General Rehabilitation Principles for Patients with Cerebral Palsy After Single-Event Multilevel Surgery (SEMLS)
https://doi.org/10.15690/vsp.v23i3.2763
Abstract
Single-Event Multilevel Surgery (SEMLS) is the standard for surgical correction of secondary orthopedic deformities in cerebral palsy (CP). SEMLS include simultaneous correction of soft tissue contractures, bone deformities, incomplete and complete joint dislocation to improve the gait and functional activity of patients with CP. The surgery volume determines the need for planned and long-term postoperative rehabilitation, however, there are no confirmed guidelines, neither Russian, nor foreign, on the patient’s management during postoperative period. This review provides an analysis of rehabilitation approaches after SEMLS at CP, offers recommendations on preparation and step-by-step postoperative restoration of motor function, and prevention of any associated complications.
Keywords
About the Authors
Olga A. KlochkovaRussian Federation
Moscow
Disclosure of interest:
Not declared
Dmitry A. Popkov
Russian Federation
Kurgan
Disclosure of interest:
Not declared
Ayaz M. Mamedyarov
Russian Federation
Moscow
Disclosure of interest:
Not declared
Ulvi F. Mamedov
Russian Federation
Kurgan
Disclosure of interest:
Not declared
References
1. Sadowska M, Sarecka-Hujar B, Kopyta I. Cerebral Palsy: Current Opinions on Definition, Epidemiology, Risk Factors, Classification and Treatment Options. Neuropsychiatr Dis Treat. 2020;16: 1505–1518. https://doi.org/10.2147/NDT.S235165
2. Australian Cerebral Palsy Register Report 2023. Available online: https://cpregister.com/wp-content/uploads/2023/01/2023ACPR-Report.pdf. Accessed on May 19, 2024.
3. Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109:8–14.
4. Graham HK, Thomason P, Willoughby K, et al. Musculoskeletal Pathology in Cerebral Palsy: A Classification System and Reliability Study. Children (Basel). 2021;8(3):252. https://doi.org/10.3390/children8030252
5. Himuro N, Mishima R, Seshimo T, et al. Change in mobility function and its causes in adults with cerebral palsy by Gross Motor Function Classification System level: a cross-sectional questionnaire study. NeuroRehabilitation. 2018;42(4):383–909. https://doi.org/10.3233/NRE-172340
6. Benner JL, Hilberink SR, Veenis T, et al. Long-term deterioration of perceived health and functioning in adults with cerebral palsy. Arch Phys Med Rehabil. 2017;98(11):2196–205.e1 https://doi.org/10.1016/j.apmr.2017.03.013.
7. Hanna SE, Rosenbaum PL, Bartlett DJ, et al. Stability and decline in gross motor function among children and youth with cerebral palsy aged 2 to 21 years. Dev Med Child Neurol. 2009;51(4):295–302. https://doi.org/10.1111/j.1469-8749.2008.03196.x
8. Handsfield GG, Williams S, Khuu S, et al. Muscle architecture, growth, and biological Remodelling in cerebral palsy: a narrative review. BMC Musculoskelet Disord. 2022;23(1):233. https://doi.org/10.1186/s12891-022-05110-5
9. Rang M. Cerebral palsy. In: Lovell and Winter’s Pediatric Orthopedics. 2nd edn. Philadelphia, PA: JB Lippincott; 1986. pp. 345–396.
