Improvement In Gross Motor Function Research Articles

Role of Baclofen in Combination with Intensive Rehabilitation in Spastic Cerebral Palsy

Background: The treatment of cerebral palsy is multifactorial.Objective: In this study we find out the combined efficacy of baclofen and intensive rehabilitation in the treatment of spastic cerebral palsy.Methodology: This observational study was conducted over 30 patients in Dhaka Medical College Hospital from January 2011 to December 2011.The patient satisfying the inclusion and exclusion criteria was randomly enrolled in this study. They received Baclofen orally two times daily according to the body weight regularly in combination with intensive rehabilitation 1 hour daily five times a week for 24 weeks. All patients were followed up at 4 weeks interval and were evaluated for a total of 24 weeks.Result: Combination of Baclofen and intensive rehabilitation is effective in reducing tone in spastic cerebral palsy by using Modified Ashworth scale (p<0.05). Combination of Baclofen and intensive rehabilitation is also effective in joint angle improvement in spastic cerebral palsy measured by physician rating scale crouch (p<0.05) and foot contact, (p<0.05) and also improvement in gross motor function (p <0.05).Conclusion: For reduction of generalized spasticity regarding muscle tone, range of motion of the joint and improvement of gait in cerebral palsy patients, combination of Baclofen and intensive rehabilitation may be used.J. Natl Inst. Neurosci Bangladesh 2015;1(1):18-21

Efficacy of baclofen in combination with intensive rehabilitation in spastic cerebral palsy- a randomized clinical trial

Objective: To find out the combined efficacy of baclofen and intensive rehabilitation in the treatment of spastic cerebral palsy. Methods: This randomized clinical trial was conducted over 60 patients in Dhaka Medical College Hospital, Dhaka, between January and December 2011. The patient satisfying the inclusion and exclusion criteria was randomly enrolled into two groups; Group A (case) included 30 patients received only intensive rehabilitation and Group B (control) included 30 patients who received baclofen orally two times daily according to the body weight regularly in combination with intensive rehabilitation 1 hour daily five times a week for 24 weeks. All patients were followed up at 4 weeks interval and were evaluated for a total of 24 weeks. Results: Combination of baclofen and intensive rehabilitation has superior efficacy in reducing tone in spastic cerebral palsy over only rehabilitation measured by using Modified Ashworth scale (p<0.001). Combination of baclofen and intensive rehabilitation is also superior in physician rating scale crouch (p<0.0001) and foot contact, (p<0.0001) and also improvement in gross motor function (p<0.01). Conclusion: Combination of baclofen and intensive rehabilitation group has superior efficacy than only rehabilitation group for reduction of generalized spasticity regarding muscle tone, range of motion of the joint and improvement of gait in cerebral palsy patients. DOI: http://dx.doi.org/10.3329/jdmc.v23i1.22688 J Dhaka Medical College, Vol. 23, No.1, April, 2014, Page 18-23

The central role of trunk control in the gross motor function of children with cerebral palsy: a retrospective cross-sectional study.

Improvement of gross motor function and mobility are primary goals of physical therapy in children with cerebral palsy (CP). The purpose of this study was to investigate the relationship between segmental control of the trunk and the corresponding gross motor function in children with CP. This retrospective cross-sectional study was based on 92 consecutive referrals of children with CP in Gross Motor Function Classification System (GMFCS) levels I to V, 39 females, 53 males (median age 4y [range 1-14y]), and 77, 12, and 3 with spastic, dyskinetic, and ataxic CP respectively. The participants were tested using the Gross Motor Function Measure (GMFM), the Pediatric Evaluation of Disability Inventory (PEDI), and the Segmental Assessment of Trunk Control (SATCo). Linear regression analysis showed a positive relationship between the segmental level of trunk control and age, with both gross motor function and mobility. Segmental trunk control measured using the SATCo could explain between 38% and 40% of variation in GMFM and between 32% and 37% of variation in PEDI. This study suggests a strong association between segmental trunk postural control and gross motor function and mobility with significant clinical implications for the treatment of children with CP.

Arnold-Chiari Malformation Type III With Meningoencephalocele: A Case Report.

