The Effects of Selective Dorsal Rhizotomy on Balance and Symmetry of Gait in Children with Cerebral Palsy

Franziska Rumberg, Mustafa Sinan Bakir, William R Taylor, Hannes Haberl, Akosua Sarpong, Ilya Sharankou, Susanne Lebek, Julia F Funk, Franziska Rumberg, Mustafa Sinan Bakir, William R Taylor, Hannes Haberl, Akosua Sarpong, Ilya Sharankou, Susanne Lebek, Julia F Funk

Abstract

Aim: Cerebral palsy (CP) is associated with dysfunction of the upper motor neuron and results in balance problems and asymmetry during locomotion. Selective dorsal rhizotomy (SDR) is a surgical procedure that results in reduced afferent neuromotor signals from the lower extremities with the aim of improving gait. Its influence on balance and symmetry has not been assessed. The aim of this prospective cohort study was to evaluate the impact of SDR on balance and symmetry during walking.

Methods: 18 children (10 girls, 8 boys; age 6 years (y) 3 months (m), SD 1y 8m) with bilateral spastic CP and Gross Motor Function Classification System levels I to II underwent gait analysis before and 6 to 12 months after SDR. Results were compared to 11 typically developing children (TDC; 6 girls, 5 boys; age 6y 6m, SD 1y 11m). To analyse balance, sway velocity, radial displacement and frequency were calculated. Symmetry ratios were calculated for balance measures and spatio-temporal parameters during walking.

Results: Most spatio-temporal parameters of gait, as well as all parameters of balance, improved significantly after SDR. Preoperative values of symmetry did not vary considerably between CP and TDC group and significant postoperative improvement did not occur.

Interpretation: The reduction of afferent signalling through SDR improves gait by reducing balance problems rather than enhancing movement symmetry.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Changes of velocity related balance…
Fig 1. Changes of velocity related balance parameters.
Paired samples t-test for normally distributed data; TDC = typically developing children, CP = cerebral palsy, SDR = selective dorsal rhizotomy, BL = bilateral, UL = unilateral, R = right, L = left, * p = 0.000, † p = 0.001, ‡ p = 0.002, # p = 0.004, £ p = 0.006, ¥ p = 0.007.

