Biomechanical changes in gait following selective dorsal rhizotomy

View More View Less
  • 1 Departments of Neurological Surgery and Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia; and Department of Neurology, Washington University of St. Louis, St. Louis, Missouri
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

The purpose of this study was to evaluate the effects of selective dorsal rhizotomy (SDR) on the walking pattern of children with cerebral palsy (CP). The authors hypothesized that SDR would reduce the overactive stretch reflex and result in improved joint positions, greater joint angular velocities and motion, and greater strides. The authors also expected that the changes from the SDR would be reflected in the electrical activities of the muscles.

Methods

Twenty children with CP participated in the study. Ten underwent SDR and 10 who met the inclusion criteria but who did not undergo SDR formed a control group. Gait analysis was performed twice in both groups at comparable time intervals. Within-group (pre- and post-SDR) assessments and between-group (SDR compared with no SDR) assessments were performed. The results indicated that strides increased 1.4 cm on average (p < 0.001), hip and knee excursion increased as a result of greater hip and knee flexion in swing, and ankle dorsiflexion in stance improved. Hip-flexion and knee-extension velocities were increased in swing. Electromyography changes were consistent with these gait changes and support the authors' hypothesis.

Conclusions

By attenuating the stretch response, SDR alters gait mechanics. The effects of SDR include greater strides, joint excursions, and joint angular velocity.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Mark Abel, M.D., Kluge Children's Rehab & Research Institute, 2270 Ivy Road, Charlottesville, Virginia 22903. email: mfa2m@virginia.edu.
  • 1.

    Abel MF, , Damiano DL, , McLaughlin JF, , Song KM, , Graubert CS, & Bjornson KF: Comparison of functional outcomes from orthopedic and neurosurgical interventions in spastic diplegia. Neurosurg Focus 4 (1):E2, 1998 Abel MF, Damiano DL, McLaughlin JF, Song KM, Graubert CS, Bjornson KF: Comparison of functional outcomes from orthopedic and neurosurgical interventions in spastic diplegia. Neurosurg Focus 4(1):E2, 1998

    • Search Google Scholar
    • Export Citation
  • 2.

    Baddar A, , Granata K, , Damiano DL, , Carmines DV, , Blanco JS, & Abel MF: Ankle and knee coupling in patients with spastic diplegia: effects of gastrocnemius-soleus lengthening. J Bone Joint Surg Am 84:736744, 2002 Baddar A, Granata K, Damiano DL, Carmines DV, Blanco JS, Abel MF: Ankle and knee coupling in patients with spastic diplegia: effects of gastrocnemius-soleus lengthening. J Bone Joint Surg Am 84:736–744, 2002

    • Search Google Scholar
    • Export Citation
  • 3.

    Buckon CE, , Thomas S, , Pierce R, , Piatt JH Jr, & Aiona MD: Developmental skills of children with spastic diplegia: functional and qualitative changes after selective dorsal rhizotomy. Arch Phys Med Rehab 78:946951, 1997 Buckon CE, Thomas S, Pierce R, Piatt JH Jr, Aiona MD: Developmental skills of children with spastic diplegia: functional and qualitative changes after selective dorsal rhizotomy. Arch Phys Med Rehab 78:946–951, 1997

    • Search Google Scholar
    • Export Citation
  • 4.

    Chicoine MR, , Park TS, & Kaufman BA: Selective dorsal rhizotomy and rates of orthopedic surgery in children with spastic cerebral palsy. J Neurosurg 86:3439, 1997 Chicoine MR, Park TS, Kaufman BA: Selective dorsal rhizotomy and rates of orthopedic surgery in children with spastic cerebral palsy. J Neurosurg 86:34–39, 1997

    • Search Google Scholar
    • Export Citation
  • 5.

    Crenna P: Spasticity and ‘spastic’ gait in children with cerebral palsy. Neurosci Biobehav Rev 22:571578, 1998 Crenna P: Spasticity and ‘spastic’ gait in children with cerebral palsy. Neurosci Biobehav Rev 22:571–578, 1998

    • Search Google Scholar
    • Export Citation
  • 6.

