Selective dorsal rhizotomy (SDR) is a permanent neurosurgical procedure which reduces excessive muscle tone (known as spasticity) in the legs of children with cerebral palsy.
This fact sheet explains what to expect in the lead up to the surgery, after the surgery and when your child is discharged home and transitioned to community-based care.
For information about SDR surgery, see our fact sheet selective dorsal rhizotomy.
The key phases
Your child’s SDR journey will include 4 main stages:
- preparing for the surgery
- admission
- inpatient and day hospital rehabilitation
- discharge from hospital and community-based care.
Key appointments and assessments
- Pre-surgery review and assessments
- 6-month review
- 12-month review and assessments
- 2-year review and assessments
- 5-year review and assessments
- Review on request between 5 to 10 years
- 10-year review and assessment
Hospital wards and clinics
Your child will spend time in several areas of the Queensland Children’s Hospital. These include:
- Paediatric Intensive Care Unit (PICU)
- neurosurgery ward 12a
- 8a rehab ward
- 6g/6e rehab outpatient clinics
- other outpatient departments as required.
Your child’s care team
The SDR team includes:
- neurosurgeon
- rehabilitation paediatrician
- physiotherapist
- nurse
- occupational therapist
- social worker
- orthotist.
Preparing for surgery
The assessment and decision-making process for SDR surgery can be lengthy and often takes several months to complete. Your child will undergo various investigations and assessments to confirm that an SDR is the best option for them. We will also ask you about your goals for your child as this is an important essential factor in the decision-making and planning.
Things to discuss with your child
Here are some important things we recommend you discuss with your child before the surgery:
- your body may feel different after surgery
- your body won’t work the same at first
- you will have to lie flat for 2 days
- in the first week after the surgery, you will need to take medicine to help you feel better.
- rehabilitation (or ‘rehab’) is hard work (but fun!), and you will have to do it every day to help you get stronger, straighter, fitter, faster – so you can get back to doing what you did before and get your body on a path to doing new things into the future.
Your child’s care team will provide you with a social story to read with your child before their surgery to help them understand what to expect.
Physiotherapy review and assessments
Your child will have a range of tests and baseline measures taken to help with decision making before the surgery. These include:
- gross motor function tests
- endurance tests
- balance tests
- strength and selective control testing
- pain measures
- quality of life questionnaire
- functional questionnaire.
These measures will also be used to compare and evaluate your child’s progress after the surgery.
Social work review
Every family who has a child undergoing an SDR has access to a social worker.
The social worker provides practical and emotional support to the whole family in the lead up to, and during, your child’s admission. You can ask to speak with the social worker at any time.
The purpose of the social work review is to:
- identify and advocate for your family’s needs and support ways for you to care for your child and family during their SDR admission
- supporting access to hospital and community resources (e.g., travel and accommodation).
Occupational therapy (OT) review
- Review of your child’s current function with self-care skills (this helps with planning following surgery).
- Goal setting – specific and measurable goals for your child will be identified with you and your family. This helps to measure outcomes after the surgery.
- Discussion about your child’s individual needs and interests to allow the team to best support you and your child while they are an inpatient.
- Planning and provision of a social story to support your child’s understanding of the surgery and the post-surgery phase of recovery.
- If appropriate – a medical play session and tour of the rehab ward to help your child develop an understanding of what of the procedure and initial phase.
Medical and nursing review
The purpose of the medical and nursing review is to:
- ensure an adequate pain management plan for after the surgery
- commence medications (pregablin/gabapentin) for pain management (medications may continue for some time after surgery)
- ensure adequate management of other medical conditions
- preoperative clinical mapping (this assists with decision-making during the operation)
- Ppre surgical wash to be given
- discuss care of the surgical wound.
Equipment used during SDR rehabilitation
Your child will need the following equipment during their SDR rehabilitation journey:
- commode (special wheeled chair for toileting and/or showering)
- leg wraps
- orthotics
- standing frame
- walking aid
- wheelchair
- supportive tricycle.
Some of this equipment will be loaned from the hospital, and some will be your own.
