Cerebral Palsy Studies

Post Selective Dorsal Rhizotomy Surgery - Ben

Objective

Rehabilitation following Selective Dorsal Rhizotomy (SDR), an operation used to improve spasticity (muscle stiffness) and mobility in cerebral palsy.

Background

Ben, then aged 9, was accepted for SDR spinal surgery on the NHS and went through two years of pre-op tests and scans, including an hour long MRI under general anaesthetic. One week before the date of the operation, Ben's family received the devastating news that it had been cancelled due to lack of funding and would no longer be available on the NHS.

The family raised the money for the operation, after which they discovered that, because they had self-funded, they were also liable for Ben's physiotherapy and aftercare. The company H2O Physio based in the West Midlands, saw Ben's story in the media and donated HYDRO PHYSIO aquatic therapy sessions which helped him walk without pain by building his muscles, stretching his tendons and retraining his walking pattern.

Programme

  • Duration: 30 minutes
  • Water Temperature: 31˚C
  • Speed: 0.3 to 3.3kph
  • Depth: 900mm
  • Resistance Jets: Not activated
  • Direction: Forwards
  • Number of Sessions: 14

Outcomes

The SDR procedure was only the start, as prolonged physiotherapy and training was needed to build muscle, stretch tendons and retrain Ben's walking pattern.

Ben's programme started at a low speed of 0.3kph, with the water level at 900mm to give him plenty of support whilst building up his strength and confidence. Exercises included hamstring stretches, heel push-downs and knee to chest leg raises. In the water, he was able to exercise pain-free and push himself without the risk of a fall or injury.

Later in his programme, Ben was encouraged to let go of the handrails to include arm swing and develop a natural walking motion. This not only intensified the exercise but forced Ben to concentrate on his walking pattern. The treadmill speed was also increased to up to 3.3kph for extended periods during the sessions.

With the goal of walking unaided from his home, across the park, to his nan's house firmly in his mind, Ben, now aged 12, has shown nothing but sheer determination and hard work during his underwater treadmill sessions. We are happy to report that Ben's progress has been tremendous and he continues to improve every week.

Leah's story – H2O Physio

Objective

Improve muscle tone and core strength in cerebral palsy for the preparation of surgery.

Background

Leah, age 7, has spastic diplegia, a form of cerebral palsy characterised by frequent spasms and muscle tensing in the legs. This causes mobility problems and frequent falls. For school or long distances she relies on her walking frame, whilst at home she uses crutches.

Ultimately, the aim is for Leah to have the Selective Dorsal Rhizotomy (SDR) op, to permanently reduce the stiffness and spasticity. However, she has a long way to go before then, as she’ll first need hip surgery, followed by an operation to lengthen the tendons in her legs.

Leah needs to improve muscle strength in her legs and core. This will limit the muscle and bone changes that may occur, as well as demonstrate suitability for SDR spinal surgery. The HYDRO PHYSIO hydrotherapy treadmill is ideal for strengthening these muscles as the water increases the intensity of the exercise, while giving Leah maximum support. Having seen other pre and post SDR successes with young patients using the HYDRO PHYSIO treadmills, Leah’s family are hopeful for her outcomes.

Programme

  • Duration: 30 minutes
  • Water Temperature: 31˚C
  • Speed: Session 1 - 0.6 to 1kph / Session 18 - 0.6 to 1kph
  • Depth: 800mm
  • Resistance Jets: Not activated
  • Direction: Forwards
  • Number of Sessions: 18

Outcomes

Leah’s programme is simply walking in the underwater treadmill in a forward direction for 30 minutes, with plenty of splashing around and fun to keep her interested.

In her first hydrotherapy session, she covered a distance of 0.261km, but by the 18th session, she was up to 0.861km. In addition, the amount of time and the number of steps at the higher speeds have increased significantly.

Leah’s mum has reported a considerable improvement in her strength and noticed that she no longer needs to hold onto the treadmill handrails to steady herself while she walks. Maintaining balance is a major challenge for Leah as she is forced to walk on her toes (one of the most common symptoms of spastic diplegia). To demonstrate the effective combination of surgery and hydrotherapy, Leah's videos show a marked difference with the heel to toe action.

Leah is beginning to get a curve in her spine due to the postural impact of her condition as she grows, she has to sit in a ‘W’ shape as she is unable to cross her legs.

Being on oral baclofen since birth, to improve the spasticity, and undergoing a lumbar puncture with the same drug, to mimic the temporary benefits of SDR, are just some of the hurdles Leah has had to face.

