Viewpoint: A special service

The Association of Paediatric Chartered Physiotherapists (APCP) would like to highlight that selective dorsal rhizotomy (SDR) is now an NHS-commissioned service.

 

It has been available in England for children who fulfil certain criteria since 17 July 2014. These criteria are strict as only a select group of children will benefit. Current evidence on the effectiveness of SDR, especially on long-term function, is limited and it is important that we, as therapists, are fully aware of the literature to enable us to have honest and realistic discussions with families. 

 

The aim of SDR is to relieve spasticity in younger children – that is those aged from three to 10 years – who fall within the gross motor function classification system levels II and III. The intervention aims to improve a child’s functional abilities. Understanding a child’s motor prognosis without intervention as well as establishing realistic goals is crucial.  

 

Selective dorsal rhizotomy is frequently portrayed in the media as a ‘miracle cure’ and it is important that families understand this is not the case. Children with cerebral palsy have many difficulties associated with their condition and spasticity is only one of these. As we know, muscle weakness and poor selective motor control have a major impact on the functional abilities of these children.  

 

Cognition and a child’s ability to comply with an intensive two-year rehabilitation programme are other factors that need to be considered. Relieving spasticity doesn’t address these other difficulties and can result in a child whose level of function remains unchanged or even potentially worse.  

 

Families wishing to explore whether SDR is a suitable intervention for their child should be encouraged to be assessed by one of the five commissioned centres in England.