A Gillette Center of Excellence. Center for Gait and Motion Analysis. at Gillette Children s Specialty Healthcare

Transcription

1 A Gillette Center of Excellence Center for Gait and Motion Analysis at Gillette Children s Specialty Healthcare

2 Centers of Excellence at Gillette Children s Specialty Healthcare Treating people who have disabilities and complex medical conditions requires a team approach. At Gillette Children s Specialty Healthcare, our doctors, surgeons, nurses, therapists, orthotists, psychologists, social workers and other specialists work together to care for patients. Throughout our centers of excellence, we offer leading-edge medical treatments tailored to the unique needs of each patient. Gillette s centers of excellence: Center for Cerebral Palsy Center for Craniofacial Services Center for Gait and Motion Analysis Center for Pediatric Neurosciences Center for Pediatric Orthopaedics Center for Pediatric Rehabilitation Center for Pediatric Rheumatology Center for Spina Bifida

3 A Gillette Center of Excellence Center for Gait and Motion Analysis When our Center for Gait and Motion Analysis opened in 1987, it was the only one of its kind in the Upper Midwest. Our doctors were among the first in the world to use motion analysis in treating children with walking and movement problems. Today, we operate the busiest clinical motion analysis center in the nation, performing more than 600 examinations each year. We offer state-of-the-art technology and a highly trained staff committed to ongoing training, research and excellence in clinical care. We strive to help our patients achieve greater levels of mobility and independence. 3

4 Our Team Approach When a child is diagnosed with a complex medical condition, families face a world of new people, terms and responsibilities. That s why Gillette s team of specialists works together. We coordinate patient care so families can focus on what they know best: their kids. At Gillette s Center for Gait and Motion Analysis, our team includes technicians, engineers, physical therapists and orthopaedic surgeons who are experts in the study of human movement. Using advanced computer technology, we analyze how muscles, joints and nerves work together to make movement possible. Using motion analysis, our team helps physicians select the most effective treatments for walking and movement problems. Surgeons, therapists and other specialists then develop treatment plans based on the unique needs of each patient. Working together, we strive to maximize each patient s physical abilities. Our team includes technicians, engineers, physical therapists, orthopaedic surgeons and other support staff. Working together, we help doctors choose the most effective treatments for walking and movement problems. 4

5 Roy Wervey, engineer, explains motion-analysis data to Jack and his mother. You ll meet Jack and learn about his motion-analysis test in the following pages. We call our approach family-centered care because we believe that children and teens do best when families are at the center of the team. To help families become informed and involved, we thoroughly explain the process of motion analysis and its effect on treatment outcomes with each family. 5

6 Our Patients Motion analysis measures movement patterns in people who have complex conditions involving the muscles, joints, nerves and bones. We see people who have: Amputations Arthritis Brain injuries Cerebral palsy Conditions that cause toe-walking Legs of different lengths Misaligned bones and foot abnormalities Movement problems of the arms and hands Spina bifida Other neurological or orthopaedic conditions Motion Analysis for Upper Extremities Although health-care professionals use motion analysis primarily to understand walking problems, the technology also can measure movement of the arms and hands. Doctors and therapists use the data to recommend treatments that improve abilities. Caring for Adults We also evaluate teens and adults. Some are having motion analysis for the first time because, as they ve grown older, their conditions have begun causing pain and stiffness. Others have experienced difficulties since childhood and need ongoing evaluations and treatment. All of our patients receive health care tailored to their individual needs. 6

7 Motion Analysis Using innovative computer technology, motion analysis captures movements, muscle activity and forces that the eye can t see. Although some people have similar walking patterns, the way their muscles and joints work together can be very different. Motion analysis helps a patient s care team accurately identify problems specific to each patient. Information from motion analysis together with imaging scans, the patient s medical history and the results of other evaluations helps a patient s care team recommend the best treatments for abnormal movement. Options include braces, medication, physical therapy and surgery. During motion analysis, several cameras capture the movement of sensors attached to the patient s body. A special computer combines those images and constructs an animated, three-dimensional representation of the patient s walking pattern. 7

8 How It Works A physical therapist and a technician or engineer conduct motion analysis tests in a room equipped with advanced video, computer and monitoring equipment. A typical visit takes 21/2tothreehours. Jack s Visit Before testing a patient like Jack, a physical therapist explains how motion analysis works. Testing usually involves several steps. 1. Videotaping Jack walks across the room while being videotaped from many angles. 2. Plantar Pressure Testing Jack walks across a mat that senses the pattern and distribution of pressure under his feet. 3. Physical Exam Using special tools, the therapist assesses Jack s strength, range of motion, and levels of spasticity and muscle control. 4. Attaching the Equipment The therapist applies reflectors to help special cameras measure Jack s specific movements. The therapist also tapes sensors to Jack s muscles. They record when various muscles are active and at rest. Meet Jack! Jack wears a special backpack that collects information from the sensors. Like many patients who undergo motion analysis at Gillette, Jack has cerebral palsy a condition that can cause stiff (spastic) muscles that restrict arm and leg movement. Jack agreed to help us explain the steps of motion analysis. 8

9 Rocio Riveros-Charry, physical therapist, assesses Jack s range of motion. Patients like Jack have plantar-pressure testing before and after treatment to detect any changes in the pattern and distribution of pressure under their feet. Although patients can wear shirts during motion analysis, boys sometimes don t. Phala Hoeun, physical therapy aide, assists Riveros-Charry with attaching reflectors and sensors to Jack s body. 9

