. METHODS: During two consensus meetings, 37 experts from 12 European countries filled online questionnaires based on a Delphi approach, followed by plenary discussion after rounds. Consensus was reached for agreement ≥75%. RESULTS: The term hyper-resistance should be used to describe the phenomenon of impaired neuromuscular response during passive stretch, instead of for example 'spasticity' or 'hypertonia'. From there, it is essential to distinguish non-neural (tissue-related) from neural (central nervous system related) contributions to hyper-resistance. Tissue contributions are elasticity, viscosity and muscle shortening. Neural contributions are velocity dependent stretch hyperreflexia and non-velocity dependent involuntary background activation. The term 'spasticity' should only be used next to stretch hyperreflexia, and 'stiffness' next to passive tissue contributions. When joint angle, moment and electromyography are recorded, components of hyper-resistance within the framework can be quantitatively assessed. CONCLUSIONS: A conceptual framework of pathophysiological responses to passive muscle stretch is defined. This framework can be used in clinical assessment of hyper-resistance and will improve communication between clinicians. Components within the framework are defined by objective parameters from instrumented assessment. These parameters need experimental validation in order to develop treatment algorithms based on the aetiology of the clinical phenomena.

Efectos a medio y largo plazo sobre la marcha de un programa de ejercicio domiciliario y ortesis de uso nocturno en niños con equinismo idiopático / Medium and long-term effects on gait cycle of home-based exercise program and use of a night splint in children with idiopathic toe walking

Introducción: El equinismo idiopático es una alteración de la marcha pediátrica caracterizada por la realización de una excesiva flexión plantar del tobillo durante la marcha. No hay consenso en la literatura acerca de la mejor oferta terapéutica, coexistiendo opciones conservadoras y quirúrgicas en la práctica clínica. El objetivo de este trabajo es comprobar el impacto de un programa de ejercicios domiciliarios asociado al uso de una ortesis nocturna en el manejo del niño con equinismo idiopático. Material y métodos: Se realizó un estudio cinemático comparativo a los 6, 12 y 18 meses de 29 niños con equinismo idiopático, comparando los datos con los de 15 niños con marcha normal. La propuesta de tratamiento consistió en ejercicios domiciliarios asociados a una ortesis de uso nocturno durante 12 meses. Resultados: La propuesta terapéutica planteada ofrece normalización de los parámetros cinemáticos a los 18 meses de evolución. Se encontraron cambios estadísticamente significativos en los valores cinemáticos de la marcha estudiados (A1, A3, A5 y GDI), así como en una de las variables de la exploración física (rango de dorsiflexión). Todos los cambios se produjeron en dirección a los valores cinemáticos durante la marcha del grupo de niños sin patología. Conclusiones: El análisis del movimiento es una herramienta de monitorización de los trastornos de la marcha y control de evolución para los niños con equinismo idiopático. El ejercicio domiciliario asociado a una ortesis nocturna ofrece resultados positivos en la corrección de la marcha en niños con equinismo idiopático (AU)

Introduction: Idiopathic toe walking (ITW) is a common paediatric gait disorder characterised by excessive plantar flexion during the gait cycle. There is no consensus in the literature about the best therapeutic approach to treat ITW and different conservative and surgical options are used in clinical practice. The main objective of this study is to evaluate the clinical impact of a home-based exercise program associated with the use of a night splint (AFO) for managing gait problems in children with ITW. Material and methods: This is a comparative kinematic study. Long-term follow-ups were conducted at 6, 12, and 18 months with 29 children with ITW and 15 healthy children. The proposed treatment was a home-based exercise associated with a night splint for 12 months. Results: The therapeutic approach improved several kinematic values by the 18-month follow-up. We found statistically significant differences for gait kinematics (A1, A3, A5 and GDI) and one of the clinical examination variables (ankle passive dorsiflexion). All the differences showed a normalization of gait kinematics, with critical kinematic values close to the normalcy data. Conclusions: 3D gait analysis is an assessment tool for gait disorders and for long-term follow-up of children with ITW. Our home-based exercise associated with a night splint showed good results for gait disorders treatment in children with idiopathic toe walking (AU)

Non-pharmacological treatment for neuropathic pain in children with cancer.

Neuropathic pain (NP) associated with childhood cancer is currently a difficult problem to control. It is treated with drugs that not only fail to provide the expected improvements, but which also have side effects. Therefore, the main aim of this pilot study is to assess whether non-pharmacological treatments, Graded Motor Imagery (GMI) and Neural Mobilization (NM), have a positive effect on this pain, thus improving the associated comorbid factors and, consequently, the quality of life of the children. In an n = 6, the results after 4 weeks of treatment show a 10-point improvement in the pain threshold and a 3.1-point improvement in the perception of pain.

Relative fascicle excursion effects on dynamic strength generation during gait in children with cerebral palsy.

Evaluation of muscle structure gives us a better understanding of how muscles contribute to force generation which is significantly altered in children with cerebral palsy (CP). While most muscle structure parameters have shown to be significantly correlated to different expressions of strength development in children with CP and typically developing (TD) children, conflicting results are found for muscle fascicle length. Muscle fascicle length determines muscle excursion and velocity, and contrary to what might be expected, correlations of fascicle length to rate of force development have not been found for children with CP. The lack of correlation between muscle fascicle length and rate of force development in children with CP could be due, on the one hand, to the non-optimal joint position adopted for force generation on the isometric strength tests as compared to the position of TD children. On the other hand, the lack of correlation could be due to the erroneous assumption that muscle fascicle length is representative of sarcomere length. Thus, the relationship between muscle architecture parameters reflecting sarcomere length, such as relative fascicle excursions and dynamic power generation, should be assessed. Understanding of the underlying mechanisms of weakness in children with CP is key for individualized prescription and assessment of muscle-targeted interventions. Findings could imply the detection of children operating on the descending limb of the sarcomere length-tension curve, which in turn might be at greater risk of developing crouch gait. Furthermore, relative muscle fascicle excursions could be used as a predictive variable of outcomes related to crouch gait prevention treatments such as strength training.

