Abstract:
Introduction: This study describes a combined surgical and rehabilitation approach targeting the myofascia in spastic cerebral palsy (CP). The approach is based on the rationale that disruption of the myofascial unit in spastic muscles alters the myofascial sequence within individual segments and across interconnected segments. It integrates myofascial-targeted procedures with lever arm restoration and structured, protocol-based postoperative rehabilitation. The study assessed functional outcomes after this combined program, focusing on gross motor function, mobility, manual ability, and quality of life.
Materials and Methods: The study included 520 children and adolescents with CP, aged 3–18 years; 60% were female. Participants underwent single-event multilevel lever arm restoration and anti-spasticity surgery (SEMLARASS), followed by protocol-based rehabilitation lasting an average of 6 months. The minimally invasive surgical procedures included Orthopedic Selective Spasticity Surgery, comprising Intramuscular Release and Controlled Tendon Lengthening; release of deep fascia, myofascial fascia and inter-tendinous fascia; and correction of lever arm dysfunction using percutaneous osteotomies and external fixators. The surgical programme therefore combined soft-tissue procedures with lever arm restoration, followed by a structured period of rehabilitation.
Postoperative rehabilitation incorporated myofascial-targeted approaches, including Fascial Manipulation, Myofascial Manipulation, Advanced Biomechanical Rehabilitation or the “Zero Tonic” Approach, and the Fascial Distortion Model, among others. Additional physiotherapy aimed to improve strength and balance. Modalities included aquatic therapy, body weight-supported treadmill training, whole-body vibration therapy, hippotherapy, virtual reality-based therapy, EMG biofeedback, and functional electrical stimulation, among other interventions. We assessed functional outcomes before and after treatment using the Functional Mobility Scale (FMS), Gross Motor Function Measure (GMFM), Manual Ability Classification System (MACS), and Pediatric Quality of Life (PQOL).
Results: Pre-operative Gross Motor Function Classification System (GMFCS) levels were I (2%), II (6%), III (28%), IV (36%), and V (28%). At the 2-year follow-up, participants reported significant functional improvement. Median GMFCS scores were 4 before surgery and 2 after rehabilitation. All reported domains of GMFM, FMS, PQOL and MACS improved significantly (p < 0.05). The reported findings therefore included a change in median GMFCS classification alongside improvements across the other functional and quality-of-life measures.
Conclusions: SEMLARASS followed by protocol-based rehabilitation was associated with significant improvements in gross motor function, ambulation and quality of life in the children and adolescents studied.