Arnold-Chiari malformation type III (CM III) is an extremely rare anomaly with poor prognosis. An encephalocele with brain anomalies as seen in CM II, and herniation of posterior fossa contents like the cerebellum are found in CM III. The female infant was a twin, born at 33 weeks, weighing 1.7 kg with a huge hydrocele on the craniocervical junction. After operations were performed, she was referred to the department of rehabilitation medicine for poor motor development, swallowing dysfunction, and poor eye fixation at 22 months. The child was managed with neurodevelopmental treatment, oromotor facilitation, and light perception training. After 14 months, improvement of gross motor function was observed, including more stable head control, rolling, and improvement of visual perception. CM III has been known as a condition with poor prognosis. However, with the improvement in operative techniques and intensive rehabilitations, the prognosis is more promising than ever before. Therefore, more attention must be paid to the rehabilitation issues concerning patients with CM III.

Effect of Motor Control Program in Improving Gross Motor Function and Postural Control in Children with Sensorineural Hearing Loss-A Pilot Study

Background: Sensorineural hearing loss (SNHL) is the most common type of permanent hearing impairment and results from damage to the inner ear or the nerve pathway. Children with hearing impairment have balance and motor deficits primarily due to concomitant damage to the vestibular structures. Objective: To study the effect of motor control program on improvement of gross motor function and postural control in children with sensorineural hearing loss. Methods: A pre-post testtrial consisting of 10 participants between the age group of 6 to 12 years with the clinical diagnosis of sensorineural hearing loss. Participants received exercise sessions including 10 min of activities in the following categories: eye hand co-ordination and visual motor training, balance training, activities to improve general co-ordination for 3 days a week for 12 weeks. The outcome was assessed in terms of Pediatric Balance scale (PBS), Test for Gross Motor Development (TGMD-2). Result: There was highly significant difference seen in scores of both TGMD-2 and PBS (p<0.01). Conclusion: The findings of the study suggest thatmotor control program including eye-hand co-ordination, visuomotor training, balance training and general co-ordination exercises can be useful to maintain gross motor skills and postural control in children with sensorineural hearing loss.

Etiology-specific differences in motor function after hemispherectomy

Prediction of functional motor outcome after hemispherectomy is difficult due to the heterogeneity of motor outcomes observed. We hypothesize that this might be related to differences in plasticity during the onset of the underlying epileptogenic disorder or lesion and try to identify predictors of motor outcome after hemispherectomy. Thirty-five children with different etiologies (developmental, stable acquired or progressive) underwent functional hemispherectomy and motor function assessment before hemispherectomy and 24 months after hemispherectomy. Preoperatively, children with developmental etiologies performed better in terms of distal arm strength and hand function, but not on gross motor function tests. Postoperatively, the three etiology groups performed equally poor in muscle strength and hand function, but gross motor function improved in those with acquired and progressive etiologies. Loss of voluntary hand function and distal arm strength after surgery was associated with etiology, intact insular cortex and intact structural integrity of the ipsilesional corticospinal tract on presurgical MRI scans. In conclusion, postoperative motor function can be predicted more precisely based on etiology and on preoperative MRI. Children with developmental etiology more often lose distal arm strength and hand function and show less improvement in gross motor function, compared to those with acquired pathology.

Can a six-week exercise intervention improve gross motor function for non-ambulant children with cerebral palsy? A pilot randomized controlled trial

Objective: To determine the effect of a six-week exercise intervention on gross motor function for non-ambulant children with cerebral palsy. Design: A parallel arm randomized controlled trial. Setting: Four special schools. Participants: Thirty-five children aged 8–17 with bilateral cerebral palsy; Gross Motor Function Classification System levels IV–V. Method: Participants were randomly allocated to a static bike group, a treadmill group or control group. Participants in the bike and treadmill groups received exercise training sessions, three times weekly for six weeks. The control group received their usual care. Blinded assessments were performed at baseline and six weeks and followed up at 12 and 18 weeks. Outcome measures: Gross Motor Function Measures GMFM-66, GMFM-88D and GMFM-88E. Results: At six weeks significant differences were found in GMFM-88D scores between the bike group and the control group, and the treadmill group and the control group (P < 0.05). The mean change (SD) in GMFM-88D score was 5.9 (6.8) for the bike group; 3.7 (4.4) for the treadmill group and 0.5 (1.9) for the control group. No significant differences were found for GMFM-66 or GMFM-88E scores between the bike group and control group, or the treadmill group and control group, although trends of improvement were observed for both exercise groups. The improvements observed declined during the follow-up period. Conclusion: This study provides preliminary evidence that exercising on a bike or treadmill may provide short-term improvements in gross motor function for non-ambulant children with cerebral palsy. This needs to be tested in a large-scale randomized trial.

