Improving gait and lower-limb muscle strength in children with cerebral palsy following Selective Percutaneous Myofascial Lengthening and functional physiotherapy

Article type: Research Article

Authors: Skoutelis, Vasileios C.^{a; *} | Kanellopoulos, Anastasios^b | Vrettos, Stamatis^c | Gkrimas, Georgios^d | Kontogeorgakos, Vasileios^{a; e}

Affiliations: [a] Medical School, National and Kapodistrian University of Athens, Athens, Greece | [b] Orthopaedic Center, Iaso Children’s Hospital, Marousi, Greece | [c] ‘E-N-A’ Pediatric Physiotherapy Center, Chalandri, Greece | [d] Gait & Motion Analysis Laboratory, Hellenic Society for Disabled Children (ELEPAP), Athens, Greece | [e] First Department of Orthopaedics, ‘Attikon’ University Hospital, Chaidari, Greece

Correspondence: [*] Address for correspondence: Vasileios C. Skoutelis, 83 Salaminos Street, 18546 Piraeus, Attiki, Greece. Tel.: +30 6972806727; E-mail: [email protected].

Abstract: BACKGROUND:Selective Percutaneous Myofascial Lengthening (SPML) is an innovative minimally invasive surgical procedure, using micro incisions often combined with alcohol nerve block, for managing muscle contractures and stiffness in children with cerebral palsy (CP). There is lack of evidence of effects of a combined intervention of SPML and physiotherapy on gait function and muscle strength in CP. OBJECTIVE:This study investigated the change in gait function and muscle strength in children with CP who underwent gait laboratory assessment before and after SPML, combined with obturator nerve blocks, and 9-month post-surgical functional physiotherapy. METHODS:Ten children with bilateral spastic CP, Gross Motor Function Classification System (GMFCS) level II-IV, age 5-7 years, participated in this study. The Global Gait Graph Deviation Index (Global GGDI) and isometric muscle strength (hand-held dynamometry) were the primary outcome measures. Changes in spatiotemporal gait parameters, gross motor function and GMFCS level were secondarily examined. RESULTS:A significant improvement of Global GGDI was found (p < 0.05). The mean strength in hip flexors, extensors and adductors, knee extensors, and ankle dorsiflexors increased significantly (p < 0.05). Children improved significantly their GMFCS level and gross motor capacity (p < 0.05). CONCLUSIONS:SPML procedure combined with functional physiotherapy can improve gait function and lower-limb muscle strength.

Keywords: Cerebral palsy, surgical muscle lengthening, functional physiotherapy

DOI: 10.3233/NRE-182468

Journal: NeuroRehabilitation, vol. 43, no. 4, pp. 361-368, 2018