10. Nene AV, Evans GA, Patrick JH. Simultaneous multiple operations for spastic diplegia. Outcome and functional assessment of walking in 18 patients. J Bone Joint Surg Br. 1993;75(3):488–494. https://doi.org/10.1302/0301-620X.75B3.8496229
11. DeLuca PA. The musculoskeletal management of children with cerebral palsy. Pediatr Clin North Am. 1996;43(5):1135–1150. https://doi.org/10.1016/s0031-3955(05)70454-5
12. McGinley JL, Dobson F, Ganeshalingam R, et al. Singleevent multilevel surgery for children with cerebral palsy: a systematic review. Dev Med Child Neurol. 2012;54(2):117–128. https://doi.org/10.1111/j.1469-8749.2011.04143.x
13. Popkov DA, Zmanovskaia VA, Gubina EB, et al. The results of single-event multilevel orthopedic surgeries and the early rehabilitation used in complex with botulinum toxin treatment in patients with spastic forms of cerebral palsy. S.S. Korsakov Journal of Neurology and Psychiatry. 2015;115(4):41–48. (In Russ). https://doi.org/10.17116/jnevro20151154141-48]
14. Popkov DA, Chibirov GM, Kozhevnikov VV, Gvozdev NS. Multilevel orthopaedic surgery in children with spastic cerebral palsy. Genij Ortopedii. 2021;27(4):475–480. (In Russ). https://doi.org/10.18019/1028-4427-2021-27-4-475-480
15. Dequeker G, Van Campenhout A, Feys H, et al. Evolution of selfcare and functional mobility after single-event multilevel surgery in children and adolescents with spastic diplegic cerebral palsy. Dev Med Child Neurol. 2018;60(5):505–512. https://doi.org/10.1111/dmcn.13683
16. Õunpuu S, Pierz K, Rethlefsen SA, Wren TAL. Cost savings for single event multilevel surgery in comparison to sequential surgery in ambulatory children with cerebral palsy. Gait Posture. 2022;96: 53–59. https://doi.org/10.1016/j.gaitpost.2022.05.005
17. States RA, Salem Y, Krzak JJ, et al. Three-Dimensional Instrumented Gait Analysis for Children With Cerebral Palsy: An Evidence-Based Clinical Practice Guideline. Pediatr Phys Ther. 2024;36(2):182–206. https://doi.org/10.1097/PEP.0000000000001101
18. Palisano R, Rosenbaum P, Walter S, et al. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39(4):214–223. https://doi.org/10.1111/j.1469-8749.1997.tb07414.x
19. Sätilä H. Over 25 Years of Pediatric Botulinum Toxin Treatments: What Have We Learned from Injection Techniques, Doses, Dilutions, and Recovery of Repeated Injections? Toxins (Basel). 2020;12(7):440. https://doi.org/10.3390/toxins12070440
20. Evreinov V, Tomov A, Popkov D. Sedation effectiveness evaluation in children with cerebral palsy in the early postoperative period after acute multilevel surgical orthopedic interventions. Genij Ortopedii. 2015;(4):36–41. (In Russ). https://doi.org/10.18019/1028-4427-2015-4-36-41
21. Lamberts RP, Burger M, du Toit J, et al. A Systematic Review of the Effects of Single-Event Multilevel Surgery on Gait Parameters in Children with Spastic Cerebral Palsy. PLoS One. 2016;11(10):e0164686. https://doi.org/10.1371/journal. pone.0164686
22. Ma N, Gould D, Camathias C, et al. Single-Event MultiLevel Surgery in Cerebral Palsy: A Bibliometric Analysis. Medicina. 2023;59(11):1922. https://doi.org/10.3390/medicina59111922
23. Karimullin G.A., Levitina E.V. Vliyanie odnomomentnykh mnogourovnevykh operatsii u detei s ortopedicheskimi oslozhneniyami tserebral’nogo paralicha na ob’em dvizhenii po dannym goniometrii. Rossiyskiy vestnik perinatologii i pediatrii. 2023;68(S4):243. (In Russ).
24. Hlazkin L, Mikhovich M, Sakalouski A, Klimau R. The results of single-event multilevel surgery in children with cerebral palsy. Meditsinskie novosti. 2020;(1): 23–25. (In Russ).]
