Going to an indoor water park was on Alexis Walsh’s birthday bucket list. Alexis, who turned 14 in October, 2023, thought it would be fun, especially riding rafts down the slides with her family.
During Christmas break, Alexis fulfilled her wish and enjoyed a mini family vacation to a local water park. The outing was more than a belated birthday gift. It was a celebration of Alexis’ year-long recovery after an orthopedic procedure that straightened and realigned her legs.
Alexis, who has spastic diplegic cerebral palsy (CP), is mobile with the assistance of a walker. But in 2021, Alexis’ condition started to deteriorate. She was in pain and had trouble moving from sitting to standing and walking with her walker.
“I started getting calls from her school,” said Kris Walsh, Alexis’ mom. “It was after Lexi fell at school, that we decided it was time to see her pediatric physiatrist.”
Treating cerebral palsy
Alexis has seen Kathryn Mosher, MD, Akron Children’s pediatric physiatrist and director of the Pediatric Neuromuscular Clinic, since she was a toddler. Over the years, Dr. Mosher has recommended different therapies, procedures and medications to manage the spasticity that caused chronic muscle tightness and interfered with Alexis’ mobility.
At age four, Alexis underwent a selective dorsal rhizotomy to reduce spasticity and maintain her ability to walk. The neurosurgical procedure separates the sensory nerve roots in the spinal column. Then a physiatrist helps the neurosurgeon identify which roots are causing the spasticity, and they are cut. After recovery, Alexis went to Akron Children’s Day Rehabilitation Program where she relearned how to crawl, kneel, stand and walk.
Later, she switched to outpatient rehab at Akron Children’s Pediatric Rehabilitative Services, Boston Heights, which is closer to her Ravenna Township, Ohio, home. She also attended occupational and speech therapy to help her with daily activities at home and school.
Physical medicine and rehabilitation have always been an integral part of Alexis’ cerebral palsy care.
“Alexis would make gains in her flexibility, balance and motor development, then she would have a growth spurt,” Kris said. “Each time, she returned to therapy to address how the changes affected her.”
After the falling incidents in school, Dr. Mosher conducted tests and prescribed pain medications. She also noted changes in Alexis’ posture and ability to walk. Alexis had started to crouch, plus her feet turned inward, causing her knees to bump together when she walked.
“She was so altered by the pain this caused,” her mom said. “Even her personality changed. She wasn’t happy anymore and became socially withdrawn.”
Seeking help from the Spasticity Clinic
Initially, Alexis returned to the day rehab program before being referred to Akron Children’s Pediatric Spasticity Clinic, a multidisciplinary clinic offering pediatric expertise in physical medicine and rehabilitation, neurosurgery, orthopedics, psychology and physical and occupational therapy.
“We wanted Alexis to have the benefit of the clinic’s expertise,” Dr. Mosher said. “It’s like a brain trust in the way we collaborate to bring the best outcomes to patients. We review videos taken of the patient ahead of time and discuss recommendations. Then we meet with the patient together and make recommendations.”
Alexis’ gait concerned the team. The way she walked wasn’t sustainable and over time was likely to affect her mobility and independence. They recommended single-event multilevel surgery (SEMLS), a type of orthopedic surgery to correct the soft tissue and bone problems that affected her hips, knees, shin bones and feet.
“The advantage of SEMLS is that corrections are made all at once and minimizes the number of surgeries the patient undergoes,” said Sheryl Handler-Matasar, MD, pediatric orthopedic surgeon, director, Orthopedic Surgery & Clubfoot Clinic at Akron Children’s Mahoning Valley, and the orthopedic member of the Spasticity Clinic team.
Undergoing SEMLS surgery
Alexis and Kris met with Dr. Handler at Children’s campus in Boardman for x-rays and to discuss SEMLS details. Dr. Handler’s team also helped the Walsh family plan for Alexis’ rehabilitation at home, which included a continuous passive motion machine to bend her knees and increase mobility.
The surgery Alexis underwent in January, 2023 lasted more than five hours and involved lengthening the adductor muscles in the hips, cutting bone to straighten and realign the knees and rerouting soft tissue and tendons.
“If I’m being honest, recovering from this surgery wasn’t easy,” said Alexis, who had to avoid anything weight-bearing for a month after surgery, which impacted her self-care. That was followed by extensive rehabilitation in Children’s Inpatient Rehabilitation Program and day rehab program before moving into maintenance physical therapy.
Making amazing strides
When Dr. Handler compares before and after videos of Alexis walking, she says it is hard to imagine it’s the same person.
“From an orthopedic standpoint, this was a really big deal,” she said. “Alexis has worked so hard and come so far in the last year. She’s a rock star! I’m so proud of her and all that she has achieved.”
Alexis’ mom sees a huge difference in her daughter, who is back to being a kid having fun. Recently, Alexis danced in Children’s Dance Unlimited holiday program. She also plays on the Tallmadge Challenger league, an adaptive baseball program for individuals with physical and intellectual challenges.”
“Alexis is in a much better place after her last surgery,” Kris said. “She moves better than she did prior to the surgery, but still requires assistance with things like the stairs. She is more independent, confident and able to participate in activities she enjoys. We’re so blessed to have Akron Children’s nearby. There are so many caring doctors and therapists who are so good at what they do.”