Skoutelis V1, Kanellopoulos A2, Vrettos S3, Kalamvoki E4, Kontogeorgakos V1,5
1National and Kapodistrian University of Athens, Medical School, Athens, Greece, 2‘Iaso’ Children’s Hospital, Orthopaedic Centre, Marousi, Greece, 3‘E-N-A’ Pediatric Physiotherapy Centre, Chalandri, Greece, 4‘Paidokinisi’ Pediatric Physiotherapy Centre, Argyroupoli, Greece, 5‘Attikon’ General University Hospital, First Department of Orthopaedics, Chaidari, Greece
Background: Spastic cerebral palsy (CP) is characterized as “short-muscle disease” because of the progressive development of musculotendinous contractures, between the age of 5 to 8 years. Preexisting weakness and secondary fixed contractures affect the mobility of children, by discontinuing the gross motor development, or even declining mobility capacity from the age of 7 years. Therefore, muscle lengthening surgery is commonly inevitable and indispensable. Selective percutaneous myofascial lengthening (SPML) procedure is a novel, minimally invasive surgery, usually combined with alcohol nerve blocks, which enables immediate strengthening physiotherapy programme. Functional physiotherapy is a task-specific strength training approach through functional activities. However, reports about effects of SPML procedure and functional physiotherapy on gross mobility in children with CP are limited.
Purpose: To investigate the effectiveness of SPML procedure and post-surgical functional physiotherapy on gross mobility in school-aged children with CP.
Methods: A non-randomized controlled trial was conducted. Nineteen children aged 5-7 years, with spastic CP, Gross Motor Function Classification System (GMFCS) levels II-IV were enrolled. Ten children (5 males, 5 females; mean age 6.2±0.79 years) underwent SPML procedure, with or without alcohol nerve blocks, and functional physiotherapy for a period of 9 months. Nine children (5 males, 4 females; mean age 5,4±0.53 years), who consisted the control group, received no extra treatment and continued normally the regular physiotherapy care intervention throughout the study period. The outcome measures were the mobility capacity, using the D and E dimensions of the gross motor function measure (GMFM), and the mobility performance, measured with the GMFCS and Functional Mobility Scale (FMS). Data was analyzed using ANCOVA, Wilcoxon and Mann-Whitney U test, in SPSS statistical software (version 21.0). P-values less than 0.05 were considered significant.
Results: Statistical analysis revealed that the children underwent SPML and functional physiotherapy presented significantly higher improvement in D and E dimensions of the GMFM (p 0.05, η2=0.26-0.33). The ratings in the GMFCS and FMS for each distance (5, 50 and 500 metres) were significantly improved in children received SPML procedure and functional physiotherapy (p 0.01), but not in the control children (p>0.05). The comparison of the pre-post differences in the GMFCS and each FMS distance between the groups also demonstrated a significantly better improvement for the intervention compared to the control group (p 0.001).
Conclusion(s): To our knowledge, this is the first controlled trial of SPML and functional physiotherapy. This study provides evidence that SPML procedure and 9-month functional physiotherapy promotes the gross motor function in children with spastic CP, by increasing the degree of independent mobility. Future studies with larger sample size may be needed to further confirm these results.
Implications: The findings of this study bring a new prospect in the management of children with spastic CP. This combination of SPML and functional physiotherapy seems to break the deadlock the clinicians often face for overcoming the plateau or decline of gross motor development in children with CP.
Keywords: Cerebral palsy, Orthopaedic surgery, Physiotherapy
Funding acknowledgements: This study was self-funded.
Purpose: To investigate the effectiveness of SPML procedure and post-surgical functional physiotherapy on gross mobility in school-aged children with CP.
Methods: A non-randomized controlled trial was conducted. Nineteen children aged 5-7 years, with spastic CP, Gross Motor Function Classification System (GMFCS) levels II-IV were enrolled. Ten children (5 males, 5 females; mean age 6.2±0.79 years) underwent SPML procedure, with or without alcohol nerve blocks, and functional physiotherapy for a period of 9 months. Nine children (5 males, 4 females; mean age 5,4±0.53 years), who consisted the control group, received no extra treatment and continued normally the regular physiotherapy care intervention throughout the study period. The outcome measures were the mobility capacity, using the D and E dimensions of the gross motor function measure (GMFM), and the mobility performance, measured with the GMFCS and Functional Mobility Scale (FMS). Data was analyzed using ANCOVA, Wilcoxon and Mann-Whitney U test, in SPSS statistical software (version 21.0). P-values less than 0.05 were considered significant.
Results: Statistical analysis revealed that the children underwent SPML and functional physiotherapy presented significantly higher improvement in D and E dimensions of the GMFM (p 0.05, η2=0.26-0.33). The ratings in the GMFCS and FMS for each distance (5, 50 and 500 metres) were significantly improved in children received SPML procedure and functional physiotherapy (p 0.01), but not in the control children (p>0.05). The comparison of the pre-post differences in the GMFCS and each FMS distance between the groups also demonstrated a significantly better improvement for the intervention compared to the control group (p 0.001).
Conclusion(s): To our knowledge, this is the first controlled trial of SPML and functional physiotherapy. This study provides evidence that SPML procedure and 9-month functional physiotherapy promotes the gross motor function in children with spastic CP, by increasing the degree of independent mobility. Future studies with larger sample size may be needed to further confirm these results.
Implications: The findings of this study bring a new prospect in the management of children with spastic CP. This combination of SPML and functional physiotherapy seems to break the deadlock the clinicians often face for overcoming the plateau or decline of gross motor development in children with CP.
Keywords: Cerebral palsy, Orthopaedic surgery, Physiotherapy
Funding acknowledgements: This study was self-funded.
Topic: Paediatrics: cerebral palsy
Ethics approval required: Yes
Institution: ‘Attikon’ University General Hospital
Ethics committee: Scientific Council
Ethics number: ΕΒΔ 2199/14-03-2017
All authors, affiliations and abstracts have been published as submitted.
