Zion's Journey Through SDR Surgery and Rehabilitation

When Zion Walker came to the selective dorsal rhizotomy (SDR) program at TIRR Memorial Hermann in Houston at 6 years of age, he needed a walker to get around and a caregiver to shadow him at school to provide support when needed. Eighteen months later, 8-year-old Zion, who has cerebral palsy, now walks independently and no longer requires extra supervision. He’s also thriving academically and socially. The second-grader is an honor-roll student and has friends throughout the school.

“When I’ve walked in with him to his medical appointments, it’s like right out of that television show ‘Cheers,’ but instead of ‘Norm’ everyone says, ‘Zion,’” says his mother Biannka Jones-Walker, a flight attendant based in Houston. Zion lives in Houston with his mother and father, Sakata.

At home, Zion often plays with a karaoke machine, singing along with Michael Jackson and moonwalking. What brought about this significant change? In short, care and treatment from Children’s Memorial Hermann Hospital and TIRR Memorial Hermann, according to Zion’s mother.

Zion, born prematurely at Children’s Memorial Hermann Hospital, required years of therapies and treatments to treat his spasticity caused by cerebral palsy, including Botox® injections. Spasticity is an often-painful complication associated with central nervous system disorders such as cerebral palsy that can cause muscles in any part of the body to involuntarily contract and become stiff, which can lead to jerky or exaggerated movements. According to Sheng Li, MD, PhD, director of Stroke Recovery and Rehabilitation research at TIRR Memorial Hermann, serious cases of spasticity can affect a person’s quality of life and ability to perform common daily tasks, such as dressing, eating, walking, showering and getting into or out of bed.

Once he turned 5 years old, Zion qualified for a more permanent treatment—SDR surgery at Children’s Memorial Hermann Hospital, one of the few pediatric neuroscience programs in the country offering single-level laminectomy SDR procedures for children with cerebral palsy who suffer from spastic diplegia or spastic hemiplegia. This particular procedure is one of the most effective treatments for children with cerebral palsy. SDR surgery selectively removes the abnormal stretch reflex that causes excessive muscle tone or tightness in the legs, by carefully testing and cutting the nerve rootlets in the spinal cord.

Although SDR improves spasticity and may enhance mobility and motor control, the treatment typically entails extensive rehabilitation postoperatively and requires a strong commitment from every patient and their family. Typically, SDR patients like Zion are up and moving the day after surgery; then patients are transferred to the acute inpatient rehabilitation program at TIRR Memorial Hermann via the SDR pathway. This program was developed by Stacey Hall, DO, medical director of Pediatric Physical Medicine and Rehabilitation at TIRR Memorial Hermann, and Manish Shah, MD, director of Pediatric Spasticity and Epilepsy Surgery at Children’s Memorial Hermann and Zion’s pediatric neurosurgeon.

“The team at TIRR Memorial Hermann told us to expect Zion to be there for six weeks, and that’s tough for a parent,” Biannka recalls. “You need to trust those caregivers with your child. But, from the moment we arrived, I knew Zion would be in good hands. The staff is just amazing.”

In fact, the young patient “fell in love with his physical therapists” almost immediately, according to his mother. “He greeted them like they were Santa Claus whenever they came into the room,” Biannka says. This close bond meant that Zion not only adhered to a “very intensive” therapy regimen during his time as an inpatient—which involved bolstering leg and core strength, for mobility and balance—but he embraced it. “He achieved all his goals in four weeks,” his mother notes. “The compassion, the empathy, the care is unmatched.”

The innovative SDR recovery unit at TIRR Memorial Hermann provides specialized rehabilitation for cerebral palsy patients who have undergone SDR surgery. Guided by a multidisciplinary team, the unit care focuses on comprehensive recovery for pediatric patients to maximize motor function and quality of life. This recovery unit is unique to TIRR Memorial Hermann and is one of the only recovery units of its kind in the country.

After completing the inpatient regimen, Zion continued his rehabilitation as an outpatient, participating in three physical therapy sessions a week for a full year. “Before, he walked with a walker and he couldn’t stand in the middle of the floor,” Biannka notes. “Now, you’d never know he had difficulties walking in the past.”

Dr. Hall is quick to credit Zion and his family for his positive outcomes.

“Zion was really highly motivated to do well, and his parents were also very dedicated, which really helped in his rehabilitation,” she explains.

As Biannka says, “I am the subject matter expert on Zion.” Indeed, patients’ families and caregivers are considered a significant part of the team in the SDR pathway program, which is designed to provide multidisciplinary care in inpatient and outpatient settings.

According to Dr. Hall, the care team includes affiliated pediatric physical medicine and rehabilitation specialists, neurologists, neurosurgeons, orthopedists, physical therapists, occupational therapists, neuropsychologists and other specialists who routinely meet on all patient cases and coordinate treatment plans.

“We take a truly collaborative approach,” Dr. Hall says. “The treatment for spasticity has really evolved over the years,” Dr. Hall explains. “Many children with spasticity used to undergo muscle-lengthening surgeries annually. Now, we know it’s important to medically manage tone as well.”

The program has no bigger supporter than Biannka, who now volunteers with the patient and family advisory teams at Children’s Memorial Hermann Hospital and TIRR Memorial Hermann to help parents considering the Memorial Hermann Health System for their children’s care. She has been in their shoes.

From being hospitalized at 28 weeks pregnant for preterm labor and then a stay in the neonatal intensive care unit (NICU) at Children's Memorial Hermann Hospital, to Zion’s SDR surgery and treatment, Biannka knows what it is like to worry for your child’s life. “You need to trust those caregivers with your child. But, from the moment we arrived, I knew Zion would be in good hands. The staff is just amazing,” says Zion’s mom, Biannka.

During calls with parents considering TIRR Memorial Herman for care, she’ll answer a variety of their questions. “They’ll ask, ‘What was your experience? What was it like?’ Because it’s scary,” she notes. “It’s a sacrifice for a family to go through this process, but this year or two of their lives can change the life of their child. From the moment we came to TIRR Memorial Hermann, we felt so much comfort, both in the support they provided and in their expertise. That’s a game-changer for a parent.”