Selection Criteria for SDR at Alder Hey

Child has cerebral palsy

Spastic diplegia or quadriplegia with predominant lower limb spasticity

MRI consistent with child having bilateral cerebral palsy with spasticity

Spasticity severe enough to interfere with function, ease of cares, comfort or seating
(GMFCS IV and V)

Spasticity interferes with gait, tolerance of AFOs, causes pain (GMFCS I – III)

Spasticity not managed effectively with oral medications, intramuscular botulinum toxin
injections or other less invasive methods

Well motivated child and family

SDR assessed to be indicated by multidisciplinary team consisting of neurology, specialist

physiotherapy, orthopaedics and neurosurgery

Exclusion

Age <2 years

Evidence of neonatal/infantile meningitis

Significant scoliosis

Severeunaddressed lower limb contractures or rotational abnormalities in walking child

(GMFCS II – III)

Progressive hip subluxation in walking child (GMFCS II-III)

Lower limb weakness (mean lower limb strength MRC <3) in walking child (GMFCS II – III)

Recent or impending hip reconstruction surgery (GMFCS IV or V)