Motion-Driven Care for Cerebral Palsy Patients
When Leon Root, MD, became the first Chief of Pediatric Orthopaedic Surgery at HSS in 1970, cerebral palsy was one of the most challenging and neglected musculoskeletal conditions affecting children nationwide. Dr. Root changed that, setting standards of care, initiating innovative research to evaluate novel therapies and pioneering surgical techniques that would improve mobility and enhance function for people with CP.
“Today optimal treatment for individuals with cerebral palsy often involves a combination of surgical and nonsurgical care, and the right treatment at the appropriate time is critical,” says David M. Scher, MD, a pediatric orthopaedic surgeon at HSS. “Major advances in the evaluation of patients and our understanding of treatment outcomes have led to dramatic advancements in patient care.”
Dr. Scher and his colleague Emily R. Dodwell, MD, MPH, commonly perform multilevel surgery targeting the musculoskeletal system at two or more levels. Osteotomies, tendon transfers and similar procedures address multiple levels of musculoskeletal pathology in the lower limbs. Surgery may be performed on the hips, knees, ankles and feet simultaneously. By working as a team, surgeons at HSS are able to safely perform multiple procedures for a child in one day, under one anesthetic.
Major advances in the evaluation of patients and our understanding of treatment outcomes have led to dramatic advancements in patient care.
“Historically, children would be in and out of the hospital multiple times over many years,” Dr. Dodwell explains. “Now we operate together to decrease the number of hospitalizations and optimize the recovery process.”
Gait testing at the Leon Root, MD, Motion Analysis Lab at HSS provides critical information prior to surgery. “Gait analysis allows us to see the movements of all the joints in the trunk, pelvis and lower extremities in all three planes of motion,” Dr. Scher explains. “Digital motion capture technology enables us to identify abnormalities, or gait deviations, at every level, something that’s impossible to do with the naked eye while watching someone walk.”
“Gait analysis allows us to accurately measure our patients’ movements and apply grading and classification systems that help us track their outcomes,” Dr. Dodwell explains. “We repeat the gait analysis a year post-operatively to objectively demonstrate the improvements made.”
Digital motion capture technology enables us to identify abnormalities, or gait deviations, at every level, something that’s impossible to do with the naked eye.
“We collect and analyze movement data on individuals of all ages with cerebral palsy, as well as other orthopaedic, rheumatic or neurological diagnoses,” says Howard Hillstrom, PhD, Director of the lab, which is one of only 14 labs in the country accredited by the Commission for Motion Laboratory Accreditation. “We also conduct research and provide service and education to advance the field of musculoskeletal medicine.” As one of only two motion analysis labs in the tristate region, the HSS facility receives referrals from clinicians throughout the New York metro area.
Motion analysis can be a useful tool for nonsurgical patients as well, to help physicians and therapists develop a treatment plan. Dara Jones, MD, a pediatric physiatrist and the newest member of the team, focuses on those nonsurgical options, such as medication, bracing, equipment and walking aids.
“It’s a lifelong relationship with the patient that ideally starts in infancy,” she says. Spasticity is the most common condition she addresses. Treatment options include oral medications, physical therapy, stretching, injections of botulinum toxin, and baclofen delivered into the spinal canal.
It’s a lifelong relationship with the patient that ideally starts in infancy.
The strong spirit of collaboration among the team of CP specialists at Lerner Children’s Pavilion ensures a comprehensive approach. They include pediatric orthopaedic surgeons; a pediatric physiatrist; physical, occupational and speech therapists; orthotists; nurse practitioners; social workers; and a child life specialist.
Last year, in an effort to further optimize care for people with CP throughout the tristate region, Dr. Scher and Jennifer Jezequel, DPT, created the New York Cerebral Palsy Consortium, a network for professionals to share resources, discuss complex cases and acquire knowledge about best practices and advances in the field. To date, 60 clinicians have joined the group.
The consortium seeks to advance care for individuals of all ages, as people with CP need continuing care across the lifespan.
“A driving force for establishing the consortium was to break down some of the barriers that exist between institutions and work together to put the patient first,” says Dr. Jezequel, a clinical specialist in the HSS Department of Rehabilitation. “We envisioned it to function much like a local chapter of the American Academy of Cerebral Palsy and Developmental Medicine.”
“The consortium seeks to advance care for individuals of all ages, as people with CP need continuing care across the lifespan,” adds Sherry Backus, DPT, Clinical Lead, Department of Rehabilitation. “HSS is proud to be a leader in this endeavor.”