Cerebral Palsy and Spasticity
- Dr. Peacock is the pioneer of the Selective Dorsal Rhizotomy (SDR) surgery
- Dr. Hoffinger, 2010 President of the CP Academy
- Comprehensive treatment paradigm with in patient physical and occupational therapy
- Rhizotomy is performed super-selectively with neurophysiological criteria to only cut the nerves most responsible for the spasticity and not those that go to the bladder and muscle groups that we want to preserve
- Rhizotomy surgery is only half the treatment. The other half is the in-patient rehabilitation
- Drs. Aguilar, Neufeld and Haining are our experienced pediatric rehabilitation physicians
- Creighton’s Spasticity Story - Selective Dorsal Rhizotomy Surgery
Damaged brain pathways in children with cerebral palsy can result in stiff muscles that interfere with walking (spasticity) and other abnormal body movements. Neurosurgical procedures, like Selective Dorsal Rhizotomy and Baclofen pump
placement, combined with orthopaedic surgery and intensive physical rehabilitation therapy, can improve the quality of life for children with cerebral palsy.
The Peacock Center for Cerebral Palsy & Movement Disorders
The Peacock Center for Cerebral Palsy & Movement Disorders
at UCSF Benioff Children's Hospital Oakland is the Northern California leader in the treatment of children with cerebral palsy and spasticity. The center’s team includes physical therapists, occupational therapists, pediatric neurosurgeons, pediatric rehabilitation physicians and pediatric orthopedist, Scott Hoffinger, MD. Dr. Hoffinger is an orthopaedic leader in cerebral palsy and the President of the Cerebral Palsy Academy in 2010.
In 2009 the Center was named in honor of Warwick Peacock, MD, the founder of modern Selective Dorsal Rhizotomy surgery. He has collaborated with the Center’s clinical team for six years. “I’m proud to have this spasticity center named after me, it is the best in the West,” was Dr Peacock's response to the new center's name. He believes that "having a dedicated center allows the pediatric specialists here at Children's to collaborate on each child's unique condition and determine the most appropriate therapies, interventions and diagnostics on a case-by-case basis as a team"
“In naming the center for Dr. Peacock, we are paying tribute to a man who has given so much of himself in service to alleviating the debilitating effects of spasticity," says Dr. Peter Sun, Medical Director of Neurosurgery and Director of the Peacock Cerebral Palsy & Movement Disorders Center. "One whose years of focus and dedication has led to achieving great strides in the treatment options for neuro-spinal disorders. Our program evaluates each child with the entire specialty-team and we offer the only pediatric inpatient rehabilitation unit in Northern California. The Peacock Center at Children's is the only center west of Kansas with such a wide range of services and expertise."
What is Selective Dorsal Rhizotomy Surgery?
Selective Dorsal Rhizotomy (SDR) is a surgery performed on certain children with cerebral palsy and spasticity. The purpose of the surgery is to reduce leg muscle stiffness and spasticity in these children. Reduced spasticity can improve or create the ability to walk for some children. The overall treatment program includes neurosurgery, intensive inpatient physical and occupational therapy, followed by orthopaedic surgery. A SDR surgery allows a child to be able walk or stand and transfer independently over a lifetime when he or she would have otherwise been bound to a wheelchair.
An SDR surgery involves sectioning (cutting) of some of the sensory nerve fibers that come from the muscles and enter the spinal cord. The surgery is usually performed when children are between the ages of 6 and 16. Because there is so much overlap in the sensory innervations (the supply of nerve fibers) of the legs, there is no loss of sensation when the nerves are cut. We select the parts of the nerve under the microscope that is responsible for the spasticity by stimulating the individual nerve bundles to check for abnormal responses.
The responses are monitored by our neurophysiologist, Charles D. Yingling, PhD. Dr. Yingling is the author of “Selective Dorsal Rhizotomy” in the Handbook of Clinical Neurophysiology Vol 8 (2008 Elsevier B.V.) Those nerves with abnormal responses are then cut. SDR surgery requires exposing four levels of the lumbar spine by lifting up the bones and putting them back (lumbar laminoplasty). By putting the bones back, there is little risk of spinal deformity. We believe that this selective method, as developed by Dr. Warwick Peacock, MD, is critical for safe, effective surgical results.
Surgery is only one half of our rhizotomy treatment program. After SDR surgery, we admit the child to our inpatient rehabilitation unit for 4-6 weeks for intense inpatient therapy. We would not perform the surgery without an extended inpatient rehab program. Learning how to use their “new” legs is critical for these patients right after surgery. This learning is best done over a period of weeks in the rehab unit with our staff of experienced therapists.
Most children with cerebral palsy, who undergo a SDR, will also have orthopaedic deformities. Nine to twelve months after the SDR surgery, they are evaluated by our pediatric orthopedist to consider treatment for these deformities. Results of the orthopaedic interventions are much better when abnormal muscle tightness has already been addressed. This orthopaedic intervention becomes the final phase of our entire treatment program. It helps to assure that a child with cerebral palsy and spasticity will become a "lifetime walker."
Creighton’s Spasticity Story - Selective Dorsal Rhizotomy Surgery
Creighton has Cerebral Palsy with spasticity. He was evaluated by Dr. Sun, when he was four years old and it was determined that he might be a good candidate for a surgery called selective dorsal rhizotomy. This surgery could help to reduce Creighton’s spasticity. When he was older, Dr. Sun and his colleagues at Children’s Hospital Oakland operated on Creighton. This highly technical procedure cuts very specific nerves in Creighton's legs which are responsible for the spasticity. Children’s Hospital Oakland is one of a very few medical centers in the country that performs selective dorsal rhizotomy surgery. The procedure was developed by our spasticity consultant and world renowned surgeon, Dr. Warwick Peacock. The Peacock Center for Cerebral Palsy and Movement Disorders is named in honor of his work. Fourteen months after surgery, Creighton has shown marked improvement and has become much more independent in his daily life. His mother now believes that it he will someday " walk into a job interview and walk down the aisle on his wedding day."
Hypertonicity - Spasticity Program
The Hypertonicity Program at UCSF Benioff Children’s Hospital Oakland provides specialty care for infants, children and adolescents who have developed spasticity from injuries to the brain and spinal cord and suffer from abnormal development of the brain. Many children seen in this center have cerebral palsy, spasticity in one or more extremities, brain injury or Rett’s Syndrome. The hypertonicity specialized care team brings together pediatric specialists from multiple disciplines to improve outcomes and patient care.
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