title: Objective measurement of muscle strength in children with spastic diplegia after selective dorsal rhizotomy.
abstract: OBJECTIVE
  To examine changes in isometric muscle strength at the elbow, knee, and ankle at 6 months and 1 year after selective dorsal rhizotomy (SDR) and to determine if SDR altered the frequency of muscle cocontraction.
  
  
  METHODS
  Prospective outcome study of a consecutive sample.
  
  
  METHODS
  Children's hospital.
  
  
  METHODS
  Ten children with spastic diplegia (7 independent and 3 dependent ambulators who used assistive devices) and 8 age-matched controls.
  
  
  METHODS
  SDR; physical and occupational therapy; elbow, knee, and ankle measured for flexion and extension strength during three 10-second isometric contractions for each muscle group; and monitored cocontraction measured via muscle electrodes.
  
  
  METHODS
  Absolute and normalized values of isometric strength; and alterations in the frequency of cocontraction at 6 months and 1 year postoperatively.
  
  
  RESULTS
  Children with spastic diplegia showed significantly weaker knee extensors, ankle dorsiflexors, and ankle plantarflexors than age-matched controls. There were no significant differences in strength between the 2 groups in the elbow flexors, elbow extensors, and knee flexors. Isometric strength did not increase or decrease significantly after SDR. Cocontraction during knee extension was normalized after SDR, whereas cocontraction during ankle plantarflexion was unchanged by SDR in the majority of children.
  
  
  CONCLUSIONS
  SDR did not result in a significant decrease in muscle strength in ambulatory children with spastic diplegia. The normalization of the electromyographic patterns at the knee and not the ankle after SDR lends support to the premise that in children with cerebral palsy cocontraction is multifaceted, representing a volitional strategy to enhance control, as well as a disorder of the mechanisms that govern patterns of muscle activity.
authors.affiliation: Clinical Research Department, Shriners Hospital for Children, 3101 SW Sam Jackson Park Rd., Portland, OR 97201, USA. CEB@SHCC.org
authors.forename: Cathleen E
authors.initials: CE
authors.lastname: Buckon
authors.forename: Susan Sienko
authors.initials: SS
authors.lastname: Thomas
authors.forename: Gerald E
authors.initials: GE
authors.lastname: Harris
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Piatt
authors.forename: Michael D
authors.initials: MD
authors.lastname: Aiona
authors.forename: Michael D
authors.initials: MD
authors.lastname: Sussman
mesh_terms: D002547:Cerebral Palsy / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007537:Isometric Contraction / Q000502:physiology*; D008297:Male; D018482:Muscle, Skeletal / Q000503:physiopathology; D011183:Postoperative Complications / Q000503:physiopathology*; D011446:Prospective Studies; D019051:Rhizotomy