Abstract
Equinus deformity is one of the most common musculoskeletal deformities of Cerebral Palsy (CP) which is defined as an abnormality in ankle dorsiflexion that can cause severe walking disability. The standard surgical intervention for Equinus deformity is Achilles Tendon Lengthening (ATL) with post-operative leg casting, however in some cases, it requires months of recovery post-operation to regain movement. The objective of this study was to find an alternative to leg casting that would provide a safe and faster time course to recovery. Therefore, we conducted a semi-experimental clinical trial study of a population that included 62 CP patients between the ages of 6 - 15 years of age with diplegia, hemiplegia, or quadriplegia that randomly underwent ATL followed by subsequent leg casting (control, 32 patients) or bandage and ankle-foot orthosis (AFO; experimental, 30 patients). Patients were periodically evaluated for mobility and walking ability pre-operation and at 2 weeks post- operation, 6 weeks post-operation, and then every month for 6 months. We found that all 32 patients in the experimental group regained their walking ability within two weeks (100%), while majority of patients in the control group (84%) regained their walking ability after 4 - 6 weeks, regardless of CP type. We also found that on 6-month follow-up, progression of walking abilities was similar in both groups. Rupture of the repaired tendon was not observed in any of the participants in either group. This study suggests applying a bandage with a foot or ankle orthosis as an alternative to long leg cast in children of 15 years of age or younger with CP treated with ATL for Equinus deformity to facilitate faster post-operative recovery. It also recommends follow-up studies on confounding factors, categorization of pre- and post-operative range of movement, and post-op complications with longer follow up while treating CP patient with ATL followed by AFO.
Highlights
Cerebral Palsy (CP) is not an individual disorder with a single underlying etiology, but rather an umbrella term with diverse causes and symptomatology, the latter of which can change significantly with age [1] [2]
We conducted a semi-experimental clinical trial study of a population that included 62 CP patients between the ages of 6 - 15 years of age with diplegia, hemiplegia, or quadriplegia that randomly underwent Achilles Tendon Lengthening (ATL) followed by subsequent leg casting or bandage and ankle-foot orthosis (AFO; experimental, 30 patients)
This study suggests applying a bandage with a foot or ankle orthosis as an alternative to long leg cast in children of 15 years of age or younger with CP treated with ATL for Equinus deformity to facilitate faster post-operative recovery
Summary
Cerebral Palsy (CP) is not an individual disorder with a single underlying etiology, but rather an umbrella term with diverse causes and symptomatology, the latter of which can change significantly with age [1] [2]. One commonly accepted modern definition describes CP as a group of permanent but changing disorders that affect movement and posture, or motor function caused by a lesion or deficit of the developing brain [2] [3] [4]. The most recent report by the Surveillance of Cerebral Palsy in Europe (SCPE) states that the average rate of CP is 1.5 - 3.0 per 1000 live births in Europe. In the United States, it was reported to be 1.76 per 1000 live births in 2002 [6]. A correlation between birth weight and CP has been reported, stating that premature babies weighing under 1500 grams had a 70× higher rate of CP than children weighing 2500 grams or more at birth [1]
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