By Molly Dannenmaier
Children with cerebral palsy often must rely on wheelchairs or special walkers. But a new medical procedure is freeing their muscles and allowing them to walk – in many cases unassisted.
Four-year-old Damien Aguilar and his mother made a life-changing journey in January when they traveled from Dallas to meet with UTMB’s Dr. David Yngve for a procedure performed by only a handful of surgeons worldwide.
“Damien is so determined,” said his mother Gloria Mata. “He wants so much to be able to walk by himself and he is trying all the time. He holds onto chairs, tables or his friends or teachers to keep going.”
Before treatment, Damien’s leg muscles were so tight that his heels pulled upward whenever he tried to walk. It was impossible for him to straighten out his feet. Every step he took was on tiptoes, and he lost his balance after three or four steps on his own.
Yngve, chief of pediatric orthopedics at the University of Texas Medical Branch at Galveston, specializes in the minimally invasive outpatient surgery that has changed everything for Damien.
The traditional surgical treatment used to help children with cerebral palsy walk is called tendon release. It involves deep cuts to each Achilles’ tendon, and although it results in a lessening of the tension between the leg and the foot muscles, it causes muscle shortening in the calf. Yngve did this conventional surgery for many years before he found out about the new technique. Now he says he would never go back.
Traditional tendon release surgery creates a deep scar, and there is nothing desirable about deep scarring around the tendons, said Yngve. His procedure, on the other hand, entails numerous small, shallow incisions to the back of each calf. There are no stitches and no scarring, just many tiny, specially placed pricks. The procedure is called selective percutaneous myofascial lengthening.
“It allows some of the tougher tightness to be cut so the muscle underneath can actually stretch out,” said Yngve.
Yngve does about 100 of these remarkable outpatient surgeries every year for patients who travel from across the country to see him. He has been performing the procedure for a little more than five years and has recorded a great deal of success in virtually every case.
UTMB physical therapist Dana Wild has worked with Yngve since he began this new program. Her job is to document the changes each child undergoes. She videotapes the child’s attempts to walk before surgery and then again about seven months later.
“Nearly all the children have shown dramatic improvement,” she said. “It’s an amazingly effective procedure for something that is so minimally invasive.”
Damien’s mother learned about UTMB’s Yngve from another mother whose son was in a mutual physical therapy group in Dallas.
“Her son was in much worse shape than mine,” said Mata. “He couldn’t walk at all, and even after he took one step in his walker he always seemed exhausted and discouraged. Then he went to Dr. Yngve.”
“A few weeks after the surgery, we visited them at home and he was walking by himself. He was so happy. Everything had changed for him.”