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Susan Sienko Thomas, Cathleen Buckon, Joseph H.
Piatt*, Michael Aiona, Michael Sussman |
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Shriners Hospitals for Children, Portland, |
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St. Christopher’s Hospital, Philadelphia * |
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Stability in stance |
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Foot pre-positioning |
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Foot clearance |
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Stride length |
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Energy efficiency |
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Children with spastic diplegia walk with an
increase in oxygen cost of 2-3X age-matched peers. |
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Increase in oxygen cost has been attributed to
spasticity, muscle tightness and bony abnormalities. |
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No studies exist which examine the changes in
energy efficiency resulting from SDR or orthopaedic surgery on a similar
group of children. |
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To
compare the effect of orthopaedic surgery and SDR on the energy efficiency
of walking in children with spastic diplegia |
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As part of a comprehensive study evaluating the
functional outcome of children with spastic diplegia following SDR or
orthopaedic surgery, children were recruited into the study if they were
candidates for multi-level orthopaedic surgery and SDR. |
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Parents received a booklet explaining both
surgeries, following discussions with research and medical personnel,
parents chose the surgical option that they felt was best for their child. |
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SensorMedics 2900 metabolic cart in the dilution
mode |
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All children were kept NPO and tested at 8:00 am |
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Velocity, oxygen consumption and oxygen cost
data were collected during 5 minutes of steady state walking |
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Steady state: less than 10% variation in VO2,
VE and RQ |
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Evaluations were performed pre-operatively, one
and two years post-operatively. |
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Only children who had complete energy data from
the first 2 years and had not had further surgical intervention prior to
the two year follow-up were included in this analysis. |
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All children were candidates for multi-level
orthopaedic surgery and SDR. |
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Parents received a booklet explaining both
surgeries, following discussions parents chose the surgical option for
their child. |
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Children participated in the study for three
years, however only data from the first 2 years is reported. |
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Evaluations were performed pre-surgery, one and
two years post-operatively. |
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21
children with spastic diplegia |
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Mean age
6+10 years (range 4-11 years) |
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14-SDR,
7-orthopaedic surgery |
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12
independent ambulators, 9 dependent ambulators |
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Variables: (% age-matched norms) |
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Velocity (m/s) |
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O2 consumption (mL O2/kg/s) |
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O2 cost (ml O2/kg/m) |
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Two-way repeated measure ANOVAs |
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Linear contrasts |
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Significance set at p=.05 (+ Bonferroni) |
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Frequency counts |
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SDR |
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Signif increase |
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1-2 yrs |
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Ortho |
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Signif increase |
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pre-op -2 yrs |
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SDR vs Ortho |
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No differences |
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SDR |
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No changes |
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Ortho |
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No Changes |
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SDR vs Ortho |
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No differences |
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SDR |
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No signif changes |
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Ortho |
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Marginal decrease |
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SDR vs Ortho |
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No differences |
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Following SDR, major increases occurred between
1-2 years. |
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Following orthopaedic surgery, increases in
velocity were more gradual over the two years. |
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Only children receiving orthopaedic surgery had
a marginally significant reduction in oxygen cost between pre-1 year
post-op, although both groups showed reductions in oxygen cost. |
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Dependent ambulators made the greatest
reductions in oxygen cost which continued between 1-2 yrs post-operatively. |
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Children who have an oxygen cost > 200% of
age-matched peers have significant reductions in oxygen cost regardless of
the type of surgery they received |
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Children with an oxygen cost < 200% of
age-matched peers were less likely to make a significant reduction in
oxygen cost regardless of the type of surgery they received |
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Since it has been reported that children with
cerebral palsy increase energy cost with age, the decrease seen in this
study indicates that both surgeries have a positive impact on the energy
efficiency of walking. |
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Study participants and their families |
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Research funded by Shriners Hospitals for
Children |
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Notes