Article Evaluation
In the article Rhizotomy I believe the procedural outline goes into too much detail for the reader. Condensing it may make it easier for the reader to understand/read.
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Week 4
The first aspect of the article I would like to fix is the grammatical errors throughout the entire article. As the article suggests I would also like to add in additional citations for verification, so the reader knows where particular information was originally published. The article has a lot of good information, it just needs extra citations to help support the information. I would also like to see connecting sentences from one paragraph to another, many paragraphs randomly start discussing a new topic without concluding the last paragraph. I would also like to improve the sections about Long-Term Effects and strengthening after the procedure because in a quick search in a database I have found tons of articles explaining follow up studies several years after the procedure. I also found articles about physical therapy involvement after the procedure and how therapy sessions benefit the child. I believe these two areas are lacking the most information in the article itself. Following are citations of articles I would like to pull information from to help improve this article.
A 30-year follow-up study after selective dorsal rhizotomy: neuromuscular and functional status of adults with cerebral palsy and bilateral lower limb spasticity. (2017). Developmental Medicine & Child Neurology, 5971-72. doi:10.1111/dmcn.110_13511
Al-Shaar, H. A., Imtiaz, M. T., Alhalabi, H., Alsubaie, S. M., & Sabbagh, A. J. (2017). Selective dorsal rhizotomy: A multidisciplinary approach to treating spastic diplegia. Asian Journal Of Neurosurgery, 12(3), 454-465. doi:10.4103/1793-5482.175625
Bolster, E. M., van Schie, P. M., Becher, J. G., van Ouwerkerk, W. R., Strijers, R. M., & Vermeulen, R. J. (2013). Long-term effect of selective dorsal rhizotomy on gross motor function in ambulant children with spastic bilateral cerebral palsy, compared with reference centiles. Developmental Medicine & Child Neurology, 55(7), 610-616. doi:10.1111/dmcn.12148
Daunter, A. K., Kratz, A. L., & Hurvitz, E. A. (2017). Long-term impact of childhood selective dorsal rhizotomy on pain, fatigue, and function: a case-control study. Developmental Medicine And Child Neurology, 59(10), 1089-1095. doi:10.1111/dmcn.13481
FRIGON, C., LOETWIRIYAKUL, W., RANGER, M., & OTIS, A. (2009). An acute pain service improves postoperative pain management for children undergoing selective dorsal rhizotomy. Pediatric Anesthesia, 19(12), 1213-1219. doi:10.1111/j.1460-9592.2009.03184.x
Grunt, S., Becher, J., & Vermeulen, R. (2011). Long-term outcome and adverse effects of selective dorsal rhizotomy in children with cerebral palsy: a systematic review. Developmental Medicine & Child Neurology, 53(6), 490-498. doi:10.1111/j.1469-8749.2011.03912.x
Josenby, A., Wagner, P., Jarnlo, G., Westbom, L., & Nordmark, E. (2012). Motor function after selective dorsal rhizotomy: a 10-year practice-based follow-up study. Developmental Medicine & Child Neurology, 54(5), 429-435. doi:10.1111/j.1469-8749.2012.04258.x
Macwilliams, B., Johnson, B., Shuckra, A., & D'Astous, J. (2011). Functional decline in children undergoing selective dorsal rhizotomy after age 10. Developmental Medicine & Child Neurology, 53(8), 717-723. doi:10.1111/j.1469-8749.2011.04010.x
McLaughlin, J. (2012). Motor function after dorsal rhizotomy. Developmental Medicine And Child Neurology, 54(5), 389-390. doi:10.1111/j.1469-8749.2012.04255.x
Rumberg, F., Bakir, M. S., Taylor, W. R., Haberl, H., Sarpong, A., Sharankou, I., & ... Funk, J. F. (2016). The Effects of Selective Dorsal Rhizotomy on Balance and Symmetry of Gait in Children with Cerebral Palsy. Plos ONE, 11(4), 1-11. doi:10.1371/journal.pone.0152930
Steinbok P. Outcomes after selective dorsal rhizotomy. Developmental Medicine And Child Neurology [serial online]. March 2015;57(3):214-215. Available from: MEDLINE, Ipswich, MA. Accessed September 27, 2017.
