Post-operative rehabilitation

 

 

What to expect after the operation:

• Your child will have little pin-prick needle marks on their legs from where the EMG machine was used to test activity in the muscles in their legs during surgery.
• They will have a small scar (approximately 3cm) in the middle of their back that will be covered with a plaster.
• Your child is likely to complain of a headache and pain in their back.
• Your child will feel tired and may feel a little anxious and frustrated as their legs will feel different to before the operation.
• They will have some altered sensation of their legs and particularly their feet can feel more sensitive. This is common post SDR surgery and will improve initially with medication and then gradually reduce over time. To help you can hold their feet firmly, wear socks and try firm massage of the feet.
• Your child may have a urinary catheter in place and a cannula.
• On HDU (Daisy Ward) the nurse will perform observations on your child every hour including checking their hands and feet. As your child becomes more stable this is reduced to 2hourly checks, and then 4hourly checks. These 4hourly observations will continue until you are discharged from the hospital to the hotel.
• Your child will have to remain completely flat; either on their front, back or side for 48hrs.
• The morning ward round is done before 8am.
• Lights out on the ward is 9pm, with quiet hours between 9pm and 6am.

What to expect from Physiotherapy:

Day 1 after surgery: Your child will remain in bed resting for the first 48hours after their surgery. The physios will measure your child and provide gaiters if they don't already have their own. From Day 1 we ask for gaiters to be worn twice daily for 1hour to maintain length of hamstrings (and calf if worn together with AFO's). They won't do any other physiotherapy exercises this day.

Image shows leg gaiters

Day 2: The first session will be at the bedside. The Physio's will assist your child in sitting up over the edge of the bed for the first time. They will assess their core and leg strength in this position. Your child is likely to feel some dizziness following the bed rest and they may also feel anxious due to their body feeling different. A bed exercise programme will also be provided. We ask for these exercises to be completed twice daily in addition to the physiotherapy sessions.

Day 3:  The Physio's will help your child transfer from bed to chair and they will sit in their chair for minimum 45 minutes depending on fatigue. Your child will have an orthotics appointment to fit their splints; this is usually on Day 3. These splints will need to be worn when your child is sitting out, along with their shoes. The urinary catheter will be removed on day 3 or 4.

Image shows foot splint

From Day 4: Your child will have 2 scheduled Physiotherapy sessions on each weekday. They will do their first stand in a physiotherapy session. Ask the Physio's how much standing and stepping your child should be doing with you on the ward and then at the hotel as this usually progresses quite quickly.   The cannula is usually removed on day 4 or 5. If your child is unwell this may be delayed.

Image shows child standing in parallel bars

(This photos is for equipment example purposes only, a patient was not used in this photo.)

From Day 5, outpatient rehabilitation: Paula, our SDR co-ordinator, will book for you to stay in a local hotel for your outpatient rehabilitation phase once discharged from the ward. This discharge usually happens around a week after surgery, unless they have also had orthopaedic treatment. For example, those who have surgery on a Monday will be discharged from the ward on the Friday, providing that they are safe for you to transfer in/out of their wheelchair. Most children undergo a further 2 weeks of twice daily Physiotherapy.

Day 6-15, outpatient rehabilitation:  Your child will usually have 2 Physio sessions each weekday for up to an hour at a time; one in the morning, and one in the afternoon. You will be given a therapy timetable each week of when your child's Physio sessions will be. Please note that therapy sessions are only on weekdays and not on bank holidays. These sessions depend on the other children undergoing rehabilitation at the same time, other clinical activity and staffing levels. Session times are subject to change but wherever possible will stay as timetabled. If there are any special considerations that you would like us to know about when scheduling therapy; please do tell us!

Image shows standing frame, functional electrical stimulation and trike

Discharge to community team: Your last therapy session is on the Thursday afternoon of your second week of outpatient rehab. This day will comprise of a rehabilitation session and a discharge summary session. We will provide a detailed discharge report, an exercise programme and a therapy protocol for you to take away with you to give to your local therapy team.

(This information can also be found within the paediatric neurosurgery webpages.) (Please note some photos taken prior to facemask policies being in place in hosptials.)