Reactive Balance Control Following Selective Dorsal Rhizotomy in Child With Diplegic Cerebral Palsy

Abstract

Cerebral palsy (CP) is the most common motor disability in early childhood characterized by impaired selective motor control. Children with CP often exhibit delayed and disorganized muscle activation in response to external perturbations, resulting in a high incidence of falls and decreased participation in activities compared with their peers. We examined changes in reactive balance control post-selective dorsal rhizotomy (SDR) in a child with CP in which the major goal of this surgery is to reduce lower extremity spasticity. A 7-year-old girl with spastic diplegic CP (Gross Motor Function Classification System II) participated. Along with clinical evaluations, we employed computerized dynamic posturography to quantify changes in reactive balance control post-SDR, including the Motor Control Test and the Adaptation Test to simulate unexpected perturbations and assess the child's reactive balance control. Post-surgery evaluations indicated improved symmetry in lower extremity weight bearing, particularly in response to forward perturbations. No falls were observed post-surgery in conditions that previously caused imbalance. However, the latency response times to perturbations were longer than in typically developing peers, and the child's force to overcome induced sway was larger than her peers. Although SDR effectively decreased spasticity in our participant, it did not address other factors like soft tissue contractures, muscle weakness, and fixed biomechanical alignment constraints that contributed to balance issues in CP. To our knowledge, this is the first work that demonstrates such limitations post-SDR. The limited tools available to clinicians to assess reactive balance control in children with CP highlight the need for more effective measurements. This case report sheds light on the importance of targeted clinical approaches to enhance reactive balance control post-SDR.