Category Archives: Treatments and Therapies

Selective Dorsal Rhizotomy: An Overview

Selective Dorsal Rhizotomy

By Casey Daniel

Selective dorsal rhizotomy (SDR) is an irreversible neurosurgery performed on the lower spinal cord to treat spasticity, especially in the lower limbs. A neurosurgeon identifies nerve rootlets in the spinal cord that are sending abnormal messages and cuts them. SDR is presently the only surgical procedure that can provide permanent reduction of muscle spasticity caused by spastic CP.

How Does SDR Work?

Sensory nerves collect information from a muscle and bring it to the spinal cord, which sends motor nerves back to the muscle, telling it to contract. Normally, the brain “oversees” muscle activity by communicating with the spinal cord. In people with CP, the brain has less control, and the spinal cord instructs some muscles to contract continuously.

During SDR surgery, doctors cut only the sensory nerve rootlets that cause spasticity. Motor nerves are untouched. This means that muscle tightness is reduced, but other functions, like leg movement, remain intact.

The Surgical Process

First, an incision – usually less than six inches long – is made on the child’s back. The spinal canal is opened so the surgeon can locate nerve roots. Using a surgical microscope, he or she then separates roots into smaller “rootlets.”

Several dozen rootlets are stimulated via electric impulse; this allows the surgeon to see which rootlets create spastic reactions. The sensory rootlets that cause spasticity are then cut.

What are the Benefits of SDR?

Reduction of spasticity offers muscle groups the opportunity to move normally. This leads to a broadened range of functional mobility, which makes self-care activities – like dressing and grooming – easier. SDR also lessens contractures, prevents bone and joint deformities, improves gait patterns, and optimizes the body’s use of energy and oxygen.

What are the Risks of SDR?

The most serious complications include paralysis of the legs and bladder, impotence, and sensory loss. Wound infections and meningitis are possible but generally controllable with antibiotics. Spinal fluid sometimes leaks from the wound and requires surgical correction.
Sensitivity of the skin on the feet and legs is common following SDR surgery, but usually goes away within two months. Temporary changes in bladder control are also relatively common, but usually cease within a few weeks.

Who are candidates for SDR surgery?

SDR is generally performed on children with spastic CP between the ages of 3 and 10, though older children are sometimes candidates. Because SDR involves considerable post-op rehabilitation, candidates for this surgery are cognitively able to follow directions.

Spastic diplegics. Children with spastic diplegic CP that affects the legs more than the arms are the most common candidates for SDR. Sometimes called “borderline ambulators,” spastic diplegics can take a few steps forward without assistance, often on their tiptoes.

Spastic diplegics who undergo SDR virtually always experience reduced spasticity, and recurrence of spasticity is extremely rare. For these children, SDR can improve gait and leg function.

Severe spastic quadriparetics/quadriplegics. In certain cases, SDR can increase the physical comfort and independence of severe spastic quadriparetics or quadriplegics. Parents report that caretaking tasks, like diaper changes and mealtimes, are less challenging after SDR surgery. However, for this group, SDR has a lower success rate and higher risk of spasticity recurrence.

How Can I know if SDR is Right for My Child?

SDR is not right for every child with spastic CP, so a team of specialists will screen your child to determine whether the surgery is appropriate. This team can include a pediatric neurosurgeon, a pediatric orthopedic surgeon, a physical therapist, an occupational therapist, a rehabilitation medicine physician, and/or a nurse, depending on your hospital. When evaluating your child’s spasticity, they may order MRI brain scans, visits with a pediatric neurologist, or other pre-op tests as necessary.

Even if the team concludes that SDR is not right for your child, their evaluation can provide useful information about his or her therapy program and care. Some children who are not immediate candidates for SDR are invited to return in several months for reevaluation.

What Should I Expect if My Child Undergoes SDR Surgery?

Prior to surgery, patients will have a series of pre-op appointments with their doctor. On the date of the procedure, surgery typically lasts 3-4 hours. The patient will spend about 3-5 days recovering, closely monitored by nurses. After this period, comprehensive rehabilitation begins.

Because SDR reduces muscle spasticity permanently, patients must learn to walk and move differently than before. Physical and occupational therapists help patients learn basic self-care and motor skills, as well as helping to increase strength, alignment, and balance. Regular physical therapy sessions – usually several times per week – continue for several months after your child comes home. Doctors set a schedule of follow-up appointments to periodically evaluate your child’s progress.

 

Sources

The Cleveland Clinic:  Treatments and Procedures – Selective Dorsal Rhizotomy

St. Louis Children’s Hospital Center for Cerebral Palsy Spasticity:  About Selective Dorsal Rhizotomy

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Sensory Activities for Winter

By Casey Daniel

Winter is a great time to engage in sensory activities with your child! The weather is colder, the leaves are crispier, and – depending on where you live – the outdoors may be blanketed in snow. Here are some tactile activity ideas to help your family make the most of the holiday season!

In the Kitchen

Cooking and preparing food is a great way for your child to explore their sensory abilities. If you have access to a fireplace or campfire, consider supervising your child while he or she makes s’mores. This activity can improve sensory integration and precision grasps – and yields delicious treats! You can even download a special s’mores lesson plan from Special Chef, a website that specializes in teaching cooking skills to kids with special needs. (They also have a lesson plan for hot chocolate – perfect for chilly winter nights!)

Chocolate-covered strawberries also make for a fun and delicious tactile activity. Substitute white chocolate to make “snow-capped strawberries,” or use green and red sprinkles for an instant Christmas theme. Try this recipe from Cooking with Kids.

