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Scott Webb (Host): Established in 1984, the Motion Analysis Center at Shriner's Hospital for Children Portland is a wonderful addition to the comprehensive care provided at the hospital. The Motion Analysis Center offers a critical component of care by performing clinical motion analysis, which ultimately provides insight into patient's movement abnormalities, and helps inform treatment planning and outcome evaluation.

And here today to go into detail as to how the data gathered in the Motion Analysis Center, directs patient care, is Dr. Ellen Raney. She's a Pediatric Orthopedic Physician and President of the Medical Staff at Portland Shriner's Hospital. Welcome to Healing Heroes, PDX, the podcast series from the specialists at Shriners Hospital for Children in Portland.

I'm Scott Webb and Dr. Raney, can you first start by describing what gait is and how gait abnormalities can impact a child?

Ellen Raney, M.D. (Guest): So, gait is just simply how our bodies move when we walk. That's how we think about it. And you know, the human body is just so amazing. We perform all these complicated activities like walking without even thinking about them. So, when you take steps, you follow a pattern, but every step you take is not exactly the same.

So, this helps us break it down. And if you think about it, like if you're listening to somebody walking down the hallway, especially somebody with high heels, you hear those heels ticking, that's because your heels always hit first. Right? I mean, that's the noise that you hear. Another part of gait is that like your feet generally point in front of you are more or less in front of you and you're walking.

So if you have of something like a limp, then the gait analysis can help us understand, you know, what happens to the rest of your body. If we understand that your ankle is weak or a common way to think about it is, you know, if you have ski boots on, you know, they hold your ankles up a little bit so you're in a better position to go down the hill. But then when you walk in them, you have to walk with your knees bent. So that's kind of thinking about what's happening below controls what's happening above and vice versa.

Host: Yeah, I think you're so right. A lot of what we do, we just sort of take for granted. We don't think about our body just kind of does it, but when you really think about it and you do analyze it the way you do, it's pretty interesting and is assessing a patient's gait's standard for treating orthopedic conditions? And how long has this form of assessment been utilized?

Dr. Raney: It's very standard in anything that we're looking at, it involves the way you walk. I mean, obviously if you had like a hand problem, we wouldn't have to worry about your gait analysis, but an awful lot of what we do involves looking at how we walk. And especially if you're doing any scientific research or we want to know for sure, you know, are we making people better. The gait analysis is very important and it also helps us tease out exactly what's going on. And the study of this really took off in the 1950s when there was the time of polio. And one of the things that I think is kind of cool is that, one of the pioneers, one of the big leaders in this was actually also one of the first women to become an orthopedic surgeon. It's been a male dominated field. So, the surgeon, Jackie Perry was really famous and really brought the field along. And she was actually a physical therapist before she became a doctor because when she was finishing school, it wasn't even an option for her to go to medical school.

Host: What kinds of conditions or disorders necessitate gait analysis? And at what point during the cycle of care, do you recommend this type of evaluation?

Dr. Raney: You know, anything that interferes with the way you walk or is changing the way you walk would be somebody that we could look at with gait analysis. I mean, we wouldn't jump right to that. It would usually be like, maybe when we're reaching a decision point, like we've tried something small. And this wouldn't be say, if you hurt your knee skiing, we wouldn't jump right to a gait analysis, but you, if you have a child that doesn't walk straight and we're trying to understand why, then gait analysis is a good thing to do, especially if we're reaching a treatment decision, we've tried something, like maybe you've tried some exercise or some stretching, and now it's time to think, you know, do we need to do something more, then gait analysis can really help us decide that.

Host: That's interesting that you mentioned the skiing and I was just, is it more, you know, a gait analysis is more for chronic conditions than acute?

Dr. Raney: Yeah. I think that's a good way to look at it. If you just have an injury, if you have a broken bone or a torn ligament, that's not something that we would be looking at a gait analysis for. It's more like if your legs aren't straight or one leg is longer than the other, are we a lot of children that we care for that have cerebral palsy or, you know, a generalized disturbance.

So, we're looking at that and the way that they walk, we're also seeing a lot of children right now who constantly walk on their tip toes. They can't get their heels down to their ground. And the gait analysis helps us figure out is this because you know, your tendon is too short or is this because you have a balance issue or muscle spasticity?

Host: When you're analyzing a child's gait, what specifically are you looking for?

Dr. Raney: We really look at many different parts of it, you know, starting with how the feet hit the ground to what your ankles do and your knees, hips, back, even your shoulders when you take a step. So, if you think about, if I were watching somebody walk in a hallway, I can usually watch them from the front or the back. It's pretty hard to watch them from the side and the computer helps us do that. The computer could even look at say, you were looking from the top down and see where you are in that plane. So, we're looking at each of the joints, what they're doing. We can see what the muscles are doing and then we can really be nerds. We can nerd out and look at the fancy stuff, you know, from your physics class, where we're measuring the forces that are going across each joint.