    Damiano DL, , Quinlivan J, , Owens BF, , Shaffrey M, & Abel MF: Spasticity versus strength in cerebral palsy: relationships among involuntary resistance, voluntary torque, and motor function. Eur J Neurol 8 (suppl 5):4049, 2001 Damiano DL, Quinlivan J, Owens BF, Shaffrey M, Abel MF: Spasticity versus strength in cerebral palsy: relationships among involuntary resistance, voluntary torque, and motor function. Eur J Neurol 8 (suppl 5):40–49, 2001

    • Search Google Scholar
    • Export Citation
  • 7.

    Fonseca ST, , Holt KS, , Saltzman E, & Fetters L: A dynamical model of locomotion in spastic hemiplegic cerebral palsy: influence of walking speed. Clin Biomechanic 16:793805, 2001 Fonseca ST, Holt KS, Saltzman E, Fetters L: A dynamical model of locomotion in spastic hemiplegic cerebral palsy: influence of walking speed. Clin Biomechanic 16:793–805, 2001

    • Search Google Scholar
    • Export Citation
  • 8.

    Gage JR: Gait Analysis in Cerebral Palsy. London: MacKeith Press, 1991 Gage JR: Gait Analysis in Cerebral Palsy. London: MacKeith Press, 1991

    • Search Google Scholar
    • Export Citation
  • 9.

    Granata KP, , Abel MF, & Damiano DL: Joint angular velocity in spastic gait and the influence of muscle-tendon lengthening. J Bone Joint Surg 82:174186, 2000 Granata KP, Abel MF, Damiano DL: Joint angular velocity in spastic gait and the influence of muscle-tendon lengthening. J Bone Joint Surg 82:174–186, 2000

    • Search Google Scholar
    • Export Citation
  • 10.

    Kitchens DL, & Park TS: Dorsal rhizotomy for spastic diplegia: operative indications and techniques. Contemp Neurosurg 16:17, 1994 Kitchens DL, Park TS: Dorsal rhizotomy for spastic diplegia: operative indications and techniques. Contemp Neurosurg 16:1–7, 1994

    • Search Google Scholar
    • Export Citation
  • 11.

    McLaughlin JF, , Bjornson KF, , Astley SJ, , Graubert C, , Hays RM, & Roberts TS, et al: Selective dorsal rhizotomy: efficacy and safety in an investigator-masked randomized clinical trial. Dev Med Child Neurol 40:220232, 1998 McLaughlin JF, Bjornson KF, Astley SJ, Graubert C, Hays RM, Roberts TS, et al: Selective dorsal rhizotomy: efficacy and safety in an investigator-masked randomized clinical trial. Dev Med Child Neurol 40:220–232, 1998

    • Search Google Scholar
    • Export Citation
  • 12.

    Palisano R, , Rosenbaum P, , Walter S, , Russell D, , Wood E, & Galuppi B: Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 39:214223, 1997 Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B: Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 39:214–223, 1997

    • Search Google Scholar
    • Export Citation
  • 13.

    Park TS, & Owen JH: Surgical management of spastic diplegia in cerebral palsy. N Eng J Med 326:745749, 1992 Park TS, Owen JH: Surgical management of spastic diplegia in cerebral palsy. N Eng J Med 326:745–749, 1992

    • Search Google Scholar
    • Export Citation
  • 14.

    Rosenbaum PL, , Walter SD, , Hanna SE, , Palisano RJ, , Russell DJ, & Raina P, et al: Prognosis for gross motor function in cerebral palsy: creation of motor development curves. JAMA 288:13571363, 2002 Rosenbaum PL, Walter SD, Hanna SE, Palisano RJ, Russell DJ, Raina P, et al: Prognosis for gross motor function in cerebral palsy: creation of motor development curves. JAMA 288:1357–1363, 2002

    • Search Google Scholar
    • Export Citation
  • 15.

