NEW YORK, N.Y.—July 2, 2007
As is the case with more than 500,000 Americans with this crippling disorder, Anthony was left with few options and his family turned to Hospital for Special Surgery with the hope of finding answers to effectively address his condition.
They were introduced to David M. Scher, M.D., a pediatric orthopedic surgeon at Special Surgery, who also serves as co-medical director of the Leon Root, M.D. Motion Analysis Laboratory at the hospital. Dr. Scher believed that motion analysis could be used as an additional imaging tool to figure out the best approach to surgery to prevent Anthony from losing his ability to walk.
"We evaluated Anthony's functional limitations during walking, a process known as gait analysis," said Dr. Scher. "We discovered Anthony had severe deformities, specifically in his knee that prevented his ability to walk and the analysis allowed our team to quantify some of the problems with his gait that we saw qualitatively."
Dr. Scher values motion analysis as both a diagnostic as well as a monitoring tool since it allows clinicians to objectively measure the gains that are achieved following proper medical or surgical intervention.
With the help of gait analysis, Dr. Scher determined which surgical approach was the best option. The surgery entailed cutting the end of the thigh bones to straighten the legs and moving the patellar tendon further down the leg to give it more leverage. Next, Dr. Scher cut the right heel bone to move it in line with his leg and fused a deformed joint in the foot at the bottom of the big toe that prevented Anthony from being able to push off with each step.
Now 16, Anthony's ability to walk efficiently has been restored. What's more, Anthony can expect that he will maintain the ability to walk and remain mobile and productive throughout his lifetime.
"The central theme of the lab is to study the relationships between lower and upper extremity
structure and function," said Howard Hillstrom, Ph.D., director of the Leon Root, M.D., Motion Analysis Laboratory. "We believe that the key to understanding many of the biomechanically related diseases and injury mechanisms is identifying those relationships."
"Think of motion analysis as having 15 pairs of eyes focused on a moving body part," said Dr. Scher. "Motion analysis imaging shows all three planes - front, side and top down all at once. While other imaging options can show these views one by one, they can't show them simultaneously and in motion."
In addition to seeing how the different parts of the body are moving simultaneously, we are able to monitor how and when the muscles turn on and off during the act of walking. This all translates into a thorough understanding of how we can properly and accurately treat a patient who suffers from mobility issues, Dr. Scher noted.
By focusing on the trunk, pelvis, hips, knees and ankles, digital video cameras take images of a patient's movement and process the data through a high-tech computer system that analyzes the movement and reveals precisely where muscles and joints are and are not functioning properly.
One design feature of the Leon Root, M.D. Motion Analysis lab is the mechanical isolation of the data collection zone. The laboratory floor is completely detached from the structure of the building it resides in, explained Dr. Hillstrom. Constructing the floor in this fashion was purposefully done to ensure that measurements during motion analysis had a negligible error due to vibrations that occur in most buildings. The use of high resolution digital video cameras also helps obtain a highly accurate description of each patient's movement patterns for both clinical and research applications. The air-bearing assemblies beneath each force plate allow them to be adjustably repositioned, further adding to the versatility of the lab. From the gait of a toddler to a seven-foot basketball player, a wide range of neuromusculoskeletal activities may be studied.
The lab plays a critical role in the care of young patients with conditions such as cerebral palsy and spina bifida, and adult patients with neurological diseases and stroke. Tests may be performed to evaluate a patient's functional limitations when performing purposeful movements, such as walking. Analysis of a patient's structure and alignment enables staff to better understand the cause of impaired movement and determine an effective treatment.
The research goals of the lab, according to Dr. Hillstrom, include developing methods of tracking upper extremity motions; studying the effect of foot orthotics in patients with knee osteoarthritis; examining the influence of shoe design on feet; and identifying improved methods of evaluating cerebral palsy.
Further, Frank Cordasco, M.D., co-medical director of the Motion Analysis Laboratory, leads an effort with Hospital for Special Surgery's nationally recognized Sports Medicine and Shoulder Service to use motion analysis technology to determine the mechanics behind sports medicine injuries. They will also study movements of weekend and professional athletes to boost performance and correct physical habits that impede their ability to succeed.
One obstacle in using motion analysis as a diagnostic tool, cautioned Dr. Scher, is insurance, as many carriers do not cover this technique. "The onus is on us to prove its importance and to advocate for our patients by insisting that this tool enhances our ability to provide optimal care," said Dr. Scher.
"The Leon Root Motion Analysis Laboratory is a center of excellence that is doing important research and clinical work for the betterment of patients who have musculoskeletal disorders," concluded Dr. Scher. "The applications for motion analysis as a tool to identify problems and provide accurate treatment are limitless and we encourage colleagues within and outside of Hospital for Special Surgery to use us as a resource in helping all patients achieve proper mobility."
About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the eighth consecutive year) and No. 3 in rheumatology by U.S. News & World Report (2017-2018). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.