Zhang Yanyun,Cai Haiqing,Wang Zhigang,et al.Preliminary experience of multidisciplinary team therapy for spastic cerebral palsy children with crouch gait[J].Journal of Clinical Pediatric Surgery,,21():516-522.[doi:10.3760/cma.j.cn101785-202202050-004]
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Preliminary experience of multidisciplinary team therapy for spastic cerebral palsy children with crouch gait

Journal of Clinical Pediatric Surgery[ISSN:1671-6353/CN:43-1380/R] volume: 第21卷 Number: 2022 06 Page: 516-522 Column: 专题·儿童脑瘫的外科治疗 Date of publication: 2022-06-28
Author(s):
Zhang Yanyun1;  Cai Haiqing2;  Wang Zhigang2;  Xu Chunxin3;  Lu Yangyang3;  Chen cen3;  Shen Min3;  Jin Sheng2
1 Operating Room, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China;
2 Department of Pediatric Orthopedics, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China;
3 Yangzhi Rehabilitation Hospital, Tongji University, Shanghai 200127, China
Keywords:
Cerebral Palsy/SU; Orthopedic Procedures; Muscle Spasticity/RH; Gait Apraxia/RH; Exercise Therapy; Telerehabilitation; Treatment Outcome; Child
DOI:
10.3760/cma.j.cn101785-202202050-004
Abstract:
Objective To summarize the preliminary experiences of multidisciplinary team (MDT) treating crouch gait in spastic cerebral palsy (CP) children.Methods From June 2018 to January 2020, a total of 29 children with spastic CP with crouch gait were recruited.There were 20 boys and 9 girls with an average age of 14.3(12-16.5) years.After three-dimensional gait analysis, treatment protocols were formulated jointly by orthopedic surgeons, gait analysis technicians and rehab therapists.Preoperative rehabilitation education and rehabilitation training were provided for 3-4 weeks (including family rehabilitation 1-3 weeks).Also position placement, position transfer, wheelchair training and strength training were offered.Single event multi-level operations were performed, including hip reconstruction, patellar tendon advancement, shortening extension osteotomy of distal femur and Mosca procedure for flat valgus foot.At 2 weeks post-operation, hospital rehabilitation continued for 8 weeks.Home rehabilitation training and online instructions were offered for 10 months.Outpatient re-evaluation was performed every 3 months post-operation and three-dimensional gait analysis at 12 months after evaluating clinical efficacy.Results Twenty-nine children with spastic cerebral palsy with crouch gait completed the MDT treatment program.Time of hospital rehabilitation training and rehabilitation instruction was (0.5-2) weeks and time of family rehabilitation training lasted 2-3 weeks.Family rehabilitation training instruction was completed online.Single event multi-level operations were performed, including patellar tendon advancement (n=29), distal femoral shortening stretch (n=20), adductor release (n=10), rectus lengthening (n=1), iliopsoas release (n=15), Dega pelvic osteotomy with proximal femur derotation osteotomy (n=3), hamstring lengthening (n=14), talonavicular joint reduction with subtalar joint arthrodesis (n=5) and Mosca procedure (n=13).The mean time of postoperative 3D gait analysis was 13.5(12-15) months.The results showed that the maximum extension angle of the postoperative hip joint in the middle and end of the support phase was improved by 12.29° on average, the flexion angle of the knee joint in the mid-support phase was improved by 26.84° on average, and the dorsiflexion angle of the ankle joint in the mid-support phase was improved by 7.05° on average. The rehabilitation assessment demonstrated that the strength of hip abduction, hip extension, knee extension and ankle plantar flexor was significantly improved, and the balance stability was enhanced compared with that before surgery, but the trunk lateral displacement was not improved during walking. Conclusion In children with spastic cerebral palsy, MDT treatment for crouch gait showed promising results by effectively improving knee stiffness, enhancing muscle strength of lower extremities and correcting abnormal gait appearance.Therefore a combination of orthopedic and rehabilitation therapy for crouch gait in children with spastic cerebral palsy has an excellent short-term efficacy.However, MDT mode should be further observed for long-term outcomes.