A house move which saw Leah change NHS Trust areas resulted in her weekly physiotherapy sessions being dropped to one every 3 to 6 months. Leah is progressing extremely well and Leah's family continue to fundraise in the hope that she'll eventually be accepted for SDR surgery.

Aran - Cerebral Palsy Aged 4...

Objective

Personal development, mobility and increased confidence.

Background

As Aran was growing he wasn’t developing a range of movement or getting any form of cardiovascular exercise. He lacked in confidence but had the goal to walk in the water, the same as any other child.

Programme

  • Duration: 45 minutes per session
  • Water Temperature: 35˚C
  • Speed: 0.2 to 0.8kph as sessions developed
  • Depth: 540mm
  • Resistance Jets: Only to play at the end!
  • Direction: Forward and reverse
  • Number of Sessions: 10

Outcomes

Aran was accompanied in the HYDRO PHYSIO trainer to offer extra support. By changing the treadmill to reverse settings he could see and interact with his family; the variation in direction also held his attention and made the whole experience more enjoyable.

The optional lower handrails were fitted for Aran, which helped to increased his confidence.

Aran gets too cold in a conventional pool so the ability to set water to an appropriate temperature and depth provided a comfortable, supportive environment for him to achieve a sustained and rewarding session. Confidence is a major factor in the achievement of an individual's potential; users of HYDRO PHYSIO have consistently reported a significant improvement in their sense of accomplishment.

Rayn's story – H2O Physio

Objective

Rehabilitation to improve spasticity (muscle stiffness) and mobility in cerebral palsy.

Background

Rayn, now age eight, had an extremely challenging start to life. Born early at 25 weeks and weighing just over a pound, he suffered a bleed on the brain, experienced breathing difficulties and spent his first two months on life support. He went home after six months, but required oxygen for a further six months.

As he developed, his mobility issues became more apparent. With diplegic cerebral palsy, also known as spastic diplegia, symptoms include tense muscles and spasms. Leg muscles in particular tend to be extremely tight, and over time, this causes joints to stiffen, reducing the range of motion.

Programme

  • Duration: 30 minutes
  • Water Temperature: 31˚C
  • Speed: - 1.5 to 3kph
  • Depth: 900mm
  • Resistance Jets: Not activated
  • Direction: Forwards
  • Number of Sessions: 20

Outcomes

Rayn's programme combines hands-on physiotherapy for realignment with HYDRO PHYSIO hydrotherapy treadmill sessions to build muscle, stretch tendons and retrain his walking pattern. Exercising in the warm water helps to loosen his tight muscles and allows him push himself in a low impact, supportive environment. Therapy aims have focused on heel to toe action, leg lift and working towards walking independently of the hoist and his splints.

Rayn had 15 hydrotherapy sessions in a HYDRO PHYSIO treadmill before undergoing Tendon Release Surgery on both legs, Rayn recovered well. After being off his feet for a few months, he resumed treatment, building back up to his previous speeds and times quickly.

Since starting hydrotherapy, the improvement in his mobility has been impressive. He originally walked on his toes, being unable to get his heels down, which caused problems with his balance and resulted in plenty of falls. To help him walk, his parents needed to either hold his hands, support him under his arms or put him in a walker.

Now, Rayn is able to walk unaided and can even run! A typical eight year-old boy, he's so full of energy that his mum says she'd have to "chain him down" to stop him racing around.

Joel - Cerebral Palsy Aged 6...

Objective

Personal development, mobility and increased confidence.

Background

For many years part of Joel's therapy has been swimming pool based, which he does not enjoy. As Joel was growing his posture was being formed by the shape of his wheelchair. His hamstrings were tightened to such a degree that his range of movement was very limited.

Programme

  • Duration: 35 minutes per session
  • Water Temperature: 36˚C
  • Speed: 0.2 to 0.8kph as sessions developed
  • Depth: 770mm
  • Resistance Jets: To push legs with reverse
  • Direction: Forward and reverse
  • Number of Sessions: 10

Outcomes

The ease of access to the HYDRO PHYSIO Lifestyle and the upright, assisted movement of the treadmill helped Joel develop greater concentration towards his therapy.

Setting the exact water level for maximum buoyancy allowed Joel to extend his range of movement as sessions developed. Physical steps forward were matched by his strides in confidence.

Joel's Mum and Dad consistently reported a significant improvement in his sense of accomplishment. For wheelchair users a non-slip ramp and decking around the unit is popular. This enables access to the entrance of the trainer, using the side handles for support.