10 Some patients use braces, walkers or crutches during motion analysis. 4. Motion Analysis Wearing the reflectors, sensors and backpack, Jack walks across the motion analysis testing room. Special instrumentation, built into the floor, measures the forces produced by his muscles at the joints. Several cameras track the movements of the reflectors. 5. Oxygen Consumption Test After the therapist removes the reflectors, sensors and backpack, Jack wears a mask over his nose and mouth. The mask measures the amount of oxygen Jack inhales and carbon dioxide he exhales. This test helps his doctors understand how much energy Jack uses when walking. Riveros-Charry adjusts Jack s reflectors before his motion analysis. Wervey monitors and records motionanalysis information at the computer. Jack wears a special mask that helps to measure his oxygen consumption. As Jack walks, Wervey follows with a computer that collects the information. 10

11 6. Analyzing the Data The engineer processes the data and creates a series of graphs showing Jack s movements, muscle activity, force production and energy use. The therapist and an orthopaedic surgeon compare the data from Jack s motion analysis and physical exam to typical walking patterns. After reviewing the data, the therapist and the surgeon generate a list of problems and potential treatments. They give this information to Jack s specialty physician, who will discuss it with Jack and his family on their next visit. Riveros-Charry reviews Jack s motion-analysis data with Tom Novacheck, M.D., orthopaedic surgeon. 7. Follow-up Evaluation After surgery, physical therapy or a change in medication, we often bring patients back to the Center for Gait and Motion Analysis for follow-up testing. Repeated analyses help us determine whether patients have improved after treatment. We can then decide what additional treatments if any would be beneficial. Degrees Left Side Right Side Control Group Gait Comparison Gait Cycle This graph compares the movement of Jack s right and left knees with that of people who have typical walking patterns (the control group). 11

12 Case Study Andrew, 6, has the spastic quadriplegia form of cerebral palsy, which affects both arms and legs. When he underwent an evaluation at the Center for Gait and Motion Analysis, we found significant spasticity. We first recommended orthopaedic surgery to correct bone deformities and to lengthen and transfer muscles, tendons and other soft tissues. To help with rehabilitation, we recommended botulinum toxin injections to temporarily ease spasticity in his hamstrings. Motion analysis conducted seven months after surgery confirmed our previous finding of significant spasticity and indicated that Andrew would benefit from selective dorsal rhizotomy surgery. During that procedure, neurosurgeons guided by intraoperative nerve monitoring cut selected nerve rootlets to ease muscle spasticity in the legs. One year after his rhizotomy surgery, motion analysis showed that proper bone alignment and reduced spasticity had made a marked improvement in his gait. In addition, oxygen consumption testing showed that his energy expenditure had decreased in other words, he tired less easily when walking. His parents report that they are extremely satisfied with the results of his surgeries. His mother notes, He can walk much better, and he has more strength and endurance. Before treatment, Andrew walked in a crouch position, with his right foot and knee rotated inward. After treatment, the boy s gait improved dramatically. He is more upright, and his bones are properly aligned. 12

13 Research Gillette has conducted the most comprehensive study ever of motion analysis and its role in determining treatments for children with cerebral palsy. We studied the walking patterns of 135 patients with cerebral palsy. We also surveyed families to find out how well participants were doing on 22 functional skills, including walking and climbing stairs. Our goal was to find out whether surgery guided by presurgical motion analysis helps patients gain or maintain abilities. Results showed that 93 percent of the participants who were treated with rhizotomy and orthopaedic surgery improved or maintained their skills, mobility, quality of movement, and efficiency. Without treatment, walking difficulties tend to worsen in people who have cerebral palsy. Therefore, no change typically indicates an improvement over the natural course of the condition. Even in those whose conditions worsened, the magnitude of change was small when compared to the significant improvement most patients experienced. In addition, study participants decreased their energy expenditure by an average of 30 percent after treatment. That enables them to be more physically active without tiring. These results indicate that surgical intervention when guided by preoperative motion analysis is safe and successful in a majority of children who have cerebral palsy. 79% Improved Following Treatment 14% Maintained Abilities Following Treatment 7% Worsened Following Treatment Overall Patient Outcomes 13

14 Information & Referrals For more information about Gillette s Center for Gait and Motion Analysis, call or (toll-free). To refer a patient, call Gillette s Center for Gait and Motion Analysis is located on our St. Paul campus, at the intersection of Jackson Street and University Avenue in St. Paul, Minn. For a detailed map and directions, visit our Web site at LEARN MORE! For more information about motion analysis, visit our Web site at 14

15 Our Mission Gillette meets the special health-care needs of people primarily children and teens who have disabilities. Our mission is to help those we serve realize greater well-being, independence and enjoyment in life. We combine medical, nursing, therapeutic, technical, psychosocial and other expertise in family-centered programs. We provide services at our clinics, in our hospital and throughout the region, in response to community needs and often in collaboration with other organizations. We seek to build community partnerships that help continue our mission and enhance care for people who have disabilities.

16 St. Paul (Main) Campus 200 University Ave, E. St. Paul, MN (toll-free) Burnsville Clinic 305 E. Nicollet Blvd. Burnsville, MN (toll-free) Duluth Clinic Lakewalk Center 1420 London Rd. Duluth, MN (toll-free) Maple Grove Clinic 9550 Upland Ln. N. Maple Grove, MN (toll-free) Minnetonka Clinic 6060 Clearwater Dr. Minnetonka, MN (toll-free) Mobile Outreach Clinic For locations and schedules: (toll-free) St. Paul Phalen Clinic 435 Phalen Blvd. St. Paul, MN (toll-free) Copyright 2008, Gillette Children s Specialty Healthcare. All rights reserved.