Single-Event Multilevel Surgery for the Upper Extremity in Cerebral Palsy

Abstract

Single-event multilevel surgery (SEMLS) has become the normal standard for addressing gait disabilities in children with cerebral palsy (CP). The concept for this approach is to identify all the impairments which can be surgically corrected and then schedule the corrections at an appropriate age. This limits the amount and frequency of surgical procedures, allowing the child and family to minimize medical contact, rehabilitation time, and time lost from work and school. The SEMLS approach to upper extremity correction has received less attention and research; however it has also become the norm in the approach of correcting upper extremity deformity. For the SEMLS approach to work, all the impairments have to be able to be identified, their interactions understood, and an appropriate treatment program developed. To understand and develop a treatment program, consideration has to be given toward the severity of the central CP lesion, the presence of movement disorder, muscle tone, voluntary control, sensation, and the child and family’s goals. Development of patient-specific goals is more difficult in upper extremity surgery than for comparable lower extremity impairment. With lower extremity impairments, the given goal is almost always to improve ambulation. For the upper extremity, the goals may include ease of care for activities of daily living, improved ability to use the limb, improvement in cosmetic appearance of the limb, and reduction in discomfort related to position of the upper limb. The outcome of a SEMLS approach to upper limb correction requires a consideration of the primary goal to be addressed. Outcome studies related to how these goals are reached are limited but show improved function after SEMLS. The goal for this chapter is to outline an approach for evaluating impairments, developing a plan to address the concerns of the patient and family and review available literature on the outcome of the SEMLS approach.