Long Term Gait, Mobility, and Daily Living Outcomes after Orthopedic Surgery for Youth with Cerebral Palsy: Influence of Rehabilitation Dose and Setting

Background/Purpose: Cerebral palsy (CP) is a broad diagnostic description of early brain insult causing motor impairment. To help correct gait abnormalities, many children with CP undergo an orthopedic single event multi-level surgery (SEMLS). After surgery and most importantly SEMLS, rehabilitation is important to recovery. The purpose of this study was to examine the effects of post-op therapy setting and dose on functional mobility outcomes for youth with CP. Methods: Outcome measures included gait deviation index (GDI), walking speed, Pediatrics Outcomes Data Collection Instrument (PODCI), Gross Motor Function Mobility-D (GMFM-D). Data on post-op rehab therapy were retrieved from electronic medical records. Multiple Regression, Two-Way ANOVA, and Welch’s t-tests were used. Patient Sample: 74 cases were eligible. Average age at baseline gait analysis was 11.5, at surgery was 12, and at post-op gait analysis was 13.3 years old, with Gross Motor Function Classification System (GMFCS) levels I (9%), II (53%), III (34%), and IV (4%). Results: There was variability in therapy setting, with 33 different therapy centers. Higher burden of surgery was associated with more therapy sessions. Patients with low burden surgeries tended to improve in PODCI scores, but patients with high burden surgeries did not. These trends were not related to therapy dose, however, patients receiving Nemours Outpatient therapy had a positive association with PODCI gains. Similarly, patients who had low burden surgery improved GMFM-D and those with high burden did not. A minimal threshold of therapy dose was identified for cases with low burden surgery. Patients who attended 46 sessions or more saw GMFM-D improvements and patients who attended 25 sessions or fewer did not improve. Conclusion: Clinical practice recommends rehab therapy after SEMLS, but implementation is inconsistent. Post-op therapy varied widely by setting and number of sessions. As expected, youth who had low-burden surgery had less post-op therapy. Those above a minimum threshold and those at Nemours settings tended to show improvement at one-year post-op. At one year post-op, youth with high burden surgery demonstrated less gains, which is likely related to ongoing recovery in year two

The Effectiveness of Serial Casting in Children with Arthrogryposis

The most common foot deformity in children with arthrogryposis is clubfoot, which is typically stiffer than in the idiopathic clubfoot (IC). While the use of the Ponseti method in IC has led to improved foot mobility and reduced invasive surgical procedures, there is currently limited information of the effectiveness of serial casting (SC) in arthrogryposis. The purpose of this research is to determine the effect of serial casting in recurrent clubfoot in children with arthrogryposis on brace tolerance, foot position, patient reported outcome, and the need for surgery

The Best Studied Crab in Astronomy: Searching for Variability in VHE Emission from the Crab Nebula

The Crab Nebula is the remnant of a powerful stellar explosion first observed in 1054 AD and has been extremely well studied for decades. previous very high energy (VHE); GeV) studies have observed no variability in the nebula flux making the Crab a standard reference tool for gamma-ray telescopes. As part of the VERITAS (Very Energetic Radiation Imaging Telescope Array System) collaboration, we continue monitoring the nebula’s flux to understand the VERITAS telescopes and physical processes occurring within the nebula. We are analyzing over 80 hours of data from 2017 and 2018 from VERITAS Collaboration, developing and adding to a light curve that includes data since 2007. Our analysis of the 2017-2018 combined dataset determined a spectral index of -2.324 plus or minus 0.005489 and fitting the light curve with a constant function yields a mean integrated flux above 200 GeV of, which is significantly lower than a 2007-2016 dataset