Preoperative Education and Rehabilitation: Building Resilience Before Multi-Level Surgery (MLS) in Cerebral Palsy

Multi-level surgery (MLS) has become the standard of care for correcting musculoskeletal deformities in youth with CP who are ambulatory. MLS is defined as a single surgical episode of two or more operative procedures, at two or more levels, requiring a single hospital admission and rehabilitation episode. Postoperative rehabilitation is an established and essential part of the care plan, as patients who undergo MLS demonstrate decreased strength and mobility for 6 to18 months. Preoperative pediatric rehabilitation is not yet an established clinical program and research is lacking on its application for youth with CP undergoing MLS. Our center has created a preoperative education program and has piloted a prehabilitation program to support patients and families, as many are overwhelmed by MLS planning. Every patient who will undergo MLS receives one, or both, depending on burden of surgery and level of function. Both programs allow unique opportunities for psychological screening and family education. The prehabilitation program has the addition of an intensive physical therapy (PT) plan of care to offset the expected functional losses during the acute recovery.

This session will review the development, implementation of both programs, and early outcomes of piloted prehabilitation program. Our goal is to improve meaningful collaboration between providers and families and empower patients to navigate the surgical journey with resilience, working towards self-directed outcomes that enhance quality of life. Time will be spent examining surgical preparedness, reviewing cases, and discussing strategies for successful clinical implementation in other centers.