Melanie Cole (Host): Shriners Hospital for Children Chicago has an extensive cerebral palsy program comprised of a multidisciplinary team of specialists that offer a combined 75 years of expertise in caring for the child with mild to complex cases of cerebral palsy. My guest today is Nancy Scullion. She's a senior physical therapist and board-certified pediatric specialist at Shriners Hospital for Children Chicago. Welcome to the show. Tell us a little bit for the listeners what is cerebral palsy.

Nancy Scullion, PT, MPT, PCS (Guest): Cerebral palsy is an umbrella term that is often used to describe patients who have had a prenatal or perinatal anoxic event, which basically means that the brain was deprived for a brief period of time of oxygen and that results in movement disorders that we call cerebral palsy.

Melanie: How common is it?

Nancy: Cerebral palsy is one of the most common perinatal non-progressive neurological disorders that we see here at Shriners Hospital.

Melanie: Tell us about the specialty CP clinic that you have at Shriners Hospital.

Nancy: Our cerebral palsy clinic is comprised of an orthopedic surgeon, we also have a physical medicine and rehabilitation specialty physician that consults with us, we have physical therapists, occupational therapists, certified orthotists and a neurologist also on staff who can consult with us at the time we meet the patient for the first time.

Melanie: It’s a real multidisciplinary care. Tell us how everybody works together.

Nancy: We try to make it as patient-friendly as possible when we first meet a patient in our cerebral palsy clinic. We each take turns going in and meeting the family, speaking to the family about what their concerns are about their child. We also have child life specialists and recreational therapy specialists that are available to us if the child is feeling particularly anxious or not feeling comfortable. Everybody takes a turn getting to know the family, talking to the patient trying to figure out what their needs are, and then at the end of the session, we’ll all go in together and have a conference with the family to discuss our findings and to make some recommendations about the next course of treatment for the patient.

Melanie: Tell us a little bit about treatment and bracing and splints. Explain a little bit about how that works.

Nancy: There are many different types of treatments that we use here at the hospital for patients with cerebral palsy. Obviously, surgical intervention is one of the things that is often the issue that brings the family to see us initially. However, we do have lots of different treatment options to provide. Botulinum toxin, also known as Botox, is something that's a fairly conservative intervention that the physicians will use for spasticity treatment or improve range of motion in patients that have cerebral palsy. We have physical therapists who make recommendations and based on their evaluation will suggest different types of bracing also known as orthotics for patients to help with their walking patterns. Occupational therapists who can make recommendations about different types of upper extremity splints or hands splints that can be used during the day and also different kinds of splinting that we might recommend for the night time. That's to improve range of motion and to improve the function of the patient that has cerebral palsy.

Melanie: You mentioned bracing and splints. Where are these made? Can they be made directly there?

Nancy: Yes. On site here at Shriners Hospital Chicago, we do have a prosthetic and orthotic department that will measure patients here at the hospital and then they're fabricated off-site but they are sent and delivered here. The bonus to that in my opinion as a physical therapist is that I can consult directly with the orthotist about what kinds of bracing I think would benefit the child and at delivery we can look at the brace, we can analyze how the patient is using the brace and make different kinds of modifications right then and there to really improve the fit and function of the device.

Melanie: That’s absolutely fascinating and how cool that you can make them right there. Tell us a little bit about how the motion analysis center is involved in CP care.

Nancy: The motion analysis center is a laboratory here on site in the Chicago hospital that allows us to analyze patient movement patterns real-time so it allows us to use three-dimensional technology similar to what they use in green screen technology in movies and cartoons and things like that. It's a noninvasive procedure, we put reflective markets and EMGs and we have force plates that the patients walk across and our computer program is able to generate a model of the patient walking. Through that, we can analyze the different joints that are being affected by the patient's disease and we can then analyze the improvement that we would hope to see when the patient is walking with their orthotic device or any other type of assistive device. It really does allow us to see real-time information with respect to the conservative interventions that we’re implementing here at the hospital.

Melanie: Tell us about some of the exciting research being done at Shriners Hospital Chicago to provide the best care with CP.

