Week 5:
Children’s Hospital Colorado

July 9, 2014

This week I went to the Gait Analysis Data Review. Since I shadowed Amy (physical therapist), during her evaluation of patient who was “toe” walking, she invited me to see how this whole process came together. There were multiple physical therapists, orthopedic surgeons, and engineers who attended. It felt like a big discussion amongst these specialist as we watched each patient’s walking abilities (video recordings), and evaluated their EMG’s. Each specialist shouted their own recommendations. However, the engineer was the most helpful I thought since he explained the EMG’s. He went in depth about the patients’ knee/ ankle strength based on the EMG curves and progression, and told us which muscles were stimulated during the patient’s gait.

One patient they evaluated was a 42-year-old male, who sustained an injury while working. He complained about tightness/ pain in his ankles. Based on the lateral view of his legs, you could see that his right leg was weaker. His calf muscles were more developed and prominent compared to his right (affected limb). In addition, one of the possible diagnoses was nerve damage; however, he was able to walk on his toes, so the doctors claim that he must have some control over his leg and sensation. His ankles were also inverted slightly, and there was no record of him tripping. Based on his EMG, he had knee stiffness, in order to compensate his weak ankles. Overall, the doctors recommended more ankle stability, it doesn’t matter in what form, and also for the patient to lose some weight. This patient was slightly overweight, and the possible pain in his ankles could be from his weight bearing as well.

In addition, attending this meeting, made me wonder, how doctors deal with patients with illnesses that cannot be resolved or improved? It must be difficult telling the patient and his/ her family. One patient that they evaluated was a young girl who has an unknown diagnosis, however has had multiple rotational issues in her knees. Her left knee was inward. She recently had a surgery before this evaluation, to fix what a “minor” inwardness of the knee was. However, her parents felt that she never recovered from surgery in the first place and that it never worked. There were no changes post-operatively though, and the physical therapist claim that, that is how she normally walked, it just got progressively worse. The patient would do other rotational surgery, but the problem may arise again and she simply cannot have a rotational surgery all the time/ when she needs it. Her size may have been a factor that contributed to this problem, but there are other factors to consider, like walking less, since she is in a wheel chair most of the time, her legs became weaker. Overall, the doctors/ specialist claim that they are not optimistic. They plan to have a family conference to explain her condition.

Moreover, this week I shadowed the Rehab Clinic. The doctor that I shadowed did not tell me the background/ condition of the patients before we evaluated them, which was quite unusual. I guess he thought I knew more than I did, because he asked me a couple of times if I knew the condition of the patient just by the looks of them. Maybe if I was more experienced and observant, I would have realized that the left side of the patient does not function properly. However, he did give a good recommendation about Cornell College, and said it was a wonderful school.

One patient I saw had a dislocated hip. His ball-shape head of the femur bone was not implanted into his pelvis cup. Due to the spasticity: his low muscle tone it kind of basically “slip” out of the cup as the doctor explained to the patient’s mother. He recommended fixing this ASAP since the cartilage on the femur bone dissolves and the pelvis does not form a cup anymore, making it much harder to treat later. This included manually shaping the cup. However, with this upcoming surgery in September, surgeons will be able to put the head back in the cup, and hopefully the cup will remodel. This was due to the patient’s inactivity.

No work during Fourth of July, hope everyone had a wonderful Independence Day!