Gillette Children Research Articles

Performance of Deep Learning Models in Forecasting Gait Trajectories of Children with Neurological Disorders.

Forecasted gait trajectories of children could be used as feedforward input to control lower limb robotic devices, such as exoskeletons and actuated orthotic devices (e.g., Powered Ankle Foot Orthosis—PAFO). Several studies have forecasted healthy gait trajectories, but, to the best of our knowledge, none have forecasted gait trajectories of children with pathological gait yet. These exhibit higher inter- and intra-subject variability compared to typically developing gait of healthy subjects. Pathological trajectories represent the typical gait patterns that rehabilitative exoskeletons and actuated orthoses would target. In this study, we implemented two deep learning models, a Long-Term Short Memory (LSTM) and a Convolutional Neural Network (CNN), to forecast hip, knee, and ankle trajectories in terms of corresponding Euler angles in the pitch, roll, and yaw form for children with neurological disorders, up to 200 ms in the future. The deep learning models implemented in our study are trained on data (available online) from children with neurological disorders collected by Gillette Children’s Speciality Healthcare over the years 1994–2017. The children’s ages range from 4 to 19 years old and the majority of them had cerebral palsy (73%), while the rest were a combination of neurological, developmental, orthopaedic, and genetic disorders (27%). Data were recorded with a motion capture system (VICON) with a sampling frequency of 120 Hz while walking for 15 m. We investigated a total of 35 combinations of input and output time-frames, with window sizes for input vectors ranging from 50–1000 ms, and output vectors from 8.33–200 ms. Results show that LSTMs outperform CNNs, and the gap in performance becomes greater the larger the input and output window sizes are. The maximum difference between the Mean Absolute Errors (MAEs) of the CNN and LSTM networks was 0.91 degrees. Results also show that the input size has no significant influence on mean prediction errors when the output window is 50 ms or smaller. For output window sizes greater than 50 ms, the larger the input window, the lower the error. Overall, we obtained MAEs ranging from 0.095–2.531 degrees for the LSTM network, and from 0.129–2.840 degrees for the CNN. This study establishes the feasibility of forecasting pathological gait trajectories of children which could be integrated with exoskeleton control systems and experimentally explores the characteristics of such intelligent systems under varying input and output window time-frames.

Distress Debriefings After Critical Incidents: A Pilot Project.

Ethics in Critical Care| June 15 2018 Distress Debriefings After Critical Incidents: A Pilot Project Kerry P. Appleton, MAN, RN, CCRN; Kerry P. Appleton, MAN, RN, CCRN Kerry P. Appleton is Clinical Education Specialist, Children’s Minnesota, 2525 Chicago Avenue South, Minneapolis, MN 55404 (kerry.appleton@childrensmn.org). Suzanne Nelson is Simulation Specialist, Children’s Minnesota, Minneapolis, Minnesota. Shawn Wedlund is Pediatric Nurse Practitioner, Neurosurgery Department, Gillette Children’s Specialty Healthcare, Saint Paul, Minnesota. Search for other works by this author on: This Site PubMed Google Scholar Suzanne Nelson, MSN, RN, PCNS; Suzanne Nelson, MSN, RN, PCNS Kerry P. Appleton is Clinical Education Specialist, Children’s Minnesota, 2525 Chicago Avenue South, Minneapolis, MN 55404 (kerry.appleton@childrensmn.org). Suzanne Nelson is Simulation Specialist, Children’s Minnesota, Minneapolis, Minnesota. Shawn Wedlund is Pediatric Nurse Practitioner, Neurosurgery Department, Gillette Children’s Specialty Healthcare, Saint Paul, Minnesota. Search for other works by this author on: This Site PubMed Google Scholar Shawn Wedlund, DNP, APRN, CNP Shawn Wedlund, DNP, APRN, CNP Kerry P. Appleton is Clinical Education Specialist, Children’s Minnesota, 2525 Chicago Avenue South, Minneapolis, MN 55404 (kerry.appleton@childrensmn.org). Suzanne Nelson is Simulation Specialist, Children’s Minnesota, Minneapolis, Minnesota. Shawn Wedlund is Pediatric Nurse Practitioner, Neurosurgery Department, Gillette Children’s Specialty Healthcare, Saint Paul, Minnesota. Search for other works by this author on: This Site PubMed Google Scholar AACN Adv Crit Care (2018) 29 (2): 213–220. https://doi.org/10.4037/aacnacc2018799 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Email Tools Icon Tools Cite Icon Cite Get Permissions Citation Kerry P. Appleton, Suzanne Nelson, Shawn Wedlund; Distress Debriefings After Critical Incidents: A Pilot Project. AACN Adv Crit Care 1 January 2018; 29 (2): 213–220. doi: https://doi.org/10.4037/aacnacc2018799 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search nav search search input Search input auto suggest search filter All ContentAACN Advanced Critical Care Search Advanced Search Concerns about moral distress and burnout are not new; moral distress and burnout among health care professionals has been identified for decades.1–5 Moral distress was defined by Jameton in 1984 as “when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action.”6(p6) Current definitions of moral distress include the personal constraints of moral distress. Often, the choices of what is best for a patient may conflict with what is best for the organization, the care providers, the family, or even other patients.3 Nurses experience moral distress when they act in a manner contrary to their personal and professional values, which then undermines their integrity and authenticity.1 Frequently, nurses may not be able to protect patients from harm or provide patients with all the care needed.... ©2018 American Association of Critical-Care Nurses2018 You do not currently have access to this content.

