Functional Change Following Surgical Intervention for Ambulant Patients with Cerebral Palsy

Description

In this presentation, David McDonald, an ST8 based in Aberdeen, discusses a project focused on assessing functional changes following surgical interventions in ambulant patients with cerebral palsy. He provides background information on the James Lind Alliance, which addresses key medical research questions, highlighting that one of their top concerns involves functional outcomes after lower limb surgery in walking individuals with cerebral palsy. McDonald outlines the aims and methodologies of a retrospective study utilizing six years of data from the Cerebral Palsy Integrated Pathway (CPIP) database, which monitors all cerebral palsy patients in Scotland, including their surgical histories and functional mobility assessments.



The study includes a total of 168 surgeries performed on 114 patients, primarily with spastic cerebral palsy, and analyzes their functional mobility scale (FMS) scores pre- and post-surgery. Results reveal that only 26% of patients showed improvement in their FMS post-intervention, with the majority showing no change and a notable percentage experiencing a decline. McDonald discusses specific surgical interventions, indicating that selective dorsal rhizotomy (SDR) and multi-level single event surgery yielded better functional outcomes compared to Botox treatments.



In conclusion, he emphasizes the relatively low likelihood of functional improvement post-surgery and the need for careful consideration before surgery due to the risk of unchanged or worsened functionality for many patients. The discussion includes queries from the audience, addressing concerns over the duration of follow-up for assessing long-term effects, the role of Botox in functional improvement, and potential further studies to examine other outcome measures.

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