Effects of Modified Adeli Suit Therapy on Improvement of Gross Motor Function in Children With Cerebral Palsy

Objective This study aimed to investigate the effects of the Modified Adeli suit therapy (MAST) on improvement of gross motor function in children with cerebral palsy (CP). Methods Thirty-six children with CP assigned by match pairs to three equal groups such as the MAST, the AST, and the Neurodevelopmental Treatment. They were treated for 4 weeks, 2 hr/d, 5 d/wk. All children were tested by the Gross Motor Function Measure (GMFM) at baseline, immediately before and 16 weeks after treatments. Results All groups had improvement in the GMFM after treatment ( p < .01) and there were significant differences among groups ( p < .01). In the follow-up study, no significant improvement in the GMFM was seen within groups ( p > .05), but again there were significant differences among groups ( p < .01). Conclusion The MAST was more effective than using either the AST or the Neurodevelopmental treatment on improvement of gross motor function in children with CP after treatment and at follow-up.

Efficacy of occupational therapy and serial casting in lower limbs of cerebral palsy children administered with phenol nerve block

Abstract To see the efficacy of occupational therapy and serial casting over occupational therapy alone in case of sciatic nerve block in cerebral palsy children. In the study 18 spastic cerebral palsy children were treated with in-traneural phenol block (open technique) followed by occupational therapy to bring out functional change. All the 18 patients were administered with intraneural phenol block. In 9 patients serial casting combined with occupational therapy (experimental group) was given while in another group 9 patients were treated with occupational therapy alone (control group). The treatment session for each patient lasted for 6 weeks. To measure the outcome GMFM 66, pediatric balance test (PBT), active range of motion, passive range of motion, modified Ashworth scale were used as tool. There was significant reduction in spasticity of all the 18 patients (after administration of intraneural phenol nerve block) when compared with their pre-operative status. There was significant improvement of gross motor function (GMFM 66), active and dynamic balance (through PBT), and active range of movement of knee joint in experimental group. There was no significant difference between the groups in passive range of motion and reduction of spasticity. The study concludes that intraneural phenol block reduces spasticity in cerebral palsy children to a significant level thus improving the functional outcome in these children. Serial casting when combined with occupational therapy after phenol block gives much better and quicker improvement in gross motor function and motor milestone development.

Short- and long-term effects of selective dorsal rhizotomy on gross motor function in ambulatory children with spastic diplegia

The primary aim of this prospective cohort study was to evaluate the short-term (1 year) and long-term (mean 6 years) effects of selective dorsal rhizotomy (SDR) on gross motor function and spasticity in ambulatory children with spastic diplegia. Secondary aims were to investigate side effects, additional treatment during follow-up (botulinum toxin type A injections or orthopedic surgery), and parental satisfaction. Thirty-three children who had undergone SDR at a mean age of 6 years and 7 months (± 2 years) were included. There were 7 children at Gross Motor Function Classification System (GMFCS) Level I, 7 at Level II, and 19 at Level III. Gross motor function was assessed with the Gross Motor Function Measure-66 (GMFM-66). Spasticity was measured according to a modified Tardieu scale. Side effects, additional treatment, and parental satisfaction were recorded using a parental questionnaire and medical records. At 1-year follow-up, mean GMFM-66 scores improved significantly by 4.3 ± 4.1 points. Children at GMFCS Levels I and II showed significantly more improvement (7.2 points) on the GMFM-66 compared with children at GMFCS Level III (2.9 points). On long-term follow-up (mean 6 years ± 22 months), mean GMFM-66 scores improved significantly by 6.5 ± 5.9 points, without a difference between children at GMFCS Levels I and II and Level III. No relapse of spasticity was noted. Ten children (30%) needed orthopedic surgery and 13 children (39%) received botulinum toxin type A treatment after SDR. Twenty (91%) of the 22 parents who answered the questionnaire at long-term follow-up believed that their child's functioning had improved after SDR. Selective dorsal rhizotomy resulted in short- and long-term improvements in gross motor function, without relapse of spasticity. However, the majority of the children still needed additional surgery or botulinum toxin A treatment.

