Highlights
- •Baseline gait quality is related to gait improvement 5 years after SDR.
- •Gait improves more after SDR in children with GMFCS level I and II compared to III.
- •Effects are comparable for children with and without abnormalities on brain MRI.
- •Selective motor control is related to specific improvements in knee kinematics but not to overall gait quality.
Abstract
Objective
To identify factors associated with long-term improvement in gait in children after
selective dorsal rhizotomy (SDR).
Design
Retrospective cohort study.
Setting
University medical center.
Participants
Children (N=36) (age 4-13y) with spastic diplegia of Gross Motor Function Classification
System (GMFCS) level I (n=14), II (n=15), and III (n=7) were included retrospectively
from the database of our hospital. Children underwent SDR between January 1999 and
May 2011. Patients were included if they received clinical gait analysis before and
5 years post-SDR, age >4 years at time of SDR and if brain magnetic resonance imaging
(MRI) scan was available.
Intervention
Selective dorsal rhizotomy.
Main Outcome Measures
Overall gait quality was assessed with Edinburgh visual gait score (EVGS), before
and 5 years after SDR. In addition, knee and ankle angles at initial contact and midstance
were evaluated. To identify predictors for gait improvement, several factors were
evaluated including functional mobility level GMFCS, presence of white matter abnormalities
on brain MRI, and selective motor control during gait (synergy analysis).
Results
Overall gait quality improved after SDR, with a large variation between patients.
Multiple linear regression analysis revealed that worse score on EVGS and better GMFCS
were independently related to gait improvement. Gait improved more in children with
GMFCS I and II compared to III. No differences were observed between children with
or without white matter abnormalities on brain MRI. Selective motor control during
gait was predictive for improvement of knee angle at initial contact and midstance,
but not for EVGS.
Conclusion
Functional mobility level and baseline gait quality are both important factors to
predict gait outcomes after SDR. If candidates are well selected, SDR can be a successful
intervention to improve gait both in children with brain MRI abnormalities as well
as other causes of spastic diplegia.
Keywords
List of abbreviations:
BoNT-A (botulinum toxin-A), CP (cerebral palsy), EVGS (Edinburgh Visual Gait Score), GDI (gait deviation index), GMFCS (Gross Motor Function Classification System), HSP (hereditary spastic paraplegia), ITB (intrathecal baclofen), MRI (magnetic resonance imaging), NNMF (non-negative matrix factorization), PVL (periventricular leukomalacia), SDR (selective dorsal rhizotomy), VAF (variance accounted for)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 04, 2018
Footnotes
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