References

    1. Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B, et al. Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol. 2005;47(8): 571–6.
    1. Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol. 2007;109 (Suppl): 8–14.
    1. Krägeloh-Mann I, Horber V. The role of magnetic resonance imaging in elucidating the pathogenesis of cerebral palsy: a systematic review. Dev Med Child Neurol. 2007;49(2): 144–51.
    1. Thilmann AF, Fellows SJ, Garms E. The mechanism of spastic muscle hypertonus. Variation in reflex gain over the time course of spasticity. Brain. 1991;114(Pt1A): 233–44.
    1. Sheean G. The pathophysiology of spasticity. Eur J Neurol. 2002;9 (Suppl 1): 3–9; discussion 53–61.
    1. Eyre JA. Corticospinal tract development and its plasticity after perinatal injury. Neurosci Biobehav Rev. 2007;31(8): 1136–49.
    1. Woollacott MH, Shumway-Cook A. Postural dysfunction during standing and walking in children with cerebral palsy: what are the underlying problems and what new therapies might improve balance? Neural Plast. 2005;12(2–3): 211–9; discussion 63–72.
    1. Nashner LM, Shumway-Cook A, Marin O. Stance posture control in select groups of children with cerebral palsy: deficits in sensory organization and muscular coordination. Exp Brain Res. 1983;49(3): 393–409.
    1. Rose J, Wolff DR, Jones VK, Bloch DA, Oehlert JW, Gamble JG. Postural balance in children with cerebral palsy. Dev Med Child Neurol. 2002;44(1): 58–63.
    1. Donker SF, Ledebt A, Roerdink M, Savelsbergh GJ, Beek PJ. Children with cerebral palsy exhibit greater and more regular postural sway than typically developing children. Exp Brain Res. 2008;184(3): 363–70.
    1. Pavao SL, dos Santos AN, Woollacott MH, Rocha NA. Assessment of postural control in children with cerebral palsy: a review. Res Dev Disabil. 2013;34(5): 1367–75. 10.1016/j.ridd.2013.01.034
    1. Hsue BJ, Miller F, Su FC. The dynamic balance of the children with cerebral palsy and typical developing during gait. Part I: Spatial relationship between COM and COP trajectories. Gait Posture. 2009;29(3): 465–70. 10.1016/j.gaitpost.2008.11.007
    1. Hsue BJ, Miller F, Su FC. The dynamic balance of the children with cerebral palsy and typical developing during gait Part II: Instantaneous velocity and acceleration of COM and COP and their relationship. Gait Posture. 2009;29(3): 471–6. 10.1016/j.gaitpost.2008.11.008
    1. Wallard L, Dietrich G, Kerlirzin Y, Bredin J. Balance control in gait children with cerebral palsy. Gait Posture. 2014;40(1): 43–7. 10.1016/j.gaitpost.2014.02.009
    1. Burtner PA, Qualls C, Woollacott MH. Muscle activation characteristics of stance balance control in children with spastic cerebral palsy. Gait Posture. 1998;8(3): 163–74.
    1. Shumway-Cook A, Hutchinson S, Kartin D, Price R, Woollacott M. Effect of balance training on recovery of stability in children with cerebral palsy. Dev Med Child Neurol. 2003;45(9): 591–602.
    1. Hannah RE, Morrison JB, Chapman AE. Kinematic symmetry of the lower limbs. Arch Phys Med Rehabil. 1984;65(4): 155–8.
    1. Stolze H, Kuhtz-Buschbeck JP, Mondwurf C, Johnk K, Friege L. Retest reliability of spatiotemporal gait parameters in children and adults. Gait Posture. 1998;7(2): 125–30.
    1. Patterson KK, Gage WH, Brooks D, Black SE, McIlroy WE. Evaluation of gait symmetry after stroke: a comparison of current methods and recommendations for standardization. Gait Posture. 2010;31(2): 241–6. 10.1016/j.gaitpost.2009.10.014
    1. Mittal S, Farmer JP, Al-Atassi B, Gibis J, Kennedy E, Galli C, et al. Long-term functional outcome after selective posterior rhizotomy. J Neurosurg. 2002;97(2): 315–25.
    1. Chan SH, Yam KY, Yiu-Lau BP, Poon CY, Chan NN, Cheung HM, et al. Selective dorsal rhizotomy in Hong Kong: multidimensional outcome measures. Pediatr Neurol. 2008;39(1): 22–32. 10.1016/j.pediatrneurol.2008.03.017
    1. Nordmark E, Josenby AL, Lagergren J, Andersson G, Stromblad LG, Westbom L. Long-term outcomes five years after selective dorsal rhizotomy. BMC Pediatr. 2008;8: 54 10.1186/1471-2431-8-54
