1. Improved outcomes in the GMFCS IV & V CP subpopulation with SDR
Sruthi P. Thomas, MD, PhD
Pediatrics/PM&R Combined Residency, University of Colorado, PGY5
Assistant Professor, PM&R and Pediatrics, Baylor/Texas Children’s Hospital
CPRN Investigator Meeting - Houston, TX 5/31/18-6/1/18

2. Problem
Research in spasticity management for cerebral palsy is focused on the GMFCS I-III subpopulation
Greatly improved medical management has led to increased lifespan of the GFMCS IV-V subpopulation stretching well into adulthood
What can we do to improve quality of life and reduce caregiver burden in the GMFCS IV-V population?

3. Potential Solution: SDR

4. Potential Solution: SDR
Lower extremity spasticity 3-3.2 MAS points (essentially dropped to 0)
Upper extremity spasticity 
Significant improvement in urinary continence
SDR superior to ITB in those who initially had ITB pumps
Improved range of extension and flexion in all extremities
Caregivers report improved ROM & nursing care

5. Questions Raised
What are the trends for SDR for GMFCS IV & V in the US?
Is there a subset of GMFCS IV & V patients that would benefit from ITB pumps over SDR?
If the goal is no longer to retain ambulation, should this procedure be extended to the ≥18 yo population?

6. Questions Raised Is there improvement in pain?
Can dystonia be controlled with combined selective ventral rhizotomy?
Should we be adding intraoperative electrophysiological monitoring of upper extremities in the OR?

7. Proposed Grant
Aim 1: Observational study to characterize current practice patterns across the US
Aim 2: Systematic review of studies focused on SDR and GMFCS IV & V (there may be too few for this to be completed)
Aim 3: Multi-center retrospective case series investigating the role of SDR for spasticity management in the GMFCS VI & V population

8. Questions?