Multidisciplinary Spasticity Management Improves Mobility for Adolescent with Cerebral Palsy

An adolescent with cerebral palsy and longstanding lower-extremity spasticity achieved significant functional improvements following selective dorsal rhizotomy (SDR) and intensive rehabilitation through the Comprehensive Movement Disorders and Spasticity Clinic at Children's Mercy.

Karli, who was diagnosed with cerebral palsy in early childhood, presented with significant lower-extremity muscle tightness, spasticity and toe walking that affected her mobility. After undergoing multiple interventions over the years, her family sought evaluation at Children's Mercy's multidisciplinary spasticity clinic, where specialists from pediatric neurology, physical medicine and rehabilitation, and pediatric neurosurgery conducted a comprehensive assessment to determine the most appropriate next steps.

The clinic's collaborative model allows specialists to evaluate patients together in a single visit, facilitating shared clinical decision-making and development of individualized treatment plans. Karli's care team included Rose Gelineau-Morel, MD, pediatric neurologist; Sathya Vadivelu, DO, pediatric rehabilitation medicine physician; and Paige Haynes, MD, pediatric neurosurgeon. 

Following multidisciplinary evaluation, the team determined Karli was an appropriate candidate for selective dorsal rhizotomy, despite being older than the typical age range for the procedure. Providers cited her motivation, maturity and ability to participate fully in the rigorous postoperative rehabilitation process as key factors supporting candidacy. SDR is a neurosurgical procedure that reduces lower-extremity spasticity by selectively sectioning sensory nerve rootlets that contribute to abnormal muscle tone. 

The procedure was performed by pediatric neurosurgery in partnership with rehabilitation medicine specialists, who provided intraoperative monitoring to help identify appropriate nerve rootlets for treatment. Following surgery, Karli transitioned directly into Children's Mercy's inpatient rehabilitation program, allowing for early initiation of intensive therapy without delays in care. 

Postoperative rehabilitation included several weeks of inpatient therapy followed by a coordinated transition to outpatient rehabilitation services closer to home. This integrated approach supports continuity of care while enabling patients and families to remain connected to local support systems during recovery. 

Karli demonstrated strong engagement throughout rehabilitation and experienced meaningful functional gains following treatment. Within months of completing inpatient rehabilitation, she was participating in recreational activities including swimming, basketball and soccer and entered high school with improved walking ability and confidence in her mobility. 

For patients with cerebral palsy and persistent lower-extremity spasticity, comprehensive evaluation by a multidisciplinary movement disorders and spasticity team can help identify candidates who may benefit from advanced interventions such as SDR. Careful patient selection, coordinated surgical care and intensive rehabilitation remain critical to achieving optimal outcomes.