The application process will depend on the SDR surgeon you choose. Many require in-person consultations. Some require baclofen trials (this involves injecting baclofen into the spinal fluid, mimicking the action of a baclofen pump) or Botox injections, with the goal of seeing how the muscles function after spasticity has been reduced. Dr. Park does not use either method to judge his patients’ candidacy for SDR, as he doesn’t believe that these provide an accurate prediction of a person’s SDR outcome.
How to Apply for SDR at St. Louis Children’s or Barnes-Jewish Hospital:
Dr. Park’s office allows in-person consultations and video consultations, so patients can choose the option they prefer. If you choose the video consultation, you will likely get your answer sooner, because there’s often a long waitlist for the in-person consultations. Either way, the first step is to fill out the patient information form in step 1 below.
- Fill out the patient information form: https://www.stlouischildrens.org/conditions-treatments/center-for-cerebral-palsy-spasticity/sdr-patient-information-form. You’ll then receive an email, typically within a few business days; if they think you might be eligible for SDR based on your initial responses, you’ll receive instructions for the next steps of the application process.
- If you’re opting for an in-person evaluation, they will call you to schedule an appointment with Dr. Park. If you’re opting for a video evaluation, the email will contain all of the materials and instructions you need. You’ll be asked to send in:
• forms filled out with your medical history;
• forms filled out by a local physical therapist that describe your abilities to perform specific tasks (don’t worry if you can’t do everything perfectly; if you could, you wouldn’t be considering SDR!)
• a video showing your abilities to perform specific tasks, like walking, sitting, kneeling, kneel-walking, and moving your ankles (you can film this at home on a tablet or smartphone; I did most of it in my living room and asked my therapist to help with the parts I wasn’t sure about)
• hip and spine x-rays
• a brain MRI if you were not born prematurely or if there are other unusual circumstances involved in your situation Don’t worry too much about finding the perfect physical therapist; ideally, you’ll want to find a good PT who can work with you both before and after SDR, but you can always switch to a new one for your post-op rehab if needed. Some people who have had trouble finding a PT to fill out their forms have been able to complete them independently.
Be sure to get tracking on your package when you send it in so that you can be sure that it has safely arrived!
- If you’ve opted for an in-person opportunity and you are accepted as a candidate, you’ll have an opportunity to schedule a date for surgery at that appointment. If you’ve opted for a video evaluation, you’ll typically hear back within several weeks (typically it takes at least a month, often 6 weeks; the timing varies depending on how busy the team is). If you’re a US patient, you’ll receive a phone call from St. Louis (314 area code, so you know what to look out for!). If you’re international, you’ll receive an email. US patients can typically schedule a surgery date as early as 3 months from their acceptance; international patients typically wait longer (a year or so) because they need to have a 3-week therapy block available after surgery. International patients can be asked to be placed on a waitlist for an earlier date, however!
Note that adult patients typically have to be able to walk at least a few steps independently to be accepted with Dr. Park, with stricter criteria for patients in their 40s compared to those in their 20s. Other surgeons may have different selection criteria.
This link provides more information about the selection criteria for SDR in St. Louis: https://www.stlouischildrens.org/conditions-treatments/center-for-cerebral-palsy-spasticity/patient-selection.