research

gait lab & orthopaedics

summary

Our gait lab & orthopaedics research group focuses on the investigation and management of walking (gait) abnormalities or disorders in children

group leader(s)

Professor Kerr Graham
Gait Lab & Orthopaedics
Royal Children's Hospital
Flemington Rd
Parkville
Victoria 3052
Australia

T +61 3 9345 5399
E kerr.graham@rch.org.au

group leader biography

current research projects

Project 1: Centre for Clinical Research Excellence in Clinical Gait Analysis and Gait Rehabilitation (Gait CCRE)

Clinical gait analysis uses high-tech equipment to measure how people are walking and uses this to decide what treatment is likely to help them and also to evaluate how successful a treatment has been. We use the same technology as is used in the movie industry to capture how actors move and turn these into animations, like Gollum in Lord of the Rings. There are now State of the Art Gait Analysis Laboratories at the Kingston Centre of Southern Health, the Royal Children's Hospital, La Trobe University and the University of Melbourne (three systems). These have come together in partnership to form the Gait CCRE.

The CCRE has been funded by a grant from the National Health and Medical Research Council to develop better ways of performing gait analysis and investigate how such techniques can be best used. Patients benefiting are children and adults with cerebral palsy, people with Parkinson's disease or osteoarthritis, who have had a stroke or brain injury. This project has a special emphasis on translating the results of research in this area into routine clinical practice so that everyone can benefit.

Project 2: Orthopaedic Surgery for Children with Cerebral Palsy

Cerebral palsy is a condition that affects two children in every 1,000 that are born in Victoria. It is caused by damage to the brain at or around the time of birth. It can vary greatly in severity and in how it affects the child. For many children the main problems are those arising from the failure of the brain to control how the muscles work. Not only do the muscles not work well at any given time but living with the condition often results in muscles being too tight and some bones not growing properly. Many children have orthopaedic surgery to help them with these problems.

The surgery is complex and difficult to plan. This is now only ever done in Melbourne with the help of computerised gait analysis measurements. It places huge demands on the children and their families, with recovery after surgery often taking over a year. In order to justify this investment in the child's health it is necessary to establish exactly what benefits children gain form such surgery. A project that has been running over the last 8 years has been following children who have had surgery to determine the short, medium and long-term benefits of their treatment.

Project 3: Gait Patterns in Cerebral Palsy
 
One of the reasons we have to rely on expensive and time-consuming gait analysis of children with cerebral palsy is that we do not have a clear understanding of how they walk and exactly how the specific damage to the brain leads to particular patterns of movement. With our present knowledge we have to consider each child as an individual. If we could identify features that allowed us to categorise children with similar walking problems then it would be much easier to work out exactly what treatment they would be likely to benefit from.

We are therefore looking at the two major groups of children with cerebral palsy (those that have one side of the body affected and those that are affected on both) to identify the characteristics of common walking patterns. We are approaching all children listed on the Victorian Cerebral Palsy Register in specific age groups to participate in this study to ensure that the groups reflect the whole population and not just those we happen to see at the Royal Children's Hospital.

Project 4: Better software for Gait Analysis

The high technology camera systems that we use to monitor patient's movements, record the positions of little circular markers that we stick on the skin of the subjects with double sided sticky tape. The results we get depends critically on the skills and expertise of those placing markers. We are not really interested in how these markers on the skin are moving but on how the underlying bones are moving. All this means that our measurements are susceptible to error and we have to maintain scrupulous quality assurance measures to protect against this.

We are now working with the major international manufacturers of gait analysis systems, Oxford Metrics from Oxford in the UK to develop new software for handling the measurements we get from the cameras in such a way that it minimises the potential for measurement error and the reliance on the skills of our marker placers. This is likely to be adopted by Oxford Metrics for the next generation of their software and will thus have an big influence on how gait analysis is conducted throughout the world.

