Physiotherapy for Selective Dorsal Rhizotomy (SDR)

Selective Dorsal Rhizotomy (SDR) involves cutting the nerve rootlets in the spinal cord that contribute to spasticity and send abnormal messages to the muscles. There are a lot of potential benefits from having this surgery partly depending on the GMFCS classification of cerebral palsy .

Surgery is most common in GMFCS Levels I – III, but surgery is available (usually privately funded) for children in GMFCS Levels IV and V.

Some of the key potential benefits of surgery with intensive physiotherapy for SDR include:

• Reduced spasticity, painful spasms and joint pain;
• Improved flexibility and movement;
• Better quality of movement;
• Improved motor abilities on the floor/bed, sitting and standing;
• Increased balance (although gravitational insecurity can be an issue);
• Increased functional and independent skills;
• Improved walking pattern and ability;
• Enhanced sleep and comfort;
• Increased strength and stamina;
• Improved exercise tolerance and energy.

There are clinical benefits of physiotherapy and hydrotherapy/aquatic physiotherapy in the pre and post operative rehabilitation stages.

We offer individual sessions, and small group SDR rehabilitation blocks of 3, 5 and 10 days, please see our Services page.

Pre-operative Physiotherapy

You may need a pre-operative video of motor abilities/movement for the SDR team before surgery if undertaken in USA and some counties.

It is important that your child is as strong as they can be before surgery and that they know what to expect of physiotherapy after surgery when they will initially be very weak.

They will be able to perform some of the post-operative exercises in the hydrotherapy pool because the heat of the water and physiological effects of immersion reduce spasticity whilst they are in the pool, and the buoyancy and support of the water makes it easier to move.

After surgery the muscles will be expected to work in a way they have not worked in before and very specific and individualised muscle and task training will be required.

Post-operative Physiotherapy and Rehabilitation

A good physiotherapist will always empower a young person to take as much control over their life and physio as possible. A physiotherapist can help to find the best approach to suit the individual.

Physiotherapy will be tailored to meet your child or young person’s needs based on their pre-operative assessment. Initially they may be a little sore on their back. Depending upon their GMFCS classification we aim to help your child to get back onto their feet as quickly as possible. We will work with them to regain their pre-operative abilities but with a focus on the movement patterns they use and the quality and control of their movements.

Specific muscle and task training, use of a standing frame, parallel bars, and gym equipment if required, re-education of gait (walking pattern), mobilising and balance activity are but a few of the ways we will help them to rehabilitate.

We will provide programmes and games to continue at home to support the physiotherapy sessions. The rehabilitation post-operatively is very intense to optimise the effects of surgery. Interspersing gym sessions with hydrotherapy (once the wound is healed) is a great way to motivate your child. Remember you may continue to see improvement for as long as 2 years after your surgery.

Any issues with swimming, sports or highly physically challenging activities will be addressed and we will focus on increasing strength, fitness, stamina and exercise tolerance on land and in the pool.

Physiotherapy will focus on addressing muscle imbalance and increasing strength, fitness, stamina and exercise tolerance on land and in the pool whilst increasing flexibility and joint range of movement. Strenuous exercise is easier when undertaken in the hydrotherapy pool because you will be able to exercise for longer without becoming as tired as you would on land, and without putting strain through your joints as the water takes your weight. You can also learn or regain more physically demanding activities in the water, such as using steps, running and squatting.

Hydrotherapy / Aquatic Physiotherapy Benefits can include:

• Increased muscle strength and endurance using modified PNF, the properties of water and Aquaepps® techniques.
• Able to work in standing and even step before it is possible on land due to the buoyant reduced weightbearing effects.
• Increasing functional activities using buoyancy, rotational effects and drag with specific PNF and Aquaepps® techniques.
• Children are often very fearful of falling when they first relearn how to stand. The water aids balance in all positions with reduced risk of falling, using the drag and rotational effects of water. The density of water allows more time to respond and react in different positions with lots of sensory feedback.
• Helps work towards and maintain sit to stand transfers.
• Improving sitting balance.
• Increasing fitness and stamina as less effort required to exercise in water. Remember SDR does not completely remove spasticity so you still want the warm the water to aid movement.
• Learning new skills such as running and jumping.
• Work on respiratory function and breath control using Aquaepps® and Halliwick techniques, alongside trunk control and spinal mobility.
• Gait (walking and stepping) re-education in a reduced weightbearing environment.
• Increased movement using Watsu®, mobilising, Aquastretch and Aquaepps® techniques, and due to the physiological effects of immersion in heated water inducing muscle relaxation and releasing endorphins.
• Freedom of movement as an unencumbered environment.
• Children often lose their sense of where the middle is and where there joints are in space because their body feels different. The pool provides sensory stimulation and increased proprioception (awareness of where joints are in space) due to hydrostatic pressure of water against body and turbulent drag of water moving around body.
• Learning or relearning to swim.
• It’s fun.