Vasileios C Skoutelis1,2,3, Anastasios D Kanellopoulos4, Stamatis G Vrettos5, Zacharias Dimitriadis6, Efstratia Kalamvoki7, Argirios Dinopoulos1,8, Panayiotis J Papagelopoulos1,9, Stefanos S Vrettos10, Vasileios A Kontogeorgakos1,9. 1. Medical School, National and Kapodistrian University of Athens, Athens, Attica, Greece. 2. Laboratory of Neuromuscular & Cardiovascular Study of Motion, Department of Physiotherapy, School of Health and Caring Sciences, University of West Attica, Egaleo, Attica, Greece. 3. Department of Physiotherapy, 'Attikon' University General Hospital, Chaidari, Attica, Greece. 4. Department of Orthopaedics, 'Iaso' Children's Hospital, Maroussi, Attica, Greece. 5. 'ENA' Pediatric Physiotherapy Practice, Chalandri, Attica, Greece. 6. Health and Quality of Life Research Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece. 7. 'Paidokinisi' Pediatric Physiotherapy Practice, Argyroupolis, Attica, Greece. 8. Third Department of Paediatrics, 'Attikon' University General Hospital, Chaidari, Attica, Greece. 9. First Department of Orthopaedic Surgery, 'Attikon' University General Hospital, Chaidari, Attica, Greece. 10. Department of Medical Physics and Biomedical Engineering, University College London, London, UK.
Abstract
PURPOSE: This non-randomised controlled trial investigated whether a combined programme of functional physiotherapy and minimally invasive orthopaedic surgery improves the level and degree of capacity and performance of gross motor function in children with spastic cerebral palsy (CP). METHODS: Fifty-two children with spastic CP aged 5-7 years, Gross Motor Function Classification System (GMFCS) levels II-IV, were allocated to two equal groups: experimental group (selective percutaneous myofascial lengthening [SPML] procedure and 9-month functional strengthening physiotherapy programme) and control (standard physiotherapy) groups. At baseline and at the end of the 9-month intervention, the capacity and performance of gross motor function were assessed with the Gross Motor Function Measure (GMFM) D and E subcategories and Functional Mobility Scale (FMS), respectively. The level of gross motor function was measured with the GMFCS. RESULTS: There was a statistically significant difference in the post-intervention improvements in the GMFM D (experimental mean difference = 19.63 ± 10.46; control mean difference = 2.40 ± 4.62) and E (experimental mean difference = 19.33 ± 11.82; control mean difference = 4.20 ± 6.26) between experimental and control group (p < 0.001). There was a significant improvement in the GMFCS level and each FMS distance for the experimental group (p < 0.001), but not for the control group (p > 0.05). CONCLUSION: SPML procedure combined with functional physiotherapy improves gross motor function in children with spastic CP, by raising the degree and level of motor independence.
PURPOSE: This non-randomised controlled trial investigated whether a combined programme of functional physiotherapy and minimally invasive orthopaedic surgery improves the level and degree of capacity and performance of gross motor function in children with spastic cerebral palsy (CP). METHODS: Fifty-two children with spastic CP aged 5-7 years, Gross Motor Function Classification System (GMFCS) levels II-IV, were allocated to two equal groups: experimental group (selective percutaneous myofascial lengthening [SPML] procedure and 9-month functional strengthening physiotherapy programme) and control (standard physiotherapy) groups. At baseline and at the end of the 9-month intervention, the capacity and performance of gross motor function were assessed with the Gross Motor Function Measure (GMFM) D and E subcategories and Functional Mobility Scale (FMS), respectively. The level of gross motor function was measured with the GMFCS. RESULTS: There was a statistically significant difference in the post-intervention improvements in the GMFM D (experimental mean difference = 19.63 ± 10.46; control mean difference = 2.40 ± 4.62) and E (experimental mean difference = 19.33 ± 11.82; control mean difference = 4.20 ± 6.26) between experimental and control group (p < 0.001). There was a significant improvement in the GMFCS level and each FMS distance for the experimental group (p < 0.001), but not for the control group (p > 0.05). CONCLUSION: SPML procedure combined with functional physiotherapy improves gross motor function in children with spastic CP, by raising the degree and level of motor independence.
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