A Program to Measure Walking Activity pre & post Surgery in Youth with Cerebral Palsy
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1 A Program to Measure Walking Activity pre & post Surgery in Youth with Cerebral Palsy Presenters: Julieanne Sees, DO and Nancy Lennon, MS, PT The Nemours A.I. dupont Hospital for Children, Wilmington, DE contact: PURPOSE Describe a clinical program to measure mobility performance in youth with cerebral palsy Learning Objectives 1. Gain an understanding of typical walking activity (WA) levels in children and youth with cerebral palsy 2. Describe differences in WA for youth with CP by age groups, disability levels, and pre / post surgery. 3. Develop knowledge-based skills in methods to measure and interpret (WA) for children and youth with cerebral palsy. BACKGROUND o Program Rationale o Outcomes of Gait Surgery o Physical Activity and Health o Device Selection o Dimensions of physical activity PROGRAM DEVELOPMENT o Devive Performance o Data accuracy, reliability, and validity o Feasibility and durability o Measurement Protocol o Settings o Timing KNOWLEDGE BASE o Literature Reports o Walking Activity in Children and Youth with CP o Laboratory Specific Data
2 CLINICAL APPLICATION o Clinical Cases o long term outcomes of walking performance o short term patterns of losses / gains o recovery insights o therapy implications o surgical planning considerations o family education and motivation PROGRAM STATUS o Overview of one & two-year outcomes o Future Directions QUESTIONS / DISCUSSION Additional Handouts: Calibration Form Family Instructions / Home Log Sample Results Letter & Data
3 Step Watch Data Sheet Name: Date: MRN: Height (inches): GMFCS: Serial #: Quick Step Walk Speed Speed Range Leg Motion YES Slow Rarely Varies Geriatric NO Normal Moderate Normal Fast Both Extremes Severely Impaired Fidgety/Dynamic Cadence: # Observed Steps: Accuracy: Sensitivity: # Measured Steps:
4 STEPWATCH INSTRUCTIONS Please wear the Step Watch tomorrow and keep it on everyday through the end of the day on. How to Wear the Step Watch Wear the Step Watch ALL DAY (except when swimming or bathing). o Take it off before going to bed. Please do not put it in the dryer if it gets wet. The Step Watch is worn just above your RIGHT ankle, on the side of your calf. o Wear the device face up as shown. o It needs to stay on the SIDE of your leg and should not slip around. o Wear over bare skin, socks, or an AFO, but not over pants. Additional Daily Requirement Please answer the questions on the back of this sheet daily. How to Return the Step Watch After the 8 days are up on, (don t wear it that day) Please put the Step Watch and the completed Question Sheet into the small bubble envelop (this will protect the Step Watch during shipping) Put the small bubble envelope into the pre-addressed FedEx mailing envelope. Deposit the FedEx mailing envelop in a FedEx pickup box or location. Gait Lab Follow-Up We will be in contact with you throughout the next 2 weeks. Thank you again for participating. Please call if you have any questions.
5 Example Day 1 Day 2 I put the StepWatch on at: 8:00am I took the StepWatch off at: 10:00pm Comments: I forgot to put on the StepWatch when I first got up at 7:00am I put the StepWatch on at: I took the StepWatch off at: Comments: I put the StepWatch on at: I took the StepWatch off at: Comments: Day 3 Day 4 Day 5 I put the StepWatch on at: I put the StepWatch on at: I put the StepWatch on at: I took the StepWatch off at: I took the StepWatch off at: I took the StepWatch off at: Comments: Comments: Comments: Day 6 Day 7 Day 8 I put the StepWatch on at: I put the StepWatch on at: I put the StepWatch on at: I took the StepWatch off at: I took the StepWatch off at: I took the StepWatch off at: Comments: Comments: Comments: Comments: ere you sick during the last week? Any special activities/events?
6 To The Parents / Guardians of, Enclosed are the results of your child s recent assessment of walking activity. Thank-you for your cooperation in having your child wear the Step Watch monitor. The results have been reviewed by the physician in the Gait Lab and have been added to your child s medical record. The first page shows your child s walking activity data from this recent episode. The top bar graph shows the number of strides for each day. The black horizontal line provides a comparison to other children with CP whose condition is similar. The three graphs below show how many strides taken at low intensity (< 15 steps/min), medium intensity (15 40 steps/min), and high intensity (> 40 steps/min). The comparison lines on these three graphs are to typically developing children of similar age. The second page shows summarized data from each Step Watch monitoring episode. We use these graphs to evaluate how the child is recovering from surgery. The box on the left side lists the dates that go along with each bar in the graph. The surgeons would like to monitor walking activity using the Step Watch for 24 months post-surgery. The span from one to two years after surgery is when we expect the child to exhibit the highest walking totals. Every child is different though and having data to evaluate recovery will help the surgeons and therapists direct rehabilitation efforts to reach the best outcome. The surgeon who referred you to the Gait Lab can discuss this with you in more detail. Thank-you again for your cooperation in completing this testing, Sincerely yours, Kristen Nicholson, PhD Nancy Lennon, M.S., P.T. Biomechanical Research Engineer, Physical Therapist, Gait Lab Gait Lab & CP Program (302) nlennon@nemours.org (302)
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