Host: I love that, you can really nerd out and I can picture that. I can picture, you know, you and your team nerding out on some of this stuff, which is really cool. When a family is referred to the Motion Analysis Center, what can they expect during that appointment? What types of tests are conducted?

Dr. Raney: Sure. Well, the schedulers would call a family to work out the best date and time to come in. It does take a couple hours. So, we generally don't do this for kids who are less than say five years of age, or aren't going to be able to cooperate with walking back and forth several times. But we also start out, the physical therapist performs the examination, just pretty much like the doctor does. We're going to see how much each joint moves and how strong you are, push against my hand, or, you know, can you stand on your tippy toes? And then the child walks back and forth in this designated path multiple times and we take some videos and then we put on little stickers on your boney prominences like where your knee sticks out, put stickers on there that the camera that's attached to the computer can then see. And then that sends the information back to the computer that our engineers help us analyze.

And that's how we come up with all of these angles and these measurements and the moments and the forces and all that nerd stuff.

Host: Yeah. And, and you see why it might be tough for younger kids to have the patience to do this for hours. That makes sense completely, especially as a parent. So, if I've brought my daughter in, let's just say she was a patient, she's completed the gait analysis, what happens next? How are those results used to help inform whatever the treatment options might be?

Dr. Raney: Sure. So, after the staff has put all this information together in a report, you actually get multiple doctor's opinions rather than the just the one who's going to see you when you bring your child in, because we get together at conferences every week and we get a bunch of us together and we look at each one of these reports together and go through them, again, one part at a time. And we looked at the video and we looked at the forces and the graphs, and that helps get the opinion of what we should do. I mean, they, you know, recommendation might just be focusing on exercise or physical therapy, or sometimes it's reassuring just to know that what you might think of as a funny walk is really not a problem. It's a variety of the way people come. Like some of us are tall and some of us are short or light and dark. And that's a good thing. It's not like a problematic difference, but if we see a problematic difference, again, sometimes it would be a physical therapy. Sometimes it's a bracing, or sometimes we even use that information to recommend a surgery.

Host: I guess what we're after here with the gait analysis is really when does it just become the unique way that you walk versus a problem, right?

Dr. Raney: Right. We have a range within most people will walk. So, most people would have to, in order to clear your foot. So, you're going to have to bend your knee 60 degrees. And if you bend your knee 40 degrees, it's not a problem. But if you're only bending it 30, and then we can see that your toe is dragging and you can't get your toe off the ground, then we can identify that as a problem.

Host: Yeah, definitely. So, let's talk about the goals. What are the goals for patients that undergo gait analysis and how do you ensure that those goals are met?

Dr. Raney: Sure. We want everybody to have the best chance to do what they want to do in life, right? Whether that's running or playing, or just being able to take a walk with your family and your friends and get some good exercise. So, those would be the goal to give each person the most functional way of being with and doing what they want. Right? And then we assure that the goals are met. If we recommend a change based on the gait analysis, say I recommend a brace or I recommend surgery, then after a period of time, when you would have a chance to get used to that, you would come back and we would repeat it. And we would say, you know, okay, this is better. Or sometimes maybe this isn't better. Maybe that brace isn't really doing what we thought it was gonna do.

Host: This is all very cool. When you and I were speaking off the air before we got started, I said, I was really hoping to learn from you today as I'm sure listeners are and I definitely have. As we get close to wrapping up here, can you describe any other components of care that can assist a patient with gait abnormalities?

Dr. Raney: We mentioned physical therapy. We mentioned bracing. Sometimes it comes to surgery. Sometimes it's something as simple as a little lift in your shoe. And then, sometimes some people will say, well, you know, you actually walk much better with the crutches or a walker or something. So those are all things that we would look at.

Host: Well, Doctor, this has been a really educational and really fun. You have a great way about you, and I love to hear you nerding out over this stuff and just great to know that you're there at Shriners, you know, helping people, helping patients, helping kids. And as you say, you want to go for a walk, you want to be a runner, you want to be an athlete, whatever you want to do, you're there to help. And I appreciate your time. Yi=ou stay well.

Dr. Raney: All right. Thank you so much. It's good talking to you.

Host: For more information about care provider, the Portland Shriner's hospital, please call 5 0 3 2 2 1 3 4 2 2. Or visit our This email address is being protected from spambots. You need JavaScript enabled to view it..

And that concludes this episode of Healing Heroes, PDX, the podcast series from the specialists at Shriners Hospital for Children.

Head over to our website at portlandshrinershospital.org for more podcast episodes. I'm Scott Webb. Stay well.