J Med Assoc Thai 2019; 102 (10):52

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Evaluation of Gross Motor Function Classification System (GMFCS) Improvement After Selective Myofascial Release for the Treatment of Cerebral Palsy
Eamsobhana P Mail, Chalayon O , Luanglert T

Background: Cerebral palsy (CP), which results from a non-progressive injury that occurs during brain development, is the most common movement disorder in children. Objective: To evaluate the improvement in Gross Motor Function Classification System (GMFCS) status after orthopedic surgical intervention in children with spastic CP.

Material and Methods: This retrospective chart review included spastic cerebral palsy patients aged 7-11 years who underwent lower extremity soft tissue release during 2009 to 2014. All patients had complete preoperative and postoperative data with a minimum follow-up of 2 years. Patients were re-evaluated at 2-years postoperatively for GMFCS level, and those results were compared with preoperative function.

Results:Of the 92 study participants, the preoperative GMFCS level was II in 48, III in 14, and IV in 30 patients. The mean age at first evaluation was 7.61±1.93 years. Seventy-five percent of patients with GMFCS level II remained at their preoperative level at surgery. Fifty-seven percent of patients with GMFCS level III improved to GMFCS level II. Twelve patients (40%) with GMFCS level IV improved to level III, and 2 patients (6.67%) improved from GMFCS IV to GMFCS II. However, none of the aforementioned improvements in GMFCS category were statistically significant. No significant association was observed between improvement in GMFCS level and gender, preoperative or postoperative popliteal angle, and number or type of operation.Conclusion: In this study, 42.9% of patients in GMFCS III and 53.3% of patients in GMFCS IV showed improvement in GMFCS level after soft tissue surgery at the lower extremities. Almost half (44.12%) of patients who had multilevel operations demonstrated improvement in GMFCS, but the improvement was not statistically significant. Keywords:Evaluation, Gross Motor Function Classification System, GMFCS, improvement, selective myofascial release, treatment, cerebral palsy

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