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Saturday, March 13, 2004

Researchers find prior surgery affects outcomes in children with cerebral palsy

By Mary Ann Porucznik

Ambulatory patients with cerebral palsy often can benefit from surgery to improve range of motion, extension and flexion in the knee. Two common procedures are bilateral hamstring lengthening and bilateral rectus transfer. Researcher for Poster Exhibit 375 found that younger children without prior surgery achieved more technical goals.

Using Goldberg's model of cerebral palsy outcome assessment, researchers conducted a retrospective review of 313 consecutive ambulatory spastic cerebral palsy patients who had orthopaedic intervention between 1994 and 2000. The mean age at surgery was 11.4 years (range: 4.1 years to 19.2 years). Each child served as his/her own control for pre-and postoperative comparisons at about one year.

Procedure-specific technical goals based upon clinical examination and kinematic data were established for each patient. Researchers examined functional assessments by mobility, velocity, oxygen cost, and Pediatric Outcomes Data Collection Instrument (PODCI) questionnaire. Postoperative satisfaction was assessed via an in-house questionnaire.

A higher percentage of technical goals were achieved in four instances:

Although there were overall advances in mobility (p<0.001), no difference was found in preoperative/postoperative velocity (p=0.08). Among the 113 patients for whom oxygen cost data was available, postoperative oxygen cost was significantly lower (p<.001). Upper extremity, comfort level, and happiness scores improved postoperatively among the 33 patients with PODCI scores (all=p<.05). When parents were surveyed, 96 percent were either very satisfied or satisfied.

"The best technical outcomes results occurred in those children without prior musculo-skeletal lower extremity surgery, at younger ages, and when all factors, arising from both muscle and bone and significantly affecting the gait patterns, were addressed at a single surgical intervention," noted lead researcher Douglas A. Barnes, MD.

In addition to Dr. Barnes, researchers included Nancy Scarborough, PT; Barry Goode, MS; Allison C. Scott, MD; Janine Calmes; and Elroy Sullivan, PhD, all of Houston.

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Last modified 01/March/2004