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Early mobilisation by locomotion therapy following minimally invasive multi-level surgery for children and young adults with cerebral palsy
Conference Paper: International Conference on Cerebral Palsy and other Childhood-onset Disabilities at Stockholm
Strobl, Walter; Senghaas, P.; Schuseil, J. [u. a.]
Online-Ressource: Eigenverlag, 2016
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This study compares the outcomes of locomotion therapy following minimally invasive single-event multi-level surgery with conventional mobilisation following conventional single-event multi-level surgery. Our aim was to evaluate the functional outcome of intervention techniques using the combination of recent surgical, orthetic, and therapeutic achievements.
A retrospective study of two groups was undertaken. 32 children and young adults with bilateral spastic cerebral palsy GMFCS II-IV with a mean age of twelve years and three months (5.4 to 21.2) had multi-level minimally invasive surgery following early verticalisation, full weight bearing, and locomotion therapy from day 3 (1 to 5) postoperatively. They were provided by bilateral ankle foot orthoses at the same day and underwent a full rehabilitation program by 3,5 (2 to 5) weeks postoperatively. The minimally invasive techniques included percutaneous lengthening of muscles and osteotomies fixed by locked plates. This group was compared with 30 children and young adults with a mean age of twelve years and six months (6.9 to 20.8) who had conventional single-event multi-level surgery, conventional osteotomies, following short leg casts and a conventional step by step rehabilitation program including standing and walking exercises by 6,8 (4 to 11) weeks postoperatively. Goal attainment scale, isometric muscle strength and gross motor function were assessed before and 12 months after interventions. Postoperative pain has been measured by visual analog scale.
The early mobilization group had significantly less pain, significantly improved muscle strength as well as gross motor function, and significantly improved GAS outcome. Minimally invasive surgery provided reduced operation time and blood loss with a significantly improved time to mobilisation. There were no complications intraoperatively or during rehabilitation in either group.
We consider that early mobilisation by functional orthoses and locomotion therapy following minimally invasive single-event multi-level surgery can be achieved effectively and safely with significant advantages over conventional surgical and rehabilitation techniques in children and young adults with bilateral cerebral palsy.
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