Dorsal rhizotomy for children with cerebral palsy: support for concepts of motor control

The results from selective dorsal rhizotomy research suggest that therapists need to question some common clinical assumptions about movement dysfunction. The rationale for performing a selective dorsal rhizotomy is based on the clinical assumptions that spasticity is the underlying cause of disordered movement and that reducing or eliminating the spasticity will improve movement. This article reviews the literature related to movement dysfunction, the effects of selective dorsal rhizotomy, and the evidence for disordered motor control in children with spastic cerebral palsy. Selective dorsal rhizotomy appears to reduce spasticity and increase joint range of motion. Abnormal movement patterns, however, persist after the spasticity is reduced. Well-coordinated movement patterns are acquired slowly and appear to be related to an intense period of physical therapy. I argue that these results provide evidence that the presence of spasticity alone is an insufficient explanation for abnormal movement patterns. I propose that physical therapists redirect their efforts from developing methods for reducing spasticity to developing adequate assessment, treatment, and measurement techniques for assessing motor control in children with cerebral palsy. I believe we can maximize the functional potential of children with cerebral palsy by identifying problems related to motor control and applying sound principles of motor learning to treatment.