[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].

ABSTRACT

OBJECTIVE: To evaluate motor possibilities of patients with children spastic palsy (CSP) one year after single-event multilevel orthopedic low extremity surgeries in combination with early rehabilitation treatment including botulinum toxin treatment. MATERIAL AND METHODS: Authors studied the results of operative orthopedic treatment in 55 patients with CSP, aged from 5 to 17 years (mean 11.9 ± 2.5 years), who underwent multilevel surgeries with early functional rehabilitation using 1.5 treatment courses with 6-8 week treatment-free periods during 9-12 months in combination with a single injection of disport in the post-operative period. We performed 74 surgeries 140 episodes of botulinum toxin treatment using average doses of Botulinum toxin 10 U per kg of body mass injected into low extremity muscles. RESULTS: In the post-operative period, authors recorded a significant reduction in pain syndrome, assessed with a pain intensity scale, from 8.6 ± 1.2 to 4.3 ± 1.1 scores (p < 0.001). An analysis of gait demonstrated an improvement of gait patterns in all patients able to move independently. An increase in motor abilities, measured with the Gillette Functional Assessment Questionnaire, by 1 level was identified in 28 (50.9%) patients, by 2 levels in 2 (3.6%) patients, no changes were observed in 25 (45.5%) patients. CONCLUSION: Single-event multilevel orthopedic surgeries in children with CSP reduce a number of repeated surgeries. The effective control over pain syndrome in patients with CSP using multilevel botulinum toxin treatment in the post-operative period promotes the functional rehabilitation, increases rates of loading during training sessions and the motivation of CSP patients to restore the lost activity.