title: Functional performance in self-care and mobility after selective dorsal rhizotomy: a 10-year practice-based follow-up study.
abstract: OBJECTIVE
  To explore changes in performance in daily activities (self-care and mobility) 10 years after selective dorsal rhizotomy (SDR).
  
  
  METHODS
  Twenty-four children with bilateral spastic cerebral palsy were followed; the median age at SDR was 4 years 1 month (range 2y 5mo-6y 4mo) and at 10-year follow-up was 14 years 6 months (range 12y 3mo-16y 9mo). The preoperative Gross Motor Function Classification System (GMFCS) levels were: I (n=1), II (n=7), III (n=4), IV (n=11), and V (n=1). The Pediatric Evaluation of Disability Inventory (PEDI) was used to assess performance in functional skills, caregiver assistance, and frequency of modifications and adaptive equipment (MAE) in self-care and mobility domains. Changes were analysed in relation to preoperative GMFCS levels, PEDI scores, and age at operation.
  
  
  RESULTS
  All scores improved significantly (p<0.01) during the first 5 years in patients assigned to GMFCS levels I-III and IV-V. Between 5 years and 10 years, changes were seen in patients grouped in GMFCS levels I-III in the functional skills, mobility (p=0.04), caregiver assistance self-care (p=0.03), and caregiver assistance mobility (p=0.03) domains. Those grouped in GMFCS levels IV-V showed small changes between 5 years and 10 years after surgery. Changes were dependent on the preoperative GMFCS levels in all domains; caregiver assistance, self-care and mobility changes were dependent on preoperative values. The use of MAE increased in participants in GMFCS levels IV-V.
  
  
  CONCLUSIONS
  Children who underwent SDR and physiotherapy improved in functional performance in self-care and mobility and were more independent 10 years postoperatively.
authors.affiliation: Department of Health Sciences, Lund University, Lund, Sweden.
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: D000203:Activities of Daily Living; D000293:Adolescent; D002547:Cerebral Palsy / Q000534:rehabilitation* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D019051:Rhizotomy / Q000379:methods*; D012648:Self Care; D012720:Severity of Illness Index; D013997:Time Factors