    1. Van Schie PE, Schothorst M, Dallmeijer AJ, Vermeulen RJ, van Ouwerkerk WJ, Strijers RL, et al. Short- and long-term effects of selective dorsal rhizotomy on gross motor function in ambulatory children with spastic diplegia. J Neurosurg Pediatrics. 2011;7: 557–562.
    1. Tedroff K, Lowing K, Jacobson DN, Astrom E. Does loss of spasticity matter? A 10-year follow-up after selective dorsal rhizotomy in cerebral palsy. Dev Med Child Neurol. 2011;53(8): 724–9. 10.1111/j.1469-8749.2011.03969.x
    1. Josenby AL, Wagner P, Jarnlo GB, Westbom L, Nordmark E. Motor function after selective dorsal rhizotomy: a 10-year practice-based follow-up study. Dev Med Child Neurol. 2012;54(5): 429–35. 10.1111/j.1469-8749.2012.04258.x
    1. Bolster EA, van Schie PE, Becher JG, van Ouwerkerk WJ, Strijers RL, Vermeulen RJ. Long-term effect of selective dorsal rhizotomy on gross motor function in ambulant children with spastic bilateral cerebral palsy, compared with reference centiles. Dev Med Child Neurol. 2013;55(7): 610–616. 10.1111/dmcn.12148
    1. Dudley RW, Parolin M, Gagnon B, Saluja R, Yap R, Montpetit K, et al. Long-term functional benefits of selective dorsal rhizotomy for spastic cerebral palsy. J Neurosurg Pediatr. 2013;12(2): 142–50. 10.3171/2013.4.PEDS12539
    1. Funk JF, Panthen A, Bakir MS, Gruschke F, Sarpong A, Wagner C, et al. Predictors for the benefit of selective dorsal rhizotomy. Res Dev Disabil. 2014;37C: 127–134.
    1. Roberts A, Stewart C, Freeman R. Gait analysis to guide a selective dorsal rhizotomy program. Gait Posture. 2015;42(1): 16–22. 10.1016/j.gaitpost.2015.04.004
    1. Grunt S, Henneman WJ, Bakker MJ, Harlaar J, van der Ouwerkerk WJ, van Schie P, et al. Effect of selective dorsal rhizotomy on gait in children with bilateral spastic paresis: kinematic and EMG-pattern changes. Neuropediatrics. 2010;41: 209–16. 10.1055/s-0030-1267983
    1. Langerak NG, Tam N, Vaughan CL, Fieggen AG, Schwartz MH. Gait status 17–26 years after selective dorsal rhizotomy. Gait Posture. 2012;35(2): 244–9. 10.1016/j.gaitpost.2011.09.014
    1. Bakir MS, Gruschke F, Taylor WR, Haberl EJ, Sharankou I, Perka C, et al. Temporal but not spatial variability during gait is reduced after selective dorsal rhizotomy in children with cerebral palsy. PLoS One. 2013;8(7): e69500 10.1371/journal.pone.0069500
    1. Thomas SS, Aiona MD, Pierce R, Piatt JH 2nd. Gait changes in children with spastic diplegia after selective dorsal rhizotomy. J Pediatr Orthop. 1996;16: 747–52.
    1. Funk JF, Haberl H. Monosegmental laminoplasty for selective dorsal rhizotomy—operative technique and influence on the development of scoliosis in ambulatory children with cerebral palsy. Childs Nerv Syst. 2016. January 13 [Epub ahead of print]. 10.1007/s00381-016-3016-3
    1. Park TS, Johnston JM. Surgical techniques of selective dorsal rhizotomy for spastic cerebral palsy. Technical note. Neurosurg Focus. 2006;21(2): e7
    1. Phillips LH, Park TS. Electrophysiologic studies of selective posterior rhizotomy patients In: Park TS, Phillips LH, Peacock WJ (eds) Neurosurgery: state of the Art reviews: management of spasticity in cerebral palsy and spinal cord injury. Hanley & Belfus, Philadelphia: 1989. pp. 459–469.
    1. Peacock WJ, Staudt LA. Functional outcomes following selective posterior rhizotomy in children with cerebral palsy. J Neurosurg. 1991;74(3): 380–5.
    1. Rodda JM, Graham HK, Carson L, Galea MP, Wolfe R. Sagittal gait patterns in spastic diplegia. J J Bone Joint Surg Br. 2004;86(2): 251–8.
    1. Wolff DR, Rose J, Jones VK, Bloch DA, Oehlert JW, Gamble JG. Postural balance measurements for children and adolescents. J Orthop Res. 1998;16(2): 271–5.
    1. Taylor WR, Kornaropoulos EI, Duda GN, Kratzenstein S, Ehrig RM, Arampatzis A, et al. Repeatability and reproducibility of OSSCA, a functional approach for assessing the kinematics of the lower limb. Gait Posture. 2010;32(2): 231–6. 10.1016/j.gaitpost.2010.05.005
    1. O'Connor CM, Thorpe SK, O'Malley MJ, Vaughan CL. Automatic detection of gait events using kinematic data. Gait Posture. 2007;25(3): 469–74.
