The initial evaluation consists of an educational video, a physical therapy consult and an appointment with Dr. Park, in which he examines the patient and reviews the medical history with the patient/family.
Pelvic and spine x-rays are reviewed at the initial evaluation, and will be taken at some follow-up appointments. Bring all assistive devices to your appointment (braces, walker, crutches). Occasionally a head MRI may be requested before or after the initial evaluation to enable us to better determine if the patient is a suitable candidate.
Magnetic Resonance Imaging (MRI)
An MRI scan can show damage to the area of the brain that controls the motor systems, which causes cerebral palsy (CP). This information helps predict how well the patient will walk after selective dorsal rhizotomy (SDR). Occasionally, an MRI is done after the initial evaluation to determine candidate selection.
Range of motion, muscle tone, gait, and functional skills are videotaped on the day prior to surgery during a 1½ hour session. This provides an objective measure of the patient's preoperative state, which can be compared with postoperative progress videotaped at the four and 16-month visits. Patients should bring all assistive devices (braces, splints, walkers, crutches, and canes) and are asked to wear a bathing suit or shorts during videotaping.
Preoperative Physical Therapy Assessment
The physical therapy assessment focuses specifically on the following areas:
- Developmental history: When did the patient first crawl? Sit up? Get into a sitting position? Pull to stand? Stand alone? Walk? Are other areas of development delayed? Speech and language? Hand use? Cognition? Vision or hearing?
- Spasticity: Is spasticity the primary problem interfering with motor skills? Does spasticity affect the arms and legs? Legs only? Is there more spasticity on one side than the other? More in the legs than the arms? More in hips, knees, or ankles? Does spasticity interfere with getting into a standing or walking position? Are there independent joint movements? Can clonus be elicited at the ankles?
- Strength: Strength is often the most difficult area to assess in the presence of spasticity. The therapist must determine if the patient has the strength to independently assume a variety of positions, including hands and knees, half-kneeling, sitting, side-sitting, standing, and squatting. Can the patient maintain these postures if placed in them? Repeat a specific movement at least 5 times? Can the patient move throughout the available range of motion? Does the patient have the force and the endurance to complete a task? Is there any obvious muscle atrophy?
- Motor Control: Can the patient move rapidly when asked? Change speed? Make reciprocal movements for crawling? For walking? Does the patient have difficulty starting a movement? Stopping? Changing the direction of movement? Can the patient time and direct the movement for the task? Determine the appropriate force needed? Are the movements smooth and coordinated?
- Developmental Functions: Can the patient sit on a small bench independently? Sit on the floor with legs out straight and back straight? Can the patient get into sitting on a bench? On the floor? Pull up to stand at a bench or table? Stand, holding onto support? Walk with help? Walk with hands held or with a walker? Walk alone?
- Range of Motion: Does the patient have normal passive range of motion? Can the patient move actively throughout available range? Is there any limitation in range at the hips, knees, or ankles? Are there any fixed contractures or deformities?
- Balance: Can the patient balance sitting on a bench? Sitting on the floor? Does the patient need to use the hands to maintain sitting posture? Can the patient stand without hand support? What kind of support is needed to stand? Are the walker, crutches, or canes hand-held?
- Gait: What does the swinging leg look like? What does the standing leg look like? Is the stride even? Is the step short? Can the patient put the heel down first? Are hips and knees bent during walking or standing? Does the patient need a walker or crutches? Is walking confined only to indoors? Can the patient climb stairs? How good is balance? Can the patient stop? Turn around? Squat down and return to stand? Can the patient carry items by hand?