Edinburgh Visual Gait Score- Article Review
Article Review:
Evolution of gait in adolescents and young adults with spastic diplegia after selective dorsal rhizotomy in childhood: A 10 year follow-up study
Purpose
The purpose of this study was to investigate long term carry over effects on gait quality in adults with spastic diplegia who had a selective dorsal rhizotomy procedure performed during their childhood.
Study Population
A total of 19 children with spastic diplegia who had received an SDR procedure from the same neurosurgeon at the VU University Medical Center.
Inclusion Criteria:
- Diagnosis of spastic diplegia
- Able to ambulate prior to SDR procedure
- Procedure performed within a 9 year period (1998-2007)
- Older than 4 years old at time procedure was performed
- Consistent gait assessments (pre-procedure, 2 year follow up, 5 year follow up, 10 year follow up)
No specific exclusion criteria are listed.
Methods & Intervention
Participants for this study were recruited from a specific institute database retrospectively. RDS procedure was performed by neurosurgeon after a multidisciplinary team concluded it was indicated. Children also received AFOs to prevent knee flexion contractures and underwent physical therapy post-op for 6 months. Participants had a gait assessment performed prior to the procedure, as well as 2, 5 and 10 years post-op. At each assessment the Gross Motor Function Classification System was performed and all participants were classified between I and III on the GMFCS. Participants then walked barefoot over 10 m at a comfortable speed with or without an assistive device. Videos were taken and analyzed to calculate Edinburgh Visual Gait Scores as well as for quantifying lower limb joint angles during specific phases of the gait cycle.
Outcome Measures
- Edinburgh Visual Gait Score
- Lower Limb joint angles during gait cycle (initial contact, mid-stance, opposite initial contact, mid swing)
- Tibial Inclination
- Gross Motor Function Classification System
Results
Edinburgh Visual Gait Score:
The MCID used for improvements was a 2.4 points decrease in score. A p value of <.05 was used.
- Edinburgh Visual Gait Scores significantly improved for the group as a whole at 2 years post surgery at scores continued to decrease at each follow up.
- Scores per each GMFCS level improved after the initial RDS procedure.
- Participants with GMFCS levels of I or II showed continual improvement over the ten year period.
- Less improvement was noted with EVG scores for GMFCS level III where they improved initially then demonstrated a plateau in the later years after surgery.
Lower Limb Kinematics:
- Minimal to no change in hip and pelvis kinematics.
- Significantly improved knee and ankle kinematics noted at initial follow up which were maintained throughout the 10 years.
- Significantly increased dorsiflexion at 10 year follow up during initial contact and opposite initial contact.
- Decreased knee flexion after SDR procedure at initial contact and opposite initial contact.
Tibial Inclination:
- Less pronounced after procedure at opposite toe off which was significant. This changed was maintained at 10 year follow up.
Gross Motor Function Classification System:
- Two patients improved from GMFCS level II to level I but all other participants maintained the same level
Strengths
- Multiple follow-ups were performed.
- Looked at differences in carry over between participants with different GMFCS levels.
- Included children with spastic diplegia with multiple diagnoses as opposed to just CP.
Limitations
- Almost half of the participants received additional orthopaedic surgery after the SDR before the final follow up so it may be hard to conclude whether present changes after 2 years post op are due to the SDR or not.
- All participants had selective dorsal rhizotomy performed by the same surgeon, cannot necessarily expand this to all children who have had this procedure performed.
- May be beneficial to include a subjective measure of gait/quality of life.
- Small sample size
Overall Conclusion
This article suggests that for children with spastic diplegia a selective dorsal rhizotomy can have a positive impact on gait quality, particularly for those who are classified in level I or II using the Gross Motor Function Classification System. Gait quality may continue to improve into the young adult and adult years, however whether these later improvements are due solely to the SDR procedure is still unclear.
References:
Romei M, Oudenhoven LM, Schie PEV, Ouwerkerk WJV, Krogt MMVD, Buizer AI. Evolution of gait in adolescents and young adults with spastic diplegia after selective dorsal rhizotomy in childhood: A 10 year follow-up study. Gait & Posture. 2018;64:108-113. doi:10.1016/j.gaitpost.2018.06.002.
4 responses to “Edinburgh Visual Gait Score- Article Review”
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Interesting article! Impacting GMFCS is a big deal! If you could add one T/M to their outcomes, what do you think would have been meaningful to know?
I think a subjective outcome measure would be good to add. I think it would be interesting to see not only if gait quality improved, but also look at quality of life or perceived improvement.
This is very interesting. I have yet to work with a patient that has had a dorsal rhizotomy procedure, but it’s interesting the effect this article has shown it to have!
Yes, I though so too. I had not heard much about this procedure prior to reading this article.