DEVELOPMENTAL SKILLS OF CHILDREN WITH SPASTIC DIPLEGIA - FUNCTIONAL AND QUALITATIVE CHANGES AFTER SELECTIVE DORSAL RHIZOTOMY

Objective: This study examined changes in muscle tone, passive range o f motion, stability, and mobility in developmental skills at 6 months and 1 year after selective dorsal rhizotomy (SDR). Design: Prospective outcome study of a consecutive sample. Setting: Private children's ho spital. Patients: Twenty-six children with spastic diplegia: 13 indepe ndent and 13 dependent ambulators (assistive devices). Results: A decr ease in spasticity was seen at 6 months after SDR, with no further dec rease at 1 year. Increases in passive range of motion of the hip and a nkle were seen at 6 months after SDR. The ability to assume and mainta in developmental positions with improved alignment and stability was s een more frequently at 6 months after SDR, whereas an improvement in t he ability to perform transitional movements was seen more frequently at 1 year after SDR. Conclusion: SDR decreases spasticity and increase s lower extremity range of motion in children with spastic diplegia an d appears to be associated with the ability to assume a greater variet y of developmental positions with improved alignment, thus greater sta bility. Improvements in the ability to perform difficult transitional movements at 1 year after SDR are most likely the result of the combin ed effect of maturation, SDR, and intensive therapeutic intervention. (C) 1997 by the American Congress of Rehabilitation Medicine and the A merican Academy of Physical Medicine and Rehabilitation.