Abstract
Buckon CE, Thomas SS, Piatt JH Jr, Aiona MD, Sussman MD. Selective dorsal rhizotomy
versus orthopedic surgery: a multidimensional assessment of outcome efficacy. Arch
Phys Med Rehabil 2004;85:457–65.
Objective
To compare the efficacy of selective dorsal rhizotomy (SDR) and orthopedic surgery
using multidimensional (National Center for Medical Rehabilitation Research disablement
framework) outcome measures.
Design
Prospective outcome study.
Setting
Pediatric orthopedic hospital.
Participants
Twenty-five children with spastic diplegia. Eighteen participants (mean age, 71.3mo)
chose SDR. Seven participants (mean age, 78.6mo) chose orthopedic surgery.
Interventions
Children were evaluated 2 days before surgical intervention and at 6 months, 1 year,
and 2 years postsurgically.
Main outcome measures
The Gross Motor Performance Measure, the Gross Motor Function Measure, and the Pediatric
Evaluation of Disability Inventory.
Results
The SDR group improved significantly in quality of movement attributes 6 months postsurgically;
however, gross motor skills (standing; walking, running, and jumping) gains were seen
2 years postsurgically. The orthopedic group improved significantly in select quality
of movement attributes 6 months postsurgically and in standing skills within the first
postsurgical year. Self-care skills, mobility, and social function gains were seen
earlier and with greater frequency in the SDR group.
Conclusions
Both surgical interventions demonstrated multidimensional benefits for ambulatory
children with spastic diplegia. The results suggest that qualitative changes in movement,
achieved by spasticity reduction, have a greater effect on the enhancement of functional
skill proficiency, thus independence, than recognized.
Keywords
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Article info
Footnotes
☆Supported by the Shriners Hospital for Children (grant no. 15969).
Identification
Copyright
© 2004 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