    Russell D, , Rosenbaum P, & Gowland C, et al: Gross Motor Function Measure Manual, ed 2. Hamilton, ON: McMaster University, 1993 Russell D, Rosenbaum P, Gowland C, et al: Gross Motor Function Measure Manual, ed 2. Hamilton, ON: McMaster University, 1993

    • Search Google Scholar
    • Export Citation
  • 16.

    Sinkjaer T: Muscle, reflex and central components in the control of the ankle joint in healthy and spastic man. Acta Neurol Scand Suppl 170:128, 1997 Sinkjaer T: Muscle, reflex and central components in the control of the ankle joint in healthy and spastic man. Acta Neurol Scand Suppl 170:1–28, 1997

    • Search Google Scholar
    • Export Citation
  • 17.

    Steinbok P, , Reiner AM, , Beauchamp R, , Armstrong RW, , Cochrane DD, & Kestle J: A randomized clinical trial to compare selective posterior rhizotomy plus physiotherapy with physiotherapy alone in children with spastic diplegic cerebral palsy. Dev Med Child Neurol 39:178184, 1997 (Erratum in Dev Med Child Neurol 39:inside back cover, 1997) Steinbok P, Reiner AM, Beauchamp R, Armstrong RW, Cochrane DD, Kestle J: A randomized clinical trial to compare selective posterior rhizotomy plus physiotherapy with physiotherapy alone in children with spastic diplegic cerebral palsy. Dev Med Child Neurol 39:178–184, 1997 (Erratum in Dev Med Child Neurol 39:inside back cover, 1997)

    • Search Google Scholar
    • Export Citation
  • 18.

    Subramanian N, , Vaughan CL, , Peter JC, & Arens CJ: Gait before and 10 years after rhizotomy in children with cerebral palsy spasticity. J Neurosurg 88:10141019, 1998 Subramanian N, Vaughan CL, Peter JC, Arens CJ: Gait before and 10 years after rhizotomy in children with cerebral palsy spasticity. J Neurosurg 88:1014–1019, 1998

    • Search Google Scholar
    • Export Citation
  • 19.

    Sutherland DH, & Davids JR: Common gait abnormalities of the knee in cerebral palsy. Clin Orthop 288:139147, 1993 Sutherland DH, Davids JR: Common gait abnormalities of the knee in cerebral palsy. Clin Orthop 288:139–147, 1993

    • Search Google Scholar
    • Export Citation
  • 20.

    Sutherland DH, , Santi MS, & Abel MF: Treatment of stiff-knee gait in cerebral palsy: a comparison by gait analysis of distal rectus femoris transfer versus proximal rectus release. J Pediatr Orthop 10:433441, 1990 Sutherland DH, Santi MS, Abel MF: Treatment of stiff-knee gait in cerebral palsy: a comparison by gait analysis of distal rectus femoris transfer versus proximal rectus release. J Pediatr Orthop 10:433–441, 1990

    • Search Google Scholar
    • Export Citation
  • 21.

    Thomas SS, , Aiona MD, , Pierce R, & Piatt JH II: Gait changes in children with spastic diplegia after selective dorsal rhizotomy. J Pediatr Orthop 16:747752, 1996 Thomas SS, Aiona MD, Pierce R, Piatt JH II: Gait changes in children with spastic diplegia after selective dorsal rhizotomy. J Pediatr Orthop 16:747–752, 1996

    • Search Google Scholar
    • Export Citation
  • 22.

    Tuzson AE, , Granata KP, & Abel MF: Spastic velocity threshold constrains functional performance in cerebral palsy. Arch Phys Med Rehabil 84:13631368, 2003 Tuzson AE, Granata KP, Abel MF: Spastic velocity threshold constrains functional performance in cerebral palsy. Arch Phys Med Rehabil 84:1363–1368, 2003

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 306 133 11
Full Text Views 136 9 3
PDF Downloads 65 7 0
EPUB Downloads 0 0 0