team members

  • Richard Baker - RESEARCH ASSOCIATE
  • Christine Blackburn - Research Officer
  • Cvetanka Bogoeska - RESEARCH ASSOCIATE
  • Cheryl Dingey - RESEARCH ASSOCIATE
  • Fiona Dobson - Research Associate
  • Leo Donnan - HONORARY FELLOW MANAGER
  • Bev Eldridge - RESEARCH AFFILIATE
  • Adrienne Fosang - RESEARCH AFFILIATE
  • Tandy Hastings-Ison - Research Officer
  • Michael Johnson - RESEARCH ASSOCIATE
  • Abhay Khot - RESEARCH ASSOCIATE
  • Susan Liew - RESEARCH ASSOCIATE
  • Jennifer Mcginley - RESEARCH ASSOCIATE
  • Gary Nattrass - RESEARCH ASSOCIATE
  • Joanne Noonan - RESEARCH ASSOCIATE
  • Nicholas Opie - Research Assistant
  • Mark O'Sullivan - RESEARCH ASSOCIATE
  • Elyse Passmore - Research Assistant
  • Kirsten Perrett - SENIOR RESEARCH OFFICER
  • Emily Ridgewell - PhD Student Lapsed (LaTrobe AllHlth)
  • Jill Rodda - RESEARCH ASSOCIATE
  • Morgan Sangeux - RESEARCH ASSOCIATE
  • Paulo Selber - RESEARCH ASSOCIATE
  • Mary Sheedy - RESEARCH AFFLIATE
  • Pamela Thomason - RESEARCH ASSOCIATE
  • Oren Tirosh - Senior Research Officer
  • Ian Torode - RESEARCH ASSOCIATE
  • Sharon Vladusic - RESEARCH ASSOCIATE
  • Prue Weigall - RESEARCH ASSOCIATE

publications

  • Altuntas AO., Dagge B., Chin TYP., Palamara JEA., Eizenberg N., Wolfe R., Graham HK. The effects of intramuscular tenotomy on the lengthening characteristics of tibialis posterior: High versus low intramuscular tenotomy. Journal of Children's Orthopaedics 5 (3) : 225 - 230(2011) PubMed
  • Baker R., Graham K. Functional decline in children undergoing selective dorsal rhizotomy after age 10. DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 53 (8) : 677 - 677(2011) PubMed
  • Callisaya ML., Blizzard L., Schmidt MD., Martin KL., McGinley JL., Sanders LM., Srikanth VK. Gait, gait variability and the risk of multiple incident falls in older people: a population-based study. AGE AND AGEING 40 (4) : 481 - 487(2011) PubMed
  • Correa TA., Baker R., Kerr Graham H., Pandy MG. Accuracy of generic musculoskeletal models in predicting the functional roles of muscles in human gait. Journal of Biomechanics 44 (11) : 2096 - 2105(2011) PubMed
  • Dallmeijer AJ., Baker R., Dodd KJ., Taylor NF. Association between isometric muscle strength and gait joint kinetics in adolescents and young adults with cerebral palsy. GAIT & POSTURE 33 (3) : 326 - 332(2011) PubMed
  • Dobson F., Morris ME., Baker R., Graham HK. Unilateral cerebral palsy: a population-based study of gait and motor function. DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 53 (5) : 429 - 435(2011) PubMed
  • Hocking DR., Rinehart NJ., McGinley JL., Galna B., Moss SA., Bradshaw JL. GAIT ADAPTATION DURING OBSTACLE CROSSING REVEALS IMPAIRMENTS IN THE VISUAL CONTROL OF LOCOMOTION IN WILLIAMS SYNDROME. NEUROSCIENCE 197 : 320 - 329(2011) PubMed
  • Martin K., Blizzard L., Garry M., Thomson R., McGinley J., Srikanth V. Gait initiation in older people- time to first lateral movement may be the measure of choice. GAIT & POSTURE 34 (3) : 374 - 378(2011) PubMed
  • McGinley JL., Dobson F., Ganeshalingam R., Shore BJ., Rutz E., Graham HK. Single-event multilevel surgery for children with cerebral palsy: a systematic review. DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 54 (2) : 117 - 128(2011) PubMed
  • Papadopoulos N., McGinley J., Tonge BJ., Bradshaw JL., Saunders K., Rinehart NJ. An investigation of upper limb motor function in high functioning autism and Asperger's disorder using a repetitive Fitts' aiming task. Research in Autism Spectrum Disorders (2011)
  • Sangeux M., Peters A., Baker R. Hip joint centre localization: Evaluation on normal subjects in the context of gait analysis. GAIT & POSTURE 34 (3) : 324 - 328(2011) PubMed
  • Tan DM., McGinley JL., Danoudis ME., Iansek R., Morris ME. Freezing of Gait and Activity Limitations in People With Parkinson's Disease. ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION 92 (7) : 1159 - 1165(2011) PubMed
  • Thomason P., Baker R., Dodd K., Taylor N., Selber P., Wolfe R., Graham HK. Single-Event Multilevel Surgery in Children with Spastic Diplegia A Pilot Randomized Controlled Trial. JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME (5) : 451 - 460(2011) PubMed
  • Ye LZ., Kalichman L., Spittle A., Dobson F., Bennell K. Effects of rehabilitative interventions on pain, function and physical impairments in people with hand osteoarthritis: a systematic review. ARTHRITIS RESEARCH & THERAPY 13 (1) (2011) PubMed