Spasticity
Many patients with Cerebral Palsy (C.P.) have tightness/spasticity in the muscles of their arms, legs, and trunk. Spasticity can decrease the speed of movement, limit flexibility, and interfere with the development of walking. Over time, contractures (fixed tightness) of the joints and deformities of the bones can develop from continuing spasticity. Selective Dorsal Rhizotomy can reduce this spasticity.

Causes of Spasticity
The tightness of a muscle is called muscle tone in CP. The brain tells the spinal cord how much tone or tightness each muscle should have. This message is sent by the sensory nerve fibers. The feedback from these sensory fibers to reduce muscle tone must be well coordinated in the spinal cord for muscles to work smoothly and easily while keeping their strength. The brain of a patient with C.P. is unable to clearly send the command because of injury/damage at an early age or before birth.

Selective Dorsal Rhizotomy
An operation called Selective Dorsal Rhizotomy reduces the muscle tone in patients who have Cerebral Palsy. Each sensory nerve rootlet is stimulated electrically to identify those roots involved in spastic tone, after which the abnormal roots are cut. The remaining roots which send correct messages are left whole and remain functional.

Who Can Benefit
A small percentage of patients with Cerebral Palsy can benefit from this operation. The following may be used as guidelines to determine who may be a candidate for surgery.

Age: Usually two years and older

Type of C.P.: Spastic Diplegia or Quadriplegia

Past History: Often have a history of premature birth

Condition:

• Difficulty walking because of spasticity;
• Adequate muscle strength;
• Had no previous orthopaedic surgery or who may need repeated orthopaedic surgery due to continued spasticity

Therapy: Can actively participate in physical therapy and respond to requests of the physical therapist

Family: Families can provide follow-up physical therapy two to five times a week for one year post-operatively

Who May Not Benefit
Certain conditions may prevent a child from a being suitable candidate, including:

• Multiple orthopaedic surgeries on hips, knees and ankles
• Fixed contractures
• Diagnosis of mixed C.P. or athetosis, ataxia, or dystonia
• Severe Scoliosis

Pre-Operative Evaluations
First, a written referral by a physician should be submitted to the nurse coordinator of the Tone Management Team.

Then, prior to being seen by the Tone Management Team, each child will be evaluated by the physical and occupational therapist to help determine appropriateness for Rhizotomy surgery. Additional evaluation in the Gait Analysis Laboratory will be done, if indicated.

Clinical Evaluation
During the visit with the Tone Management Team, each patient and family will meet with the neurosurgeon, neurologist, orthopaedist, and physical and occupational therapists. This evaluation will take approximately one hour. We ask that you bring a pair of shorts so that leg movements may be observed by members of the team. In addition, please bring all equipment such as braces, crutches, and walkers used for mobility.
With the family present, the team will offer their patient assessment and will discuss the appropriateness of the Rhizotomy procedure. They will also answer any questions the family might have.

The family, in turn, is encouraged to ask questions. No question is unimportant. If Rhizotomy is recommended, the team neurosurgeon will meet privately with the parents and patient at a later date to discuss the specifics of surgery and answer any further questions.

For More Information, contact:
Orthopaedic Care Center
Nurse Coordinator: (860) 545.9070
Occupational Therapy: (860) 545.8600
Physical Therapy: (860) 545.8600