Selective Dorsal Rhizotomy Service

The Selective Dorsal Rhizotomy (SDR) Service at Great Ormond Street Hospital (GOSH) offers an additional opinion regarding assessment, diagnosis, prognosis and management of children with locomotor or movement disorders of neurological origin, including spasticity or dystonia.

This service is designed to benefit children with movement disorders where there are specific questions regarding diagnosis, prognosis and motor management, with a particular emphasis on the management of spasticity and dystonia.

Referrals may be initiated by any member of the local team, but must be endorsed in writing by the child’s consultant paediatrician or orthopaedic surgeon.

Referrals marked MDC new referral should be sent electronically from a secure account to:

gos-tr.Neurodisabilityreferrals@nhs.net

A summary of the medical history, together with relevant reports and investigations, should be included. Contact details for the local physiotherapist/occupational therapist are mandatory to facilitate pre-clinic liaison.

The child’s physiotherapist/occupational therapist is welcome to attend the clinic appointment with the family’s permission. Parents are asked where possible to bring to the clinic their child’s usual walking aids and current orthotics.

During the assessment the child’s medical history is reviewed, including past and current medical issues and developmental concerns. Any questions parents and children have for the clinic team are also discussed.

Emphasis is placed on current mobility, equipment, orthotics, therapy provision, physical management programmes, previous interventions and surgery.

Following this discussion, the team will assess the child. This includes looking at joint ranges, selective muscle control, spasticity, functional movements and mobility (transfers and walking). Where gait is being assessed, the child will be asked to walk with and without their usual aids and orthoses.

The parents are present throughout the assessment.

Following assessment and discussion, the team meets briefly to consider the findings and coordinate feedback. The team then discusses the findings, conclusions and recommendations with the parents and child.

Following the appointment, the team physiotherapist will contact the local physiotherapist (if not present at the appointment) to discuss findings and recommendations. A written report is sent to the parents, referrer and an agreed circulation list.

The multidisciplinary team is made up of a consultant paediatric neurologist, a consultant developmental paediatrician, a consultant in paediatric neurodisability, a consultant paediatric neurosurgeon, clinical specialist physiotherapists, and a specialist registrar.

For specific queries about SDR, our SDR coordinator may be contacted on 020 7405 9200 ext 1532.

Selective Dorsal Rhizotomy clinical outcomes