Surgical outcomes for the ambulatory child with cerebral palsy
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Cerebral Palsy (CP) is one of the most common neurologic conditions treated by physical therapists (PTs); and, improving the ambulation ability of these children is often the most common goal of treatment. Orthopedic surgical intervention can improve the gait of children with spastic CP that have difficulty with walking. Finding which surgical procedures or combination of procedures are the most effective for improving the walking ability of these children is a complex task. This three study dissertation examines the surgical outcomes, and the measures used to determine surgical outcome, of children with spastic CP undergoing orthopedic surgical intervention to improve their gait. All three studies were retrospective in design, and utilized a sample of convenience at a motion analysis laboratory of a hospital that specialized in orthopedic surgery for children with CP. The data reviewed and contained within these studies spanned the years 1994 to 2011. The subject's' ages ranged from 4.5 years to 18. 2 years. There are several findings within these studies. The first finding is that orthopedic surgical intervention used in conjunction with a motion analysis laboratory improves the gait of children with spastic CP as noted by the consistent improvement in the Gait Deviation Index (GDI). The second finding is support for the belief that an accurate gait outcome assessment for a given intervention should include both functional and technical gait measures. The third finding suggests that when conducting and analyzing gait outcomes in children with CP, their Gross Motor Function Classification System (GMFCS) level; pre-intervention GDI; and, pattern of involvement should be considered. The fourth finding is a suggestion that increased velocity may not always accompany improvements in the gait of children with spastic CP. Therefore increased velocity may not always be an accurate outcome measure for this particular population after undergoing orthopedic surgery to improve their gait. The fifth finding of this study is support for the use of the GDI along with surgical technical achievement goals (TAGs) as a pair of technical outcome measures for ambulatory children with CP having lower extremity orthopedic surgery to improve their ambulation.