Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
Department of Development and Regeneration, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
Dev Med Child Neurol. 2018 May;60(5):505-512. doi: 10.1111/dmcn.13683. Epub 2018 Feb 8.
To explore the evolution of self-care and functional mobility after multilevel surgery in children and adolescents with spastic diplegic cerebral palsy and to identify factors affecting these outcomes.
Thirty-four participants (22 males, 12 females) were evaluated before surgery, and at 2 months, 6 months, 1 year, 18 months, and 2 years after surgery. Self-care was assessed with the Pediatric Evaluation of Disability Inventory Dutch edition. The Mobility Questionnaire47 (MobQues47) and Functional Mobility Scale (FMS) were used to measure functional mobility.
All outcomes revealed a significant decrease 2 months after single-event multilevel surgery (SEMLS) (p-value between <0.001 and 0.02) followed by a significant increase at 6 months (p<0.001 and p=0.045). Between 6 months and 1 year, a significant increase was also revealed for Mobques47 (p<0.001), FMS (p≤0.008), and the Pediatric Evaluation of Disability Inventory Functional Skills Scale (PEDI-FSS) (p=0.001). Improvement continued until 18 months for the PEDI-FSS. Initial score, initial muscle strength, Gross Motor Function Classification System level, age, and number of surgical interventions significantly influenced time trends for self-care and/or functional mobility.
Most preoperative scores are regained at 6 months after SEMLS. Further improvement is seen until 18 months. Participants with a higher functional level before surgery will temporarily lose more than participants with lower initial functional ability, but they also fast regain their function.
Self-care and functional mobility decrease significantly in the first months after single-event multilevel surgery (SEMLS). Six months after SEMLS most preoperative scores are regained. Impact of SEMLS is more pronounced for functional mobility than for self-care. Muscle strength and functionality at baseline are important influencing factors on the evolution after SEMLS.
探讨痉挛性双瘫脑瘫患儿接受多水平手术治疗后自我护理和功能性移动能力的演变，并确定影响这些结果的因素。
34 名参与者（22 名男性，12 名女性）在手术前、手术后 2 个月、6 个月、1 年、18 个月和 2 年进行评估。采用儿童残疾评估量表（Dutch edition）评估自我护理能力。使用移动问卷 47（MobQues47）和功能性移动量表（FMS）评估功能性移动能力。
所有结果均显示，单事件多水平手术（SEMLS）后 2 个月显著下降（p 值均<0.001 至 0.02），随后 6 个月显著增加（p<0.001 和 p=0.045）。在 6 个月至 1 年之间，Mobques47（p<0.001）、FMS（p≤0.008）和儿童残疾评估量表功能技能量表（PEDI-FSS）（p=0.001）也显著增加。PEDI-FSS 的改善持续到 18 个月。初始评分、初始肌肉力量、粗大运动功能分类系统水平、年龄和手术干预次数显著影响自我护理和/或功能性移动的时间趋势。
大多数术前评分在 SEMLS 后 6 个月内恢复。直到 18 个月，仍有进一步的改善。术前功能水平较高的参与者暂时会失去比初始功能能力较低的参与者更多的功能，但他们也会迅速恢复功能。
单事件多水平手术（SEMLS）后第一个月，自我护理和功能性移动能力显著下降。SEMLS 后 6 个月，大多数术前评分恢复。SEMLS 对功能性移动的影响比对自我护理的影响更为明显。基线时的肌肉力量和功能是影响 SEMLS 后演变的重要因素。