    1. Sharenkov A, Agres AN, Funk JF, Duda GN, Boeth H. Automatic initial contact detection during overground walking for clinical use. Gait Posture. 2014;40(4): 730–4. 10.1016/j.gaitpost.2014.07.025
    1. Murray MP, Drought AB, Kory RC. Walking patterns of normal men. J Bone Joint Surgery. 1964;46: 335–360
    1. Hof AL. Scaling gait data to body size. Gait Posture. 1996;4(3): 222–223.
    1. Crenna P. Spasticity and 'spastic' gait in children with cerebral palsy. Neurosci Biobehav Rev. 1998;22(4): 571–8.
    1. Buckon CE, Thomas SS, Piatt JH Jr, Aiona MD, Sussman MD. Selective dorsal rhizotomy versus orthopedic surgery: a multidimensional assessment of outcome efficacy. Arch Phys Med Rehabil. 2004;85(3): 457–65.
    1. Cole GF, Farmer SE, Roberts A, Stewart C, Patrick JH. Selective dorsal rhizotomy for children with cerebral palsy: the Oswestry experience. Arch Dis Child. 2007;92(9): 781–5.
    1. Engsberg JR, Olree KS, Ross SA, Park TS. Spasticity and strength changes as a function of selective dorsal rhizotomy. Neurosurg Focus. 1998;4(1): e4
    1. Engsberg JR, Ross SA, Collins DR, Park TS. Effect of selective dorsal rhizotomy in the treatment of children with cerebral palsy. J Neurosurg. 2006;105(1 Suppl): 8–15.
    1. Lundkvist A, Hagglund G. Orthopaedic surgery after selective dorsal rhizotomy. J Pediatr Orthop B. 2006;15(4): 244–6.
    1. MacWilliams BA, Johnson BA, Shuckra AL, D'Astous JL. Functional decline in children undergoing selective dorsal rhizotomy after age 10. Dev Med Child Neurol. 2011;53(8): 717–23. 10.1111/j.1469-8749.2011.04010.x
    1. McLaughlin J, Bjornson K, Temkin N, Steinbok P, Wright V, Reiner A, et al. Selective dorsal rhizotomy: meta-analysis of three randomized controlled trials. Dev Med Child Neurol. 2002;44(1): 17–25.
    1. Trost JP, Schwartz MH, Krach LE, Dunn ME, Novacheck TF. Comprehensive short-term outcome assessment of selective dorsal rhizotomy. Dev Med Child Neurol. 2008;50(10): 765–71. 10.1111/j.1469-8749.2008.03031.x
    1. Liao HF, Jeng SF, Lai JS, Cheng CK, Hu MH. The relation between standing balance and walking function in children with spastic diplegic cerebral palsy. Dev Med Child Neurol. 1997;39(2): 106–12.
    1. Goble DJ, Marino GW, Potvin JR. The influence of horizontal velocity on interlimb symmetry in normal walking. Hum Mov Sci. 2003;22(3):271–83.
    1. Saunders JB, Inman VT, Eberhart HD. The major determinants in normal and pathological gait. J Bone Joint Surg Am. 1953;35-A(3): 543–58.
    1. Prosser LA, Lauer RT, VanSant AF, Barbe MF, Lee SC. Variability and symmetry of gait in early walkers with and without bilateral cerebral palsy. Gait Posture. 2010;31(4): 522–6. 10.1016/j.gaitpost.2010.03.001
    1. Berger W, Altenmueller E, Dietz V. Normal and impaired development of children's gait. Hum Neurobiol. 1984;3(3): 163–70.
    1. Bleck EE. The Sense Of Balance. Dev Med Child Neurol, 1994;36: 377–378.
    1. Chen J, Woollacott MH. Lower extremity kinetics for balance control in children with cerebral palsy. J Mot Behav. 2007;39(4): 306–16.
    1. Sadeghi H, Allard P, Prince F, Labelle H. Symmetry and limb dominance in able-bodied gait: a review. Gait Posture. 2000;12(1): 34–45.
    1. Kim CM, Eng JJ. Symmetry in vertical ground reaction force is accompanied by symmetry in temporal but not distance variables of gait in persons with stroke. Gait Posture. 2003;18(1): 23–8.
    1. Lythgo N, Wilson C, Galea M. Basic gait and symmetry measures for primary school-aged children and young adults whilst walking barefoot and with shoes. Gait Posture. 2009;30(4):502–6. 10.1016/j.gaitpost.2009.07.119
    1. Lythgo N, Wilson C, Galea M. Basic gait and symmetry measures for primary school-aged children and young adults. II: walking at slow, free and fast speed. Gait Posture. 2011;33(1):29–35. 10.1016/j.gaitpost.2010.09.017
    1. Patterson KK, Gage WH, Brooks D, Black SE, McIlroy WE. Evaluation of gait symmetry after stroke: a comparison of current methods and recommendations for standardization. Gait Posture. 2010;31(2): 241–6. 10.1016/j.gaitpost.2009.10.014

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren