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Journal of Integrative Neuroscience  2019, Vol. 18 Issue (3): 305-308    DOI: 10.31083/j.jin.2019.03.146
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Utilization of electromyography during selective obturator neurotomy to treat spastic cerebral palsy accompanied by scissors gait
Songtao Ren1, 2, Weidong Liu2, Li Wang3, 4, Changli Guo2, Qi Pang1, *()
1 Department of Neurosurgery, the Affiliated Provincial Hospital, Shandong University, Jinan, Shandong Province, 250021, P. R. China
2 Department of Neurosurgery, Liaocheng People’s Hospital, Liaocheng, Shandong Province, 252000, P. R. China
3 Department of Gynecology, Scientific Research Department, Liaocheng People’s Hospital, Liaocheng, Shandong Province, 252000, P. R. China
4 Liaocheng University, Liaocheng, Shandong Province, 252000, P. R. China
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Abstract  

Selective obturator neurotomy is a commonly used neurosurgical intervention for spastic cerebral palsy with scissors gait. Here we report the use of surface electromyography to assess the accuracy and effect of selective obturator neurotomy procedures. Selective obturator neurotomy was carried out on 18 patients while using intraoperative electromyography. Contractions of adductor muscles were recorded by electromyography before and after neurotomy and assessed using root mean square and integrated electromyography tests. Passive and voluntary movements were recorded for all patients. Our results show that adductor spasms and adductive deformity of hip were improved in all patients with spastic cerebral palsy. Adductor muscle spatiality was improved significantly, confirmed by a significant decrease in the values of root mean square and integrated electromyography in both passive and voluntary movements after surgery. We show that electromyography is an effective tool for accurately and safely targeting nerve tracts during selective obturator neurotomy. Thus, we demonstrate a valuable noninvasive method to objectively evaluate the effect of treatment in spastic cerebral palsy patients.

Key words:  Spastic cerebral palsy      selective obturator neurotomy      electromyography     
Submitted:  03 April 2019      Accepted:  16 July 2019      Published:  30 September 2019     
*Corresponding Author(s):  Qi Pang     E-mail:  zslrsd@sdu.edu.cn

Cite this article: 

Songtao Ren, Weidong Liu, Li Wang, Changli Guo, Qi Pang. Utilization of electromyography during selective obturator neurotomy to treat spastic cerebral palsy accompanied by scissors gait. Journal of Integrative Neuroscience, 2019, 18(3): 305-308.

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https://jin.imrpress.com/EN/10.31083/j.jin.2019.03.146     OR     https://jin.imrpress.com/EN/Y2019/V18/I3/305

