ORIGINAL ARTICLES   Free access

European Journal of Physical and Rehabilitation Medicine 2011 December;47(4):569-77

Copyright © 2012 EDIZIONI MINERVA MEDICA

language: English

Intensive mobility training postcerebral hemispherectomy: early surgery shows best functional improvements

Fritz S. L. ¹, Rivers E. D. ¹, Merlo A. M. ¹, Reed A. D. ², Mathern G. W. ³, De Bode S. ⁴ ✉

¹ Department of Exercise Science Physical Therapy Program, the Blanchard Machinery Company Rehabilitation Laboratory, School of Arnold Public Health University of South Carolina, Columbia, SC, USA; ² Rehabilitation Department, Rehabilitation Institute of Chicago, Chicago, IL, USA; ³ Departments of Neurosurgery and Psychiatry and Biobehavioral Sciences, Intellectual and Developmental Disabilities Research Center, Brain Research Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA; ⁴ Brain Division, Utrecht University Medical Center, Utrecht, The Netherlands

BACKGROUND:Limited research exists on rehabilitative techniques focused on reducing disabilities after cerebral hemispherectomy despite persistent hemiparesis.
OBJECTIVES:The efficacy of Intensive Mobility Training (IMT) for improving gait, balance and mobility was evaluated in patients after cerebral hemispherectomy and compared with clinical variables for signs of developmental neuroplasticity.
METHODS: Participants (N.=19; 13.8±5.7 years) postcerebral hemispherectomy received IMT, three hours/day for 10 days. Outcomes measures were assessed pre- and post-intervention using the GAITRite electronic walkway® (velocity, toe in/out, step length of affected an unaffected leg), Dynamic Gait Index, Fugl-Meyer Scale, Berg Balance Scale, Timed Up and Go and Six-Minute Walk Test. Six of the nine measures that showed moderate effect sizes were incorporated into a Combined Functional Index (CFI) to assess global impact of therapy.
RESULTS: After IMT, improvements were identified for toe in/out, step length of unaffected leg, Dynamic Gait Index, Berg Balance Scale and Six-Minute Walk (P<0.05; Effect Size 0.36-0.50). Using CFI for these six measures, patients improved from 77.3% to 82.7% (+5.3±3.7%) of normal following IMT. Improvements in CFI were greater in patients five years or younger at time of surgery (+7.7±3.6%) compared with older patients (+3.2±2.5%), and this accounted for 22% of variability in the change in score.
CONCLUSION: The younger the participant at time of surgery correlated with the greatest improvements following IMT. These findings support the concept that the remaining hemisphere retains greater neuroplasticity if the contralateral surgery occurs earlier in cerebral development.