Date of Award

Spring 1992

Document Type

Thesis

Degree Name

Master of Science (MS)

Program/Concentration

Physical Therapy

Committee Director

John L. Echternach

Committee Member

Evangeline Yoder

Committee Member

Martha Walker

Abstract

Surgical management of cerebral palsy children typically involves multiple orthopaedic surgeries in order to achieve and maintain the maximum functional level of ambulation. Orthopaedic intervention to address lower extremity spasticity often includes: muscle lengthenings, muscle releases and tendon transfers. The most recent advance in management of lower extremity spasticity has been through a neurosurgical approach; selective dorsal rhizotomy. The long term effects of dorsal rhizotomy are still being investigated. Through the use of instrumented gait analysis, the specific objective results of both of these types of surgeries can be investigated. The purpose of this retrospective study was to examine the effects of multiple simultaneous orthopaedic surgeries and selective dorsal rhizotomy on gait parameters of two groups of children with spastic diplegia cerebral palsy.

Nine subjects were included in this study. Four subjects had undergone multiple simultaneous orthopaedic surgeries, and five subjects had undergone selective dorsal rhizotomy. Both groups underwent gait analysis prior to surgery and approximately one year postoperatively using the Vicon five camera motion analysis system.

Data was collected on a total of nineteen variables. This included sagittal plane hip, knee and ankle joint rotation angles at initial contact, midstance and foot off; sagittal plane joint excursion at the hip, knee and anlde; average stride length; velocity; single limb support; and foot progression angle at initial contact.

Postoperative changes were averaged within each group and subjected to statistical analysis. Average changes were then compared between groups to determine statistically significant changes between the groups. The Wilkes-Shapiro Test determined appropriateness of statistical comparisons for either Student’s t-Test or Wilcoxon Sign Test.

Statistical analysis revealed three variables of improvement in the orthopaedic group: knee joint rotation angles at initial contact, ankle joint rotation angles at initial contact and at midstance. The hip angle at foot off changed in a negative direction postoperatively.

In the dorsal rhizotomy group there were five variables improved postoperatively: knee and ankle joint rotation angles at initial contact and midstance, and overall hip excursion.

Variables of stride length, hip excursion and hip joint rotation angle at foot off were significantly more improved in the dorsal rhizotomy group postoperatively when compared to the orthopaedic group.

Overall, there was sagittal plane improvement at the knee and ankle in both groups with a higher amount of improvement in the dorsal rhizotomy group postoperatively. Three gait parameters were more improved in the dorsal rhizotomy group postoperatively when compared to the orthopaedic group.

DOI

10.25777/ty98-dr09

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