Long-term outcome of children with cerebral palsy undergoing selective dorsal rhizotomy

Abstract: The overall aim of the thesis was to describe long-term development of functional outcomes in children with cerebral palsy undergoing selective dorsal rhizotomy (SDR) combined with physiotherapy and to evaluate measures used in follow-up. Five years after SDR muscle tone was reduced, passive range of motion (PROM) increased in hip, knee and foot, gross motor function measured by the Gross Motor Function Measure (GMFM) improved as well as functional performance and independence by the Pediatric Evaluation Disability Inventory. SDR was safe and effective. Combined with physiotherapy, SDR provided lasting functional benefits (Paper I). In Paper II the amount and types of orthopaedic surgery five years after SDR were analyzed. Subtalar arthrodesis, achilles and adductor tendon lengthening were the most frequent operations, 42% of the children had undergone orthopaedic surgery. In Paper III the longitudinal construct validity (LCV) of different GMFM scores was studied. Large Effect Size and Standardized Response Mean at 12 months were seen for GMFM-88 and GMFM-66 scores at later follow-ups. All scores showed large LCV during the 5-year follow-up. Changes in gait pattern in three dimensional gait analyses during 5 years were shown by Gait Profile Score and Movement Assessment Profile. The instruments were found to be useful for longitudinal studies (Paper IV). Changes in functional outcomes between pre- and 10 years after SDR were described and factors explaining the changes were identified. Muscle tone was reduced, PROM was similar to preoperative measurements and GMFM-66 improved. Changes were related to levels of severity and age (Paper V).