The role of orthotics after SDR surgery in children

Selective Dorsal Rhizotomy (SDR) surgery is a life-changing procedure for children with spastic cerebral palsy, as it reduces muscle stiffness and improves mobility.

While SDR addresses the root cause of spasticity by selectively cutting sensory nerve fibres, a comprehensive rehabilitation plan is essential for maximising the benefits of the surgery. One critical component of this plan is the use of orthotics.

Why are orthotics important after SDR?

Post-SDR surgery, children can experience significant changes in muscle tone and movement patterns. While the reduction in spasticity allows for more fluid and controlled movements, it also requires the muscles and joints to relearn how to function in this new state.

This is where bespoke orthotics come in. When prescribed alongside gait lab analysis, they can:

• Improve stability: After SDR, weakened muscles may struggle to provide adequate support for standing and walking. Orthotics help stabilise joints, allowing children to focus on improving their balance and mobility during physical therapy.
• Improve alignment: Reduced spasticity can reveal underlying joint misalignments or abnormal movement patterns. Orthotics promote proper alignment of the feet, ankles, knees, and hips, reducing the risk of complications like joint pain or deformities.
• Enhance function: Orthotics act as tools to assist with walking and other functional movements. By improving gait mechanics, they help children practice more efficient and effective movement patterns during rehabilitation.
• Prevent fatigue: Weak muscles can lead to quicker fatigue. Orthotics provide additional support, making it easier for children to participate in therapy and daily activities for longer periods.

Types of orthotics prescribed after SDR

The type of orthotic prescribed depends on the child’s specific needs, which are assessed by the rehabilitation team. Common prescriptions include:

• Ankle Foot Orthoses (AFOs): These are the most widely used orthotics post-SDR. They provide support to the ankle and foot, ensuring proper alignment and stability during walking.
• Knee Ankle Foot Orthoses (KAFOs): For children with significant muscle weakness, KAFOs offer additional support to the knees and help maintain proper leg alignment.

For children with milder needs, custom foot orthotics can provide subtle corrections and support.

How orthotics fit into the rehabilitation plan

Orthotics are just one part of the broader rehabilitation plan following SDR. Physical therapy plays a central role, focusing on strengthening weakened muscles, improving flexibility, and developing motor skills. Orthotics work hand-in-hand with therapy by:

• Enabling safe practice of new movement patterns.
• Protecting joints as children build strength.
• Supporting gradual progression toward more independent mobility.

Ongoing finetuning monitoring

Every child’s needs after SDR are unique, and orthotics must be customised to match their specific requirements. Regular follow-ups with your orthotist and rehabilitation team ensure that the devices are adjusted as the child’s strength, range of motion, and functional abilities improve.

Orthotics play a vital role in helping children transition to improved mobility and function after SDR surgery. Providing stability, promoting alignment, and enhancing movement, they support the child’s journey toward achieving greater independence and quality of life.

Parents and caregivers should work closely with their child’s rehabilitation team to ensure that orthotics are effectively integrated into the recovery process.