Affiliations: [a] Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| [b] Center for Physical Medicine, Rehabilitation and Rheumatology, Al-Agouza Hospital, Giza, Egypt
| [c] Department of Neurosurgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
Correspondence:
[*]
Address for correspondence: Amira M. Abd-Elmonem, Department Physical Therapy for Pediatrics, Faculty of Physical
Therapy, Cairo University, 7 Ahmed Alzayate St., Been Alsarayat, Giza 12662, Egypt. E-mail: amira.mahmoud@cu.edu.eg; ORCID: http://orcid.org/0000-0002-5877-8339.
Abstract: BACKGROUND:Children with spastic diplegia experience tonicity, lack of selective motor control, subnormal postural stability and delayed motor development. Selective dorsal rhizotomy followed by physical therapy is a permanent procedure aimed to alleviate hypertonicity. OBJECTIVE:To explore the efficacy of selective dorsal rhizotomy (SDR) followed by a physical training on gross motor function (GMF), functional balance, walking capacity, selective motor control (SMC) and energy cost of walking (ECW) of ambulant children with spastic diplegia. METHODS:Forty-two children with spastic diplegia aged 5 to 8 years were randomly assigned into the control or SDR-group. Both groups received a designed physical training of progressive functional strength training and standard orthotic management (SOM) 3 times a week for 6 months. GMF, functional balance, ECW, functional capacity and SMC were assessed by gross motor function measure (GMfM-88), pediatric balance scale (PBS), energy expenditure index (EEI), six-minute walking test (6MWT) and selective control assessment of lower extremity (SCALE), respectively. Assessment was carried out before the treatment (baseline), after 6 months (post I) and 1-year follow-up (post II). RESULTS:From baseline to post I and post II assessments, changes of GMF, functional balance, ECW, functional capacity and SMC within the control and SDR groups showed significant improvements (P < 0.001). Moreover, group comparison showed significant differences in favor of the SDR group. CONCLUSION:Integrated physical training followed SDR demonstrated qualitative changes and enhancement in motor function, achieved by spasticity reduction.
Keywords: Dorsal rhizotomy, energy cost of walking, progressive resistance exercise, selective motor control, spastic cerebral palsy
