Recommendations for surgical intervention in children with hemiplegia or cerebral palsy
Surgery for CP should only be carried out by surgeons with appropriate expertise, based on a combination of interest and experience.
Clearly defined treatment goals should be established with the family before surgery.
Outcome measures should be used to assess interventions.
Use functional outcome measures, supported where possible with objective measures, using gait analysis in particular.
Instrumental gait analysis should be used before and after surgery wherever possible.
The prevention of hip problems is important. The aim of management should be to prevent dislocation. Children with subluxation should be monitored regularly using X-rays. Surgical treatment should be discussed by the specialist(s) concerned.
There is little evidence to support extensive use of rhizotomy. However, this may be considered in individual children depending on the clinician's opinion. It should still be regarded as experimental treatment.
Quantify the quality of the package of care delivered by services rather than individual procedures (for example, is a child walking better?)