3D gait analysis could help avoid need for surgery

Up to now, 3D assessments were conducted at the Central Remedial Clinic in Dublin where there are long waiting lists, according to Enable Ireland physiotherapist Gillian O’Dwyer.

Sending kids to Dublin gave rise to “legitimate concerns about making life-changing surgical decisions based on data obtained from children with spasticity problems who had just spent five or six hours in a car or ambulance”, Enable Ireland said.

“Up to now, we have been providing 2D gait analysis which is very limited,” Ms O’Dwyer said. The 3D version allows a more in-depth look at the muscles, allowing accurate pin-pointing of muscles that would benefit from botox injections to tackle spasticity, which may eliminate the need for complex surgical interventions, including bone realignment.

Enable Ireland, which has made a pitch for long-term funding for the service to the HSE, estimates it will cost €1,300 per child.

Each child would require two to four gait analysis assessments between one and three times during their childhood up to circa age 18.

Enable Ireland says it has 125 potential candidates among children with cerebral palsy and another 25 with musculoskeletal disorders from the Cork and Kerry region. They include children with disabilities at risk of scoliosis or other neuromuscular impairments.

Separately, Enable Ireland will use its third international conference on paediatric spasticity, orthopaedic, and postural management to call for the implementation of a national spinal/hip surveillance protocol database for children with disabilities.

Ms O’Dwyer said spinal surveillance would ensure referral “at early stages of scoliosis” and hip surveillance would prevent hip dislocation and also prevent contractures in children with cerebral palsy and similar conditions.

“To ensure that children get the right service, at the right time, we need to have a national cerebral palsy database,” she said.

Cost estimates are €6,000 for year one and €3,000 per annum subsequently.

“We need to do this to decrease the number of children with physical and neurodisability getting into the red zone where spinal rods for spinal surgeries is too late and hip dislocation is not reversible.”

Orthopaedic surgeon Pat Kiely from Our Lady’s Children’s Hospital in Crumlin is backing the call for a database.

The conference gets under way in the Rochestown Park Hotel tomorrow.

‘We thought he would have to have his legs broken’

“We were building ourselves up for a big job. We thought he would have to have his legs broken and reset. You can imagine how we felt about that,” Ger Cunningham says of his young son David Swords Cunningham, who has cerebral palsy.

The launch in Cork of a highly specialised 3D gait-analysis service, whereby sophisticated motion- analysis software provides a “snapshot in time” of an individual’s walking pattern, has obviated any immediate need for surgery for the 11-year-old.

Prior to the event of the 3D system in Cork, David and his parents were psyching themselves up for complex orthopaedic service because it was thought his bones were the problem. However, the new service showed the difficulties were muscle-related.

“The 3D system pinpointed exactly what muscles were not working for David and now he can go and get Botox for those specific muscle groups,” explained Ger.

“If he’d had to go for surgery, we were looking at possibly 16-18 weeks in a wheelchair. Instead, he should walk out of hospital within a day or two.”

Two previous sets of Botox injections followed 2D scans, which did not have the same degree of precision.

“It was a bit of a guessing game as to what muscles the Botox should go to,” said Ger.

The 3D scan identifies precisely the muscle groups causing the issues. In David’s case, Botox injections will loosen the muscles and this will be followed by intensive physiotherapy with the Enable Ireland team in Cork.

Enhanced results are expected and his recovery time will be reduced to one third of a “bone” recovery time.

This is good news for a boy who was initially upset when his parents told him he would not need surgery because he thought it would mean his legs would not get fixed. Now that he’s reaping the benefits, he’s delighted. His main passion in life is playing soccer and he recently got to meet one of his heroes, West Ham goalkeeper Adrián, at London Stadium.

“Over the years we’ve been offered a wheelchair when he got bad, but even when we took it, he wouldn’t get into it. He’s determined to be independent and that makes it easier. All he wants to do is play soccer,” said Ger.

Prof Ger Kelly, head of mechanical biomedical and manufacturing engineering at Cork Institute of Technology, where the gait-analysis laboratory is located, said they were “delighted” to be able to collaborate with Enable Ireland and contribute to the provision of an integrated orthopaedic service for children in Cork and Kerry.