Assessment of Neuromuscular Control Through Muscle Synergy in Patients with Cerebral Palsy After Selective Dorsal Rhizotomy

Abstract

Gait in children with cerebral palsy (CP) is characterized by alterations resulting from the combination of various neurological factors, including spasticity. Selective dorsal rhizotomy (SDR) is a common treatment for these children to alleviate spasticity. Different strategies have been proposed to describe the neuromuscular control required by studying surface electromyography of the muscles in the lower limb. In this way, non-negative matrix factorization has been utilized to identify muscle synergies. This study aims to investigate the behavior of muscle synergies in a group of children with CP who underwent SDR to eliminate muscle spasticity and improve their walking. Therefore, we studied a group of children with CP who were treated at the Fleni Institute and underwent gait analysis before and after SDR. Additionally, the study included a control group of typically developing children. Our results show improved gait post-SDR, with a significant increase in the range of knee flexion-extension movement. Consistent with the literature, our findings indicate that children with CP exhibit simplified muscle control during gait compared to typically developing children. Furthermore, we observed no statistically significant changes in motor control among children with CP after SDR. These results suggest that post-surgical rehabilitation may not have an impact on synergy structures due to altered neural plasticity in children with CP. Alternatively, it is possible that these children may require a longer period of rehabilitation to allow the central nervous system to acquire new synergies that enable more complex motor control, similar to typically developing children.