Introducing the Two-Day Mobility Surgery Evaluation for Children with Cerebral Palsy

For many children with cerebral palsy (CP), a major focus of treatment involves improving walking skills and maintaining that ability for life. Surgery often is the best way to help these children reach their full potential.

Cincinnati Children’s now is offering a comprehensive, two-day mobility surgery evaluation that can provide answers and help families chart a clear path forward. The mobility surgery visit includes:

• An evaluation in the Surgical Spasticity Clinic, where a pediatric neurosurgeon, physical therapist and rehab medicine physician examine the child and consider surgical options to reduce muscle spasticity
• An assessment in the Orthopaedic Cerebral Palsy Clinic, where an orthopaedic surgeon provides a thorough exam
• Testing in the Motion Analysis Lab to identify the underlying causes of the child’s walking difficulties

After these appointments, the clinical team meets to discuss the child’s condition, needs and goals, and then collectively presents the family with a unified treatment recommendation. The plan may include:

• Selective dorsal rhizotomy (SDR), a surgery which involves examining the nerve roots that connect the spinal cord to the leg muscles, then selectively cutting any roots that are causing spasticity
• Baclofen pump implantation, in which the pump delivers baclofen directly to the target nerves in and around the spinal cord to reduce severe spasticity
• An orthopaedic surgery, such as tendon lengthening, tendon transfer or functional electrical stimulation
• Nonsurgical options, such as changing the child’s medications or modifying the child’s bracing, physical therapy or occupational therapy regimens

“The surgical spasticity team has treated hundreds of patients over the years, and it’s exciting to be part of this new, comprehensive evaluation process for children with CP who could potentially improve their walking abilities through surgery,” says Charles Stevenson, MD, FACS, who established the Surgical Spasticity Clinic about seven years ago. “We are able to offer surgical treatment and therapy options that may not be available to families closer to home. Our patients include children of all ages, including toddlers and young adults who have been told elsewhere that they are too young or too old for spasticity surgery.”

The two-day evaluation is designed for children with CP who are age 2 to 18 and can stand and take steps, with or without assistance, but could potentially improve their walking abilities through surgery. Good examples of patients who may benefit include:

• Toddlers who are not walking well or not meeting their walking milestones or goals
• Children who are losing early walking skills
• Children who are no longer benefitting as much from therapies that seemed to be helping previously

About the Cerebral Palsy Program at Cincinnati Children’s

The Cerebral Palsy Program includes more than 50 physicians, surgeons, occupational and physical therapists, nurses, social workers, speech-language pathologists and other providers. Each year, over 1,600 children depend on these experts for comprehensive evaluations, treatment recommendations, specialized therapies, medical and surgical interventions, and care coordination.

“Helping patients achieve their full ambulatory potential takes time, commitment and the implementation of a very personalized approach,” Stevenson explains. “It is always so rewarding to help them achieve a level of independence they have never experienced before.”

To learn more, contact Charles.Stevenson@cchmc.org.