Nancy: We are currently working on a study that will allow us to look at customized orthotic intervention, so those are braces that are developed for the particular patients and they are what we call tuned or modified right here on site to allow for the most optimal walking pattern that we can achieve in the motion lab. That’s one of the research areas that I'm very interested in, trying to optimize patient’s walking patterns with something as simple as an ankle-foot orthosis that has been customized for their particular involvement pattern. We also have a study that’s going on looking at patients who are now adults who have had different types of surgical interventions to their feet long ago but now we’re interested in looking at how they're doing now that they're adults. As we age, things change and so we’re looking at how these patients are doing now that they're in the adult world and doing different kinds of things and what they would have done when they were children. We’re also looking at the long-term results of patients who have had what we call single event multilevel surgeries, so multiple joints surgerized at one time, and we then are able to look at what they looked like walking in the motion lab before their surgery and then we look at them in a future point in time and we can analyze the differences and detect any change that may have been implemented through the surgical intervention. We're looking at two years out, five years out and we hope to look at 10 years out so we can have a better understanding of how patients move and function after their orthopedic surgery for years to come. We’re also looking at pre and post-operative spine surgical interventions, so in the motion analysis lab, we’re able to look at trunk movements and we’re looking at patients that have idiopathic scoliosis and we’re looking at their movement patterns before and after surgery to help guide our long-term follow-up programs so we can help patients prepare for what their bodies may be moving like when they have their surgical interventions.

Melanie: As a physical therapist, tell us a little bit about some of the rehab that’s involved whether they're using the pool or are they able to use treadmills or upper extremity training. Tell us a little bit about what goes on in rehab.

Nancy: Our rehab department has the benefit of a lot of wonderful rehabilitation devices. We have many robotic-assisted devices that can be used for rehabilitation purposes, so one of the devices we have is the ReWalk, which is an exoskeletal device that the patient is able to don and then practice walking in the device to help relearn different movement patterns. We also have something called the locomat, which is a more stationary but very similar device that the patient is placed in and then we’re able to walk the patients over treadmills to try to reestablish some of those movement patterns that may have been damaged with injury or through disease. We have an upper extremity robotic device also that the occupational therapists use a great deal with patients whose had upper extremity surgical interventions and also for patients with spinal cord injuries. We have an antigravity treadmill which allows us to progressively improve the patient’s walking pattern as they're able to control their limbs after surgical interventions and we do have a pool as well which is really great for the patients that have had their multilevel surgical interventions and are getting back to be able to weight bear or walk on their limbs again after several weeks, often months, of not being able to put weight through their limbs. We have lots of different fun activities and devices that we can use with the patients to help them rehabilitate following surgery or injury.

Melanie: Since you mentioned following surgery, what about your intensive rehab visits that are popular with CP families as far as speech therapy and occupational therapy? Is that all along the same lines?

Nancy: It is. Our intensive rehabilitation program allows patients to come and stay for many weeks at a time, somewhere between two and four weeks at a time to rehabilitate in our hospital environment. The nice thing about that is that patients can get several different disciplines for therapeutic interventions in a given weekday. Many patients will have occupational therapy, physical therapy and speech therapy on the same day working on their goals to improve their functional abilities either after injury or after surgery. It’s a really great program, but families are able to stay with the patients and learn their care and really understand what their children are going through in the rehab setting so they can carry it over at home when they return. It’s a great program and I'm really proud to be a part of it.

Melanie: That’s so cool. Wrap it up for us with information that you would like listeners to know about the CP clinic at Shriners Hospital for Children Chicago and just what you want them to know about how you're all working together there to provide the best care.

Nancy: I think that the nice thing about our hospital is that we do have a multidisciplinary approach to all of our clinics, but the CP clinic specifically allows us to really do wrap around care with our patients and really allows the families to feel that every option that we have available to them is being presented when they come to clinic. I think the nice thing about that is that if, for example, a physical therapist is not necessarily needed for a particular child but has some resources that they may be able to offer the family or referrals can be made very easily in the clinic to have the patient see another discipline or another type of physician within the hospital if we offer that service. It really is a nice setting in that we're able to really get to know the families and have the opportunities to speak to the patients and find out what exactly their goals are for themselves and also what the family goals are for them and how we can best facilitate that in a non-threatening, very family friendly environment.

Melanie: Thank you so much for coming on with us today and sharing your expertise and explaining about the cerebral palsy clinic at Shriners Hospital for Children Chicago. This is Pediatric Specialty Care Spotlight with Shriners Hospital for Children Chicago. For more information, please visit shrinerschicago.org. That’s shrinerschicago.org. This is Melanie Cole. Thanks so much for listening.