Effect of Selective Dorsal Rhizotomy on Gait in Children with Bilateral Spastic Paresis: Kinematic and EMG-Pattern Changes

S. Grunt; W. J. P. Henneman; M. J. Bakker; J. Harlaar; W. J. R. van der Ouwerkerk; P. van Schie; A. Reeuwijk; J. G. Becher; R. J. Vermeulen

doi:10.1055/s-0030-1267983

Neuropediatrics 2010; 41(5): 209-216
DOI: 10.1055/s-0030-1267983

Original Article

Effect of Selective Dorsal Rhizotomy on Gait in Children with Bilateral Spastic Paresis: Kinematic and EMG-Pattern Changes

S. Grunt¹ ^, ² , W. J. P. Henneman¹ , M. J. Bakker¹ , J. Harlaar¹ ^, ³ , W. J. R. van der Ouwerkerk⁴ , P. van Schie¹ , A. Reeuwijk⁵ , J. G. Becher¹ ^, ³ , R. J. Vermeulen⁶

¹Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, the Netherlands
²Department of Child Neurology, University Children's Hospital, Inselspital, Berne, Switzerland
³Research Institute MOVE, VU University Medical Center, Amsterdam, the Netherlands
⁴Department of Neurosurgery, VU University Medical Center, Amsterdam, the Netherlands
⁵Department of Physical Therapy. VU University Medical Center, Amsterdam, the Netherlands
⁶Department of Child Neurology. VU University Medical Center, Neuroscience Campus Amsterdam, the Netherlands

Abstract

Introduction: Selective dorsal rhizotomy (SDR) is an effective treatment for reducing spasticity and improving gait in children with spastic cerebral palsy. Data concerning muscle activity changes after SDR treatment are limited.

Patients and Methods: In 30 children who underwent SDR a gait analysis was performed before and 12–24 months postoperatively. Subjects walked on a 10-m walkway at comfortable walking speed. Biplanar video was registered and surface EMG was recorded. Sagittal knee angles were measured from video and observational gait assessments were performed using the Edinburgh gait assessment scale (EGAS).

Results: The EGAS significantly improved after SDR (p<0.001). There were significant improvements of the knee angle kinematics (p<0.001). Only slight changes in EMG activity were observed. The activity of the m. gastrocnemius (GM) decreased and a late peak appeared in stance, the activity of the m. semitendinosus (ST) increased in stance. The activity of the m. rectus femoris (RF) decreased in swing.

Conclusion: SDR improved overall gait performance but EMG changes were only slight. Better timing of the GM in stance and reduced activity of RF in swing may have increased knee flexion in swing. Reduced hamstrings spasticity may have led to postural instability in the hip.

Key words

cerebral palsy - selective dorsal rhizotomy - gait analysis - spasticity

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Referenzen

References

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Correspondence

R. Jeroen VermeulenMD, PhD

Department of Child Neurology

VU University Medical Center

De Boelelaan 1117

Postbox 7057

1007 MB Amsterdam

The Netherlands

Telefon: +31/20/444 4856

Fax: + 31/20/444 0840

eMail: rj.vermeulen@vumc.nl