gait analysis and single event multi level surgery the melbourne experience n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Gait analysis and Single-event Multi-level surgery The Melbourne Experience PowerPoint Presentation
Download Presentation
Gait analysis and Single-event Multi-level surgery The Melbourne Experience

Loading in 2 Seconds...

play fullscreen
1 / 55

Gait analysis and Single-event Multi-level surgery The Melbourne Experience - PowerPoint PPT Presentation


  • 129 Views
  • Uploaded on

Gait analysis and Single-event Multi-level surgery The Melbourne Experience. Richard Baker Professor of Clinical Gait Analysis. Clinical scientist. Member of IPEM Registered with HPC. Me!. MA Physics and Theoretical Physics PhD Biomechanical Engineering

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Gait analysis and Single-event Multi-level surgery The Melbourne Experience' - olympe


Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
gait analysis and single event multi level surgery the melbourne experience

Gait analysis and Single-event Multi-level surgeryThe Melbourne Experience

Richard Baker

Professor of Clinical Gait Analysis

clinical scientist
Clinical scientist
  • Member of IPEM
  • Registered with HPC
slide3
Me!
  • MA Physics and Theoretical Physics
  • PhD Biomechanical Engineering
  • 7 years Gait Analysis Service Manager Musgrave Park Hospital, Belfast
  • 9 years Gait Analysis Service Manager Royal Children’s Hospital, Melbourne
population
Population

Victoria 5.5 million

Melbourne 4.1 million

(Greater Manchester 2.6 million)

120 new cases of CP annually

optimising gross motor function for children with cp1
Optimising gross motor function for children with CP
  • GMFCS (Gross motor classification system)
  • Age
  • Unit/bilateral involvement
  • Motor type
  • (CP like conditions)
slide10

Level I

Level II

Level III

GMFCS

Level IV

Level V

Palisano et al. DMCN 1997

Revised and extended Palisano et al. DMCN 2008

impairments and age
Impairments and age

Muscle Contracture

Joint contracture

Bony deformity

Spasticity

Weakness

Botox

ITB

SDR

Exercise?

Strenghtening?

Diet?

SEMLS

Physiotherapy and orthoses

semls
SEMLS
  • Minimum of one procedure at two levels (hip/knee/ankle) on both sides
typical semls
Typical SEMLS
  • Psoas recession
  • Femoral derotationosteotomy
  • Semitendinosus transfer
  • Gastrocnemius recession
  • Calcaneal lengthening
semls who for
SEMLS – who for
  • GMFCS I rare (too good)
  • GMFCS II
  • GMFCS III
  • GMFCS IV rare (too bad)
  • GMFCS V never
semls why
SEMLS – Why?

ICF WHO 2001

semls why1
SEMLS – Why?
  • Improve gross motor function (not just walking)
  • Prevent deterioration
  • Increase activity and participation?
  • Improve quality of life?
semls when
SEMLS – When?
  • After
    • maturation of gross motor performance
    • consolidation of skeleton (particularly feet)
  • Before
    • increased education demands
    • grumpy adolescence
pre operative processes
Pre-operative Processes
  • Spasticity management in early childhood
  • Surgeon decides surgery is required (8-10 years old)
  • Pre-op gait analysis to determine nature of surgery
pre admission clinic
Pre-admission clinic
  • Admitted as “day case”
  • Child and family get to meet ward staff
  • Equipment arranged(orthoses, walking aids, other OT)
  • Rehabilitation discussed
  • Consultation with community physio
in patient
In-patient

In-patient

  • 7 days
  • No rehab
  • Appropriate lying
0 3 months
0-3 months

Restricted mobility and therapy

  • Non weight-bearing 3 weeks
  • Cast change at 3 weeks
  • Orthoses delivered 6 weeks.
  • 6-12 weeks back on feet with Solid AFOs walking with frame or crutches
  • 12 weeks: 1st post-op video session
3 6 months
3-6 months

Intensive therapy

  • Community based (home/school)
  • Move off frame/crutches
  • Extending walking distances
  • Maintain knee extension
  • 6 months: 2nd post-op video
6 12 months
6-12 months

Routine therapy

  • Community based (home/school)
  • Maintain progress
  • Move off crutches/sticks
  • Move to hinged orthoses?
  • 9 months: 3rd post-op video session
  • 12 months: post-op gait analysis (outcome assessment)
12 24 months
12-24 months
  • Optimum function will not generally be achieved until into the second year.
video sessions
Video sessions
  • Standardised video recording and simplified clinical exam.
  • Review by specialist physiotherapist in person and surgeons by video.
  • Review progress (walking aids and orthoses)
  • Ensure knee extension.
pip fund

INTERVENTION

HOURS PROVIDED

Botox – calves only

6 hours

Botox – multilevel

12 hours

Single level surgery – hemiplegia

6 hours

Single level surgery – diplegia

12 hours

Two level surgery – hemiplegia

12 hours

Two level surgery – diplegia

18 hours

Non-ambulant – hip surgery

12 hours

SEMLS – hemiplegia (bony and soft)

30 hours

SEMLS – diplegia (bony and soft)

70 hours

PIP fund
gait analysis
Gait analysis
  • To identify impairments
  • Basis for planning surgery
  • Outcome assessment
impairment focussed assessment
Impairment focussed assessment
  • Aims to identify impairments
  • Clearly link this to evidence from:
    • Instrumented gait analysis
    • Physical examination
rct of semls
RCT of SEMLs

Thomason et al. JBJR-Am 2011

participants
Participants
  • 6-12 years old, GMFCS II or III
  • 11 in SEMLS group
  • 8 in control group
audit of semls
Audit of SEMLs

Rutz et al. ESMAC 2011

participants1
Participants
  • All patients having SEMLS 1995-2008
  • 121 patients GMFCS II and III
  • 48 girls, 73 boys
  • Age 10.7+/- 2.7
gmfcs
GMFCS
  • 113 (93%) no change in GMFCS
  • 6 children from GMFCS III to II
  • 2 children from GMFCS II to I
  • No child deteriorated by GMFCS level
  • Children who improved were either marginal or had evidence of earlier deterioration
predictors of gps change
Predictors of GPS change
  • Age at surgery
  • GMFCS
  • GPS pre-op
  • No. of procedures
  • Adverse events
  • Private health insurance
  • Previous surgery
slide52
MAP

N = 47

slide53
MAP

N = 28

summary
Summary
  • SEMLS does not change GMFCS status (but might restore it)
  • It can help improve walking (GPS) and more general gross motor functions (GMFM)
summary1
Summary
  • Evidence of mild deterioration over 12 months in absence of intervention
  • Optimal outcomes at 2 years, maintained for ten years
  • More involved children appear to have more to gain