Young patient with cerebral palsy continues core and leg strengthening via physical therapy, but most spasticity issues have been eliminated
Sometimes seeing is believing. That’s the case for Phil and Christina Webb after witnessing the dramatic improvement in their adopted son, Noah, following selective dorsal rhizotomy (SDR) treatment.
Born with a mild case of cerebral palsy, Noah, 5, had struggled to walk due to spasticity in his legs. Physical therapy helped, and his parents saw firsthand the many benefits as Noah slowly improved his walking gait over the years. But they still felt more was needed.
After several years of non-surgical therapies, the Webbs learned about SDR as a possible treatment option and spoke with doctors at Cincinnati Children’s to determine if Noah would be a good candidate for the procedure.
“We thought – and really found out – that this was something that would be beneficial for Noah,” said Christina. “He was the perfect age for it. They recommend 3 to 4 years old as being perfect for this surgery. So the time was right. It was just the perfect procedure for him.”
Selective Dorsal Rhizotomy (SDR) Treatment
One month before he turned 4 years old, Noah’s SDR was performed at Cincinnati Children’s.
Doctors explained to the family that it often takes several weeks to months after SDR before patients begin walking again. It depends on how quickly they re-learn certain muscle movements, build strength and improve coordination in their legs. But given Noah’s good mobility skills, trunk and leg strength prior to surgery there was optimism that he would be walking sooner rather than later.
It took him only a few days to defy his parents’ expectations.
“Noah was in the hospital for five days. He came home and within seven days he was up on his feet and walking short distances. It was absolutely miraculous. From the moment he started walking we noticed his gait was better,” said Christina.
“We have video of Noah prior to the surgery and post-surgery. And he is like two different children. It’s the difference between night and day. He can run. He can play. The surgery was miraculous as far as I’m concerned,” she added.
Graduating from the Spasticity Clinic
Following the SDR, Noah, like most patients, had one complete year of follow-up visits with the multidisciplinary spasticity team. During this time, he was evaluated every three months and “graduated” upon achieving all of the team’s goals for him upon his final visit.
His doctors in the Surgical Spasticity Clinic, Charles B. Stevenson, MD, a pediatric neurosurgeon, and Paola Maria L. Mendoza-Sengco, MD, a pediatric physical medicine and rehabilitation physician, believe that his uncomplicated procedure will offer him long-term spasticity control and allow continued improvements in his walking and balance skills.
Treatment plans are tailored for each individual patient, explained Stevenson, and in Noah’s case he will continue to be seen in other specialty clinics designed for children with cerebral palsy at Cincinnati Children’s.
“Everyone is different and unique in their own abilities as well as their challenges,” said Stevenson. “When we evaluate a patient in the Surgical Spasticity Clinic, our goal is always first and foremost to determine how best to optimize that specific child’s functional outcome. By maximizing their comfort, range of motion, strength, and mobility we are really helping to maximize their independence and improve their quality of life.”
For Noah, SDR was able to make a profound impact on his gait and mobility, added Stevenson.
“Today, Noah is able to walk and run and climb much more easily than he ever could before, and it is immensely gratifying to know that we were able to make such a positive impact in his life with a single, straightforward procedure.”
Noah continues to wear braces following the SDR to help maintain his range of motion and overall mobility as he grows. He also continues to work with physical therapists regularly to build strength and further refine his walking and higher level balance skills.
For now, Noah is busy having fun and playing backyard sports like baseball, football and soccer. He wants to be able to do everything that other kids can do and he doesn’t dwell on his physical differences or limitations.
“Some kids might say, ‘What’s that?' and he will just say, ‘Oh, that’s my braces.’ ” said Christina.
“He doesn’t have any realization that he’s different,” added Phil. “He’s not afraid of anything.”
(Published November 2020)