title: Multidimensional outcome measure of selective dorsal rhizotomy in spastic cerebral palsy.
abstract: BACKGROUND
  One of the treatment option to reduce spasticity in cerebral palsy children is selective dorsal rhizotomy. Several studies have demonstrated short and long term improvements in gait and other activities after rhizotomy but this surgery still remains a controversial procedure and patient outcome indicators measures are not uniform.
  
  
  OBJECTIVE
  To describe our assessment and outcome evaluation protocol and to verify by this protocol short term results of rhizotomy.
  
  
  METHODS
  We recruited 9 cerebral palsy children (mean age 7.9 years ± 3.2) affected by mild to moderate spastic diplegia and operated by rhizotomy. Patients were studied preoperatively and at 12 months after surgery by the following clinical and instrumental measures correlated to the International Classification of Functioning: modified Ashworth Scale, passive Range of Motion, Medical Research Council Scale, Selective Motor Control Scale, 3D-motion analysis and energy cost of locomotion measurements (indicators of "body functions"); Gross Motor Functional Measure and Motor Functional Independence Measure (indicators of "activities and participation").
  
  
  RESULTS
  Our data showed, after rhizotomy, reduction of spasticity specially in plantarflexors muscles (p < 0.01), increase of strength of knee flexors/extensors and foot plantar/dorsiflexion muscles (p < 0.01), improvement of selective motor control (p < 0.05), more similar spatio-temporal parameters of gait analysis to healthy subjects, reduced equinus foot and knees hyperflexion as energy cost.
  
  
  CONCLUSIONS
  The complementary use of multiple indicators may improve the evaluation of the results of dorsal rhizotomy. A beneficial outcome measured by these indicators has been found in our spastic diplegic children one year after rhizotomy.
authors: "E. Medea" Scientific Institute, Conegliano Research Centre, Conegliano, TV, Italy. Electronic address: elena.carraro@cn.lnf.it.
authors: Elena
authors: E
authors: Carraro
authors: Functional Neurosurgery Unit, Neuroscience Department, University of Torino, Torino, Italy.
authors: Sergio
authors: S
authors: Zeme
authors: "E. Medea" Scientific Institute, Conegliano Research Centre, Conegliano, TV, Italy.
authors: Valentina
authors: V
authors: Ticcinelli
authors: "E. Medea" Scientific Institute, Conegliano Research Centre, Conegliano, TV, Italy.
authors: Carlo
authors: C
authors: Massaroni
authors: "E. Medea" Scientific Institute, Conegliano Research Centre, Conegliano, TV, Italy.
authors: Michela
authors: M
authors: Santin
authors: Department of Pediatric Neurosurgery, Regina Margherita Children's Hospital, Torino, Italy.
authors: Paola
authors: P
authors: Peretta
authors: "E. Medea" Scientific Institute, Conegliano Research Centre, Conegliano, TV, Italy.
authors: Andrea
authors: A
authors: Martinuzzi
authors: "E. Medea" Scientific Institute, Conegliano Research Centre, Conegliano, TV, Italy.
authors: Enrico
authors: E
authors: Trevisi
mesh_terms: D001696:Biomechanical Phenomena; D002547:Cerebral Palsy / Q000150:complications / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000209:etiology / Q000601:surgery*; D009460:Neurologic Examination; D017063:Outcome Assessment, Health Care / Q000379:methods*; D016059:Range of Motion, Articular; D019051:Rhizotomy / Q000379:methods*; D013126:Spinal Nerve Roots / Q000601:surgery*
keywords: Cerebral palsy; Gait; Muscle spasticity; Oxygen consumption; Rhizotomy