1st Joint ESMAC-GCMAS Meeting - Análise de Marcha
1st Joint ESMAC-GCMAS Meeting - Análise de Marcha
1st Joint ESMAC-GCMAS Meeting - Análise de Marcha
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O-58<br />
RECOVERY OF MUSCLE STRENGTH FOLLOWING MULTI-LEVEL<br />
ORTHOPAEDIC SURGERY IN DIPLEGIC CEREBRAL PALSY<br />
Seniorou Maria, MD, Thompson Nicky, MSc, MCSP, Theologis Tim, FRCS<br />
Oxford Gait Laboratory, Nuffield Orthopaedic Centre, Oxford, UK<br />
Summary/conclusions<br />
This study was un<strong>de</strong>rtaken to establish the length of muscle strength recovery following multilevel<br />
orthopaedic surgery in diplegic cerebral palsy. We <strong>de</strong>monstrated that the majority of lower<br />
limb muscle groups are weaker than pre-operatively at 1 year from operation, <strong>de</strong>spite intensive<br />
physiotherapy.<br />
Introduction<br />
We have previously shown that children with cerebral palsy are weak and at 6 months post multilevel<br />
surgery there is a significant reduction in both muscle strength and motor function, <strong>de</strong>spite<br />
significant improvements in gait at this stage. Following intensive physiotherapy focusing on<br />
muscle strengthening at 6 months post-op, partial recovery of muscle strength was observed [1].<br />
The aim of the present study was to assess the continuing recovery of muscle strength by<br />
following-up patients to 1 year post-surgery.<br />
Statement of Clinical Significance<br />
Surgical techniques and post-operative physiotherapy regimes following multi-level surgery<br />
should improve further in or<strong>de</strong>r to preserve and improve muscle strength.<br />
Methods<br />
Twenty children with spastic diplegia who un<strong>de</strong>rwent single-stage multi-level surgery (mean age<br />
at surgery 12.5 years, GMFCS level I-III) were matched for age, sex and functional level and<br />
randomised to two groups. Both groups immediately commenced routine post-operative<br />
physiotherapy, and at 6 months post-op additional strength training regimes were administered<br />
three times weekly for six weeks. Group A (n=11) un<strong>de</strong>rtook a progressive resistance training<br />
regime using weights and Group B (n=9) an active exercise regime against gravity only. A<br />
control group of 10 children with cerebral palsy/spastic diplegia (GMFCS levels I-II, mean age<br />
11 years) were also recruited for comparison.<br />
Gait (Vicon 612 system), isometric muscle strength (hip flexors, hip extensors, hip abductors,<br />
knee flexors, and knee extensors at 90° and 30° of flexion, MIE digital dynamometer) and motor<br />
function (GMFM-88) were assessed in both groups pre-operatively, at 6 months post-operatively<br />
prior to strength training, and immediately after strength training. The same measurements were<br />
repeated at 12 months. Within group comparisons were analysed using paired sample t-tests.<br />
Differences between the two groups were evaluated using analysis of co-variance. P=0.05 was<br />
consi<strong>de</strong>red the level of significance.<br />
Results<br />
In the control group, no changes in muscle strength were observed at 6 or 12 months. The<br />
GMFM showed trends towards <strong>de</strong>terioration without reaching statistical significance. Sagittal<br />
kinematics and some kinetic parameters showed significant <strong>de</strong>terioration at 1 year post-baseline.<br />
In both surgical groups, significant <strong>de</strong>crease of strength was observed post-surgery and partial<br />
improvement following physiotherapy at 6 months. Strength improved further at 1 year post-op<br />
but did not reach pre-op values, with the exception of hip abductors and knee extensors at 30°<br />
(Table 1). No significant difference was observed between the two surgical groups un<strong>de</strong>rgoing<br />
different physiotherapy regimes.<br />
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