Cerebral Palsy
Conditions
Keywords
standard orthotic management, Selective dorsal rhizotomy, Bilateral Cerebral Palsy, Functional balance, Energy Cost of Walking, Functional capacity, Selective voluntary motor control:
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.
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)
Interventions
OTHERConcomitant 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.
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.
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.
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
4 Years to 8 Years
Healthy volunteers
No
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.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Functional Balance | after 6 months and after 1 year (follow-up) | The pediatric balance scale was used to assess the child's functional performance with total score is 56 and 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 used to evaluate the motor function with total score is 100 and higher scores representing a better performance. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Selective voluntary motor control | after 6 months and after 1 year (follow-up) | Selective motor control of lower extremity scale is used for assessment of motor control 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). |
| Functional capacity | after 6 months and after 1 year (follow-up) | The six-minute walking test is used to assess walking capacity in children with and without disabilities. |
Countries
Egypt
Outcome results
None listed