Tedroff, K., Löwing, K., & Åström, E. (2015). A prospective cohort study investigating gross motor function, pain, and health-related quality of life 17 years after selective dorsal rhizotomy in cerebral palsy. Developmental Medicine & Child Neurology, 57(5), 484-490. doi:10.1111/dmcn.12665
Trost, J. P., Schwartz, M. H., Krach, L. E., Dunn, M. E., & Novacheck, T. F. (2008). Comprehensive short-term outcome assessment of selective dorsal rhizotomy. Developmental Medicine And Child Neurology, 50(10), 765-771. doi:10.1111/j.1469-8749.2008.03031.x
Vermeulen, R. J., & Becher, J. G. (2015). Long-term outcome in selective dorsal rhizotomy in spastic cerebral palsy: differentiation in mobility levels is needed. Developmental Medicine And Child Neurology, 57(5), 408-409. doi:10.1111/dmcn.12695
What do we know about physical therapy post selective dorsal rhizotomy?. (2017). Developmental Medicine & Child Neurology, 5919. doi:10.1111/dmcn.24_13511
Week 5 •Change CP abbreviation to Cerebral Palsy •Reorganize the first paragraph of the lead section to help make the process easier to understand for the reader. •Try to decrease big, medical terms, especially unnecessary terms, if the therm is needed then an small explanation would suffice to help the reader understand and comprehend the article. •A better description of the actual procedure itself and how it can help reduce spasticity •Overall, organize the lead in a manner that flows and doesn't jump all over the place. I felt lost reading the lead and almost felt as if the author was jumping from one topic to the next without giving an adequate description of each topic.
EDITS TO LEAD (INTRODUCTION) A rhizotomy is a term chiefly referring to a neurosurgical procedure that selectively destroys problematic nerve roots in the spinal cord, most often to relieve the symptoms of neuromuscular conditions such as spastic diplegia and other forms of spastic cerebral palsy.[3] Neurosurgeons specializing in spastic cerebral palsy primarily use spastic dorsal rhizotomy (SDR), which involves pinpointing dorsal nerve roots which relay sensory input from the muscle to the spinal cord. During the surgery the surgeon divides each dorsal root into rootlets. These rootlets are stimulated and by examining electromyography (EMG) the surgeon can determine which rootlets are causing the spasticity. Once the spasticity causing rootlet is identified the surgeon cuts the nerve decreasing the amount of sensation coming from the muscle to the spinal cord thus reducing spasticity. Normal rootlets, not involved with the spasticity, are kept in tact. (INSERT CITATION HERE - Center for Cerebral Palsy Spasticity). Rhizotomies can also be used to treat neck and pack pain resulting from arthritis of the facet joints. The procedure works by distrupting the medial branch nerve signals which often carry the pain signals. The patient is given a local anesthetic and the surgeon inserts a cannula to the nerves, he then can place a radiofrequency electrode through the cannula and stimulates nerves to see if the reproduce the patient's pain. If pain is reproduced but there is no muscle activity the surgeon knows they are in the correct spot, at this point the nerve is cauterized disrupting communication to the brain. This procedure blocks pain signals from reaching the brain. (INSERT CITATION HERE - Southern Spine Insitute).
EDITS TO BACKGROUND Dorsal rhizotomy or selective dorsal rhizotomy (SDR), is the most widely used form of rhizotomy. It is the primary treatment for spastic diplegia, said to be best done in the youngest years before bone/joint deformities from the pull of spasticity take place, but it can be performed safely and effectively on adults as well. An incision is made in the lower back just above the buttocks and the nerves accessed and dealt with are in that area of the spinal column. (no reference for this)
SDR is a permanent procedure that addresses the spasticity at its neuromuscular root: i.e., in the central nervous system that contains the misfiring nerves that cause the spasticity of those certain muscles in the first place. After a rhizotomy, assuming no complications, the person's spasticity is usually completely eliminated, revealing the "real" strength (or lack thereof) of the muscles underneath. SDR's result is fundamentally unlike orthopaedic surgical procedures, where any release in spasticity is essentially temporary. (reference?)
Because the muscles may have been depending on the spasticity to function, there is almost always extreme weakness after a rhizotomy, and the patient will have to strengthen the weak muscles with intensive physical therapy, and to re-learn activities of daily living without the adapted support of spasticity. (reference?)
