Who would have thought it would be possible to make a living connecting the dots? Yet, that's exactly what Lauren Rosen, PT, MPT, ATP, Motion Analysis Center program coordinator at St Joseph's Children's Hospital, Tampa, Fla, has been able to do—well, sort of.

"The computer sees the dots, but at the beginning it does not know what each dot represents, so the first couple of times the patient is doing things, I play ‘connect the dots' and tell it what each of the dots is attached to," Rosen says.

These dots are markers used as part of a 3D graphic program that uses a number of infrared cameras that record the motion of strategically placed markers on a patient performing an activity such as walking. The result is a 3D image of the person—and a myriad of information for PTs.

"The biggest thing it gives you that you can't get visually is a transverse plane. This is the one way to see the whole picture all at once," Rosen says. "We can see everything about what's going on with them, so we can, with greater certainty, say what the results will be from whatever treatments are going to be recommended."

Rosen accepts any child—and the occasional adult—for examination in her state-of-the-art motion-analysis center. Developed by Vicon, the 3D simulation program also provides reports of the subject's performance compared with an able-bodied individual.

GETTING IT RIGHT

In addition to building animated models of patient movement, Rosen uses electromyography (EMG), a process in which electrodes are adhered to very specific locations on the child's legs, such as on top of individual muscles. The system provides detailed information on which muscles are active, and when.

"It really is important information, especially in children with neurological disorders, such as cerebral palsy," Rosen says. "You watch somebody walk, but there are certain things about their walking that you can see—and there are certain things about their walking that you can't see."

EMG will identify exactly which muscles are moving, helping PTs differentiate between actual problems and compensations.

"With cerebral palsy, for example, there are a few muscles that have a tendency sometimes to be overactive—one being the rectus timorous muscle," Rosen says, explaining that surgery can relocate the muscle, causing it to function more like a hamstring. "But if the rectus timorous is not overactive and we move that muscle, then that didn't help. It really is a big puzzle, and this lets us figure out, with some certainty, what is the problem and what is a compensation."

In most cases, once the problem is resolved, the compensation will repair itself. Rosen also makes use of a pedobarbograph, which looks at the forces on the bottom of the foot relative to the floor, illuminating how a patient uses his or her muscles when walking.

"There are certain times when you walk that you are supposed to be doing certain kinds of contraction," Rosen says. "Using this combination of force plates and cameras, we are able to tell how patients are using their muscles."

The device is somewhat sensitive, and in order to return information, only one foot can touch the mat at a time. Because of this, it is not compatible with those using assistive devices or individuals who take short or shuffling steps.

WALK THIS WAY

After putting patients through their paces, Rosen consults with the lab's orthopedic surgeon to read the study. From this one-on-one, she creates a report that includes suggestions for treatments.

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"There are a lot of different recommendations that come out of what we do, one of which is surgery, but as a physical therapist, it is not within the means of my licensure to recommend surgery. If there's going to be surgery recommended, there has to be a [physician] involved," Rosen says. "We do recommend medications to control spasticity, as well as things that are more a PT's domain, such as assistive devices: Somebody uses one, is it the right kind for them? If they don't use one, should they?"

Other recommendations include bracing—either evaluating the effectiveness of an existing orthotic or advising on the implementation of a new one. And, of course, the use of physical therapy to improve strength and gait.

Performing her battery of technical measurements provides Rosen with an objective viewpoint that can be beneficial to patients.

"Because I don't carry a caseload, the other real benefit is I can take a truly objective look at patients and tell the truth. I'm not saying there's anything wrong with a therapist who becomes attached. In fact, if they didn't lose some of their objectivity, there would be a problem," Rosen says. "But when you are around people for a long time, you lose a sense of full objectivity; you miss things."

HUMAN TOUCH

No matter how wired the gait lab gets, technology will never edge out the vital human component. Rosen is often surprised at how her initial thoughts can be changed when she sees the results of the computer-generated data.

"A lot of people think that the computer does our job; they think that the computer tells us what's wrong with somebody—and that's not what happens," Rosen says. She notes that the computer provides outlines of what is abnormal—if a patient should be able to bend his or her knee a certain amount, it tells the PT if that isn't happening. "But there are a lot of different causes for why you can't bend your knee, and that is why physical therapists are involved in all of this. In addition to doing this walking testing, we also do the regular physical therapy work: range of motion, spasticity assessments. The computer gives us the what, and we have to figure out the why."

Dana Hinesly is a contributing writer for  Physical Therapy Products. For more information, contact .