Intensive follow-up maximizes surgical outcomes for kids with cerebral palsy
Surgery can relieve the symptoms of spasticity, but the key to long-lasting benefit is intensive follow-up and post-surgical rehabilitation therapy. Specialists at Cincinnati Children’s maintain close communication with referring physicians and physical therapists before and after surgery to help coordinate care and ensure patients progress long after their baclofen pump implantation or selective dorsal rhizotomy procedures.
“We are now receiving referrals for patients who live as far away as Cleveland, Pittsburgh, southern Kentucky and middle Tennessee,” says pediatric neurosurgeon Charles Stevenson, MD, who helped establish the multidisciplinary Surgical Spasticity Clinic at Cincinnati Children’s in 2015. “Our goal is to evaluate patients with cerebral palsy and associated dystonia/spasticity who may benefit from intrathecal baclofen therapy or minimally invasive selective dorsal rhizotomy, and to provide comprehensive follow-up care for those who undergo one of these interventions. Many questions regarding optimal management may arise as a child makes functional improvements in the months following surgery for spasticity, so it is important that our team maintain close communication with families and their local health care providers to optimize outcomes. We want to ensure these kids have the resources and guidance they need to augment their recovery.”
A “one-stop” experience The multidisciplinary clinic evaluates patients every other week, with a core team that includes Stevenson; physical medicine and rehabilitation (PM&R) specialists Doug Kinnett, MD, and Andrea Paulson, MD; and Molly Thomas, PT, DPT. It is a “one-stop” experience, as the physicians and physical therapist evaluate the patient together in one room. “We have a great time working together, meeting with the children at each visit and assessing their muscle tone, clonus, reflexes and strength,” Stevenson says. “Often we play games with them to help them relax and in order to more fully evaluate their overall functional status and determine how we may better help them. The family is in the room with us the whole time, and afterward we all talk together about next steps for managing the child’s spasticity.”
The care team sends referring physicians and therapists a follow-up letter at the end of each visit to share their findings and give consensus recommendations. Additional information is available in the electronic medical record, and the care team is available for phone and email consults as well.
Intensive therapy after SDR Follow-up care for children who undergo surgery for spasticity varies depending on the type of procedure they have. Patients who travel to Cincinnati Children’s to undergo baclofen pump insertion may need less intensive follow-up from the Cincinnati Children’s team, as the local referring physician may desire to make the necessary adjustments to the pump settings and refill the pump themselves. Local patients will typically have their pumps programmed and refilled in the Cincinnati Children’s PM&R Clinic with Kinnett and Paulson.
It is a different story for children who undergo selective dorsal rhizotomy. After surgery, these patients participate in intense “boot camp”-style physical therapy. The goal is to build muscle and stretch ligaments after surgery has reduced the spasticity – after all, they are developing skills they have never had before. Upon returning home, patients typically have physical therapy about four times a week, combining both land-based and aquatic therapies. Thomas keeps in close contact with the patients’ primary therapists, providing resources, therapy goals and timelines for all metrics. She also works with physicians and orthotists when decisions need to be made about braces and other assistive devices.
Patients return to the clinic every three to six months so the team can assess their functional gains. “Our team loves those visits, because the kids are so proud to show off their new skills,” Stevenson says.
To learn more about the multidisciplinary Surgical Spasticity Clinic or to refer a patient, please email Stevenson or call him at 513-636-4726.
2018 Neurosurgery Conference for Advanced Practice Providers
The Cincinnati Children's Division of Neurosurgery will host its fifth annual Advanced Practice Provider Neurosurgery Conference April 19-20, 2018, at the medical center. The conference will feature presentations by faculty and advanced practice providers, who will share cutting-edge practices within pediatric neurosurgery.
To learn more, contact Allie.Mains@cchmc.org.