Aquatic Therapy for a Child with Type III Spinal Muscular Atrophy: A Case Report

ABSTRACTSpinal muscular atrophy (SMA) is a neuromuscular disorder characterized by degeneration of alpha motor neurons. This case report describes an aquatic therapy program and the outcomes for a 3-year-old girl with type III SMA. Motor skills were examined using the 88-item Gross Motor Function Measure (GMFM), the Peabody Developmental Motor Scales (PDMS-2), and the GAITRite system. The child received aquatic therapy twice per week for 45-min sessions, for 14 weeks. The intervention included aquatic activities designed to improve gross motor skills and age-appropriate functional mobility. The GMFM total score improved by 11% following the intervention. The Standing Dimension score improved by 28% and the Walking, Running, and Jumping Dimension score improved by 18%. The gross motor quotient for the PDMS-2 improved from 66 to 74. The child's gait showed improvement in walking velocity, stride length, and single-limb support time as a percentage of the gait cycle. The outcomes of this case report demonstrate the successful improvement of gross motor function and gait in a 3-year-old child with SMA. This study provides clinical information for therapists utilizing aquatic therapy as a modality for children with neuromuscular disorders.

A Systematic Review of Common Physiotherapy Interventions in School-Aged Children with Cerebral Palsy

ABSTRACTThis systematic review focused on the common conventional physiotherapy interventions used with children with cerebral palsy (CP), aged 4 to 18 years, and critically appraised the recent evidence of each of these interventions using the Oxford Centre for Evidence-Based Medicine Levels of Evidence. The search strategy yielded 34 articles after inclusion and exclusion criteria were applied. The investigated physiotherapy interventions included strength and functional training, weight-supported treadmill training (WBSTT), and neurodevelopmental treatment (NDT). A category of treatment dosage was also included. Strength training was the most studied intervention with significant improvements found in the strength of selected muscle groups using dynamometry, with fewer studies showing significant improvement in function. Functional training showed improvements in gross motor function, endurance, and temperospatial measures, such as gait speed and stride length. Nonsignificant trends of improvement on the Gross Motor Function Measure (GMFM) and gait velocity were found for WBSTT by a few studies with low levels of evidence (case series). Of three studies that evaluated NDT, one high-level evidence study, i.e., randomized controlled trial (RCT) found significant improvements on the GMFM. All studies reviewing treatment dosage had high levels of evidence (RCTs), yet found no significant differences for different intensities of treatment. These results indicate that the levels of evidence for physiotherapy interventions, particularly strengthening and to a lesser extent functional training, in school-aged children with CP has improved; however, further high-level evidence is needed for other interventions.

Preoperative MRI findings and functional outcome after selective dorsal rhizotomy in children with bilateral spasticity

PurposeTo identify MRI characteristics that may predict the functional effect of selective dorsal rhizotomy (SDR) in children with bilateral spastic paresis.MethodsWe performed SDR in a group of 36 patients. The gross motor functioning measure-66 (GMFM-66) was applied before and after SDR. Available cerebral MRIs were retrospectively classified into three diagnostic groups: periventricular leucomalacia (PVL; n = 10), hydrocephalus (n = 2), and normal (n = 6). In patients with PVL, we scored the severity of the MR abnormalities. We compared the changes in the GMFM-66 after SDR in the diagnostic groups. In patients with PVL, we correlated the severity of the MR abnormalities with the changes in the GMFM-66.ResultsThe mean follow-up period was 5 years and 4 months (range, 1 year and 1 month to 9 years). The best improvement in gross motor function was observed in patients with normal MRI, and the slightest improvement was observed in patients with hydrocephalus. The severity of the PVL did correlate with the GMFM-66 score before SDR but not with the functional effect of SDR.ConclusionWe conclude that with respect to gross motor skills, the improvements after SDR are good in patients with no MRI abnormalities. In the patients with hydrocephalus, the improvements after SDR were insignificant. In patients with PVL, the improvements were intermediate and did not correlate with the degree of PVL.

