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Early mobilisation by locomotion therapy following minimally invasive multi-level surgery for children and young adults with cerebral palsy

Authors:
Walter Michael Strobl at Pediatric Orthopaedic Institute MOTIO
Walter Michael Strobl
  • Pediatric Orthopaedic Institute MOTIO
Patricia Senghaas
Patricia Senghaas
Patricia Senghaas
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Jobst Schuseil at Orthopädisch/Unfallchirurgische Klinik Rummelsberg
Jobst Schuseil
  • Orthopädisch/Unfallchirurgische Klinik Rummelsberg
Markus Kollaschinski at Sana Kliniken AG
Markus Kollaschinski
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Abstract

Aim: 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. Method: 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. Results: 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. Conclusion: 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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Early mobilisation by locomotion therapy following minimally invasive multi-level surgery for
children and young adults with cerebral palsy
Strobl W, Senghaas P, Schuseil J, Kollaschinski M
Aim: 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.
Method: 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.
Results: 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.
Conclusion: 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.
Please contact:
Walter Michael Strobl
Prof., M.D., MBA Health Care Management
Head/ Senior Surgeon
Clinic for Pediatric Orthopaedic & Neuroorthopaedic Surgery
Orthopaedic Hospital Krankenhaus Rummelsberg
Germany, 90592 Schwarzenbruck -Nuremberg, Rummelsberg 71
Tel +49-9128-5043240
Fax +49-9128-5043270
walter.strobl@sana.de
www.krankenhaus-rummelsberg.de
MOTIO – Institute for Pediatric Orthopaedics & Neuroorthopaedics
Austria, 1080 Vienna, Breitenfeldergasse 18-20
Tel +43-1-405050-20
Fax +43-1-405050-24
walter.strobl@motio.org
www.motio.org
... In the remaining 10 records, there were missing key variables that hampered analysis and data could not be retrieved. Of these patients, n = 4 are currently still using the Innowalk; n = 1 died due to complications due to the original diagnosis (brain injury); n = 1 stopped usage after improvement and reaching prespecified goals, no further data were available; in n = 2 lack of time/motivation of the parents to use the Innowalk was the reason for not further responding and further two patients were lost to FU. Raw data from 2 out of 11 studies could not be obtained in a high enough quality to be included (n = 30; Strobl et al., 2016;n = 11;Rosenstand & Fløistrup, 2009). One duplicate patient was identified in one case series and eliminated from the analysis. ...
Effect of assisted walking-movement in patients with genetic and acquired neuromuscular disorders with the motorised Innowalk device: an international case study meta-analysis
Article
Full-text available
  • Jun 2019
People with physical disabilities (PD) suffer from consequences due to lack of physical activity and consequently, are at increased risk of chronic diseases. We aimed to evaluate the ability of a motorised assistive device for dynamic standing with weight-bearing in addition to standard state-of-the-art therapy to improve clinical outcome in a meta-analysis of available studies. A total of 11 studies were identified from different European countries analysing the effect of the dynamic device Innowalk. Raw data of nine studies were pooled including a total of 31 patients observed between 2009 and 2017. Standardised questionnaires and physical outcomes were examined in this exploratory meta-analysis. We recorded patients’ characteristics, duration, intensity, and location of usage as well as general clinical outcomes and improvement of passive range of motion (PROM). The analysed population consisted in 90% cases of patients younger than 18 years of age. Patients were severely disabled individuals (aged 8 (6–10) years; 58% male; 67% non-ambulatory, 86% cerebral palsy). A total of 94% used the Innowalk in a home-based or day-care setting. For nearly all individuals (94%), improvements were recorded for: walking or weight-bearing transfer (n = 13), control/strength of the trunk or head (n = 6), joint mobility (n = 14), sleep (n = 4 out of 6/67%), or muscle strength (n = 17), vital functions (n = 16), bowel function (n = 10), attention/orientation (n = 2). PROM of the hip (flexion, abduction, and adduction) significantly (p < 0.001 for multiple comparisons) increased after 1 month (p < 0.05 flexion, adduction) and further after 5 months (p < 0.05 each) in contrast (p < 0.05 each) to a control group with state-of-the-art therapy. Similarly, PROM showed a trend towards improvement in dorsal extension of the ankle (p = 0.07). In summary, this is the first report of a novel device with additional benefit to standard therapy for severe PD. These intriguing results warrant the planned prospective randomised controlled trial to prove the concept and mechanism of action of this device.
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