Comparison of Functional Outcomes following Surgical Intervention and Inpatient Rehabilitation in Children with Cerebral Palsy

Thursday, November 10, 2022

3:48 PM – 3:53 PM

Location: Station 7

Presenting Author(s)

Christian M. Niedzwecki, DO, MS

Associate Professor
Baylor College of Medicine
Houston, Texas, United States

Non-presenting Author(s)

Amy Barbuto, PT, DPT

Physical Therapist
Texas Children's Hospital
The Woodlands, Texas, United States
KM

Katy Mitchell, PT, PhD

Professor
Texas Woman's University
Houston, Texas, United States
Steven Z. Wirt, M.S., OTR/l, C/NDT, CHFP

Therapy Manager
Texas Children's Hospital
Spring, Texas, United States
MS

Michelle Seymour, MD/PhD

Pediatric Rehabilitation Medicine Fellow
Baylor College of Medicine/Texas Children's Hospital, United States
Sruthi P. Thomas, MD, PhD

Assistant Professor
Texas Children's Hospital
Houston, Texas, United States
AS

Aloysia Schwabe, MD

Associate Professor, Baylor College of Medicine
BCM/Texas Children's Hospital
Houston, Texas, United States

Research Objectives: To compare length of stay (LOS) and functional outcomes in children with CP following one of three surgical procedures (SP) and inpatient rehabilitation unit (IRU) stay.

Design: Retrospective cohort study.

Setting: Tertiary care pediatrics.

Participants: Children with CP following one of three SPs and subsequent IRU stay.

Interventions: One of three SPs (selective dorsal rhizotomy (SDR), single-event multilevel orthopedic surgery (SEMLS), intrathecal baclofen (ITB) pump implantation) and subsequent IRU stay.

Main Outcome Measures: This study explored the effect of four independent variables: 1) type and pattern of limb involvement (TPI) (diplegia, triplegia, quadriplegia, hemiplegia), 2) SP (SEMLS, SDR, ITB), 3) dichotomized etiology (prematurity, other), and 4) IRU admission GMFCS level against five dependent variables: 1) IRU LOS, 2-4) IRU admission and discharge WeeFIM total, mobility, and self-care scores, and 5) WeeFIM efficiency scores. This study also investigated if there were significant differences in these same four independent variables in patients who made greater than average versus less than average total WeeFIM improvement.

Results: The SDR group had a significantly longer LOS compared to others (p≤.015). TPI, SP, and GMFCS sub-groups made significant improvements in WeeFIM total and self-care scores between admission and discharge (p≤.001). TPI and GMFCS sub-groups, made significant improvements in WeeFIM mobility scores between admission and discharge (p≤.001). The diplegia group had significantly higher WeeFIM efficiency scores compared to triplegia and quadriplegia (p≤.046). GMFCS II group had significantly higher WeeFIM efficiency scores compared to III and IV. The CP prematurity group had significantly higher WeeFIM efficiency scores compared to CP other (p=.034). When higher and lower WeeFIM change scores were considered, higher performers tended to be those with diplegia, underwent the SDR procedure, GMFCS II, had a longer LOS, and higher admission WeeFIM scores (p≤.045).

Conclusions: This study found significant and meaningful functional improvement in children with CP following three different surgical interventions and a subsequent IRU stay regardless of TPI, SP, or GMFCS.

Author(s) Disclosures: No disclosures

Learning Objectives:

Upon completion, participants will be able to understand the effect of various factors on IRU length of stay and WeeFIM admission and discharge scores.
Upon completion, participants will be able to understand differences in various factors among patients who made greater than average versus less than average total WeeFIM improvement following SP and IRU.
Upon completion, participants will be able to understand functional improvements gained by children with CP following three SPs and IRU related.