Impact of Occupational Therapy on Self-Care After Selective Dorsal Rhizotomy Among Children With Cerebral Palsy

Abstract

Abstract Importance: Selective dorsal rhizotomy (SDR) is an established treatment for spastic cerebral palsy (CP). The effects and predictors of occupational therapy’s benefit for self-care after SDR in children with CP have not been thoroughly investigated. Objective: To identify changes in self-care after occupational therapy post-SDR and determine whether changes were affected by age, Gross Motor Function Classification System (GMFCS) level, and number of occupational therapy dressing sessions. Design: In this retrospective cohort study, we collected outcomes pre-SDR, at discharge, and at 1-yr follow-up. Paired t tests and regression analysis were performed. Setting: Commission on Accreditation of Rehabilitation Facilities–accredited pediatric inpatient rehabilitation facility. Participants: Seventy-three children (GMFCS Levels I–III, ages 4–17 yr) diagnosed with spastic CP who underwent SDR from 2014 to 2018. Intervention: After having SDR, each child received an average of twice daily occupational therapy for an average of 37.3 days. Outcomes and Measures: The Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI–CAT) and Functional Independence Measure for Children® (WeeFIM) were used to assess self-care performance. Results: The mean WeeFIM dressing (upper and lower body) and mean PEDI–CAT daily activities scores from baseline to discharge and mean WeeFIM lower body dressing at 1-yr follow-up improved significantly. The improvement in lower body dressing correlated with GMFCS level and the number of occupational therapy dressing sessions. Conclusions and Relevance: The improvement in upper and lower extremity dressing and PEDI–CAT daily activities scores suggests that inpatient occupational therapy post-SDR may provide benefits. What This Article Adds: Children diagnosed with CP may undergo surgical interventions to improve their ability to walk. This article demonstrates the benefit of occupational therapy services after SDR to improve upper and lower body dressing skills.