The association between gait analysis measures associated with crouch gait, functional health status and daily activity levels in cerebral palsy

The medium-term effects of selective dorsal rhizotomy on gait compared to a matched cerebral palsy non-SDR group: A follow-up study

BACKGROUND

Selective dorsal rhizotomy (SDR) has been shown to improve gait in the short-term in children with cerebral palsy (CP). Further study is needed to look at the trajectory of outcomes over the longer-term.

RESEARCH QUESTION

What are the medium-term effects of SDR on gait compared to a matched CP non-SDR group?

METHODS

Participants underwent SDR at mean age 6.3 years and completed baseline, 1-year and 5-year follow-up gait analyses. Non-SDR participants were matched at baseline. Differences were assessed within and between groups. Kinematic variables were analysed using Statistical non-Parametric Mapping (SnPM). Other gait and clinical data were analysed using Friedman's one-way repeated measure analysis of variance and a Mann-Whitney U-test.

RESULTS

The initial SDR group consisted of 29 participants, reducing to 22 at 5-year follow-up. Of these, 15 (68 %) had orthopaedic surgeries either concurrent with or in the intervening period since the SDR, mean 3.3 procedures per participant. The initial non- SDR group had 18 participants, reducing to 17 at 5-year follow-up. Of these, 13 (76 %) had orthopaedic surgeries, mean 5.7 procedures. At 1-year follow-up the SDR group had significantly improved knee extension, ankle dorsiflexion, foot progression, Gait Deviation Index, and normalised step length compared to baseline, p < 0.05, and outcomes were maintained at 5-years. At 1-year follow-up the non-SDR group kinematic patterns were unchanged, but at 5-year follow-up this group demonstrated significantly improved knee extension, ankle dorsiflexion and foot progression. There were no significant kinematic differences between the SDR and the non-SDR group at medium-term follow-up.

SIGNIFICANCE

We have documented the trajectory of gait outcomes post-SDR over 3 assessments and found that short-term gait changes endured in the medium-term. However, kinematic changes were similar to a non-SDR group undergoing routine and orthopaedic care. These outcomes are important to guide surgical decision making and to manage treatment goals and expectations.

Persistence of Chemotherapy-Induced Peripheral Neuropathy Despite Vincristine Reduction in Childhood B-Acute Lymphoblastic Leukemia

BACKGROUND

Children with B-acute lymphoblastic leukemia (B-ALL) are at risk for chemotherapy-induced peripheral neuropathy (CIPN). Children's Oncology Group AALL0932 randomized reduction in vincristine and dexamethasone (every 4 weeks vs 12 weeks during maintenance in the average-risk subset of National Cancer Institute standard-B-ALL (SR AR B-ALL). We longitudinally measured CIPN, overall and by treatment group.

METHODS

AALL0932 standard-B-ALL patients aged 3 years and older were evaluated at T1-T4 (end consolidation, maintenance month 1, maintenance month 18, 12 months posttherapy). Physical and occupational therapists (PT/OT) measured motor CIPN (hand and ankle strength, dorsiflexion and plantarflexion range of motion), sensory CIPN (finger and toe vibration and touch), function (dexterity [Purdue Pegboard], and walking efficiency [Six-Minute Walk]). Proxy-reported function (Pediatric Outcome Data Collection Instrument) and quality of life (Pediatric Quality of Life Inventory) were assessed. Age- and sex-matched z scores and proportion impaired were measured longitudinally and compared between groups.

RESULTS

Consent and data were obtained from 150 participants (mean age = 5.1 years [SD = 1.7], 48.7% female). Among participants with completed evaluations, 81.8% had CIPN at T1 (74.5% motor, 34.1% sensory). When examining severity of PT/OT outcomes, only handgrip strength (P < .001) and walking efficiency (P = .02) improved from T1-T4, and only dorsiflexion range of motion (46.7% vs 14.7%; P = .008) and handgrip strength (22.2% vs 37.1%; P = .03) differed in vincristine and dexamethasone every 4 weeks vs vincristine and dexamethasone 12 weeks at T4. Proxy-reported outcomes improved from T1 to T4 (P < .001), and most did not differ between groups.

CONCLUSIONS

CIPN is prevalent early in B-ALL therapy and persists at least 12 months posttherapy. Most outcomes did not differ between treatment groups despite reduction in vincristine frequency. Children with B-ALL should be monitored for CIPN, even with reduced vincristine frequency.

Estimation of Gross Motor Functions in Children with Cerebral Palsy Using Zebris FDM-T Treadmill

A standardized observational instrument designed to measure change in gross motor function over time in children with cerebral palsy is the Gross Motor Function Measure (GMFM). The process of evaluating a value for the GMFM index can be time consuming. It typically takes 45 to 60 min for the patient to complete all tasks, sometimes in two or more sessions. The diagnostic procedure requires trained and specialized therapists. The paper presents the estimation of the GMFM measure for patients with cerebral palsy based on the results of the Zebris FDM-T treadmill. For this purpose, the regression analysis was used. Estimations based on the Generalized Linear Regression were assessed using different error metrics. The results obtained showed that the GMFM score can be estimated with acceptable accuracy. Because the Zebris FDM-T is a widely used device in gait rehabilitation, our method has the potential to be widely adopted for objective diagnostics of children with cerebral palsy.