Himanshu Prasad Chooses the Road to Independence

Eighteen-year-old Himanshu Prasad was born with spastic diplegic cerebral palsy, a neurological condition that permanently affects muscle control and coordination. The disorder increased the muscle tone in his legs, causing the muscles to stiffen and tighten so that he walked on his toes with an exaggerated gait.

“Growing up, I tried to do as much as I could, but as a child, I wasn’t very physically active,” Prasad says. “When I turned 14, I started working out twice a week and biking on my own, which loosened my muscles and helped control my spasticity.”

Over the years, he and his family saw numerous doctors, all of whom failed to provide a specific diagnosis or path for improvement. The turning point came on a day when the family was driving home after yet another doctor’s appointment. “No one in the car was talking,” Prasad recalls.

“Finally, my dad said that the spasticity was getting worse, and the doctor mentioned having to use a wheelchair permanently. That was not how I wanted to spend my life. When we got home, I started an online search for potential treatments and read about selective dorsal rhizotomy (SDR). The next step was to find a doctor.”

The entire family started researching SDR. “At first, Himanshu was nervous about the procedure because it involved cutting nerves to the spine,” says his father Suryabhan Prasad. “We did a nationwide search for neurosurgeons who do the procedure and then started to look locally and discovered that Dr. Manish Shah is considered one of the best in the country. We read stories about his patients and his track record of success, and learned that he uses a different approach.”

Manish N. Shah, MD, associate professor in the Division of Pediatric Neurosurgery and William J. Devane Distinguished Professor at McGovern Medical School at UTHealth Houston, is director of the Texas Comprehensive Spasticity Center (TCSC) at McGovern Medical School. TCSC, which offers comprehensive care for patients affected by cerebral palsy, spasticity or movement disorders, is home to a dedicated team of experts who see patients together in one appointment, offering convenience and collaborative expertise.

“Himanshu was older than the traditional SDR patient, but he was very mature and very committed to the long process of rehabilitation after surgery,” Shah says. “The best time for the surgery is around age 4, before spasticity begins to ravage the joints. But he met all the criteria for success: the spasticity was limited to his legs, he had good trunk control and no previous orthopedic procedures, he could tolerate physical and occupational therapy and he had strong family support.”

SDR selectively cuts problematic nerve roots in the spinal cord. The neurosurgical procedure can provide an immediate permanent reduction in spasticity and offers children who follow a program of intensive postoperative therapy the potential to walk independently.

Shah took Prasad to the OR at Children’s Memorial Hermann Hospital on Monday, Aug. 23, 2021. Twenty-four hours later, he was out of bed and moving around, thanks to a specialized pain protocol developed by the TCSC team and published in JNS Pediatrics in 2019.1

The following Thursday, he was admitted to TIRR Memorial Hermann in the Texas Medical Center for eight weeks of rehabilitation. “We’ve been able to reduce drastically the work our patients have to do in therapy,” Shah says. “We use a single incision at one level of the spine and cut 75 to 80% of the nerve rootlets.

Most neurosurgeons use longer incisions and cut only about 30% of the rootlets. Evidence shows that this 30% approach often fails in the long term, with a return of the spasticity. SDR is a one-shot procedure with no room for revision if it fails.” Despite the reduction in therapy time, Prasad considered his rehabilitation rigorous. “But I went from needing the help of five people to get out of bed and into the wheelchair to being able to get up by myself and use a walker to move from place to place,” he says. At TIRR Memorial Hermann, he completed a specialized post-SDR rehabilitation program with five hours of intense therapy five days a week and, because he was older and taller than most patients, he also was able to use an exoskeleton-assisted therapy twice a week to help develop a proper heel-to-toe gait pattern.

“Himanshu was profoundly weak and had to relearn how to move without using his spasticity for assistance,” says Stacey Hall, DO, assistant professor in the Department of Physical Medicine and Rehabilitation at McGovern Medical School and medical director of pediatric rehabilitation medicine at TIRR Memorial Hermann. “We worked very hard to strengthen his core and legs and improve his posture.

Additionally, using the exoskeleton made a huge difference in his programming. By the time he left us, he was able to walk with a heel-to-toe gait pattern, which he’d never in his life done. We began with the exoskeleton supporting 100% of his body weight, and as he got stronger, we gradually took away that support. He did lots of repetitions of this beautiful walking pattern that translated into being able to do it on his own.

“It’s really hard to re-pattern how you’ve walked for 17 years but he was so dedicated,” she adds. “One advantage of being older is that these patients know what they want and what it will take to get there. In addition to those many hours of therapy, he did all his high school work and aced his courses. He’s an incredible young man.”

Suryabhan Prasad sees a significant change in his son. “He is more flexible now, and he’s get ting close to being able to walk independently,” he says. “Himanshu is working very hard. He’s going to school and working three days a week at the gym with a personal trainer. He’s very self-motivated and fully committed to his rehabilitation plan to reach his goal. We’re looking forward to the day when he leaves the forearm crutches behind.”

Prasad was a senior at Cypress Ridge High School in Houston when he had the SDR surgery. Today, he’s a freshman in Texas A&M University’s College of Engineering, with the goal of pursuing a career in materials science and engineering.

“In materials science we get to learn about the composition of metals down to the atom, and how to create new metals,” he says. “My long-term goal is to use my knowledge to create a device that will help kids with cerebral palsy become more mobile so that they can enjoy a full childhood. That’s something I missed out on – being able to run around with other kids. It didn’t stop me from having fun, but it would make me very happy to help others enjoy that experience.

“The only reason I’m here today is because of the support of my parents,” he says. “I knew the road to recovery would be a long one, but I was up for the challenge. With my new flexibility, I can get into a car and just drive. I can lift my legs higher than before without pain. I bike a lot now. I can get upstairs easily using my forearm crutches. These may seem like small things but to me they’re giant steps toward a lifetime of in dependence.”

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