References:

[1] Arnold AS, Anderson FC, Pandy MG, et al.Muscular contributions to hip and knee extension during the single limb stance phase of normal gait:a framework for investigating the causes of crouch gait[J].J Biomech, 2005, 38(11):2181-2189.DOI:10.1016/j.jbiomech.2004.09.036.
[2] Gage J.Gait analysis in cerebral palsy[M].London:Mac Keith Press, 1991.
[3] Westbom L, H?gglund G, Lundkvist A, et al.New therapeutic methods for spasticity and dystonia in children with cerebral palsy require multidisciplinary team work.Comprehensive approach yields good results[J].Lakartidningen, 2003, 100(3):125-130.
[4] Murphy KP.Cerebral palsy lifetime care-four musculoskeletal conditions[J].Dev Med Child Neurol, 2009, 51(Suppl 4):30-37.DOI:10.1111/j.1469-8749.2009.03431.x.
[5] 中国康复医学会儿童康复专业委员会, 中国残疾人康复协会小儿脑性瘫痪康复专业委员会, 中国脑性瘫痪康复指南编委会.中国脑性瘫痪康复指南(2015):第一部分[J].中国康复医学杂志, 2015, 30(7):747-754.DOI:10.3969/j.issn.1001-1242.2015.07.028.Chinese Association of Rehabilitation Medicine:Committee of Rehabilitation of Children, China Association of Rehabilitation of Disabled Persons:Committee of Rehabilitation of Pediatric Cerebral Palsy, Editorial Board of Guideline for Cerebral Palsy Rehabilitation in China:Guideline for Cerebral Palsy Rehabilitation in China (2015):Part I[J].Chinese Journal of Rehabilitation Medicine, 2015, 30(7):747-754.DOI:10.3969/j.issn.1001-1242.2015.07.028.
[6] Freeman M.Cerebral palsy[M].New York:Springer, 2004.
[7] Perry J.Gait Analysis:Normal and Pathologic Function[M].Thorofare, NJ:Slack, 1992.
[8] Harris G, Smith PA.Human Motion Analysis;Current Applications and Future Directions[M].New York:The Institute of Electrical and Electronic Engineers, 1996.
[9] Damiano DL, Kelly LE, Vaughn CL.Effects of quadriceps femoris muscle strengthening on crouch gait in children with spastic diplegia[J].Phys Ther, 1995, 75(8):658-667.DOI:10.1093/ptj/75.8.658.
[10] Fong DT, Hong Y, Li JX.Lower-extremity gait kinematics on slippery surfaces in construction worksites[J].Med Sci Sports Exerc, 2005, 37(3):447-454.DOI:10.1249/01.mss.0000155390.41572.de.
[11] Hoffinger SA, Rab GT, Abou-Ghaida H.Hamstrings in cerebral palsy crouch gait[J].J Pediatr Orthop, 1993, 13(6):722-726.DOI:10.1097/01241398-199311000-00006.
[12] Saraph V, Zwick EB, Uitz C, et al.The Baumann procedure for fixed contracture of the gastrosoleus in cerebral palsy.evaluation of function of the ankle after multilevel surgery[J].J Bone Joint Surg Br, 2000, 82(4):535-540.DOI:10.1302/0301-620x.82b4.9850.
[13] Damron T, Breed AL, Roecker E.Hamstring tenotomies in cerebral palsy:long-term retrospective analysis[J].J Pediatr Orthop, 1991, 11(4):514-519.DOI:10.1097/01241398-199107000-00018.
[14] Parent A, Pouliot-Laforte A, Dal Maso F, et al.Muscle fatigue during a short walking exercise in children with cerebral palsy who walk in a crouch gait[J].Gait Posture, 2019, 72:22-27.DOI:10.1016/j.gaitpost.2019.05.021.
[15] 邓海燕, 周玉萍.痉挛型双瘫的脑瘫患儿矫形外科术后综合康复治疗观察[J].中国实用医药, 2018, 13(34):189-191.DOI:10.14163/j.cnki.11-5547/r.2018.34.106.Deng HY, Zhou YP.Comprehensive rehabilitative therapies for children with dual cerebral palsy after reconstructions[J].China Practical Medical, 2018, 13(34):189-191.DOI:10.14163/j.cnki.11-5547/r.2018.34.106.

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收稿日期:2022-02-23。
基金项目:上海市卫生健康委员会科研项目（青年）资助项目（20214Y0154）
通讯作者:金晟,Email:bassoon_js@hotmail.com

Last Update: 1900-01-01