Selective Dorsal Rhizotomy is a surgical procedure in which the nerve fibres that carry sensory impulses between the muscles and the spinal cord are selectively severed. During the surgery, the nerves are stimulated electronically at their rootlets to determine which are contributing to spasticity and which are carrying mostly normal impulses. “We identify five or six rootlets per nerve, and we take the worst two,” explains Dr. Jean-Pierre Farmer, Surgeon-in-Chief (neurosurgery) at Montreal Children’s Hospital. “They’re not all normal or abnormal. It’s a scale of grey rather than black and white. So we want to take the ones that are most involved in the spasticity.”

Because the surgery so dramatically changes the neural pathways for gross motor function, patients are transferred to Shriners Hospital within a few days of the operation, where a six-week inpatient rehabilitation and recovery program begins. “We keep the kids very busy,” says Shriners physiotherapist Corinne Mercier. “The therapy is very intensive because it’s a relearning process. We have to break down the habits that the kids developed when they had spasticity. We have to work on the quality, consistency, and isolation of movement, and on developing good gait patterns.” Care does not stop after six weeks. Families are part of the care team and learn exercises with the therapists so that therapy can continue at home. Patients like Gianfranco return to the hospital for follow-ups on a regular basis with transportation ensured by the Shriners Fraternity.

These weeks of hands-on physiotherapy, including exercises in the pool, and time on specialized tricycles and standing frames, are essential to getting these young patients on the right path towards independence. “By the time they leave, they’re usually already walking significantly better than they were pre-op,” says Dr. Farmer. “And, since we continue to follow them at Shriners Hospital, we have the studies that show that they continue to improve for years afterwards.”

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