Moreau N, Tinsley S, Cavell A, Semones S; Louisiana State University Health Sciences Center, Department of Rehabilitation Sciences, Program in Physical Therapy, Shreveport, LA and Shriners Hospitals for Children, Shreveport, LA. stinsl@lsuhsc.edu.

PURPOSE: The purpose of this study was to compare pre-, 1-year, and 3-year postoperative outcomes of rectus femoris transfer in children with CP to determine if one-year postoperative outcomes persist as the children develop. SUBJECTS: Twenty-four children (43 sides) with cerebral palsy were evaluated. All subjects underwent rectus femoris transfers in conjunction with other multi-level surgeries. METHODS: Subjects underwent preoperative, one- and three- year post-operative gait analyses using a VICON 370 motion capture system. Retrospective chart review was used to gather information on the following variables for ANALYSIS: peak knee flexion in swing (PKFS), knee flexion swing range (KFSR), and barefoot and braced walking velocity (m/s). All subjects received 2-12 weeks of inpatient physical therapy bid following surgery. ANALYSIS: A one-way repeated measures MANOVA was used to analyze changes in PKFS and KFSR from pre-, 1-, and 3-year gait analyses. A one-way repeated measures ANOVA was used to analyze changes in pre-, 1-, and 3-year barefoot walking velocities. To identify differences in walking velocities between the two conditions (barefoot and braced) and between the two times of analysis (1 and 3 years), a two-way repeated measures ANOVA was utilized. For all statistical tests, pair wise comparisons were performed to identify where significant differences lay. Statistical significance was considered when p < 0.05. RESULTS: One year after surgery, PKFS and KFSR both significantly increased and continued to increase over the next two years. The initial decrease in barefoot velocity seen 1-year post-operatively does not persist at 3-years post but significantly improved. Three years after surgery, both barefoot and braced walking velocities were significantly greater than preoperative values. At both one- and three-years after surgery, braced walking velocity was significantly greater than barefoot walking velocity. CONCLUSIONS: Our results indicate that the benefits of rectus femoris transfers on PKFS and KFSR are maintained 3-years post-operatively. Although rectus transfers may have a short-term effect on walking speed, velocity is significantly improved over time both barefoot and braced. In addition, research in this area will also provide information on neurological adaptations and viscoelastic changes that occur in the muscles of children with CP and aid in identifying the most appropriate post-operative interventions. FUNDING SOURCE: None.

Copyright 2004 by the American Physical Therapy Association

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