Wednesday, October 17, 2012

Technology: a gaitway to life


Prof Tim O'Brien, who has motor neuron disease, uses software that tracks his eye movements to communicate.Prof Tim O'Brien, who has motor neuron disease, uses software that tracks his eye movements to communicate.Photograph: Alan Betson

Prof Tim O’Brien is a co-founder of one of the first gait laboratories in the world, writes JUNE SHANNON

PROF TIM O’BRIEN, consultant orthopaedic surgeon and director of the gait analysis laboratory at the Central Remedial Clinic (CRC) in Dublin, was the first professor of orthopaedics to be appointed in Ireland.

Over the past 37 years he has been at the forefront of education, clinical research and innovation in his chosen specialty. During this time he was also diagnosed with motor neuron disease (MND).
While MND cruelly robs sufferers of the use of their body it does not affect the mind. Diagnosed in 1993 it is testament to O’Brien’s strength of character that he continues to work full-time despite being paralysed and reliant on a portable ventilator.

He communicates using special software, which enables a sensor to follow his eye movements allowing him to pick out letters on a specially adapted laptop, which then transmits the words he types into speech.

In 2005 O’Brien was awarded the prestigious Lifetime Achievement Award at the Irish Journal of Medical Science (IJMS) Doctor Awards for his life-long clinical interest and research achievements in orthopaedics, including research on the development of the immature hip joint in babies and the assessment of gait patterns in children.

In 1990, together with physiotherapist Anne Jenkinson, O’Brien established one of the world’s first gait laboratories in the CRC which remains the only clinical gait laboratory in the State.
Gait analysis is the scientific study of how somebody walks. Using technology, O’Brien and his team assess, diagnose and recommend treatment for patients with a variety of gait disorders.
“When we started it was a big investment and we did not know how it would develop as there were only a few other clinical laboratories in the world,” O’Brien explains.

The majority of patients seen at the gait lab are children with neurological disorders such as cerebral palsy. Caused by an abnormality in the brain that controls muscle movement, children with cerebral palsy suffer a range of physical disabilities that affect their ability to walk, such as a lack of muscle co-ordination and tightness or stiffness in the muscles.

Gait analysis can make a huge difference to these children particularly where it picks up issues that may stop a child from walking altogether.

The gait lab in the CRC sees about 360 patients a year and the numbers are increasing every year. Approximately 50 per cent of the patients attending the lab live outside Dublin and in an effort to reduce the amount of travelling his patients had to endure, O’Brien and the manager of the gait lab, Mike Walsh, pioneered the world’s first mobile gait analysis unit in 2004.

A mobile gait lab now travels to Limerick and Waterford a number of times a year.

The gait lab uses an impressive range of technology to assess a patient, including video to record how they walk. Computer markers are placed on specific points such as the ankle, knee and hip joints and motion analysers then replicate an accurate 3D computerised model of how the person walks. Force plates built into the floor of the lab measure the amount of force a person puts on their joints when walking and a system called electromyography (EMG) is used to measure the electrical activity in the muscles which can show if a muscle is over or underactive.

O’Brien explains that the gait lab was initially established as a means of recording walking patterns to see how children at the CRC responded to therapy and surgery.

“As a result of the gait laboratory, surgery has changed and some procedures are no longer advised while some others are seen to make a big difference to walking.

“As we became more experienced we identified patterns of walks that would respond to surgery and we adopted an advisory role. Now 10 per cent of our clients are referred for diagnostic reasons. This is because certain neurological disorders or injuries have characteristic patterns of movement which we can see but are too hard to observe clinically,” he added.

Alongside pioneering technology in the development of gait analysis, O’Brien also uses technology that allows him to continue working and to share his expertise.

On the day of my visit to the CRC I sat in on a meeting where members of the team presented cases to O’Brien that they had assessed the previous week in the lab.

I watched in amazement as O’Brien studied the videos of patients walking, analysed graphs and read the results of complex tests, all of which were projected onto a large screen.

Having completed his expert review he then wrote and emailed the results of his assessment along with recommendations for further treatment, such as surgery where necessary, back to the referring doctor. He did all of this with his eyes.

“There is no doubt that technology has made a big difference for me personally and professionally,” O’Brien says. “When I first saw gait analysis in Boston in 1984 the staff were tracing out limb movement from photographs. It was a start but in two dimensions.

“Now we have automated three-dimensional gait analysis using improved technology. This also extends to our office management and record-keeping in a Sharepoint application where all records are digital and instantly available.

“Efficiency and labour saving are the big advantages of this system. Personally new technology allows me to work efficiently,” he said.

Seeing how technology can make a massive difference to both his life and that of his patients, O’Brien says that the public health service appeared slow to adopt new technology.
“Here in our laboratory through private funding we developed a Sharepoint application that allows us to retrieve all patient data including documents, X-rays and gait analysis with one click. Such systems should be widely available in the health service as they save so much time.”

O’Brien is also an accomplished researcher and writer and has a huge interest in the great megalithic sites of Newgrange and Loughcrew.

Asked about how he felt on being diagnosed with motor neuron disease O’Brien says that by the time he received the diagnosis he had “a fair idea” and was not shocked by the news.

He also pays tribute to his wife and constant companion Mary, who is one of the State’s leading experts in domiciliary ventilation.

“I concentrated more time on those aspects of my practice that were easier for me such as teaching, research and the gait laboratory.

“With great support from the CRC and the children’s hospital [Temple Street] it has been possible for me to continue in full-time work. Technology and my wife make up for my lack of mobility,” he said.

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