Gait Change – We Are Marquette

Dr. Gerald Harris — with an eager team of student researchers — takes gait analysis labs global to help children’s orthopedic issues

By Dan Simmons

The 14-year-old girl’s sweet face and slightly shy demeanor belied her circumstances. X-rays of her right leg told a different story, of pain and deformity. The tibia bone bent inward between the knee and ankle, at an angle so severe it looked like a flexed elbow. She had come to this clinic in Manila from a different Philippine province.

The fracture happened when she was just 1, she explained to the medical team in her native Tagalog language, and her family lacked the money and resources to have it properly treated. Over time it bowed more and more, and the break point formed into a pseudo-joint. With age and weight gain, the pain grew worse.

Also in the room were Dr. Gerald Harris, PE, Grad ’78, ’81, professor of biomedical engineering and director of the Orthopaedic and Rehabilitation Engineering Center, who started this clinic in 2014, Dr. Jacob Rammer, Eng ’09, Grad ’15, ’17, research assistant professor of biomedical engineering, plus a group of three Marquette students from their Global Mobility Outreach course, there as part of a service-learning trip. They got to practice skills and concepts learned in class in an extraordinary real-world setting.

“It provided us great practical experience working with surgeons and residents and others on the medical team,” says Katarina Radmanovic, Eng ’16, a third-year graduate student in biomechanical engineering. “But also, to be able to do it on the other side of the world in a completely different health care system, that was really cool.”

Harris, who will retire from his teaching career in December, arrived at Marquette in 1987. His career spans a variety of classes and research interests — from gait analysis to bone and tissue characterization to total joint replacement and robotics. In recent years, he’s turned his focus to the developing world, bringing first-world gait analysis labs to countries where his labs are often the only one of their kind.

He and others who’ve joined the project install a runway of sorts, with cameras on the sides to capture muscle and joint movement in three dimensions, with a base plate below that provides useful feedback about force, torque and balance upon foot strike.

Sometimes, the patients are as young as 2 years old, with a variety of sensors attached to their bodies, and need parents to walk beside them for balance and reassurance. Most are a bit older, in kindergarten or early elementary grades.

The data provided by the human motion analysis lab helps doctors more effectively treat children with neuromuscular issues of all types, from cerebral palsy to clubfoot to spina bifida. Recent upgrades in the software Harris’ labs use have dramatically sped up the treatment process, cutting the time it takes to download and process useful data in half.

“By doing this, you’re eliminating the birthday syndrome, where kids get a different surgery every year,” Harris says. “There are lots of examples where surgeons will do something that’s appropriate for a 6-year-old, but actually blows up by the time the child’s 8 or 9. As they gain weight, their power-to-weight ratio changes. This system helps you avoid many of those errors.”

He started the first such lab in Cali, Colombia, in 2012. His longtime friend and collaborator Dr. Peter Smith, an orthopedic surgeon, has been making twice yearly trips to a town near Cali as part of his Silver Service Children’s Foundation. Smith and orthopedic colleagues perform surgery on 35 to 40 pediatric patients with orthopedic issues each trip. Harris had been refining his gait analysis system to be more accurate and less expensive for use in and around Milwaukee. But he got to thinking about expanding their horizons.

“I said, ‘Peter, what do you think about us trying to put in a gait lab in Colombia to help you with your surgical decisions?’” Harris says. “He said, ‘Yeah, why don’t you come down and try it?’”

That first foray gave Harris and colleagues a chance to refine their methods and, through a lot of trial and error, establish a template that helped many children at little to no cost to them. And there was little reason it couldn’t be repeated elsewhere, always in collaboration with orthopedic surgeons and their care teams.

“The engineer needs to know about the rehabilitative treatment and then the surgeon needs to know about the accuracies and inaccuracies of the motion analysis,” Harris says. “What are the best planes of data and the worst?”

He’s since opened clinics in Manila in 2014, Mexico City in 2016 and Mumbai, India, in 2019. A former postdoctoral fellow and current adjunct research professor Dr. Karla Bustamante started another lab in Chihuahua, Mexico. Harris is in talks to open labs in five new places: Hawaii, Uganda, Nepal, Argentina and a second India site in New Delhi.

“We’re blessed that this is working out as well as it is,” he says. “We’re in this to help kids because the technology is very effective, and it’s a great way to help a lot of kids who otherwise wouldn’t get help.”

A private donor has funded each of the labs, which typically cost about $60,000 for startup and about $12,000 in annual operating costs. Harris and Rammer, who recently accepted a new job at University of Wisconsin–Milwaukee, have worked to get the labs operational and visit periodically.

“We will set up a lab at no cost and support the lab to get them to be self-sufficient,” Harris says.

Harris and Rammer brought the first group of Marquette students to Manila in 2018. The group oversaw the lab, with a dozen children going through a day, and also hosted a one-day clinic on a genetic disorder — osteogenesis imperfecta, or brittle bone disease — that’s the focus of a research project headed by Harris. The students also helped to install a postural stability assessment program.

“It was a rigorous week,” Harris says, “and they were exposed to all sorts of very interesting aspects of biomedical engineering, including surgery.”

This year’s students followed a similarly rigorous program, which included giving a summary presentation to the Filipino clinic staff. Biomedical engineering undergrads Eric Blais and Claire Rogozinski, along with Radmanovic, focused on the girl with the tibial malunion, or severely deformed lower right leg.

“That’s just not something you really ever see in a developed country,” says Radmanovic. In fact, it was an outlier for the Filipinos, too. “No one in the lab or hospital had ever seen anything like it,” she says.

The students described how gait analysis identified how the leg deformity affected the girl’s gait, caused one leg to grow longer than the other and generated pain and disordered functioning in her hips, knees, ankles and hamstrings. To remedy the issues, surgeons will break the pseudo-joint that’s developed, then set the bones into alignment using metal pins and a metal halo-like device around the leg called an Ilizarov external fixator. The girl will be given a wrench, which she’ll use to tighten the apparatus slightly each day.

“It will be fixed in three to five months,” says Radmanovic, “which is pretty good given that severe of a fracture.”

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