Improvement Enables Cerebral Palsy Patients to See Specialists in One Two-Day Visit

A recently improved gait analysis testing and reporting process at Cincinnati Children’s has streamlined treatment planning for some children and teens with cerebral palsy (CP)—specifically those who undergo surgical evaluations through the health system’s two-day, multidisciplinary Mobility Clinic.

The refined process makes it possible for experts in the Cincinnati Children’s Motion Analysis Lab to provide next-day treatment recommendations for Mobility Clinic patients and providers. This means families find out before the end of their visit whether their child needs surgery and can immediately begin reviewing their options and discussing next steps.

A Convenient, Comprehensive Option for Out-of-Town Patients

When the Mobility Clinic opened in 2021, it quickly became a resource for patients who may need surgery to improve their walking ability—but can’t find comprehensive CP care in their own communities. Instead of making multiple, lengthy trips to and from Cincinnati Children’s over the course of several months to visit individual providers, children and their families can see a team of CP specialists (including orthopaedic surgeons, neurosurgeons and rehabilitation professionals) in a single, 48-hour visit.

During the first day of their visit, patients undergo gait analysis in the Motion Analysis Lab. As they repeatedly walk from one end of the lab to the other, their movements are recorded with a combination of high-speed cameras, walkway sensors and electromyography (EMG). These recordings show how patients move their limbs, load their joints and use their muscles when walking.

“After analyzing the data from each walking trial, we produce a detailed report including the primary and secondary factors impacting the patient’s gait and the interventions most likely to enhance their mobility,” says Jason Long, PhD, director of the Motion Analysis Lab. “This is crucial information for any family weighing treatment options. But when the Mobility Clinic opened, we realized our normal assessment and reporting process—which typically takes two to four weeks—wouldn’t work in the context of a two-day clinic.”

Understanding the Team’s Traditional Workflow

Prior to the launch of the Mobility Clinic, gait analysis testing and reporting rarely had to be expedited. Patients and families usually were referred to the Motion Analysis Lab for a standalone visit. Once their results were available, they scheduled a follow-up appointment with their referring provider.

“With our standard process, we take all the data recorded during a gait analysis and run it through our computer modeling systems over the course of several days,” Long says. “Then we bring the completed gait report to our twice-monthly case review meeting. This seven-person team includes kinesiologists, physical therapists, orthopaedic surgeons and other specialists.

Together, we decide which surgical or nonsurgical approaches are most likely to improve each patient’s walking ability.”

However, this timeframe is not fast enough for Mobility Clinic providers who aim to present evidence-based treatment recommendations at the end of each two-day surgical evaluation.

“Our team took a hard look at all the factors impacting our testing and reporting workflow, including our staffing and the number and timing of individual steps,” Long says. “We proposed changes that might optimize our efficiency, then we tested and refined them. And our efforts paid off: We can now deliver reports for Mobility Clinic patients within 12 hours.”

Practical Changes Lead to a Streamlined Solution

To achieve this compressed turnaround time, Long and his team implemented the following changes:

• A modified lab schedule. The two-day Mobility Clinic takes place on Mondays and Tuesdays. So, Monday morning appointments in the Motion Analysis Lab are now reserved for Mobility Clinic patients only, and Monday afternoon resources are dedicated to analyzing the data from that morning’s appointments. This shift in resources opens the necessary time to complete the time-intensive analysis.
• Increased staffing. In the past, the team’s kinesiologist ran the data analysis software in between clinical duties—meaning this process occurred intermittently, when the kinesiologist had time. Today, the Motion Analysis Lab hires a full-time co-op student from the University of Cincinnati College of Engineering at the start of each semester. As an added benefit of having a student assist with data processing and compiling the final reports, the kinesiologist also has more time to focus on patient care.
• Smaller, weekly case reviews. Dr. Long and his colleagues identified four members of the larger case review team who had the ability to meet weekly instead of twice a month. This subgroup now meets every Tuesday morning to go over the reports generated Monday afternoon, allowing them to give that data (and their recommendations) to the Mobility Clinic team by the end of each patient’s two-day visit.

“The Mobility Clinic was designed with convenience in mind, and our new reporting process aligns well with that mission,” Long says. “Now, families don’t have to wait several weeks to find out whether surgery is the best and safest option for their child. Instead, they can begin treatment planning right away.”

(Published November 2024)

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