Evaluation of Gross Motor Function Classification System (GMFCS) Improvement after Selective Myofascial Release for the Treatment of Cerebral Palsy
Eamsobhana P, MD1, Chalayon O, MD2, Luanglert T, MD1
Affiliation : 1 Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand 2 Orthopedic John Hopkins Hospital Baltimore, USA
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.
Materials and Methods : This retrospective chart review included spastic cerebral palsy patients aged 7 to 11 years who underwent
lower extremity soft tissue release during 2009 to 2014. All patients had complete pre-operative and post-operative 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 pre-operative function.
Results : Of the 92 study participants, the pre-operative 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, pre-operative or postoperative popliteal angle, and number or type of operation.
Conclusion : In the present 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
