Dorsal Rhizotomy Surgery Research Articles

Urodynamic Findings in Children with Cerebral Palsy Before Dorsal Rhizotomy Surgery

Urodynamic Findings in Children with Cerebral Palsy Before Dorsal Rhizotomy Surgery

Pain Control and Positioning in Children Following Selective Dorsal Rhizotomy Surgery.

A practice was changed to elevate the head of bed from day 1 to day 3 on children after selective dorsal rhizotomy (SDR) surgery to improve pain control. Multiple methods to address pain post SDR include a continuous epidural infusion, medication administration, and repositioning/distraction. The length of time for the patient to remain flat was increased to potentially improve pain management. However, no studies in the literature were found to support the practice change. Nurses inquired whether this change resulted in optimal pain control. The primary research aim was to determine whether the change in positioning resulted in a difference in pain control. A retrospective cohort design was used to compare pain medication administered before and after the practice change. Patients between the ages of 2 and 15 years and admitted to the neuroscience unit after SDR surgery were included. Data were electronically retrieved to record the amount of medications given for pain. Descriptive and univariate statistics were used to detect differences. The retrospective component of the study analyzed a total of 385 patients. There were no statistically significant differences between the number of intermittent doses of medication administered for pain between the 2 groups (P = .661). Results support return to practice of 1 day of flat time. Nurses perceive that lying flat contributes to child and parent anxiety and limits options for distraction; therefore, decreasing flat time may lower anxiety without affecting pain control. These results are limited to postsurgical SDR patients but have implications for postoperative positioning and pain management. On the basis of these results, the neurosurgeon changed practice to zero days of flat time.

A Comparison of Gait Parameters Using Varying Orthotic Designs in a Child With Spastic Diplegic Cerebral Palsy After Selective Dorsal Rhizotomy Surgery: A Case Report

Introduction Cerebral palsy (CP) is the most common developmental disorder in children. Selective dorsal rhizotomy (SDR) is an effective neurosurgical treatment to reduce lower-limb spasticity in children with spastic diplegic CP. An intensive period of rehabilitation, including gait training, is required for most children after this surgery. Orthoses have been widely used in children with CP. However, there is a lack of research showing which orthosis type is the most appropriate for children with spastic diplegic CP after SDR. Materials and Methods In this retrospective case report, we compared spatial and temporal gait parameters using three commonly used orthoses: foot orthosis (FO), supramalleolar orthosis (SMO), and ankle-foot orthosis/footwear combination (AFO/FC), before and after 3-month accommodation of combination use in a 5-year-old male patient with spastic diplegic CP after SDR. Results The results showed that although all orthoses improved gait function, the AFO/FCs appeared to initially provide the most stable support; however, after acclimatization, spatial and temporal gait parameters generally demonstrated greater improvement in FO and SMO conditions compared with AFO/FC. Discussion This report suggests stance phase stability may be enhanced with AFO/FCs, but swing phase may improve with FO and SMO conditions in children with weakness after SDR. Further studies analyzing gait, balance, and motor function using varying orthoses in children with CP after SDR are warranted.

WITHDRAWN: P 080 - Development of gait in children with Cerebral Palsy following selective dorsal rhizotomy surgery, and considerations for post-surgery rehabilitation

WITHDRAWN: P 080 - Development of gait in children with Cerebral Palsy following selective dorsal rhizotomy surgery, and considerations for post-surgery rehabilitation

Soft tissue release and osteotomies in the treatment of patients with spastic diplegic cerebral palsy

We aim to study the outcome of soft tissue releases by tendon elongations and osteotomies in fixed joint contractures by clinical examination and patient self-reported assessment on 20 patients (14 males and 6 females) with spastic diplegic cerebral palsy treated with single-event multilevel surgery (SEMLS) between 2000 and 2012. A questionnaire was used to collect information on problems encountered before and after surgery and decision on surgery. Comparing patients with Gross Motor Function Classification System class I/II, (N = 8), III (N = 8) and IV/V , patients of classes IV/V showed much slower mean recovery time than I/II group (14.00 vs. 4.38 months, p < 0.01). SEMLS in the treatment of patients with spastic diplegia had good mid-term results in most patients. The patients who had unfavourable outcomes are associated with mental retardation, general or local complications and previous selective dorsal rhizotomy surgery. Patient selection and good rehabilitations preoperation and postoperation provided the most favourable outcomes of SEMLS.

The effect of including S2 rootlets in selective dorsal rhizotomy surgery

The effect of including S2 rootlets in selective dorsal rhizotomy surgery

Quadriceps and Hamstring Strength Changes as a Function of Selective Dorsal Rhizotomy Surgery and Rehabilitation

Quadriceps and Hamstring Strength Changes as a Function of Selective Dorsal Rhizotomy Surgery and Rehabilitation

Quadriceps and Hamstring Strength Changes as a Function of Selective Dorsal Rhizotomy Surgery and Rehabilitation

Objective measures of strength in children with cerebral palsy (CP) are needed to determine the effect that selective dorsal rhizotomy surgery (SDR) and subsequent rehabilitation have on muscle strength. This investigation quantified quadriceps and hamstring strength in children with CP pre-SDR and eight months post-SDR. Nineteen children with CP and 20 children without disabilities (WD group) were tested with an isokinetic dynamometer. The children performed a maximum concentric contraction of the quadriceps muscles as the dynamometer moved the knee from a flexed position to an extended position at 10 degrees per second. A maximum concentric contraction of the hamstring muscles was then performed as the knee was moved from extension to flexion. Four variables were recorded from the torque-angle data; peak extension and flexion torque and extension and flexion work. Children with CP, both pre- and post-SDR were significantly weaker in all strength measures compared with the WD group. Children with CP post-SDR and rehabilitation had significantly greater peak torque and work values compared with their pre-SDR values. The results agreed with previous studies indicating that children with CP are weaker than their peers without disabilities. Previous studies on strength changes after SDR remain controversial. The results of this study showed a significant increase in strength at the knee after rhizotomy and rehabilitation.