title: Motor function after selective dorsal rhizotomy: a 10-year practice-based follow-up study.
abstract: OBJECTIVE
  The aim of this study was to explore changes in motor function up to 10 years after selective dorsal rhizotomy (SDR).
  
  
  METHODS
  The participants comprised 29 children (20 males, nine females) with bilateral spastic diplegia who were consecutively operated on at a median age of 4 years and 3 months and followed until a median age of 15 years. SDR was combined with physiotherapy and regular follow-up visits. The distribution of preoperative Gross Motor Function Classification System (GMFCS) levels was as follows: I, n=1; II, n=7; III, n=8; IV, n=12; and V, n=1. Muscle tone in hip flexors, hip adductors, knee flexors, and plantar flexors was assessed with the modified Ashworth scale, passive range of motion in hip abduction, popliteal angle, maximum knee extension, dorsiflexion of the foot was measured with a goniometer, and gross motor function was assessed using the Gross Motor Function Measure (GMFM-66). The results were compared with preoperative values, taking into account age at the time of SDR.
  
  
  RESULTS
  After 10 years, muscle tone in hip flexors, hip adductors, knee flexors and plantar flexors was normalized in 19, 24, 13 and 23 participants respectively; mean change in passive range of motion ranged from -2.0° to 8.6°, and the mean increase in GMFM-66 was 10.6. Changes in GMFM-66 were associated with preoperative GMFCS level and GMFM-66 scores.
  
  
  CONCLUSIONS
  Children who underwent SDR and physiotherapy and were regularly followed up by an experienced team showed improved gross motor function for up to 10 years postoperatively.
authors.affiliation: Division of Physiotherapy, Department of Health Sciences, Health Sciences Centre, Lund University, Lund, Sweden. annika.lundkvist@med.lu.se
authors.forename: Annika Lundkvist
authors.initials: AL
authors.lastname: Josenby
authors.forename: Philippe
authors.initials: P
authors.lastname: Wagner
authors.forename: Gun-Britt
authors.initials: GB
authors.lastname: Jarnlo
authors.forename: Lena
authors.initials: L
authors.lastname: Westbom
authors.forename: Eva
authors.initials: E
authors.lastname: Nordmark
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019957:Motor Skills Disorders / Q000175:diagnosis*; D009129:Muscle Tonus; D026741:Physical Therapy Modalities; D011183:Postoperative Complications / Q000175:diagnosis* / Q000534:rehabilitation; D016059:Range of Motion, Articular / Q000502:physiology; D019051:Rhizotomy