The outcomes of single event multilevel surgery and physiotherapy in the walking spastic diplegic child with CP or HIV in a resource poor setting

• Main Author: Wood, Linda
• Format: Others
• Language: en
• Published: 2016
• Online Access: http://hdl.handle.net/10539/21278

A research dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of a Master of Science in Physiotherapy January 2016 === Cerebral palsy (CP) is the most commonly seen neurological disorder in children. The incidence of CP is two to four children per 1000 live births. With there being continuous advances in the medical field, the management of these children is continuously changing and evolving. The current preferred orthopaedic management of children with CP is single event multilevel surgery (SEMLS). Although SEMLS is well supported in the literature there is little evidence to show the outcomes of SEMLS in developing countries where resources are limited. Physiotherapy post SEMLS is less available in developing countries. There is little research showing whether the outcomes of SEMLS are still favourable with less physiotherapy intervention post surgery. There is a high prevalence of children who are infected with the Human Immunodefiency Virus (HIV) in South Africa. Many of these children have HIV Encephalopathy (HIVE) and as a result present with spastic diplegia. There is very little research investigating the appropriate management of these children. There is no research available comparing the management of these children to the management of children with spastic diplegic CP. The aim of this study was to determine the outcomes of SEMLS in children with spastic diplegia, either with CP or HIVE, Gross Motor Function Classification System (GMFCS) level two or three, who receive combined orthopaedic and physiotherapy management at Chris Hani Baragwanath Academic Hospital (CHBAH). Ten children with spastic diplegia were enrolled (six with CP, four with HIVE). All children underwent SEMLS at CHBAH and received therapy at a local clinic or hospital or a special needs school. Therapy consisted of predominantly a home-based exercise program. All children were followed up for a period of twelve months. The primary outcome measures were the Gross Motor Function Measure (GMFM), the Functional Mobility Scale (FMS) and the Edinburgh Visual Gait Score (EVGS). A total of sixty-seven procedures were performed with a mean of 6.7 procedures per child. From the baseline assessment there was an improvement in the EVGS of 6.8 at the six month follow-up and 6.4 at the one year follow-up assessment. There was a deterioration of 2.77% in the GMFM-66 scores at the six month assessment, with an improvement of 3.23% at the one year follow-up. The FMS also revealed an initial deterioration in function, with return to pre-operative function at the twelve month assessment. Changes in the EVGS for this study were not clinically significant. Changes in the GMFM-66 were found to be clinically significant. There was greater functional change post SEMLS in this study in comparison to ii previous studies. When comparing children with CP to those with HIVE the changes in the gait parameters, as measured by the EVGS, and those in function, as measured by the GMFM-66, were similar. Children who received therapy at the schools had better results when looking at the EVGS, whereas children receiving therapy at health care facilities had better results according to the GMFM-66. This study shows that SEMLS has similar outcomes in developing countries to those seen in developed countries. Children receiving therapy in different settings showed some differences with regards to improvement in function and gait parameters. This study also highlights the effectiveness of managing children with spastic diplegia due to HIVE similarly to children with spastic diplegic CP. === MT2016