Table 1  RMS and iEMG values of adducts from pre-operation, post-operation, and post-rehabilitation measurements. Data are described as mean ± SD. * P < 0.05 (compared to pre-operation value)
Parameter Pre-operation data Post-operation data Post-rehabilitation data
voluntary movement RMS (μV) 38.34 ± 9.90 17.62 ± 8.45* 16.19 ± 4.70*
voluntary movement iEMG (μVs) 33.78 ± 9.90 15.25 ± 8.46* 13.94 ± 6.50*
Passive movement RMS (μV) 75.68 ± 27.7 53.53 ± 23.47* 46.50 ± 17.57*
Passive movement iEMG (μVs) 65.71 ± 20.05 30.84 ± 16.12* 28.09 ± 13.86*
[1] Abbruzzese, G. (2002) The medical management of spasticity. European Journal of Neurology 1, 30-34.
[2] Bell, K. J., Ounpuu, S., DeLuca, P. A. and Romness, M. J. (2002) Natural progression of gait in children with cerebral palsy. Journal of Pediatric Orthopaedics 22, 677-682.
[3] Cheng, H. Y., Ju, Y. Y., Chen, C. L. and Wong, M. K. (2012) Managing spastic hypertonia in children with cerebral palsy via repetitive passive knee movements. Journal of Rehabilitation Medicine 44, 235-240.
[4] Cassidy, C., Campbell, N., Madady, M. and Payne, M. (2016) Bridging the gap, the role of Physiatrists in caring for adults with cerebral palsy. Disability and Rehabilitation 38, 493-498.
[5] Chalkiadis, G. A., Sommerfield, D., Low, J., Orsini, F., Dowden, S. J., Tay, M., Penrose, S., Pirpiris, M. and Graham, H. K. (2016) Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single-event multilevel surgery. Developmental Medicine & Child Neurology 58, 402-408.
[6] Davids, J. R. (2010) The foot and ankle in cerebral palsy. Orthopedic Clinics of North America 41, 579-593.
[7] Emery, E. (2003) Intrathecal baclofen. Literature review of the results and complications. Neurochirurgie 49, 276-288.
[8] Farina, D., Merletti, R. and Enoka, R. M. (2014) The extraction of neural strategies from the surface EMG, an update. Journal of Applied Physiology (1985) 117, 1215-1230.
[9] Icagasioglu, A., Mesci, E., Yumusakhuylu, Y., Turgut, S. T. and Murat, S. (2015) Rehabilitation outcomes in children with cerebral palsy during a 2year period. Journal of Physical Therapy Science 27, 3211-3214.
[10] Kwon, J. Y. and Kim, J. S. (2009) Selective blocking of the anterior branch of the obturator nerve in children with cerebral palsy. American Journal of Physical Medicine & Rehabilitation 88, 7-13.
[11] Majnemer, A., Shikako-Thomas, K., Lach, L., Shevell, M., Law, M., Schmitz, N., Poulin, C. and QUALA, Group ( 2014) Rehabilitation service utilization in children and youth with cerebral palsy. Child Care Health and Development 40, 275-282.
[12] Novak, I. (2014) Evidence-based diagnosis, health care, and rehabilitation for children with cerebral palsy. Journal of Child Neurology 29, 1141-1156.
[13] Onishi, H., Yagi, R., Akasaka, K., Momose, K., Ihashi, K. and Handa, Y. (2000) Relationship between EMG signals and force in human vastus lateralis muscle using multiple bipolar wire electrodes. Journal of Electromyography and Kinesiology 10, 59-67.
[14] Patikas, D., Wolf, S. and Doderlein, L. (2005) Electromyographic evaluation of the sound and involved side during gait of spastic hemiplegic children with cerebral palsy. European Journal of Neurology 12, 691-699.
[15] Park, T. S. and Johnston, J. M. (2006) Surgical techniques of selective dorsal rhizotomy for spastic cerebral palsy. Neurosurgical Focus 21, e7.
[16] Ploumis, A., Varvarousis, D., Konitsiotis, S. and Beris, A. (2014) Effectiveness of botulinum toxin injection with and without needle electromyographic guidance for the treatment of spasticity in hemiplegic patients, a randomized controlled trial. Disability and Rehabilitation 36, 313-318.
[17] Reid, L. B., Rose, S. E. and Boyd, R. N. (2015) Rehabilitation and neuroplasticity in children with unilateral cerebral palsy. Nature Reviews Neurology 11, 390-400.
[18] Rosenbaum, P., Paneth, N., Leviton, A., Goldstein, M., Bax, M., Damiano, D., Dan, B. and Jacobsson, B. (2006) A report: the definition and classification of cerebral palsy April 2006. Developmental Medicine and Child Neurology 109, 8-14.
[19] Sindou, M. (2003) History of neurosurgical treatment of spasticity. Neurochirurgie 49, 137-143.
[20] Saintyves, G., Genet, F., Allieu, Y., Judet, T. and Denormandie, P. (2011) Surgical management of spasticity of the intrinsic muscles of the long fingers in adults after cerebral palsy, 68 operated hands. Chirurgie de la Main 30, 46-51.
[21] Shin, D. S., Song, R., Shin, E. K., Seo, S. J., Park, J. E., Han, S. Y., Jung, H. Y. and Ryu, C. J. (2012) Effects of passive upper arm exercise on range of motion, muscle strength, and muscle spasticity in hemiplegic patients with cerebral vascular disease. Journal of Korean Academy of Nursing 42, 783-790. (In Korean)
[22] Sitthinamsuwan, B., Chanvanitkulchai, K., Phonwijit, L., Kumthornthip, W. and Nunta-Aree, S. (2013) Utilization of intraoperative electromyography for selecting targeted fascicles and determining the degree of fascicular resection in selective tibial neurotomy for ankle spasticity. Acta Neurochirurgica (Wien) 155, 1143-1149.
[23] Song, S., Lee, K., Jung, S., Park, S., Cho, H. and Lee, G. (2018) Effect of horizontal whole-body vibration training on trunk and lower-extremity muscle tone and activation, balance, and gait in a child with cerebral palsy. The American Journal of Case Reports 19, 1292-1300.
[24] Tomita, H., Fukaya, Y., Ueda, T., Honma, S., Yamashita, E., Yamamoto, Y., Mori, E. and Shionoya, K. (2011) Deficits in task-specific modulation of anticipatory postural adjustments in individuals with spastic diplegic cerebral palsy. Journal of Neurophysiology 105, 2157-2168.
[25] Wang, S., Miao, S., Zhuang, P., Chen, Y., Liu, H. and Zuo, H. (2011) Assessment of surface electromyographic clinical analysis of selective femoral neurotomy on cerebral palsy with .pngf knee. Journal of Neuroscience Methods 199, 98-102.
[26] Wimalasundera, N. and Stevenson, V. L. (2016) Cerebral palsy. Practical Neurology 16, 184-194.
[27] Yan, X., Lan, J., Liu, Y. and Miao, J. (2018) Efficacy and safety of Botulinum Toxin Type A in spasticity caused by spinal cord injury, a randomized, control trial. Medical Science Monitor 24, 8160-8171.
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