25. Korolkov OI, Rakhman PM. Evaluating the effectiveness of the technology of single-event multi level surgery in children with cerebral palsy. Trauma. 2018;19(6):61–70. (In Russ). https://doi.org/10.22141/1608-1706.6.19.2018.152222
26. Gubin AV, Ovchinnikov ЕN, Goncharuk EV, et al. Economic aspects in singleevent multilevel orthopedic surgery in patients with cerebral palsy. Problemi socialnoi gigieni, zdravookhranenia i istorii meditsini = Problem of Social Hygiene, Public Health and History of Medicine. 2020;28(Special Issue):716–722. (In Russ). http://doi.org/10.32687/0869-866X-2020-28-s1-716-722]
27. Edwards TA, Theologis T, Wright J. Predictors affecting outcome after single-event multilevel surgery in children with cerebral palsy: a systematic review. Dev Med Child Neurol. 2018;60(12): 1201–1208. https://doi.org/10.1111/dmcn.13981
28. Guinet AL, Khouri N, Desailly E. Rehabilitation After SingleEvent Multilevel Surgery for Children and Young Adults With Cerebral Palsy: A Systematic Review. Am J Phys Med Rehabil. 2022;101(4):389–399. https://doi.org/10.1097/PHM.0000000000001864
29. Wick JM, Feng J, Raney E, et al. Single-Event Multilevel Surgery to Correct Movement Disorders in Children with Cerebral Palsy. AORN J. 2018;108(5):516–531. https://doi.org/10.1002/aorn.12402
30. Thomason P, Graham HK. Rehabilitation of children with cerebral palsy after single-event multilevel surgery. In: Rehabilitation in Movement Disorders. Iansek R, Morris ME, eds. Cambridge University Press; 2013. pp. 203–216. https://doi.org/10.1017/ CBO9781139012942.019
31. van Bommel EEH, Arts MME, Jongerius PH, et al. Physical therapy treatment in children with cerebral palsy after single-event multilevel surgery: a qualitative systematic review. A first step towards a clinical guideline for physical therapy after single-event multilevel surgery. Ther Adv Chronic Dis. 2019;10:2040622319854241. https://doi.org/10.1177/2040622319854241
32. Klochkova OA, Kurenkov AL. Botulinoterapiya pri detskom tserebral’nom paraliche: prakticheskie sovety i ul’trazvukovoi kontrol’. Moscow: MEDpressinform; 2020. 248 p. (In Russ).
33. All About Your Single-Event Multilevel Surgery (SEMLS). Gillette Children’s; 2024. Available online: https://www.flipsnack. com/95B5CFFEFB5/all-about-your-single-event-multilevel-surgerysemls-xn84mnhbdc.html. Accessed on May 19, 2024.
34. Georgiadis AG, Schwartz MH, Walt K, et al. Team approach: single-event multilevel surgery in ambulatory patients with cerebral palsy. JBJS Rev. 2017;5(8):e10 https://doi.org/10.2106/JBJS.RVW.16.00101
35. Harryman SE. Lower-extremity surgery for children with cerebral palsy: physical therapy management. Phys Ther. 1992;72(1):16–24. https://doi.org/10.1093/ptj/72.1.16
36. Koop SE, Murr S. Postoperative care and rehabilitation. In: The Identification and Treatment of Gait Problems in Cerebral Palsy. Gage JR, Schwartz MH, Koop SE, Novacheck TF, eds. 2nd edn. London: Mac Keith Press; 2009. pp. 534–545.
37. Dolganova T, Chibirov G, Gatamov O, et al. Single-Event Multilevel Orthopedic Surgery in CP Patients with Natural and Iatrogenic Crouch Gait. In: Understanding in children with cerebral palsy: orthopedic problems. New York: NOVA Science Publishers; 2020. pp. 167–188.
38. Trankovsky SE, Malakhov OA, Malakhov OO. Surgical Correction of HIP Pathology in Children with Infantile Cerebral Palsy. Russian Journal of Pediatric Surgery. 2013;(5):4–7. (In Russ).
