Effect of SDR on gait outcomes for children with CP: Preliminary results
Effect of Selective Dorsal Rhizotomy (SDR) on gait outcomes for children with CP: Preliminary results
Introduction: SDR is currently being investigated by NHS England and is going through the Commissioning Through Evaluation process. Derby was selected as one of the 5 centres to undertake the pre-op and post-operative gait analysis which helps to inform the management and measure the outcome of the procedures. Outcome evaluation of SDR is inconclusive. A long-term follow-up by a Swedish team investigating 18 children for 15-20 years following SDR identifies that, although improvements in spasticity were maintained over time, functional improvements were not sustained and in fact deterioration in function was frequently seen. However, a Dutch team present a 10-year follow up in 29 children following SDR and report improvements in functional ability (using GMFM) at the 5 and 10 year stages with no reports of deterioration. Research Question: Does SDR positively influence gait parameters for children with CP? Methodology: All children referred to the gait lab on the CTE programme (from Nottingham) prior to and following SDR surgery were included. To date 8 children have completed both sets of data collection, however, by early April a further 3 sets of data will be available. Full kinematic gait analysis was performed both before and around 2 years after surgery and the Gait Profile Score (GPS) was calculated as part of the battery of standardised outcome measures required by the CTE team. Barefoot walking speed and step length are also reported. Results: Data from8 children (mean age 6y8m, range 2y11m:9y9m) prior to surgery are currently available. Follow-up data were collected at an average of 24 months after surgery (range 17-27 months), and 28 months after their initial assessment (range 19-35 months). Data were compared with the lab’s normative paediatric dataset which comprises 10 children aged 11±2 years without gait problems. Improvements were seen for all outcomes for the cohort as a whole, and specifically, SDR improved for ALL children. Statistical analysis has not yet been undertaken and caution will be placed on this due to small cohort numbers. Discussion: GPS was seen to increase following SDR surgery for all children, suggesting an improvement in overall gait pattern towards normal. However, interpretation of this should consider the natural development of gait in these very young children and a comparison group of children who did not receive SDR would have helped to determine the natural development of gait in this population over time at this young age. Nonetheless, these are encouraging signs of improvement following SDR. Step length and walking speed also increased following surgery, although not for every child. Again these values are expected to increase over time due to growth and caution should be placed on over-interpreting these results. Unfortunately, height values were not available for all children to allow these values to be expressed as a percentage of height to give a more normalised value of change.
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