IN CHILDREN WITH CEREBRAL PALSY DOES SELECTIVE DORSAL RHIZOTOMY AFFECT SELECTIVE MOTOR CONTROL AND DOES THIS TRANSLATE INTO FUNCTIONAL CHANGE?

R. Spear^1,2, J. Simmonds¹, D. Chugh³, A. Coomer^4,5

¹University College of London, Great Ormond Street Institute of Child Health, London, United Kingdom, ²Royal Cornwall Hospitals NHS Trust, Physiotherapy, Truro, United Kingdom, ³Great Ormond Street Hospital for Children NHS Foundation Trust, Neurodisability Physiotherapy, London, United Kingdom, ⁴UCL, Great Ormond Street Institute of Child Health, London, United Kingdom, ⁵Imperial College Healthcare NHS Trust, Physiotherapy, London, United Kingdom

Background: Cerebral Palsy (CP) is the most common cause of physical disability in childhood. Muscle spasticity is present in the majority of children with CP and often detrimental to function. Selective Dorsal Rhizotomy (SDR) is a permanent neurosurgical procedure used in the management of some children with CP to reduce lower limb spasticity. Selective motor control (SMC) is ‘the ability to isolate the activation of muscles in a selected pattern in response to demands of a voluntary posture or movement’ (Sanger et al., 2006). It is suggested to be a major influencing factor of more skilled gross motor function and efficient locomotion in children with CP however little is known regarding the effect of SDR on SMC.

Purpose: The aim of the study is to explore the effect of SDR on SMC at the foot and ankle in children with CP and to establish any relationship with change in function for children with Gross Motor Function Classification Scale (GMFCS) level II or III.

Methods: A retrospective case-note review and video analysis was conducted for children who underwent SDR at Great Ormond Street Hospital for Children (GOSH), London United Kingdom, between March 2014 and March 2019. Clinical videos and notes of the 64 patients who met the inclusion criteria were reviewed and outcome measures collated at pre-SDR and 6- and 24-months post SDR. The Boyd and Graham SMC test and GMFM-66 were primary and secondary measures in the study.

Results: The mean SMC scores of the whole sample significantly improved (p<0.001) 6- and 24-months following SDR. Mean SMC scores of children diagnosed with GMFCS level III improved (p<0.05) at 6- and 24-months post-SDR, from baseline, however improvements were non-significant for GMFCS level II children. A positive statistically significant correlation was found between changes in SMC at the foot and ankle and GMFM-66 scores 24-months post-SDR for children with CP GMFCS level III.

Conclusions: Mean SMC scores improved following SDR. Changes in SMC 24-months following SDR appear to translate into functional changes for children with CP GMFCS level III. Further research should determine optimal outcome measures of SMC and minimal clinically important difference of SMC scores.

Implications: This service evaluation provides some insight into the effect of SDR on SMC at the ankle. The results have brought to question the appropriateness of current measures used in the assessment and scoring of SMC. With further research and use of more sensitive SMC measures clinicians will be better equipped to make informed decisions, manage patient and family expectations following SDR and deliver an ever-improving service.

Funding acknowledgements: No funding was received for this study.

Keywords:
Cerebral Palsy
Selective Dorsal Rhizotomy
Selective motor control

Topics:
Paediatrics: cerebral palsy
Disability & rehabilitation
Neurology

Did this work require ethics approval? No

Reason: This study was deemed to be a service evaluation project by GOSH therefore patient consent and full ethical approvals were not required. The study was part of a larger Neurodisability SDR Project at Great Ormond Street Hospital which was registered and assigned the reference number 2704.