Mobilization versus manipulations versus sustain apophyseal natural glide techniques and interaction with psychological factors for patients with chronic neck pain: randomized controlled trial.

BACKGROUND: Three different types of manual therapy techniques for patients with neck pain and relationship with psychological factors has not been evaluated. AIM: To compare the effectiveness high velocity and low amplitude (HVLA) manipulation vs. posteroanterior mobilization (PA mob) vs. sustain appophyseal natural glide (SNAG) in the management of patients with neck pain and to evaluate the interaction with psychological factors. STUDY DESING: Randomized clinical trial. SETTING: Primary Health Care Center. POPULATION: Patients with history of chronic neck pain over the last 3 months were recruited. METHODS: Patients were randomly assigned to receive treatment with HVLA (N.=15), with PA mob (N.=16) or with SNAG (N.=17). One session was applied. Pain intensity of neck pain, pressure pain threshold over processus spinosus of C2 (PPT_C2) and cervical range of motion (CROM) were measured pre- and post-intervention. Pain catastrophizing, depression, anxiety and kinesiophobia were assessed in baseline. ANOVAs were performed, with main effects, two-way (treatment x time) and three-way interactions (treatment x psychological variable x time) were examined. RESULTS: Fourthy-eight patients (mean±SD age, 36.5±8.7 years; 87.5% female). A significant interaction treatment x time was observed for VAS-rest in HVLA and AP mob groups (P<0.05). With more pain relief to HVLA and AP mob groups than SNAG groups but all groups improve the same in CROM. Also, a significant three-way treatment x anxiety x time interaction for VAS in Flexion/Extension was identified (P<0.01), and a trend toward significance was observed for the three way treatment x anxiety x time interaction, with respect to CROM in Lateral-Flexion movement (P<0.05). CONCLUSION: The results suggest that an HVLA and PA mob groups relieved pain at rest more than SNAG in patients with Neck pain. Among psychological factors, only trait anxiety seems interact with Manual therapy, mainly high anxiety conditions interact with the Mobilization and SNAG effects but under low anxiety conditions interact with the HVLA effects. Significant mean differences can be observed both in VAS in Flexion/Extension and in CROM in lateral-flexion movement when using mobilization under high anxiety conditions CLINICAL REHABILITATION IMPACT: The findings provide preliminary evidence to support that three different techniques have similar immediate effects over neck pain and while under high anxiety levels a better outcome is expected after mobilization intervention, under low anxiety levels a better prognosis is expected after manipulation and SNAG intervention.

Cirugía multinivel para las alteraciones de la deambulación en parálisis cerebral infantil. Evaluación cuantitativa, funcional y de satisfacción de los resultados obtenidos / Multilevel surgery for gait disorders in cerebral palsy. Quantitative, functional and satisfaction outcomes measurement

Objetivo: Estudiar la eficacia de la cirugía en el tratamiento de los trastornos de la marcha en la parálisis cerebral infantil (PCI) utilizando análisis cuantitativo del movimiento. Material y método: Se realizó un estudio retrospectivo en 26 pacientes con edades comprendidas entre los 8 y los 17 años. El 64% de los pacientes presentaban un nivel funcional III y IV de la clasificación GMFCS (Gross Motor Function Clasification System). La corrección quirúrgica de las alteraciones esqueléticas se asoció a la cirugía de partes blandas, usando análisis de movimiento. La evolución fue de 16 meses. Resultados: Se encontraron mejorías significativas en la extensión máxima de rodilla en fase de apoyo y en el rango dinámico de la misma durante el ciclo de marcha. La mayor mejoría funcional se consiguió en la distancia de 50 metros. Cerca del 80% de los padres valoraron los resultados como buenos o excelentes. Conclusión: La cirugía osteoarticular multinivel es eficaz, objetiva y subjetivamente, en el tratamiento de las alteraciones de la marcha en la PCI (AU)

Objective: To study the efficacy of orthopaedic surgery with bone correction guided by quantitative motion analysis, for the treatment of gait disorders in cerebral palsy. Material and method: A retrospective study with 26 patients, aged between 8 and 17, and an average follow up of 16 months, was conducted. 60% of the patients were level III or IV. Surgery of the bone lever arm dysfunction was added to the to soft-tissue surgery when necessary. Gait cycle graphs, F.M.S. (Functional Mobility Scale), and a post-treatment satisfaction and gait functional questionnaire were used for proving differences. Results: Kinematic improvements were found in the gait cycle. Maximun values of extensión in stance phase and dynamic range of motion of the knee were better, showing a significant statistically difference. The greater functional improvement was reached in the 50 meters distance. In other words, the patients were able to use the wheel-chair at school less, after this surgical treatment. Around 80% of the parents considered results as good or excellent. Conclusion: The bone and articular surgey in the single multilevel surgery showed its efficacy in the treatment of gait disorders in cerebral palsy (AU)