SDR

Why Choose Children’s Neuro Physio (CNPhys)?

The approach to treating children with cerebral palsy who have undergone SDR is very different to that of treating children with severe spasticity or fluctuating muscle tone. A number of our team have worked in musculoskeletal fields and also for charities such as SCOPE and overseas. The approach to rehabilitation after SDR is very different to how we work with children and their families who have not had this surgery. Muscle training, increasing exercise tolerance and stamina as part of functional and day to day physical activity are key.

We have strong links with the Bristol SDR team and with several fitness instructors who see children with SDR which ensures we are able to provide the support and information you require to help your child through this challenging but life changing time.

Our Director, Dr Heather Epps, PhD undertook her master’s degree in exercise physiology. Her supervisor was Dr Vish Unnithan, now Professor of Paediatric Exercise Physiology who has published many papers in cerebral palsy, activity and exercise training. Heather’s dissertation was in measuring muscle power in cerebral palsy and muscle strength in children with and without disabilities.

Some of our team have also worked at Great Ormond Street, Alder Hey and Birmingham Children’s Hospital’s, Frenchay and Bristol Royal Hospital for Children (the largest centre undertaking SDR in the UK) and have additional experience in specialist orthopaedic paediatric physiotherapy, which gives us the edge when working with children following surgery particularly post Selective Dorsal Rhizotomy.

We also have links with Tree of Hope – a charity which helps families and friends fundraise for surgery and physiotherapy.

Dr Park pioneered SDR surgery in St Louis in the USA. At present children are operated on earlier, with differing proportions of nerves severed in the USA compared to UK. Dr Park recently told our director that his ideal age to undertake SDR is 3 years because contractures and deformities are less likely to be evident and because spasticity damages muscle.

Why is physiotherapy so important?

When muscles are in spasm they cannot work efficiently or effectively and are weak. Certain muscle fibres are affected more than others so children have weak muscles and a muscular imbalance. Reducing or losing the spasticity in muscles, means they are expected to work in a way they have never done before and through a range of movement the child did not previously possess, for example, if they always walked with bent hips that turned in, the muscles that extend and turn out the hips have become untrained and wasted. The child therefore needs to redress their muscle imbalance and learn to work the muscles concentrically, isometrically and eccentrically. It is also important to ensure that muscle power, which is measured through fatigue indices, is addressed as well as muscle strength, the force required to activate the muscle and work against resistance.

Link for SDR St Louis for further information about the procedure

These organisations can provide support and help with funding for anyone considering SDR

Outcome is affected by the proportion of nerves divided, GMFCS, level of impairment and ambulation and muscle spasticity. Joint deformity and contracture pre-operatively and engagement with the physiotherapist pre- and post-operatively.

The results we have seen at Children’s Neuro Physio (CNPhys):

• Children who were dependent on a K-Walker can walk independently;
• Children have an improved gait pattern in their walkers;
• Children who couldn’t reach the floor can squat and return to standing;
• Children now able to balance and stand independently;
• Reported improvements at school as child can keep up better with their peers and respond and react more quickly to changes in environment;
• Improved upper limb and fine motor control because sitting balance is increased;
• Young children with typical intoeing, diplegic crouch gait now walk almost normally to the untrained eye.

Steinbok P: Outcomes after selective dorsal rhizotomy for spastic cerebral palsy. Childs Nerv Syst 17:1-18, 2001.

Langerak NG, Lamberts RP, Fieggen AG, Peter JC, Peacock WJ, Vaughan CL: Functional status of patients with Cerebral palsy according to the International Classification of Functioning, Disability and Health model: a 20-year follow-up study after selective dorsal rhizotomy. Arch Phys Med Rehabil 90:994-1003, 2009

McLaughlin J, Bjornson K, Temkin N, Steinbok P, Wright V, Reiner A, et al: Selective dorsal rhizotomy: meta-analysis of three randomized controlled trials. Dev Med Child Neurol 44:17-25, 2002