UpDate - Vol. 14, No. 14, Page 1
December 8, 1994
UD-A.I. duPont partners produce positive results

     Thanks to a partnership between the University of Delaware and
the A.I. duPont Institute, there is help for children with cerebral
palsy, a non-hereditary brain abnormality, and other mobility
problems.
     Teamwork between Jim Richards, associate professor of physical
education, whose expertise is biomechanics, and surgeon Freeman
Miller, co-director of the institute's cerebral palsy clinic and
University adjunct professor of physical education, has resulted in a
sophisticated, state-of-the-art Gait Lab, where children's walking
problems are analyzed to determine beforehand how surgery and other
procedures, such as bracing, can help them.
     The Gait Lab project began when a mutual friend, who felt
Richards' and Miller's professional interests dovetailed, introduced
the men to each other. A pediatric orthopedic surgeon, Miller had
visited gait labs throughout the United States and was interested in
establishing one at the institute. The University and Richards were
contracted to design a prototype at the University that could then be
duplicated at the A.I. duPont Institute.
     As a result, a University of Delaware Gait Lab, which also is
used for biomechanics research with athletes, was built in the Sports
Science Laboratory, adjacent to the skating arenas.
     Richards used the facility to develop the hardware and software
for the Gait Lab to collect, measure and display data about mobility.
Several children were tested there.
     "The idea was to experiment, refine the procedures, get all the
bugs out of the system and then duplicate the Gait Lab at A.I.,"
Richards said.
     The plan came to fruition, and the new lab was opened last
January. To date, more than 230 children have been examined at the
facility.
     A typical session took place recently when Billi-Rae Richmond of
Clayton, Del. was tested at the Gait Lab. After being seen by the
physical therapist, the smiling, cherubic 4-year-old, dressed in a
bright bathing suit, entered the lab using her walker, accompanied by
family members. Holding onto her father's and physical therapist's
hands, she walked over an instrument that records foot
impressions-where pressure is put, the angles of the feet, whether
they are flat or high-arched and other pertinent information that is
analyzed by a computer.
     Then, the therapist attached electrodes to Billi-Rae for an
electromyograph, reassuring her about what she was doing. "Have you
ever heard of Power Rangers? Well, that's what you're going to be. I
bet you wish you had this for Halloween," she said.
     A power pack was then placed on Billi-Rae's back. "Don't try to
fly," the therapist gently teased.
     The electromyograph is similar to an electrocardiogram, in which
electrodes are placed on the body to determine heart function, Miller
said. In the Gait Lab, the electrodes trace muscle function-how
various sets of arm and leg muscles contract and relax, all presented
in a visual record with a coded print-out, similar to an
electrocardiogram.
     Next, highly reflective gray balls were placed on different parts
of Billi-Rae's body. These are picked up as lights on cameras
positioned around the lab, and the images are fed into the computer
that plots them as three-dimensional stick figures that can be moved
to view a child's path of motion from all perspectives.
     After she was wired to walk, with encouragement from her father
and the therapist, Billi-Rae moved down the runway with her walker as
six cameras recorded her movements, highlighted by the reflective
balls as the electrodes recorded her muscle function.
     Meanwhile, the third member of the Gait Lab team, Pat Castagno,
Delaware '88, '92M, who worked on the project at the University,
monitored the computer console where the results are recorded and
tabulated, occasionally leaving his station to make adjustments of the
apparatus on Billi-Rae.
     Later, Miller, Castagno and Gait Lab physical therapist Nancy
Lennon will discuss and analyze the findings and make a decision about
the kinds of surgery and treatment that are required.
     Children with cerebral palsy have a repetitive walking cycle,
each step is like the other, Richards said. Bone alignment may be off,
and some children's muscles are spastic or active all the time or at
the wrong time, he said. These children expend a great amount of
energy to walk a short distance, Richards explained.
     "We cannot change the messages from the brain for children with
neuromuscular disorders," Miller said, "but, we can improve their
walking by realigning limbs, reattaching muscles or in some cases
cutting some of the nerves along the spine so that the body reacts
differently to those messages."
     "In the lab, we predict how a child's gait will be changed by
surgery. Follow-ups after surgery indicate we are on the right track
in our evaluations. By using computerized information and software
that we have developed, we are able to help children who have cerebral
palsy or have had an injury become more mobile," Richards said.
     A before- and after-video of a young boy bears testimony to the
work of the team. In the "before" scene, the child's knees and feet
turn in, he places his toes down first as he walks and his knees are
stiff. In the "after" scene, his feet are flat on the ground as he
walks, his knees are more flexible and he points in less. In general,
he moves with greater ease.
     Richards said applying his sports biomechanics and computer
expertise to working with children with neurological disorders is as
satisfying as working with athletes over the years to improve their
performance and to avoid injuries. He has worked with the United State
Olympic luge and bobsled teams, the Philadelphia Phillies, Cincinnati
Reds and with University figure skaters among others.
     "The kids with cerebral palsy are tough with an attitude of 'I'm
fine. What's wrong with you?' and being involved in improving their
lives is rewarding to me," Richards said.
                                                   -Sue Swyers Moncure