LOC has developed a reputation in the SDR community for its treatment and management of cerebral palsy patients who have undergone this ground-breaking surgery.
The National Institute for Health and Care Excellence (NICE) guidelines describe SDR surgery: "The aim of selective dorsal rhizotomy is to ease muscle spasticity and improve mobility in people with cerebral palsy. It involves cutting nerves in the lower spine that are responsible for muscle rigidity.” While SDR surgery is not a cure for cerebral palsy, a successful procedure can help a child’s physical state by reducing muscular stiffness and improving mobility.
We feel that SDR offers cerebral palsy patients an opportunity for rehabilitation. It is the first step on a long road of treatment. In our experience, the improvements can be dramatic. However, it is also clear that without continuing rehabilitation SDR patients will not get the maximum benefit from their surgery, and could potentially lose some of the initial improvements they make postoperatively.
Orthotics play a vital part in the rehab process. We feel that the alignment of the body needs special attention to allow the physiotherapy, personal training or just the child’s continued mobility to have a significant effect. Gait training and patterning is also essential. Learning patterns of movement at this stage can pay dividends in the future.
We believe that basic orthotic principles still apply, so we always design our orthotics to protect the developing bones of the child.
Tuned Ankle Foot Orthotics are especially good for this. However, at LOC, we also use innovative orthotics, such as DAFOs or Dorsiflexion Assist SMOs to improve alignment and gait. We also see good outcomes when we use Dynamic Lycra Garments to address postural problems and improve core stability.
All the time we aim to maximise function while maintaining alignment. We do not want to over support a joint – we want our patients to have to work their own musculature to maintain stability and posture. However, we also understand that they are often weak and have an underlying misalignment. Therefore, we want our orthotics to evolve with our patients – reducing support over time, which requires good communication with parents and other therapists.
Read Jude's story and about his treatment at LOC post-SDR surgery. Or read how LOC is helping the recovery of another SDR patient Aran from our blog.
In recognition of this, we have set up a specialist clinic within LOC called OSKAR. This stands for the Optimal Kinematic Alignment approach to Rehabilitation and is an orthotic method of treating children with lower limb neurological conditions. It was originally developed by Elaine Owen MBE MSc SRP MCSP, a world-renowned physiotherapist.
In the OSKAR clinic, we dedicate even more time to the initial consultation and utilise our video vector Gait Lab facility. This gives us highly accurate information about the forces that are exerted on a body during the gait cycle. It allows us to prescribe and fit more accurate and objectively measured orthotics.
Some parents who have struggled to fund rehabilitation treatment, as well as the original surgery, have been helped by the Tree of Hope charity.
Tree of Hope endeavours to provide assistance to families of sick and disabled children trying to raise money for specialist medical surgery, treatment, therapy and equipment. As a small charity, funds are limited, but they do everything they can to help parents achieve their fundraising goals. The process starts with a telephone or email application from the parent/carer/guardian of the child in need of assistance.
Your case will be assessed on a case-by-case basis. The Tree of Hope will get back to you and hopefully provide the hands-on help and support that is needed.
Just4Children is a recently launched charity whose objective is to provide support to families to help their sick and disabled children. Specifically, they will provide support so that families can access the quality of life-enhancing surgeries and treatments like Selective Dorsal Rhizotomy (SDR). They are currently helping Layla’s family raise £60,000 for the operation and subsequent aftercare. Layla is a 3-year-old from Wiltshire who has Spastic Diplegia Cerebral Palsy which affects the use of her legs and left arm.
To find out more: just4children.org
To get in touch:
Peterson’s Fund for Children’ is a registered local charity that supports children in Surrey who struggle with severe mental and physical disabilities. It has been in existence for 10 years and through extensive fundraising efforts has provided funding for much-needed therapy, bespoke and specialised equipment and often neglected respite care otherwise unavailable on the NHS. The aim of the charity is to help as many local children in need as possible therefore improving their quality of life and offering them opportunities to maximise their individual growth and potential.
Contact details: [email protected]
An AFO is an Ankle Foot Orthosis which as the name would suggest encompasses the ankle and foot. The objective is to control the position and movement of the ankle. AFOs are used to support weak limbs; they can also be used to immobilise the ankle and lower leg to correct foot drop. When set up correctly they can also have a great influence on the knee and hip joints. They are the most commonly used Orthoses.
A patient’s comfort in their AFO is vital for compliance with the prescribed wearing regime.
So there are a number of steps the orthotist should take to ensure a comfortable fit: the patient’s heel should fit fully into the heel cup without excess space, the contours of the plantar surface of the AFO should match the patient’s foot, for children there needs to be up to half an inch growth room in the toe shelf length. At LOC we use our Gait Laboratories at our Kingston and Manchester clinics to fine-tune our bespoke orthotics.
A GRAFO is used to control instabilities in the lower limb by maintaining proper alignment of limbs and controlling their motion. It reaches around to the front of the knee extending down to the ankle. It works by altering a patient’s limb presentation to displace load and impact as well as offering further control to the knee.
The ability to drive while wearing an AFO is dependent on the condition being treated and the orthosis that has been prescribed. If wearing a hinged AFO, for example, you will be able to drive, but if wearing a knee brace, you won’t. Your orthotist will advise you.
The most flexible type of AFO is a Dynamic Ankle Foot Orthosis (DAFO). It is thin and provides flexible support to the foot and ankle.
Both normal AFOs and DAFOs improve static balance (eg: while standing). Research among MS sufferers suggests that DAFOs aided balance while walking more than AFOs.
The simple answer is: yes they can. However one has to be sensible and look for wide-fitting trousers/jeans preferably of light and thin material.
Typically an AFO is stiff and rigid whereas a DAFO is thin, flexible and wraps around the patient’s entire foot. A DAFO provides support but also allows some range of normal movement.
A Supra Malleolar Orthosis SMO gets its name from the part of the body it encompasses. Thus an SMO supports the leg just above the ankle bone or malleoli. It allows dorsiflexion and plantar flexion(toes up and toes down) but eliminates mediolateral movement.
It typically takes a few weeks but is slightly dependent on the chosen materials and current availability.
Sofia’s AFOs Help Her to Stand and Walk During Lockdown
LOC’s gait lab has helped Lilac to move independently
Sam Walmsley to explain OSKAR Framework to Neuro Conference 2021 Delegates
Meet John Turner – our Manchester Orthotics Lead
LOC to launch OSKAR Framework to CMSUK 2020 Delegates
OSKAR Clinic AFOs and gait laboratory are game-changers for cerebral palsy patient Austin
Cerebral palsy patient, Sophie, maintains independence during lockdown with LOC’s help