Trends in prevalence and characteristics of cerebral palsy among Icelandic children born 1990 to 2003

To describe trends in cerebral palsy (CP) prevalence, severity, and associated impairments among 139 Icelandic children (65 males, 74 females) born from 1990 to 1996 (period one) and 1997 to 2003 (period two). A population-based study using systematically collected data on motor functioning and associated impairments of children with CP. Mean age at assessment was 5 years 5 months (SD 7.68 mo) in period one and 5 years 5 months (SD 10.44 mo) in period two. Infants with postneonatal CP were excluded. Prevalence of CP per 1000 live births was 2.2 in period one and 2.3 in period two (p=0.862); it decreased from 1.5 to 0.9 for children born at term, was stable for preterm births, but increased from 33.7 to 114.6 for very preterm births (p=0.002). Concurrently, neonatal and infant mortality rates decreased in Iceland. The proportion of children born preterm increased over time (p=0.002), whereas improvements in gross motor function assessed with the Gross Motor Function Classification System were confined to term births (p=0.009). The proportion of children with diplegia increased, accompanied by a decrease in the proportion with quadriplegia (p=0.047). Furthermore, among term births there was a significant reduction over time in the proportion of children with epilepsy (p=0.030) and in the proportion with two or more associated impairments (p=0.030). Although CP prevalence remained stable over 14 years, we observed a decrease in prevalence and severity of the disability among term births.

Treadmill training with partial body‐weight support in children with cerebral palsy: a systematic review

The aim of this systematic review was to examine the literature on the effects of partial body-weight support treadmill training (PBWSTT) in children with cerebral palsy (CP) on functional outcomes and attainment of ambulation. We searched the relevant literature from 1950 to July 2007. We found eight studies on the use of PWSBTT on functional outcomes in children with CP. The methodology to develop systematic reviews of treatment interventions as suggested by the American Academy of Cerebral Palsy and Developmental Medicine and the Critical Review Form-Quantitative Studies Methodological Quality was used to evaluate each article. As two of the eight published articles reported on different outcomes of the same study, this review reports on seven studies with a total of 41 children. The evidence for the functional effects is limited. Statistical significance is not demonstrated in several of the studies, despite reported improvements in gross motor function, functional status, walking performance, and gait parameters. This systematic review is limited by the small number of participants, the heterogeneous level of abilities of participants from Gross Motor Function Classification System levels I to IV, and the low quality of trials. Because of these limitations, we cannot conclude that PBWSTT results in improvements for children with CP. Additional studies and well-established randomized controlled (or clinical) trials are clearly needed before determining the benefits and efficacy that would support continued use of this intervention in the clinical setting.

Hippotherapy on Gross Motor Function in a Child with Hypotonic Quadriplegic Cerebral Palsy: A 1-year Follow-up

Hippotherapy is used to improve gross motor function in children with cerebral palsy (CP). However, the therapeutic effects of hippotherapy using specific position and its longitudinal improvements in children of hypotonic CP have not been thoroughly examined. A 6-year-old girl with hypotonic quadriplegic CP was noted to have generalized hypotonia and global delay in development before intervention. There was sustained improvement in gross motor function after 12-month hippotherapy. She received a 15-minute intervention twice a week for one year with two treatment positions being used, sitting backwards for the first 3 months and prone propped position for the next 9 months. Gross motor function was measured using Gross Motor Function Measure (GMFM-88), Gross Motor Function Classification System (GMFCS), and selected GMFM-88 items assessed on horseback (GMFM-h). The improvement was limited after initial 3-month hippotherapy with sitting backward; however, marked improvement was noted after replacing the sitting backwards program by prone propped position in the following courses. GMFM scores increased from 31.37% to 82.35% and from 0 to 25% in dimension A and B, respectively. GMFCS improved from Level V to Level IV and GMFM-h total scores also increased from 29.17% to 81.25% after the prone propped treatment. We suggested that hippotherapy might enhance gross motor performance and functional ability in hypotonic CP with appropriate treatment position.

The Effect of Frequency of Cerebral Palsy Treatment: A Matched-Pair Pilot Study

The feasibility and effectiveness of a year-long integrated rehabilitation program for young children (less than 6 years old) with cerebral palsy was evaluated, and efficacy of different treatment schedules was compared. A sample of 40 children (20 male; mean age, 3 years +/-1.22) took part: 20 presented with tetraparesis, 12 with diparesis, and 8 with hemiparesis. Participants' motor abilities were classified according to the Gross Motor Function Measure classification system at baseline and after 1 year of treatment. For half of the participants, treatment consisted of continuous integrated intervention twice a week; for the other half, treatment was the 3i intervention (Intermittent, Intensive, Integrated), in which a month of intensive, twice-a-day treatment was followed by a continuous, twice-a-week phase, lasting 5 months. Overall, there was an improvement in gross motor function, with 37% of children improving and no children showing lowered function. Neither baseline general cognitive abilities nor age had a significant effect on the level of improvement, although initial gross motor function did. Children undergoing the intensive intermittent intervention showed the greatest motor function improvement. Results support the effectiveness of the integrated intervention and of periods of higher frequency intervention in young children.