Other options: Bake gingerbread men cookies and encourage your child to decorate them with red-hots, gumdrops, or other candies. Rice Krispies Snowmen treats are also sure to be a hit – you may need to cook the treats yourself, but kids will love decorating them with frosting and candies. You can also make pretty peppermint sticks, which allow your child to practice dipping the sticks in chocolate and rolling them in sprinkles. Or, if your child likes bagels for breakfast, try assembling this cute “Frosty the bagel” recipe together.

Want an even simpler tactile snack activity? Grab a skewer and some marshmallows and assemble “snowmen.” If appropriate, try making “baby snowmen” with miniature marshmallows and toothpicks for an extra challenge.

Visual Art Activities

The possibilities for winter-themed, sensory art activities are endless! Grab some green finger paints and create a handprint Christmas tree like this one. You can decorate it with whatever cutouts you like. The holidays are also a great time to make garlands using shoelaces and pony beads. You can also easily create unique Christmas ornaments by stringing beads onto pipe cleaners!

If you’re up for a bit of baking, you and your child can decorate yummy-smelling apple cinnamon ornaments. The Examiner details several holiday crafts for kids with special needs – including cotton ball snowmen, festive placemats, and a Rudolph made of handprints and footprints. KinderArt also offers basic instructions for the classic clothes-peg reindeer, as well as clay pot snowmen. (The clay pot snowman craft is a bit more ambitious and requires painting and gluing. However, it might be a good project to complete in phases over the course of a few days.)

Don’t underestimate the sensory power of good old Play-Dough in festive colors! Alternatively, consider making and playing with Christmas Cloud Dough, a sort of powdery Play-Dough that smells like peppermint. Cloud dough is designed to feel “like silky clouds in your hands,” yet still be moldable. Don’t worry, parents – this activity can get messy, but Cloud Dough vacuums up easily!

Want even more sensory, wintry, artsy fun?  Don’t miss out on these free, printable Christmas coloring pages.

Touch-Only Activities

If you’re looking for directly tactile, “touch only” activities, North Shore Pediatric Therapy suggests the following ideas:

  • Finger painting with holiday colors
  • Creating gingerbread man ornaments
  • Playing in the snow – making snowmen or throwing snowballs
  • Making “snow angels” (on the carpet, if the snow is too cold!)
  • Decorating the Christmas tree

Alternatively, you can “bring summer back” by creating a bean box – a sandbox alternative that’s suitable for indoor use. You fill a large tub with dry beans and sandbox toys. This opens opportunities for lots of learning games, like sorting the beans, making “shakers” with old medicine bottles, and hunting for buried objects. The Mother Huddle, a blog owned and operated by moms, offers detailed instructions for bean boxes here.

Want even more ideas for sensory activities?  Check out this extensive list from Mommy Poppins, a New York-based parenting blog. Enjoy your winter tactile experiences, and happy holidays!

 

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Whole Body Vibration Therapy Increases Bone Strength

From Science Codex

SAN FRANCISCO– A treatment known as whole body vibration therapy significantly increases bone strength among adolescents with cerebral palsy, a new clinical trial from New Zealand shows. The results were presented Saturday at The Endocrine Society’s 95th Annual Meeting in San Francisco.

Cerebral palsy affects more than half a million people in the United States. Caused by brain damage around the time of birth, the disorder affects muscle tone and movement, which can severely decrease the quality of life by making walking and other daily activities difficult. As movement becomes impaired, disuse weakens both the muscles and bones.

Although few therapies have proven successful at increasing bone and muscle strength among people with cerebral palsy, one promising approach is whole body vibration therapy, or WBVT. This method, as its name implies, involves standing on a machine that moves the body, causing a tilting movement of the pelvis similar to the motion of walking but much more frequently. Previous research among healthy adults, including post-menopausal women, has demonstrated that whole body vibration therapy can promote bone and muscle health.

To see if these beneficial effects occur in adolescents with cerebral palsy, researchers measured bone-mineral density and muscle mass after a course of whole body vibration therapy. They found that leg and spine bone-mineral density increased after the therapy, although total bone-mineral density did not change. Muscle mass in the legs also increased.

In terms of walking ability, whole body vibration therapy significantly increased the distance that study participants could walk for six minutes. Compared to the distance they walked at the beginning of the study, participants increased their distance by about 10 percent after receiving the whole body vibration therapy. Specifically, at the study’s start, the average distance walked was 286 meters, or 938 feet; by the end of the study, this average was 314 meters, or 1,030 feet.

“By maintaining or improving muscle and bone health during growth, WBVT can maximize mobility and bone strength into adult life, improving both mobility and quality of life,” said the study’s lead author Silmara Gusso, PhD, post-doctoral research fellow at the University of Auckland-Liggins Institute in New Zealand. “This extremely encouraging initial data strongly suggest WBVT will become a mainstay of treatment in children with loco-motor disability and justify the introduction of a completely novel and innovative treatment modality into pediatric health care.”

To assess the effects of whole body vibration therapy, researchers recruited 13 adolescents with cerebral palsy to receive the therapy for nine minutes per day for 20 weeks. Study participants included eight girls and five boys. Their average age was 17 years, and all had moderate cerebral palsy. Researchers used special X-ray tests to measure bone-mineral density and muscle mass before and after the whole body vibration therapy.

Jubilee Crippled Children’s Foundation Trust, the David Levene Foundation, the Australasian Paediatric Endocrine Group and the Maurice and Phyllis Paykel Trust provided funding for the study.

View original article.

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