Rhizotomy is usually performed on the pediatric spastic cerebral palsy population between the ages of 2 and 6, since this is the age range where orthopedic deformities from spasticity have not yet occurred, or are minimal. It is also variously claimed by clinicians that another advantage to doing the surgery at a young age is it is inherently easier for these extremely young children to restrengthen their muscles and to re-learn how to perform activities of daily living. However, recent cases of successful SDR procedures among those with spastic diplegia across all major age ranges (years 3-40 and even above) has finally proven its universal effectiveness and safety regardless of the age of the spastic diplegic patient. A counter-argument against the prevailing view concerning the younger years is that it may actually be quicker and easier to restrengthen an older patient's musculature and regaining of walking may happen faster with an older patient due to the fact that the patient is fully matured and very aware of what is going on, and so may work harder and with more focus than might a young child. These two schools of thought have equally objectively valid bases for their formation and thus are each defended quite intensely by their respective proponents. (reference)
Medical Uses I like this area, its good information relaying the criteria needed in order to have a rhizotomy done. Maybe fix grammatical errors.
Long term effects/Required Circumstances More research on long term effects, spruce up this area with research because I know I found some articles with this information. (long term effects) Add more research to required circumstances, there must be more information out there.
Criteria The criteria explains that the child should be walking independently after surgery, so I don't really consider this criteria. I am going to look at the St. Louis reference and tweak the wording because as it is written now it doesn't sound like criteria, more so what the procedure will do for the patient.
Contraindications This is a good list of contraindications, however, I don't see a reference and I think it would be easier to read in a bullet format.
Procedural Outline Organize this section and fix grammatical errors, and I only see one reference, so find more resources backing up with information.
Complications No references cited in this section. Organize and clean up this section.
History This section is in an odd spot, I think it should be moved up and parts should be taken out. It's almost too wordy and the reader gets lost in all the explanations.
Post-Surgical Rehabiliation Most rehabilitation from SDR is done on an outpatient basis, though it may also include an initial several-week inpatient component (but typically does not). Typical base restrengthening and restoration of full ambulatory function takes about twelve weeks (3 months) of intensive physical therapy 4-5 times per week, but subsequent buildup and maintenance beyond that initial several-week period is just as necessary, and may require continued 4-5 times per week therapy as much as 6 months postoperatively, for a total of about a year and four months after surgery in order to achieve maximum basic functionary movement from the surgery. Beyond that point, any continued strengthening is, as with any person's exercise regimen, undertaken strictly by the individual's own choice and direction
Outcomes following a SDR can vary based on the number of nerves cut during surgery, joint deformities (link), muscle contractures (link), and level of impairment before the procedure (Rehab Walk Citation). Following the procedure, the child will likely experience muscle weakness, which can be corrected with physical therapy (PT). (link) PT is imperative to restore functional status in the shortest amount of time (Rehab Walk). Physical therapy post SDR aims to promote independent walking, improved gait pattern, transfers, balance, and upper limb motor control (Rehab Walk). It is important to remember SDR does not cause permanent muscle weakness, rather it is temporary a few weeks following the procedure. A strengthening program is beneficial to combat this expected weakness and improve lower extremity range of motion and facilitate a near normal gait pattern (Rehab Walk). (do one citation at the end and one at the beginning)
This (website) was used as a sample post rehabilitation protocol. Week 1 post surgery, the child will typically have 30 minute physical therapy sessions for the first 4 days followed by an increase up to 45 minutes during days 5-7. (Firefly) During the second week, sessions range from 45 to 60 minutes with a focus on stretching, strengthening, developmental milestones (if appropriate), and a standing program. If necessary, an orthotic (link) assessment can be performed during the second week. (Firefly) Weeks 3 through 6 focus on the previously mentioned items but adding gait training, assessment for the need of assistive devices, and preparing a home program for the patient. Six weeks to three months following the procedure the patient will attend outpatient physical therapy 3 to 5 times a week for 45-60 minutes and focusing primarily on stretching, strengthening, ambulation, and assessing for the need for adaptive equipment such as a tricycle. (Firefly) Three to six months focus on all previous therapies with emphasis on developing proper gait mechanics. At this point, frequency of the sessions will typically decrease to 2-3 times per week (Firefly). Six to twelve months post surgery focuses on all of the above with increased emphasis on movement patterns the child may be having difficulty with. One year post procedure, frequency of sessions is 1 to 2 times per week to continue working on strengthening and refining motor control and orthotic needs continued to be monitored. (citation at beginning and end)