The Change of Gross Motor Function Following Selective Dorsal Rhizotomy in Spastic Cerebral-Palsied Children

Lee, So Young; Choi, In Sung; Han, Jae Young; Jung, Ju Chan; Wee, Jeong Sun; Oh, Myung Shin; Park, Seung Jin; Lee, Sam Gyu; Kim, Jae Hyoo

Abstract

Nine spastic cerebral-palsied children who had undergone selective dorsal rhizotomy (SDR) under electrophysiologic guidance from May 1999 to May 2000 in Chonnam National University Hospital were examined to determine whether the functional gains achieved and when the motor improvement was maximal. We conducted rehabilitative measures with neurodevelopmental treatment (NDT) according to once-a-day and 5-times-a-week program for 1 year and longer after SDR. We assessed the children immediately before surgery, and on 2 weeks, 1, 3, 6 and 12 months after SDR in following categories: spasticity and muscle tone in upper and lower extremities, assessed by Modified Ashworth Scale (MAS) functional status in activities of daily livings; assessed by Functional Independence Measure (FIM) and Modified Barthel Index (MBI) and gross motor function state measured by Gross Motor Function Measure (GMFM) scale. After SDR, we observed marked decreased spasticity and motor function for a relatively long period, and therefore should have to know the minimum time of turning point recovered from this state. Generally, SDR offers children with spastic cerebral palsy improved motor capabilities and increased level of function after six month. Although the spasticity was reduced and the motor function was improved after SDR, the child still remained the abnormal postural patterns of movement and weakened muscle strength. Therefore, intensive and consistent postoperative rehabilitation therapy was essential to ensure maximal physical progress and functional gains. The total mean score of GMFM was significantly decreased on postoperative period up to 3 months because of decreased muscle tone associated with decreased sensation of input stimuli as a result of SDR, but this score was most significantly increased on six months after SDR, especially in sitting dimension. These results showed that SDR combined with postoperative intensive rehabilitation therapy in spastic cerebral palsied-children had a significant positive effect on gross motor function, especially from postoperative six months later. According to this point, we concluded that intensive rehabilitative measures were needed for minimum 6 months or above after SDR.