Admission
Before the surgery
The hospital will contact you on the day before surgery to confirm that your child is well, the time to arrive and the fasting guideline for surgery.
The day of the surgery
- Your child’s leg wraps will be measured.
- You will meet the anaesthetist and neurosurgeon performing your child’s surgery.
- The Rehab team will meet you and your child.
Important: Remember to arrive early so your child can be admitted and ready for their surgery.
Staying at PICU
After the surgery, your child may stay in the PICU one or 2 nights to ensure they are medically stable and their pain is being adequately managed.
Neurosurgical ward (12a)
Your child will be transferred to the neurosurgical ward for about one week. During this time your child will be seen by the SDR team as well as the neurosurgical team. You can contact the SDR team’s clinical nurse consultant (CNC) if you have any queries during this time.
Aims for your child during their stay on neurosurgical ward:
- their pain is well managed
- they are medically stable
- they can sit up in bed after day 2
- their legs stay in good alignment while in bed
- they can start bed rehab exercises
- they can transfer to commode for toileting after day 3
- they can start standing transfers by the end of the week.
Rehabilitation
Ward 8a (inpatient rehabilitation)
Your child will be in the rehabilitation ward for 2 to 4 weeks. This consists of a daily rehab program from Monday to Friday. Your child will be mainly seen by the inpatient therapy team during this time.
Rehab program involves a daily (morning and afternoon) therapy sessions to:
- start and progress lower limb and trunk strength
- start and progress floor mobility
- start and progress standing endurance
- start and progress walking.
During your child’s rehab stay weekend leave can be arranged.
- The inpatient therapy team will be their main care team.
- A Queensland Children’s Hospital School teacher will give them bedside lessons.
Your child will be discharged from the rehab ward when:
- their pain is well controlled
- they can do a full-day rehab program and attend hospital school without being fatigued
- they can transfer into and out of the car
- they can tolerate car travel to and from the hospital
- preoperative independence level of transfers achieved.
Day Hospital (6e)
Your child will attend our Day Hospital Program for approximately 4 to 6 weeks. This consists of a daily rehab program from Monday to Friday. Your child will be mainly seen by the outpatient therapy team during this time.
The Day Rehab Program involves morning and afternoon therapy sessions (present at the hospital for approximately 4 to 6 hours) and off-site aquatic physiotherapy (after wound cleared by medical team) which includes:
- progressing gait training
- progressing core strength and lower limb strength
- progressing endurance
- casting and orthotic intervention if required
- attending the Queensland Children’s Hospital School.
Before your child is discharged from the Day Rehab Program, the overall goal is for them to achieve the level of mobility they had before their SDR surgery admission.
Discharge and community-based care
Once your child is discharged from the Day Rehab Program, their ongoing care will be transitioned to local community-based providers The Queensland Paediatric Rehabilitation Service will liaise with your child’s community care team regarding their SDR surgery and their ongoing care.
6 weeks–3 months after surgery
- Physiotherapy in the community at least 3 times per week plus aquatic physiotherapy.
- Continue to work on strength and gait retraining.
- Physiotherapy to remain as priority therapy with OT/other therapies as required.
- Queensland Paediatric Rehabilitation Service can support access to therapy.
3–6 months after surgery
- Balance physio sessions and extracurricular activities 3 to 4 times per week, therapy can be a mix of physio and other activities such as swimming from 3 to 4 times per week.
- Manage lower limb contractures and use of orthotics.
- Growing independence with activities of daily living.
- Increasing participation in home, school, leisure and community activities.
6–12 months after surgery
- Extracurricular activities can replace some physio sessions.
- Physio frequency from 1 to 2 times per week depending on individual progress.
- Manage lower limb contractures and orthotics.
- Building independence with activities of daily living.
- Increase participation in home, school, leisure, and community activities.
- Work towards discharge from active therapy program at the end of 12 months.
Developed by the Lactation Service, Queensland Children's Hospital. We acknowledge the input of consumers and carers.
Resource ID: FS420. Reviewed: August 2025.
Disclaimer: This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.