Our team of therapists have vast experience in assessing and treating children pre & post Selective Dorsal Rhizotomy (SDR). Our physiotherapist, Daniel Woods, has now treated over 25 children who have had the procedure in the past 6 years. Including providing regular intensive rehabilitation.
This includes children who have had the procedure at St. Louis, Leeds, Sheffield, Nottingham
A wide variety of ages: 3-16 years
As well as ranging presentations: Quadriplegia & Diplegia
Pure spasticity as well as some children with accompanying dystonia
What is SDR?
In brief, SDR is a major surgical procedure that is used to treat spasticity in children diagnosed with Cerebral Palsy (CP).
It involves dividing the lower spinal nerves and cutting those which are identified as responsible for producing spasticity
SDR is currently the only procedure that offers long-term reduction, or elimination, of spasticity in the lower limbs.
The most common form of CP deemed appropriate for this type of operation are children diagnosed with Diplegic Cerebral Palsy who present with spasticity (as opposed to ataxia or dyskinesthesia. Diplegia is where the legs are more predominantly affected. Spasticity is a restriction in the muscle to movement. It can present as tightness & it can prevent the affected muscles from actively moving through their full range of motion. Commonly this can be seen as walking on tiptoes or being couched/unable to fully straighten the knees and hips when standing and walking.
What are the potential benefits?
By reducing or eliminating spasticity in the legs, it gives the child greater potential for movement. Which in turn could lead to greater function & increased independence. As well as improving posture, the ability to stretch & position the legs and reducing pain.
In turn, this means that you can ‘re-train’ the muscles how to work, such as teaching the child to walk with their heels down and it gives you greater potential to build strength in a muscle which is less tight & restricted.
The importance of post-SDR physiotherapy
By no means is SDR considered a ‘quick fix’ & post-operative physiotherapy is vitally important to the long-term success of the operation.
In fact, the National Institute of Clinical Excellence states ‘prolonged physiotherapy and aftercare will be needed’.
Children who have always learned to walk in a certain way will continue to do so unless taught how to do it differently & physiotherapists are ideally placed to do this as experts in movement and development. They will teach what is commonly referred to as, normal patterns of movement.
Progressive strength training
Progressive strength training also forms another vital part of the rehabilitation process as it is known that children with CP have underlying weakness. Particularly where some muscles become underused, under innervated and overstretched owing to the tightness and overuse of those muscles previously affected by spasticity. With spasticity eliminated, the ability to strengthen these muscles is increased.
Of similar importance is to progress, where able, the amount of walking a child does. As well as tailoring the support they use to do so. To maximise independence and function selecting the right orthotics and walking aids, at the right stage of a child’s rehabilitation is carefully considered. The aim might be for a child to progress from walking with a frame to walking with sticks, or even to learn to walk independently. Your physiotherapist can help with progressing you child at the right stage of their rehabilitation.
Your local authority may be limited in the amount of post-operative rehabilitation they can provide & it will depend whether your SDR surgery is self-funded, NHS funded or part funded. It is important to understand this and have a plan prior to surgery.
Why choose PT Kids?
We are vastly experienced in provided rehabilitation to children who have undergone SDR. We are able to work alongside your NHS therapist as well as any specialist centres that you may visit with your child. On request, we provide update reports for your consultant when you visit clinic for your SDR review
We offer input in the home or school and deliver regular sessions 1-3 times per week, as indicated. Similarly, we act as a consultation service to families who decide to complete the rehab themselves. Reviewing children at regular intervals to update treatment plans and teach new appropriate exercises….we can be flexible to meet your child’s level of need.
For those families fundraising, we already work with charities including; Tree of Hope, Just 4 Children & Caudwell Children, which makes invoicing easy.
We consider ourselves as advocates for the surgery & have seen children achieve remarkable results over the past 6 years.
Please don’t hesitate to contact us to discuss your child’s needs