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Cerebral palsy: investigating the effectiveness of surgery to improve walking

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Cerebral palsy is the most common serious physical disability in children, affecting more than 1,500 babies born in the UK each year.1,2 Many children with symptoms in both legs will undergo a type of surgery called ‘Single Event Multi-Level Surgery’ (SEMLS) which aims to correct their muscle, bone and joint deformities. But it is unclear how effective this operation is, and which children benefit the most. Mr Tim Theologis and his team at the Oxford University Hospitals NHS Foundation Trust are carrying out a national study of SEMLS. He hopes his results will ensure that children receive the best treatment to improve their walking, helping them to live as normal and independent a life as possible.

How are children’s lives affected now?

Cerebral palsy is usually caused by damage to a baby’s brain before, during or soon after birth. A lifelong condition, children develop stiff muscles, and bone and joint deformities that affect their muscle control and movement.

One common type of cerebral palsy is called ‘bilateral cerebral palsy’, or diplegia, which affects both sides of a child’s body – especially their legs. Their leg muscles tend to be extremely tight and over time, this causes joints to stiffen, reducing the range of motion.

“This can make it difficult for a child to walk – and in the most severe cases, impossible,” says Mr Theologis.

SEMLS is a widely-used approach for treating children with this type of cerebral palsy, with surgeons aiming to correct their bone, joint and muscle deformities in a single operation. However, its effectiveness is unclear – and there are differences in how it is carried out between hospitals across the UK.

How could this research help?

“We aim to improve our understanding of how effective SEMLS is and better define which children will benefit most, which we hope will lead to future improvements,” says Mr Theologis.

The researchers will carry out a national study of SEMLS, collecting information from all children put forward for the operation across the UK over a one-year period – including families who decide not to pursue the treatment.

“We will talk to surgeons and the children’s families to find out how children are doing one and two years after their operation, focussing on what matters for patients and their families,” says Mr Theologis.

By analysing these data, the team hopes to understand which children are most likely to have a good result from SEMLS.

“Our results will help surgeons to improve how SEMLS is performed and select the best type of surgery and rehabilitation for individual children,” says Mr Theologis. “In the longer term, this project will guide future research to help children with cerebral palsy get the best possible treatment.”


1. Wimalasundera, N. & Stevenson, V.L., Cerebral palsy. BMJ Practical Neurology 2016; 16:184-194.

2. Office for National Statistics. Overview of the UK population: July 2017 [website accessed 04 Sep 2018]




Project Leader Mr Tim Theologis, MSc PhD FRCS
Project Team Dr Nicky Thompson, MSc PhD MCSP, Dr Julie A Stebbins, DPhil SRCS CSci, Professor Dan C Perry, MB ChB FRCS(Orth) PhD, Professor James G Wright, CM MD MPH FRCSC FRCSEd, Professor David J Beard, GDPhys MCSP MSc MA DPhil FRCS and Mrs Jacqueline S Birks, MA MSc
Project Location Nuffield Orthopaedic Centre, Oxford University Hospital NHS Foundation Trust
Project Location Other Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford
Project duration 3 years
Date awarded 15 August 2018
Project start date 1 June 2019
Project end date 31 March 2024
Grant amount £199,889
Grant code GN2721
Acknowledgements Supported by a generous grant from The Linder Foundation


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