Abstract
Upper extremity of persons with spastic cerebral palsy (CP) typically presents with various problems including an impaired range of motion that affects the positioning of the upper extremity. This impaired range of motion often develops into contractures that further limit functioning of the spastic hand and arm. Orthopaedic Selective Spasticity Surgery (OSSCS) involves 2 procedures of intramuscular lengthening and sliding lengthening for reduction of spasticity. To evaluate effectiveness of upper extremity OSSCS on muscle tone and functional outcome in persons with cerebral palsy (CP). A retrospective analysis was done among 120 persons with spastic quadriplegia and hemiplegia, aged 5 to 20 years, who underwent OSSCS of elbow flexors, forearm flexors, pronators and hand intrinsic muscles. The rehabilitation after the removal of plaster after 2 weeks, involved occupational therapy, physiotherapy and aquatic therapy. The rehabilitation was for 6 days per week for 5 months. The outcome measures were modified Ashworth Scale (mAS), Manual Ability Classification System (MACS) and Melbourne Assessment of Unilateral Upper Limb Function (MAUULF). Data were collected at baseline and at 5 months’ post-surgery. Follow-up data was collected 1-year post-surgery. Among the study group, females (62%) were predominant and 45% of the participants were aged 10 to 15 years. The commonest muscles released were the forearm flexors and pronators (78%). Persons who underwent OSSCS followed by rehabilitation showed a significant improvement of mAS ( P < 0.001), MACS ( P < 0.001), MAUULF ( P < 0.001) compared to the baseline. The follow-up data were obtained for around 55% of the participants, in which the progress was maintained in more than 80% of the participants. Upper extremity OSSCS followed by intensive rehabilitation is effective in reduction of upper extremity muscle tone and improvement of function among persons with cerebral palsy.
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