Abstract
AimCerebral 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.Methods18 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.ResultsMost 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.InterpretationThe reduction of afferent signalling through SDR improves gait by reducing balance problems rather than enhancing movement symmetry.
Highlights
The reduction of afferent signalling through Selective dorsal rhizotomy (SDR) improves gait by reducing balance problems rather than enhancing movement symmetry
Muscle tone abnormalities in children with cerebral palsy (CP) lead to deficits in selective motor control resulting in difficulties with coordination, gait efficiency and symmetry, as well as posture and balance [1,2]
The clear and significant impact of SDR on balance and gait in CP shown in our study demonstrates the critical importance that a full understanding and characterisation of these parameters should be gained
Summary
Muscle tone abnormalities in children with cerebral palsy (CP) lead to deficits in selective motor control resulting in difficulties with coordination, gait efficiency and symmetry, as well as posture and balance [1,2]. Spasticity, together with muscular imbalance and reduced neuromuscular control during targeted task performance, leads to weakness despite high muscle tone. In cases of cerebral or spinal damage, this balance mechanism is perturbed and the excessive sensory signals are thought to lead to spasticity [6]. Spasticity and weakness, as positive and negative features of the upper motor neuron syndrome respectively [5], are both thought to affect postural control and both balance and symmetry in subjects with CP [7]. In order to assess the extent of this condition, impaired balance in children with CP has been evaluated during standing [7,8,9,10,11] and more recently during gait [12,13,14]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
