Wood L.1, Potterton J.1, Firth G.2
1University of the Witwatersrand, Health Sciences, Johannesburg, South Africa, 2Chris Hani Baragwanath Academic Hospital, Orthopaedics, Johannesburg, South Africa
Background: Single Event Multilevel Surgery is the preferred orthopaedic management of children with Cerebral Palsy (CP) in developed countries. However in South Africa it is only starting to emerge as one of the treatment options for children with CP. Five years ago it was not a treatment offered to children with CP in South Africa in the public health care setting. With limited resources, it is essential to determine whether SEMLS is beneficial to children in this setting.
Purpose: The aim of this study was to determine the outcomes of Single Event Multilevel Surgery (SEMLS) and Physiotherapy in children with spastic diplegia as a result of Cerebral Palsy (CP) or Human Immunodeficiency Virus Encephalopathy (HIVE).
Methods: A longitudinal, single group, pre-test and post-test study was conducted at Chris Hani Baragwanath Academic Hospital (CHBAH). Assessments were done pre-operatively and at six months and one year post-operatively using the Gross Motor Function Measure (GMFM), the Functional Mobility Scale (FMS) and the Edinburgh Visual Gait Score (EVGS). All children received physiotherapy post-operatively.
Results: Ten walking children (6 females, 4 males) with CP (n=6) and HIVE (n=4) were included in this study. The mean age was nine years and ten months (SD=2y4mo, range 6-14y). A total of sixty-seven procedures were performed with a mean of 6.7 procedures per child. From the baseline assessment there was an improvement in the EVGS of 6.8 at the six month follow-up and 6.4 at the one year follow-up assessment. There was a deterioration of 2.77% in the GMFM-66 scores at the six month assessment, with an improvement of 3.23% at the one year follow-up. The FMS also revealed an initial deterioration in function, with return to pre-operative function at the twelve month assessment. Changes in the EVGS for this study were not clinically significant. Changes in the GMFM-66 were found to be clinically significant. There was greater functional change post SEMLS in this study in comparison to previous studies. When comparing children with CP to those with HIVE the changes in the gait parameters, as measured by the EVGS, and those in function, as measured by the GMFM-66, were similar.
Conclusion(s): This study shows that SEMLS has similar outcomes in developing countries to those seen in developed countries. This study also highlights the effectiveness of managing children with spastic diplegia due to HIVE similarly to children with spastic diplegic CP.
Implications: Although the sample size is small, as the first study of its kind it adds two important insights that are valuable to other health care practioners.
Firstly it is the first study to look at SEMLS in Sub-Saharan Africa where the resources differ greatly from those in a developed country.Secondly it looks at a treatment option for children with HIVE, which is an area where there is very little research.
This research sets a foundation for further research to be done in this setting and helps to shed some light on an area of treatment for children with spastic diplegia that is yet to be explored.
Funding acknowledgements: No funding was received for this study
Topic: Paediatrics
Ethics approval: Ethical clearance was granted by the Human Research and Ethics Committee (Medical) of the University of the Witwatersrand.
All authors, affiliations and abstracts have been published as submitted.