39. Tomov A, Diachkov K, Popkov D. Parameters of radiographic coxometry in reconstructive operations on the hip joint as part of multilevel surgical interventions in children with cerebral palsy. Genij Ortopedii. 2019;25(3):337–347. (In Russ). https://doi.org/10.18019/1028-4427-2019-25-3-337-347]
40. Patikas D, Wolf SI, Mund K, et al. Effects of a postoperative strength-training program on the walking ability of children with cerebral palsy: a randomized controlled trial. Arch Phys Med Rehabil. 2006;87(5):619–626. https://doi.org/10.1016/j.apmr.2006.01.023
41. Grecco LA, de Freitas TB, Satie J, et al. Treadmill training following orthopedic surgery in lower limbs of children with cerebral palsy. Pediatr Phys Ther. 2013;25(2):187–192; discussion 193. https://doi.org/10.1097/PEP.0b013e3182888495
42. Høiness PR, Capjon H, Lofterød B. Pain and rehabilitation problems after single-event multilevel surgery including bony foot surgery in cerebral palsy. A series of 7 children. Acta Orthop. 2014;85(6): 646–651. https://doi.org/10.3109/17453674.2014.960141
43. Meyns P, Pans L, Plasmans K, et al. The Effect of Additional Virtual Reality Training on Balance in Children with Cerebral Palsy after Lower Limb Surgery: A Feasibility Study. Games Health J. 2017;6(1):39–48. https://doi.org/10.1089/g4h.2016.0069
44. Seniorou M, Thompson N, Harrington M, et al. Recovery of muscle strength following multi-level orthopaedic surgery in diplegic cerebral palsy. Gait Posture. 2007;26(4):475–481. https://doi.org/10.1016/j.gaitpost.2007.07.008
45. Bache CE, Selber P, Graham HK. The management of spastic diplegia. Current Orthop. 2003;17(2):88–104. https://doi.org/10.1054/cuor.2003.0328
46. Rodda JM, Graham HK, Nattrass GR, et al. Correction of severe crouch gait in patients with spastic diplegia with use of multilevel orthopaedic surgery. J Bone Joint Surg. 2006;88(12):2653–2664. https://doi.org/10.2106/JBJS.E.00993
47. Thomason P, Selber P, Graham HK. Single Event Multilevel Surgery in children with bilateral spastic cerebral palsy: a 5 year prospective cohort study. Gait Posture. 2013;37(1):23–28. https://doi.org/10.1016/j.gaitpost.2012.05.022
48. Visscher R, Hasler N, Freslier M, et al. Long-term follow-up after multilevel surgery in cerebral palsy. Arch Orthop Trauma Surg. 2022;142(9):2131–2138. https://doi.org/10.1007/s00402-021-03797-0
49. Haumont T, Church C, Hager S, et al. Flexed-knee gait in children with cerebral palsy: a 10-year follow-up study. J Child Orthop. 2013;7(5):435–443. https://doi.org/10.1007/s11832-013-0505-8
50. Dreher T, Thomason P, Švehlík M, et al. Long-term development of gait after multilevel surgery in children with cerebral palsy: a multicentre cohort study. Dev Med Child Neurol. 2018;60(1): 88–93. https://doi.org/10.1111/dmcn.13618
51. Rodda J, Graham HK. Classification of gait patterns in spastic hemiplegia and spastic diplegia: a basis for a management algorithm. Eur J Neurol. 2001;8(Suppl 5):98–108. https://doi.org/10.1046/j.1468-1331.2001.00042.x
52. Volsky G. The role of orthotics in preoperative and postoperative management of children with cerebral palsy. In: Understanding in children with cerebral palsy: orthopedic problems. New York: NOVA Science Publishers: 2020. pp. 41–62.
53. Jarlman E, Hägglund G, Alriksson-Schmidt AI. Foot and lower leg pain in children and adults with cerebral palsy: a populationbased register study on 5,122 individuals. BMC Musculoskelet Disord. 2024;25(1):391. https://doi.org/10.1186/s12891-024-07486-y
54. Smith MG, Gibson RJ, Russo RN, et al. Examining tools for assessing the impact of chronic pain on emotional functioning in children and young people with cerebral palsy: stakeholder preference and recommendations for modification. Qual Life Res. 2024. https://doi.org/10.1007/s11136-024-03693-1
55. Almina S, Karile Y, Audrone P, Indre B. Analgesic effect of botulinum toxin in children with cerebral palsy: A systematic review. Toxicon. 2021;199:60–67. https://doi.org/10.1016/j.toxicon.2021.05.012
Review
For citations:
Klochkova O.A., Popkov D.A., Mamedyarov A.M., Mamedov U.F. General Rehabilitation Principles for Patients with Cerebral Palsy After Single-Event Multilevel Surgery (SEMLS). Current Pediatrics. 2024;23(3):152-161. (In Russ.) https://doi.org/10.15690/vsp.v23i3.2763