Motor control assessment for rhizotomy in cerebral palsy

Objective: To apply motor control assessment for selection of appropriate s pastic cerebral palsy children to receive selective posterior rhizotomy (SP R). Design: Forty children with spastic cerebral palsy (3-16 yr) were divided i nto three groups: "independent ambulator," "dependent ambulator," and "nona mbulator." Another 18 healthy children were selected as the control group. Both motor control (tested by using polyelectromyography (PEMG)) and clinic al ambulatory capability were assessed within 1 mo before SPR and 12 mo aft er. PEMG patterns were classified into seven patterns according to electrom yographic activities during hip/knee flexion and extension. Gait patterns, which were analyzed by computer DynoGraphy, were classified into four patte rns for children with ambulatory capability. Results: PEMG and gait patterns were correlated with ambulatory ability. PE MG patterns 2-3 could predict independent ambulatory ability, whereas patte rns 6-7 will interfere with ambulatory ability. PEMG patterns showed signif icant improvement after SPR in the ambulatory groups (P < 0.05), whereas th ey did not improve in the nonambulator group. Children with cerebral palsy with cc-contraction of proximal/distal muscles had better results after SPR , whereas those with diffuse co-contraction or reduced electromyography act ivities had poor results. Conclusions: PEMG patterns may allow the physician to select the appropriat e children with spastic cerebral palsy to receive SPR with good results.