For the first 4-6 weeks after surgery.

• No passive hip flexion past 90 degrees.

The patient can perform hip flexion actively to his/her tolerance.

• No passive trunk rotation/lateral flexion into extremes of range.

The patient can perform this actively to his/her tolerance.

Hamstring stretching should be done with care and limited by back pain (not discomfort caused by the stretching of the hamstring muscles)

Because of potential weakness in the feet and ankles, any necessary orthoses should be worn during all standing and walking activities.

Expect some sensory changes in the lower extremities, this may include some hypersensitivity on the plantar surfaces of the feet. This may be alleviated by handling feet firmly and wearing socks and shoes.  This hypersensitivity usually resolves in the first 6-8 weeks.  Gabapentin therapy can also be helpful.

As the oedema resolves around the site of the surgery, a bump may appear just above the scar.  This is the spinous process of T12 or L1 and should not be a cause for concern.

It is common for the child to tire more easily than normal.

The child will have a change in movement patterns and control which they may find frustrating.  Changes in behaviours such as irritability and frustration are common as the child learns that movement feels different.

Hydrotherapy may begin 2-3 weeks after the surgery (once would is healed).

Swimming may begin 4 weeks after surgery.

Do not begin or resume electrical stimulation of any kind until 6 weeks after surgery.

Do not begin horse riding or contact sports until 6 weeks after surgery.

We aim to see patients twice a day during their inpatient stay.

Treatment plans are individualised for each patients needs and often include strengthening, stabilisation and selective control work. 

At the time of discharge community teams are invited to a joint session to ensure smooth transition. The child and their family will be provided with a home exercise programme at this time.

A detailed discharge report will be sent to the patients local community team.

An improvement in function post surgery is dependent on the access to post operative physiotherapy.

The recommendations are for guidance only and local provision may vary according to access to local services and a child's GMFCS level.

Physiotherapy input is recommended as up to twice weekly up to 6 months post discharge and then monthly for the following 2 years.

Higher level GMFCS children may require less long term intervention.

Post SDR a child may have a change in function and therefore require access to additional equipment e.g. Kaye walker/tripods/standing frame/orthotic services

Post SDR each child will require additional orthotic provision.

As these children progress they will require a combined physiotherapy and orthotic review every 3-4 months.

Some children may take time to return to their pre-operative levels of endurance and will fatigue more quickly. For those children who may find full days/weeks at school difficult to start with, a phased return may be indicated.

The child may continue to progress for up to 2 years following surgery and some continue to improve up to 5 years post-op.

Where a child's abilities plateau but there is an expectation that they have further potential to improve, feel free to contact the SDR team to discuss if you would like advice.