Influence of gait analysis on decision-marketing for lower extremity surgery

Single event multilevel surgery in children with spastic cerebral palsy: a randomized controlled trial

P THOMASON M PT A,D, J ROBIN ,MBBS A,B,D, A PETERS BAPPSC
(HMS) A , R BAKER PHD A,D , K DODD PHD C, H K GRAHAM MD A,D,
P SELBER MD A, N TAYLOR PHD C, R WOLFE PHD E

  1. 1. Hugh Williamson Gait Laboratory, Royal Children’s Hospital;
  2. 2. The University of Melbourne;
  3. 3. LaTrobe University;
  4. 4. Gait Centre for Clinical Research Excellence, Murdoch Childrens Research Institute;
  5. Monash University, Melbourne, Australia

Background: Single event multilevel surgery (SEMLS), followed by a postoperative course of intensive physiotherapy, is used to correct fixed deformities with the intention of improving gait and function in ambulant children with spastic cerebral palsy (CP). Progressive resistance strength training (PRST) can improve strength and physical functioning in children with CP-related weakness and is a suitable intervention to control for postoperative physiotherapy with SEMLS. No randomized controlled trials (RCTs) have been published evaluating SEMLS.

Design: RCT.

Setting: Tertiary referral centre and motion analysis laboratory.

Participants: A consecutive study of 19 children (mean age 9y; range 7-11y) presenting for evaluation of gait and function who fulfilled specific inclusion and exclusion criteria. Inclusion criteria:age 7 to 12 years; bilateral spastic CP; Gross Motor Function Classification System Levels II and III; and instrumented gait analysis providing evidence supporting the need for SEMLS. Exclusion criteria: orthopaedic deformities dictating urgent need for intervention.

Method: Participation was offered to children fulfilling the inclusion criteria following instrumented gait analysis and standardized functional testing. Participants were randomized by the process of minimization to have SEMLS (including postoperative physiotherapy), or to the control group to undergo PRST. A wide range of assessments were performed at baseline, then at 3,6,9,12, and 24 months, addressing different domains of the World Health Organization International Classification of Functioning, Disability and Health. The preliminary results of 14 children who have completed 12-month assessments are reported.

Results: A between-group comparison was made of body structure and function in relation to fixed deformities and mobility, as determined by instrumental gait analysis, using the Gillette Gait Index (GCI). Results of the key measures of musculoskeletal deformity and mobility are given in Table C:8.

Gait (GCI) deteriorated in the control group but improved in the SEMLS group (p=0.02). Contractures improved at the ankle in the SEMLS group (p=0.02). Contractures improved at the ankle in the SEMLS group compared with the controls (gastrocnemius and soleus, p=0.05 and p=0.02 respectively), and contracture at the hips worsened in the controls (p=0.06).

Conclusions: In the domains of body structure and function, significant improvements were recorded following SEMLS in children with bilateral spastic CP. In the control group, who did not receive surgery, orthopaedic deformities increased and mobility deteriorated.

Acknowledgemewnts: National  Health and Medical Research Council, Clinical Centre of Research Excellence, and the Hugh Williamson Foundation.

 
Gallery
Gal 1 Gal 2
Supporting Organizations
 
   
   
   
 
Online Feature Partner
 
   
   
 
Locations of visitors to this page
 
 

© 2010 all rights reserved. maintained by Classic Infomedia