Volume 90, Issue 6 , Pages 994-1003, June 2009
Functional Status of Patients With Cerebral Palsy According to the International Classification of Functioning, Disability and Health Model: A 20-Year Follow-Up Study After Selective Dorsal Rhizotomy
Abstract
Langerak NG, Lamberts RP, Fieggen AG, Peter JC, Peacock WJ, Vaughan CL. Functional status of patients with cerebral palsy according to the International Classification of Functioning, Disability and Health Model: a 20-year follow-up study after selective dorsal rhizotomy.
Objective
To determine functional status of patients with cerebral palsy 20 years after they received selective dorsal rhizotomy (SDR).
Design
A prospective 20-year follow-up study.
Setting
Red Cross Children's Hospital (SDR operation and 1-year follow-up assessment) and at institutional or private locations nearby patients' homes (20-year follow-up assessment).
Participants
Referred sample of 14 patients with spastic diplegia (6 women, 8 men; mean age, 27y; range, 22–33y) who were preoperatively ambulant and fulfilled strict selection criteria for SDR operation in 1985.
Interventions
Patients were assessed before and 1 and 20 years after SDR.
Main Outcome Measures
Standardized assessments of function according to 2 dimensions of the International Classification of Functioning, Disability and Health (ICF) model: (1) body structure and function (muscle tone, joint stiffness, voluntary movement) and (2) activity (rolling, sitting, kneeling, crawling, standing, walking, transitions) were obtained. In addition, based on assessments and questionnaires, Gross Motor Function Classification System (GMFCS) levels were determined before and at 1 year after SDR retrospectively and currently at 20 years after SDR.
Results
One year after SDR, functional outcomes based on the 2 dimensions of the ICF model improved significantly, and these improvements were maintained at 20 years after surgery. Patients showed a shift in their GMFCS levels 1 and 20 years after SDR.
Conclusions
In line with our 20-year follow-up study with gait parameters as outcome measures, patients with spastic diplegia still show improvements in their functional status 20 years after SDR. We acknowledge the presence of possible confounding factors and a small sample size, but we argue that the improvements found in this study were caused mainly by SDR. Finally, changes in GMFCS levels suggest a possible role for this tool to detect changes after an intervention.
Key Words: Adult, Cerebral palsy, Follow-up studies, Rehabilitation, Rhizotomy, Spastic diplegia
List of Abbreviations: CP, cerebral palsy, GMFCS, Gross Motor Function Classification System, GMFM, Gross Motor Function Measure, ICF, International Classification of Functioning, Disability and Health, SDR, selective dorsal rhizotomy
Supported by the Science Foundation Ireland, the South African Medical Research Council, and the University of Cape Town. The study protocol was approved by the University of Cape Town's Human Ethics Committee (REC REF 139/2005). We also acknowledge the financial support of the South African Medical Research Council.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which authors are associated.
Reprints are not available from the author.
PII: S0003-9993(09)00183-X
doi:10.1016/j.apmr.2008.11.019
© 2009 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
Volume 90, Issue 6 , Pages 994-1003, June 2009
