Physiotherapy For Selective Dorsal Rhizotomy (SDR)

What Is A Selective Dorsal Rhizotomy (SDR)?

  • Selective dorsal rhizotomy surgery is done by cutting some of the tiny nerves carrying information from the leg muscles before entering the spinal cord. In children with spasticity, this reduces the number of abnormal signals that are sent from the leg muscles to the spinal cord. As a result, there is less tightness in the lower extremities.
  • The selected spinal nerve roots which are cut are located in the lower back.
  • During the surgery, the neurosurgeon makes an incision along the center of the lower back. The posterior part of the spine is opened and the spinal cord is exposed. Then, the surgeon locates the nerve roots that exit from the lower spinal cord.
  • The procedure is performed for children with Cerebral Palsy.
  • SDRs were initially performed in America but in recent years UK surgeons have also started to conduct SDRs.

What Is The Aim Of SDR Procedures?

  • The aim for SDR procedures is to reduce or completely get rid of the spasticity in the lower limbs of children with cerebral palsy in order to:
  1. Achieve a long-term reduction in spasticity
  2. Decrease leg pain
  3. Improved sitting balance, longer stride length and easier walking
  4. Improve function and mobility through strength & balance training
  5. Increase range of motion and improve positioning
  6. Reduce number of falls

Do SDRs Affect The Arms As Well As Legs?

  • SDRs are usually performed for the legs as the nerves which are cut are in the lower back.
  • However, for quadriplegics SDRs can help as spasticity in the legs can cause increased tone in the arms. Therefore, if the legs are treated, the arms can also gain some benefit.

How Do You Get The SDR Procedure?

  • Speak to your paediatrician to seek a referral for an assessment for the procedure
  • Suitable candidates usually are those who are not severely affected and have good cognitive ability to take part in the rehabilitation post-surgery.
  • Please speak to your paediatrician for more information. No all Hospitals provide SDRs.

Will My Child be Completely Better or Will They Need Physiotherapy Post Surgery?

 

  • Usually your child will need a huge amount of therapy in the initial stages.
  • Before the procedure your child would have used their high muscle tone (spasticity) to help them to move. However, as the aim of the surgery is to remove the high tone, your child will be left with their underlying leg weakness.
  • Intensive therapy post-surgery is therefore required in order to build up the muscles. Consequently, the strength of the muscles will support your child as they begin to mobilise rather than spasticity.
  • The recommended amount of therapy is usually x4-5 sessions per week for 4-6 months.
  • Then 2-3 sessions up to 18 months post- op. This of course means a huge amount of commitment from you, your child and your therapist.

 

What Will happen If My Child Does Not Get The Level Of Physiotherapy Required?

 

  • Your child would make some gains post-surgery. However, without good physiotherapy your child may start to walk with their feet turned in, develop unstable hips and bad walking patterns
  • The main advantage of the surgery is that it allows the child to practice their walking and posture in a way to prevent future problems with their hips, spine and legs.
  • If you have surgery with no rehab the outcome may not be as favourable.

 

Is Physiotherapy Funded By The NHS?

 

  • A level of physiotherapy is provided by the NHS. Commonly this is 6-12 weeks of therapy but only once a week which is far below the recommended level of physiotherapy for SDR surgeries.
  • Parents can try to incorporate activates such as swimming or cycling to help, however, additional intense physiotherapy is required to get the best outcome

What Is The Aim Of Physiotherapy?

  • A level of weakness post-surgery makes walking difficult. However, because your child will no longer be fighting their spasticity the outcomes are more favourable long term.
  • A period of up to 2 years of therapy is common in order to see real improvements to the Childs gross motor skills (large movement such as walking).
  • The level of physiotherapy input will decrease as your child gets more mobile and stronger

Tips On Choosing The Right Physiotherapist

 

  • A physio who has experience in paediatrics as treatment sessions need to be engaging and fun for the lengthy period of time physio is required
  • A physio clinic which is reasonably close
  • A physio who is willing to speak and liaise with your NHS team to ensure your child’s care is well planned and the advice your given is consistent amongst healthcare professionals.
  • A physiotherapist who is experienced in managing children who have gone under SDR surgery or has experience in neurological rehabilitation.

How Will The Physio Practice Help?

 

  • We will provide experienced Physiotherapists who has worked with children and children recovering from SDRs
  • We will ensure close links with your NHS Physio/team is maintained in order to give the best input for your child
  • Provide intensive treatment blocks for daily Physiotherapy or as required according to any post-operative advice from your surgeon.
  • We will use Play Therapy to make sessions more engaging and fun for your child
  • Our aim will be to strengthen your child trunk & legs and improve movement patterns whilst maintaining good joint range of motion.
  • ‘Pre-Hab’ (rehab pre-surgery) may also be a sensible consideration to prepare for weaknesses experienced post op and also to build a good relationship between therapist and child in readiness of the treatment ahead.