Adductor release and chemodenervation in children with cerebral palsy: A pilot study in 16 children

A pilot study with short-term outcomes of a combined surgical and medical intervention for management of generalized lower limb spasticity, hip displacement and contractures of adductors in children with bilateral spastic cerebral palsy. A prospective cohort study of 16 children (9 boys and 7 girls) aged 2-6 years with bilateral spastic cerebral palsy was performed. At entry, 5 were classified as level III and 11 as level IV, according to the Gross Motor Function Classification System (GMFCS). The intervention consisted of surgical lengthening of adductor longus and gracilis combined with the phenolization of the anterior branch of the obturator nerve, using 1 ml of 6% phenol, applied under direct vision at the time of lengthening of adductor longus. The hamstring and calf muscles were each injected with Botulinum neurotoxin A at a dose of 4 U/kg/muscle. Serial clinical (hip, knee, ankle joint range of motion), radiographic (migration percentage) and functional data-taken from a functional mobility scale (FMS) or GMFCS-were collected at 3, 6, 12 and 24 months post-operatively. There was a significant increase in hip abduction, knee extension (popliteal angle) and ankle dorsiflexion, maintained for 24 months; mean hip migration percentage decreased from 29 to 21% (P < 0.001). Using a validated mobility scale, significant improvements were noted in gross motor function. There were no complications related to the intervention. The combined surgical-medical intervention resulted in a reduction of spastic hip subluxation and improvements in gross motor function, as determined by the FMS. The combined intervention is, thus, useful as a temporizing measure, before definitive decisions are made considering such interventions as dorsal rhizotomy, intrathecal baclofen and single-event, multilevel surgery.

Effectiveness of intensive training for children with cerebral palsy – a comparison between child and youth rehabilitation and conductive education

To compare the short-term effectiveness of 1 intensive training period in child and youth rehabilitation with Move&Walk conductive education and describe the effects of 1 intensive training period in terms of changes at 1 year. The amount and influence of additional consumption of training during the 1-year follow-up was also analysed. Quasi-experimental with 2 groups: Lemo (n=23) and Move&Walk (n=29). A total of 52 children with cerebral palsy, age range 3-16 years. Data included repeated measures with Gross Motor Function Measure (GMFM) and Pediatric Evaluation of Disability Inventory-Functional Skills (PEDI-FS). Data on additional consumption of training was collected at the 1-year follow-up. There was no difference in proportion of change on the clinical measures between the training programmes, except for a higher proportion of improvement on the GMFM total score in Lemo. At the group level, small improvements were shown on GMFM and PEDI FS in the short-term and on PEDI FS only at 1 year. A higher proportion of children who participated in repeated intensive training periods showed improved social functioning. No major differences were shown between the 2 training programmes. One intensive training period facilitated small improvements in gross motor function. The majority of children had a high consumption of training during the 1-year follow-up and the added value of repeated intensive training periods was limited.

Selective posterior rhizotomy for lower extremity spasticity: how much and which of the posterior rootlets should be cut?

BACKGROUND It is well known that selective posterior rhizotomy is effective for relieving spasticity associated with cerebral palsy. However, there is significant variation between surgeons in terms of how much and which of the posterior rootlets should be cut for the improvement of ambulatory function without causing adverse effects. METHODS The study population was composed of 200 CP patients who underwent SPR more than 1 year before this study. The children were divided into 4 groups (Group A had their L1-S2 roots cut, Group B had the L2-S2 roots cut, Group C had the L2-S1 roots cut, and Group D had the L2-S1 roots and the unilateral S2 root cut). We assessed lower limb spasticity, passive range of motion, ambulatory function, and gait pattern in each group. RESULTS Inclusion of L1 and S2 in the lesioning process of SPR was more effective at relieving spasticity in terms of hip adduction and ankle dorsiflexion respectively and improving ambulatory function ( p < 0.01). Although lesioning of S2 carried a greater risk of urinary dysfunction, resection of less than 50% of S2 significantly improved ambulatory function without urinary complications ( p < 0.01). Unilateral lesioning of S2 was an alternative option in selected cases with different amounts of spasticity in the ankles for the same purpose. CONCLUSIONS We propose that L1 and S2 roots should be included in the lesioning process of SPR for effective improvement of gross motor function, but that resection of these roots should be less than 50% to prevent complications.