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      What is the functional mobility and quality of life in patients with cerebral palsy following single-event multilevel surgery?

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          Abstract

          Purpose

          To report functional mobility in patients with diplegic cerebral palsy (CP) at long-term follow-up after single-event multilevel surgery (SEMLS). The secondary aim was to assess the relationship between functional mobility and quality of life (QoL) in patients previously treated with SEMLS.

          Methods

          A total of 61 patients with diplegic CP, mean age at surgery 11 years, eight months ( sd 2 years, 5 months), were included. A mean of eight years ( sd 3 years, 10 months) after SEMLS, patients were contacted and asked to complete the Functional Mobility Scale (FMS) questionnaire over the telephone and given a weblink to complete an online version of the CP QOL Teen. FMS was recorded for all patients and CP QOL Teen for 23 patients (38%).

          Results

          Of patients graded Gross Motor Function Classification System (GMFCS) I and II preoperatively, at long-term follow-up the proportion walking independently at home, school/work and in the community was 71% (20/28), 57% (16/28) and 57% (16/28), respectively. Of patients graded GMFCS III preoperatively, at long-term follow-up 82% (27/33) and 76% (25/33) were walking either independently or with an assistive device at home and school/work, respectively, while over community distances 61% (20/33) required a wheelchair. The only significant association between QoL and functional mobility was better ‘feelings about function’ in patients with better home FMS scores (r = 0.55; 95% confidence interval 0.15 to 0.79; p = 0.01).

          Conclusion

          The majority of children maintained their preoperative level of functional mobility at long-term follow-up after SEMLS.

          Level of Evidence

          IV

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          Most cited references31

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          A report: the definition and classification of cerebral palsy April 2006.

          Peter Rosenbaum, Nigel Paneth, Alan Leviton … (2007)
          For a variety of reasons, the definition and the classification of cerebral palsy (CP) need to be reconsidered. Modern brain imaging techniques have shed new light on the nature of the underlying brain injury and studies on the neurobiology of and pathology associated with brain development have further explored etiologic mechanisms. It is now recognized that assessing the extent of activity restriction is part of CP evaluation and that people without activity restriction should not be included in the CP rubric. Also, previous definitions have not given sufficient prominence to the non-motor neurodevelopmental disabilities of performance and behaviour that commonly accompany CP, nor to the progression of musculoskeletal difficulties that often occurs with advancing age. In order to explore this information, pertinent material was reviewed on July 11-13, 2004 at an international workshop in Bethesda, MD (USA) organized by an Executive Committee and participated in by selected leaders in the preclinical and clinical sciences. At the workshop, it was agreed that the concept 'cerebral palsy' should be retained. Suggestions were made about the content of a revised definition and classification of CP that would meet the needs of clinicians, investigators, health officials, families and the public and would provide a common language for improved communication. Panels organized by the Executive Committee used this information and additional comments from the international community to generate a report on the Definition and Classification of Cerebral Palsy, April 2006. The Executive Committee presents this report with the intent of providing a common conceptualization of CP for use by a broad international audience.
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            Development and reliability of a system to classify gross motor function in children with cerebral palsy.

            Marie Wood, P Rosenbaum, R Palisano … (1997)
            To address the need for a standardized system to classify the gross motor function of children with cerebral palsy, the authors developed a five-level classification system analogous to the staging and grading systems used in medicine. Nominal group process and Delphi survey consensus methods were used to examine content validity and revise the classification system until consensus among 48 experts (physical therapists, occupational therapists, and developmental pediatricians with expertise in cerebral palsy) was achieved. Interrater reliability (kappa) was 0.55 for children less than 2 years of age and 0.75 for children 2 to 12 years of age. The classification system has application for clinical practice, research, teaching, and administration.
            Article 0 comments Cited 439 times – based on 0 reviews     Review now
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              The gait profile score and movement analysis profile.

              Richard Baker, Jennifer McGinley, Michael Schwartz … (2009)
              The Gait Deviation Index (GDI) has been proposed as an index of overall gait pathology. This study proposes an interpretation of the difference measure upon which the GDI is based, which naturally leads to the definition of a similar index, the Gait Profile Score (GPS). The GPS can be calculated independently of the feature analysis upon which the GDI is based. Understanding what the underlying difference measure represents also suggests that reporting a raw score, as the GPS does, may have advantages over the logarithmic transformation and z-scaling incorporated in the GDI. It also leads to the concept of a Movement Analysis Profile (MAP) to summarise much of the information contained within kinematic data. A validation study on all children attending a paediatric gait analysis service over 3 years (407 children) provides evidence to support the use of the GPS through analysis of its frequency distribution across different Gross Motor Function Classification System (GMFCS) and Gillette Functional Assessment Questionnaire (FAQ) categories, investigation of intra-session variability, and correlation with the square root of GGI. Correlation with GDI confirms the strong relationship between the two measures. The study concludes that GDI and GPS are alternative and closely related measures. The GDI has prior art and is particularly useful in applications arising out of feature analysis such as cluster analysis or subject matching. The GPS will be easier to calculate for new models where a large reference dataset is not available and in association with applications using the MAP.
              Article 0 comments Cited 99 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Child Orthop
                Journal ID (iso-abbrev): J Child Orthop
                Journal ID (publisher-id): jco
                Title: Journal of Children's Orthopaedics
                Publisher: The British Editorial Society of Bone & Joint Surgery (London )
                ISSN (Print): 1863-2521
                ISSN (Electronic): 1863-2548
                Publication date (Print): 1 April 2020
                Volume: 14
                Issue: 2
                Pages: 139-144
                Affiliations
                [1 ] org-divisionOxford Gait Laboratory, Nuffield Orthopaedic Centre , Oxford, UK
                [2 ] org-divisionCentre for Population Health Sciences, Usher Institute, University of Edinburgh , UK
                [3 ] org-divisionDepartment of Surgery, The Hospital for Sick Children , Toronto, Ontario, Canada
                Author notes
                Correspondence should be sent to Tomos Aled Edwards, 12 Brewery Lane, Collingwood, Melbourne, VIC, 3066, Australia. E-mail: taedwards2205@ 123456gmail.com
                Article
                Publisher ID: jco-14-139
                DOI: 10.1302/1863-2548.14.190148
                PMC ID: 7184646
                PubMed ID: 32351627
                SO-VID: dedcf8a5-560a-4f04-af93-b1040e6a7742
                Copyright © Copyright © 2020, The author(s)
                License:

                Open Access This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.

                History
                Date received : 23 September 2019
                Date accepted : 21 February 2020
                Categories
                Subject: Original Clinical Article
                Compound subject: childrens-orthopaedics, Children’s Orthopaedics

                ScienceOpen disciplines: Orthopedics
                Keywords: cerebral palsy,quality of life,functional mobility,single-event multilevel surgery
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: cerebral palsy, quality of life, functional mobility, single-event multilevel surgery

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