We have talked a lot about SDR surgery since establishing the Harlie Russell Foundation as this is the surgery that has changed Harlie's life. SDR is what relieved Harlie's body of the spasticity that caused her so much pain and made it too difficult to walk. But while Harlie was staying in St Louis in August last year, she underwent another surgery that is vital for her to be able to achieve her dream of walking. PERCS.
PERCS is a minimally invasive surgical procedure performed by orthopedic surgeon Dr Matthew Dobbs at the St Louis Children's Hospital. He uses a feathering technique to lengthen tendons in the legs. A common issue due to cerebral palsy is contractures in the hamstrings, calves and heel cords. This can cause legs to bend at the knee, and pull the heel upwards. Harlie was unable to straighten her legs nor place her heel on the ground when walking or standing.
For the first time in years, I saw Harlie with her legs completely straight. The very next morning Harlie was up on her feet and into physiotherapy. She felt uneasy with her "new legs" as they were still very weak from SDR, however her feet were flat on floor which was not possible before.
The next hurdle, was to develop a range of motion in her feet. Imagine sitting with your feet flat to the floor and pointing your toes to the sky. This range of motion is what Dr Dobbs was aiming for with Harlie and the ultimate goal was a 45 degree angle. To achieve this, Harlie was required to wear night splints and leg immobilizers each night to bed. This meant her legs were forced straight while her feet could be angled at 20 degrees with the night splints. Initially, this was incredibly uncomfortable for Harlie and she woke in pain for the first week of wearing them.
I started to lose heart, thinking she would not be able to wear them long term and this could mean she would never be able to get the range of motion required to walk heel-to-toe. But the team at St Louis Children's Hospital didn't give up. By the time we were headed back to Australia, Harlie was able to wear both the night splints and leg immobilizers every night without complaining of pain.
Fast forward 9 months and Harlie continues to wear them each night. Her right foot is now at the ideal 45 degrees and she can easily walk heel-to-toe. Her left foot is still improving but she is able to stand with her feet flat on the ground. This might not seem like much but walking on her toes was painful and Harlie was only able to manage a few steps at a time.
Whilst SDR is vital to remove the spasticity in the body, PERCS is commonly followed to allow the freedom of movement in the legs and feet. Without PERCS, the SDR surgery would not have been as successful for Harlie.
If you would like to find more information on PERCS, the St Louis Children's Hospital website has all the facts you need http://www.stlouischildrens.org/our-services/center-cerebral-palsy-spasticity/tendon-lengthening-following-sdr