Single-Event Multilevel Surgery (SEMLS)

Full recovery following SEMLS can take up to one year. Here’s an overview of the stages of rehabilitation you might expect in the first year:

Three Weeks After Surgery

Your child will need significant help with things like dressing, eating and going to the bathroom for at least three weeks after surgery.

Range of Motion

Through physical therapy, your child will work on:

• Maintaining or increasing range of motion in the joints.
• Preventing stiffness while healing.

Your child might feel anxiety or pain during physical therapy sessions, especially the first time they move their legs after surgery. Here are some tips for pain management:

• Have your child take pain medication before each physical therapy session.
• Encourage your child to let the therapist know if they’re feeling pain.
• Your physical therapist will work closely with your family and your child’s care team to manage pain.

Transferring Your Child

Specific transfer techniques for moving your child to or from bed, a wheelchair or vehicle depend on what you learn after surgery while you’re still in the hospital. For example, caregivers might use a sliding board to decrease strain on the back. Your child might be able to bear weight on their legs; however most patients have their legs in casts and aren’t able to move on their own for three weeks after surgery.

Activities

It likely won’t be easy for your child to travel at first—so there might be restrictions on the activities your child can complete. We’ll help you prepare for these restrictions and explain any adjustments your child might need in their living situation.

Three to Six Weeks After Surgery

This is the period when your child’s health care team will usually lift precautions and encourage activity.

Range of Motion

Depending on preoperative mobility, your child will participate in physical therapy two to three times a week. They’ll also need to do stretching and strengthening exercises at home.

Your child can gain strength by:

• Doing exercises.
• Changing positions (such as moving from lying down to sitting up, kneeling or standing).
• Practicing mobility (rolling and crawling).

Whether your child comes to a Gillette site or you work with a provider in your community, physical therapy will include active exercises to range-of-motion training. The overall goal will be full use of all the joints, and then we’ll add strengthening exercises. Your child might start using a three-wheeled or stationary bike.

Even if your child receives physical therapy at school, it’s likely these sessions won’t be enough to ensure a full recovery, and you’ll need to include physical therapy sessions at Gillette or with another community provider.

Weight-Bearing Activities

Your child won’t be able to put weight on their legs for at least three weeks if the surgery involved their bones. Once X-rays reveal adequate healing, your child will be able to begin bearing weight—possibly with new short leg casts.

If your child has a soft-tissue operation like muscle lengthening, a brace or ankle-foot orthosis (AFO) can provide ankle support for weight bearing. If your child could walk independently before surgery, they might start using a walker or crutches three to six weeks after surgery.

In all cases, re-educating the muscles and learning new walking patterns takes time—and your child will need to adjust to a new sense of balance and alignment.

Six to 12 Weeks After Surgery

Your child will continue strengthening and mobility activities, which will help them return to pre-surgery activity levels.

Braces

If your child has a second set of casts, we’ll remove them about six weeks after surgery. Your child will likely need braces (also known as orthoses) for support—and will work on strengthening exercises without the braces. The type of brace, how often and how long your child will need to wear braces might change once their ability to walk stabilizes.

Exercises

Six weeks after surgery, your child should continue doing strengthening exercises two to three times per week. As strength increases, your child might need to increase resistance or the amount of weight they’re using. Neuromuscular electrical stimulation might improve muscle power, walking patterns and posture.

Activities

Once your child’s casts are removed, activities can now include swimming, therapeutic horseback riding, biking without AFOs and other types of exercise.

Your child can increase how far they walk as their endurance improves. Your child might go directly from using a walker to walking independently, or they might move from a walker to crutches. The amount of time your child uses a walker or crutches will depend on how quickly they recover. An assistive device is necessary until your child is strong enough to overcome trunk sway (leaning to one side when lifting the opposite leg).

12 Weeks to One Year After Surgery

Your child will continue to work with a physical therapist on strengthening and endurance to return to their previous level of functional mobility. When your child achieves the goals set before surgery—usually related to walking—physical therapy might stop.

After physical therapy stops, it’s helpful for your child to continue regular stretching and periodic strengthening programs. It’s also a good idea for your child to do some type of aerobic exercise like biking or swimming to help maintain fitness.

Successfully identifying which patients will benefit from SEMLS, performing surgery and providing rehabilitation care require the collaboration of a highly skilled team.

You’ll have access to a full range of services and extensive family support at Gillette. An expert team will collaborate to provide comprehensive care for your child, and will help you navigate the services you need.

SEMLS to correct bone and soft tissue problems might be just one part of your child’s treatment plan, which also might include:

• Orthotics, Prosthetics and Seating.
• Gait and motion analysis.
• Neurosurgery.
• Orthopedics.
• Rehabilitation medicine.
• Rehabilitation therapies.
• Therapeutic recreation.

To help your family prepare for a hospital stay and make the most of rehabilitation care, Gillette offers support services like:

• Child life.

• Music therapy.
• Neuropsychology.
• Psychology.
• School services.
• Social work.