Physiology of Spasticity in Cerebral Palsy – Role of Keyhole Interlaminar Dorsal Rhizotomy

The mechanism underlying hypertonia in children with cerebral palsy encompasses both a neural component associated with spasticity (velocity-dependent) and a biomechanical component connected to alterations in soft tissues. Discerning between these components, though clinically challenging, holds paramount significance, given that effective treatment relies on distinguishing the former for anti-spastic interventions and the latter for physiotherapy. Additionally, spasticity often coexists with dystonia, a prolonged hypertonic state provoked by voluntary movement attempts. It’s crucial to differentiate between spasticity and dystonia as dorsal rhizotomy primarily impacts the spastic component and has limited influence on dystonia. Spasticity, inherently resistant to muscle stretching and elongation, precipitates two significant consequences. Firstly, muscles tend to remain in shortened positions, subsequently leading to soft tissue changes and contractures. Secondly, this condition restricts movement. Consequently, the intertwining of hypertonia and restricted mobility establishes a detrimental cycle culminating in pronounced ambulatory impairment characterized by intractable musculotendinous retraction and the development of joint ankylosis and bone deformities. The evolving repercussions of these effects must be meticulously considered during the evaluative phase to inform decision-making for the child’s care plan. Ultimately, the hypotonic effects of lumbosacral dorsal rhizotomy, impacting not only lower limb segments but also extending supra-segmentally via the reticular formation, are explored.

Dorsal rhizotomy stands as the gold standard for addressing spastic diplegia/quadriplegia in children with cerebral palsy, particularly when conventional rehabilitation approaches prove inadequate in managing excessive spasticity. The Keyhole Interlaminar Dorsal Rhizotomy technique has been developed to individually access all L2–S2 roots intradurally at their corresponding dural sheaths while preserving the posterior spinal architecture. Intraoperative neuromonitoring entails stimulating each ventral root to assess myotomal innervation and stimulating dorsal roots to examine reflexive muscular responses, aiding in determining the optimal proportion of rootlets to be excised.

Artificial Intelligence for Movement Analysis

The global-scale adoption of mobile phones and smartwatches equipped with high-quality sensors opened up unprecedented opportunities for measuring human health and performance. I’ll present our results on using wearables and videos for monitoring health, and our technologies for collecting movement data 100x cheaper than before using a single and multiple smartphones.

Clinical Research in Cerebral Palsy and the Role of Gait Analysis

This lecture will highlight new developments in clinical research to improve the management of children with cerebral palsy.

Firstly, research priorities were agreed upon by all relevant stakeholders in the UK. A set of core outcomes to be measured after interventions were also agreed upon by an international panel, following a pre-agreed protocol. This included a literature review, qualitative research, and a Delphi consensus process. Gait analysis and a range of patient-based and clinical outcomes were included in the core set. This work provided the foundations for wider research collaborations and attracted funding for multi-centre clinical trials.

Long-term strategy, academic support, multi-centre collaborations and adequate funding are essential in undertaking high-quality research.