Step Therapy Clinical Pediatric Spastic Cerebral Palsy

Background:Domestic surgical treatment of spastic cerebral palsy was mainly orthopedic surgery of the limbs performed before1970s. In1990, mentor Professor Xu Lin has first carried out the treatment for cerebral palsy the SPR (selective dorsal rhizotomy) among China and also Asia. With the development of technology in recent20years, more and more hospitals could perform the SPR surgery. The hospital treatment of spastic cerebral palsy has reached standardization. On the whole, it follows the basic ladder treatment process of rehabilitation-SPR-rehabilitation-orthopedic surgery-Rehabilitation. This paper analyzed the records and follow-ups of71patients who have finished the full-time escalation therapy in the orthopedic center of our hospital, and also evaluated the clinical efficacy of escalation therapy in treating children with spastic cerebral palsy.Objective:To investigate the therapeutic effect of step therapy on children with spastic cerebral palsy.Method:Select71cases with spastic cerebral palsy who had accepted the systematic ladder therapy in the period from September2010to September2012.There was35male patients and36female patients enrolled aged from3to14, mean value is (6.13±2.51) years old.7cases of the preoperative muscle tension level3,57cases of level4, and6cases of level5were reported. There were71cases of hyperref lexia and the ankle clonus. And58cases of Pathological Babinski sign. Respectively collected patients’data of SPR pre-operation, two weeks after surgery, postoperative rehabilitat ion exercise after6months, lower extremity muscle strength after12months (quadriceps, calf triceps, tibialis anterior, tibialis posterior, fibula length of the muscle), score of motor function [1](mainly including patients the prone, sitting, and standing position, walking gait, and squat transformation capacity) and cramps ratings (including1. modified Ashworth5level criteria;2. tiptoeing or scissors gait;3. tendon hyperreflexia;4, ankle clonus;5.pathological Babinski sign). Statistical software SPSS20.0is applied in statistical analysis.Results:Among71patients, the preoperative muscle tension of this group was:8patients at level3in,57patients at level4, and6patients at level5. The post operation review showed that68patients’muscle tension have been reduced to normal state (level1) after two weeks at a normal rate of95.7%. After six months, the post operation review showed that all cases of muscle tension returned to normal. Preoperative tiptoeing or the scissors gait amounted58cases, and52cases showed significantly improvement in the post operation review after two weeks with a89%of improvement. There were71cases of tendon hyperreflexia phenomenon before surgery which had all but disappeared in post operation after two weeks.62cases of ankle clonus phenomenon was reported preoperatively which all disappeared two weeks after according to the review. There were42patients with preoperative pathologic Babinski sign before surgery which all but disappeared2weeks after surgery. There was no recurrence of tendon hyperreflexia, ankle clonus, and pathological Babinski sign in the review after step therapy.Conclusion:There exists significantly difference in spasm of motor function score, score and muscle strength tested before and2weeks after SPR surgery. This indicates that, generally, the spasm was relieved and the motor function is improved, but to some extent the lower extremity muscle strength is decreased.6months after operation, with rehabilitation exercises, there is no difference in the spasm scores, but the lower extremity muscle strength and motor function scores are significantly different. This means the lower extremity muscle strength and motor function of patients have been improved after six months of rehabilitation exercises. The rehabilitation exercises are helpful in improving patients’motor function.After12months, the spasms situation score has no significant difference with that at6months after operation. However, the lower extremity muscle strength and motor function score are different. This shows that after orthopedic surgery further rehabilitation exercises will still help patents improving their lower extremity muscle strength and motor function. Through the systemic step therapies, lower limb spasticity of patients has been relieved and the lower extremity muscle strength and motor function have been improved.