Effects of Selective Dorsal Rhizotomy on Non-ambulant Children With Bilateral Spastic Cerebral Palsy
- Conditions
- Bilateral Cerebral Palsy
- Interventions
- Other: sequenced trunk co-activation exercisesOther: Standard Orthotic ManagementOther: selective dorsal rhizotomy
- Registration Number
- NCT05006144
- Lead Sponsor
- Cairo University
- Brief Summary
Children with spastic bilateral cerebral palsy are late developers. delayed gross and fine motor development require early intervention to improve the child performance and avoid secondary impairments.
- Detailed Description
increased tone of lower extremity muscles interfere with the child sitting posture and trunk control. delayed sitting and lack of trunk control contribute to the impairments of upper extremity functions.
selective dorsal rhizotomy is a surgical procedure to control increased tone of the lower extremities. Therefore, the current study is carried out to investigate the effects of selective dorsal rhizotomy on trunk control, selectivity and upper extremity function of non-ambulant children with bilateral spastic cerebral palsy
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 40
- CP, spastic diplegia
- 4-7 years of age
- On Level IV-V on Gross Motor Function Classification System
- At least six months after the last Botulinum toxin A injection in the lower extremities
- Average intelligent quotient according to medical records for active participation
- Partial trunk control (sitting with support).
- Structural non-reducible deformities or musculoskeletal surgery in the lower extremities in the past 12 months
- Ankle clonus
- Exaggerated deep tendon reflex in the legs
- Babinski sign;
- Moderate to severe signs of dystonia, athetosis or ataxia.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description control group sequenced trunk co-activation exercises control group Experimental group selective dorsal rhizotomy selective dorsal rhizotomy control group Standard Orthotic Management control group Experimental group sequenced trunk co-activation exercises selective dorsal rhizotomy Experimental group Standard Orthotic Management selective dorsal rhizotomy
- Primary Outcome Measures
Name Time Method Segmental trunk control period of the treatment was 4 successive months The Segmental Assessment of Trunk Control is applied to assess upright trunk postural control in sitting position based on subdividing the trunk into 6 segments. The head/trunk control is acquired segment by segment if upright sitting posture can be maintained under three conditions including: static control at static position, active control while the child moves the head and/or arm and reactive control after external perturbation.The trunk segments according to the scale include: head/neck, thoracic (upper, mid and lower) and lumbar (upper and lower) segments. It is an ordinal scale with a grade 1 to 7 is assigned for each segment with the score 7 indicates that the infant can't retain independent sitting (no hand support). A score of 8 is given as full trunk control is gained.
Gross motor function period of the treatment was 4 successive months The gross motor function measure-88 is a valid and reliable criterion referenced instrument; is currently used to evaluate the motor function over time in individuals with cerebral palsy. It consists of 5 sections including; A) lying and rolling, B) sitting, C) crawling and kneeling, D) standing; E) walking, running, jumping. Each item was scored on a four-point scale as 0, 1, 2 or 3 with higher scores representing a better performance. The scoring key was; 0=does not initiate, 1=initiates the task (\<10%), 2=partial completion of the task (10% to \<100%), 3=task completed (100%). If an item was not tested it was marked as not tested
- Secondary Outcome Measures
Name Time Method upper extremity function period of the treatment was 4 successive months The quality of upper extremity skill test is a reliable and valid tool used to measure the motor function in children with cerebral palsy ages of 18 months to 8 years. The assessment procedures were conducted according to the instruction manual to assess the movement patterns in four basic domains representing dissociated movement; grasp; protective extension; and weight bearing. The total scores for each domain percentage score are calculated as total score which range from zero to 100% with higher score reflects better performance.
Trial Locations
- Locations (1)
Amira Mahmoud Abd-elmonem
🇪🇬Giza, Egypt