Author: Olree S, Engsberg J, Ross A, Park T
Source: Developmental Medicine and Child Neurology. Volume 42, 2000
This article describes a laboratory-based movement analysis of 27 children (2-16 years old) with cerebral palsy before and after selective dorsal rhizotomy surgery and intensive physical therapy. The patterns of movement at the hip, knee, and ankle were compared before, and 8 months following, surgery. These joint movement patterns were also compared to the movement patterns of a group of 7 children without cerebral palsy. The children were asked to bend and straighten their knee while sitting on the edge of a table. Their movement was videotaped and then evaluated using a two-dimentional Peak Performance analysis system to determine the ability of each child to move the knee independently of the hip and ankle. Children without cerebral palsy were able to move their joints independently of one another but the children with cerebral palsy demonstrated synergy patterns. When straightening (extending) their knee, for example, they also tended to straighten (extend) their hip causing their trunk to lean backwards. Similarly, when the children with cerebral palsy flexed the knee( by bending the lower leg backwards) they also dorsiflexed the ankle causing the toes to flex toward the knee. The investigators concluded that these patterns of movement were not changed as a result of dorsal rhizotomy and physical therapy. Several questions are not answered by the study. 1) The children were not told how to move their hip or ankle when moving their knee. The children with cerebral palsy did not automatically separate movement at the hip, knee, and ankle. Could they have consciously controlled these movements following surgery and therapy if they had been instructed to move this way? 2) The therapy following surgery was not designed to teach isolated movement control bur instead emphasized increasing range of motion, strength and function. Could this skill have been successfully taught during therapy following surgery? 3) Is the ability to separate movement at different joints essential for function and an important measure of therapeutic success?
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