Efficacy of Selective Dorsal Rhizotomy on Motor Function of Ambulant Children With Spastic Diplegia
Study Details
Study Description
Brief Summary
The management of cerebral palsy is complex and requires a multidisciplinary approach. Selective dorsal rhizotomy is a neurosurgical technique that aims to reduce spasticity in the lower limbs and improve motor function.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
|
N/A |
Detailed Description
the current study is designed to assess the effectiveness of Selective dorsal rhizotomy on motor function in ambulant children with spastic diplegia. therefore, A convenient sample of ambulant children with spastic diplegia will be allocated to two groups of equal numbers (control and experimental)
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Other: control group control group |
Other: Concomitant physical rehabilitation
Children of this group will receive a regular exercise rehabilitation program including starching exercises, functional strength training and static and dynamic balance exercises.The program will be conducted by six licensed pediatric physical therapists for one hour/session, 3 times/week, and six successive months.
Other: Standard Orthotic Management
A custom-made articulating ankle foot orthosis was prescribed with a hinge at the level of the medial malleolus extends distally to the tip of the toes and proximally on the posterior surface of the leg to about 5 cm below the knee and secured straps. It is fabricated to permit free ankle dorsiflexion and lock the plantar flexion at 0 dorsiflexion. The splinting schedule started gradually for 2 h/day in the first month, 4 h/day in the second month to the entire wake-up time of the day.
|
Experimental: Experimental group selective dorsal rhizotomy group |
Other: Concomitant physical rehabilitation
Children of this group will receive a regular exercise rehabilitation program including starching exercises, functional strength training and static and dynamic balance exercises.The program will be conducted by six licensed pediatric physical therapists for one hour/session, 3 times/week, and six successive months.
Other: Standard Orthotic Management
A custom-made articulating ankle foot orthosis was prescribed with a hinge at the level of the medial malleolus extends distally to the tip of the toes and proximally on the posterior surface of the leg to about 5 cm below the knee and secured straps. It is fabricated to permit free ankle dorsiflexion and lock the plantar flexion at 0 dorsiflexion. The splinting schedule started gradually for 2 h/day in the first month, 4 h/day in the second month to the entire wake-up time of the day.
Other: selective dorsal rhizotomy
The surgical procedures were tailored to each child according to preoperative assessment plan. All SDRs were performed by a single neurosurgeon through an osteoplastic laminotomy from L2 to L5 that left the facet joints intact.
|
Outcome Measures
Primary Outcome Measures
- Functional Balance [after 6 months and after 1 year (follow-up)]
The pediatric balance scale was used to assess the child's functional performance in 3 dimensions representing sitting, standing, and postural change activities. It comprises a 14-items; each item was graded from 0 to 4 points giving a maximum total score 56 points, with a higher score representing a better performance.
- Gross motor function [after 6 months and after 1 year (follow-up)]
The gross motor function measure-88 is a valid and reliable instrument currently used to evaluate the motor function over time in individuals with CP and consists of 5 sections including; A) lying and rolling, B) sitting, C) crawling and kneeling, D) standing; E) walking, running, jumping. Each item was scored on a four-point scale as 0, 1, 2 or 3 with higher scores representing a better performance.
Secondary Outcome Measures
- Selective voluntary motor control: [after 6 months and after 1 year (follow-up)]
It is a valid and reliable tool frequently used for assessment of isolated movements of the lower limb joints in children with spastic cerebral palsy with a maximum score of 20 points, 10 points for each limb.
- Energy cost of walking [after 6 months and after 1 year (follow-up)]
The energy expenditure index (beats/meter) can be calculated as; walking heart rate (beats/min) minus resting heart rate (beats/ min) on walking velocity (meters/min). the resting heart rate will be obtained for each child during comfortable sitting position for 5 minutes by using pulse oximeter. Walking heart rate and speed will be obtained immediately following a walking test (with a comfortable speed) for duration of 5 minutes in a walkway.
- Functional capacity [after 6 months and after 1 year (follow-up)]
The six-minute walking test is a reliable and valid measure of submaximal exercise capacity in children with and without disabilities. Children are instructed to walk around a marked hallway, 20 meters in length, as fast as possible for 6 minutes at a self-chosen walking speed. The time was recorded with a stopwatch. The total distance covered was measured in meters.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
CP, spastic diplegia
-
4-8 years of age
-
The ability to walk with or without assistive devices typically on Level II-III on Gross Motor Function Classification System
-
At least six months after the last Botulinum toxin A injection in the lower extremities
-
Average intelligent quotient according to medical records for active participation
-
Good trunk control with good antigravity strength of lower extremity on clinical examination.
Exclusionary criteria
-
Ankle clonus; exaggerated deep tendon reflex in the legs
-
Babinski sign
-
Structural non-reducible deformities or musculoskeletal surgery in the lower extremities in the past 12 months
-
Moderate to severe signs of dystonia, athetosis or ataxia.
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Amira Mahmoud Abd-elmonem | Giza | Egypt | 12662 |
Sponsors and Collaborators
- Cairo University
Investigators
- Study Chair: Hazem A Aly, Phd, PhD of physical therapy for pediatrics, faculty of physical therapyCairo university
- Study Director: Ahmed Rabie, Phd, Department of neurosurgery, faculty of medicine , Alexandria university
- Principal Investigator: Sara S Saad-Eldien, PhD, Cairo university, faculty of physical therapy
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- selective dorsal rhizotomy