How does patellar tendon advancement alter the knee extensor mechanism in children treated for crouch gait?

BackgroundThe patellar tendon advancement (PTA) procedure, often coupled with a distal femoral extension osteotomy (DFEO), is increasingly used to treat persistent crouch gait. In this study, we investigated relationships between patella position, knee flexion, and the patellar tendon moment arm in children treated with the DFEO and PTA procedures. MethodsWe retrospectively analyzed pre- and post-operative radiographs and gait metrics from 63 knees that underwent DFEO and PTA procedures at Gillette Children’s Specialty Healthcare. A computational musculoskeletal model of the knee was used to simulate the PTA procedure and predict the effects on the patellar tendon moment arm. ResultsApproximately 80% of the knees exhibited patella alta prior to surgery. Post-operatively, 86% of the knees exhibited patella baja. The surgically altered patella position produced a 13% increase in the patellar tendon moment arm in extended knee postures, which agreed well with model predictions. However, the computational model also suggests that baja may compromise patellar tendon moment arms in flexed knee postures. Crouch gait was significantly reduced postoperatively, with a 27 ± 18° reduction in average knee flexion in stance. There was considerable inter-subject variability in outcomes with nine knees not exhibiting a meaningful enhancement of knee extension (<15° change). The subjects who improved were significantly younger and exhibited greater enhancement of the patellar tendon moment arm after surgery. ConclusionsThis study shows that the PTA procedure enhances the lever arm of the knee extensor mechanism, and this factor may be important in resolving crouch gait.

Orthopaedic Surgery Residency Rotations and Correlation With Orthopaedic In-Training Examination Performance

The Orthopaedic In-Training Examination (OITE) is administered annually and is used to assess medical knowledge of orthopedic surgery residents. Beginning in the 2013 to 2014 academic year, the ACGME expanded the postgraduate year (PGY)-1 curriculum from 3 to 6 months of orthopedic surgery rotations. The purpose of this study is to evaluate the effect of increased PGY-1 orthopedic surgery exposure on medical knowledge as measured by the OITE. From 2011 to 2013, 24 PGY-2 residents completed 3 months of PGY-1 orthopedic training (Group 1). From 2014 to 2016, 24 PGY-2 residents completed 6 months of PGY-1 orthopedic training (Group 2). The effect of an initial PGY-2 pediatrics rotation (Sub-group A), compared to a trauma rotation (Sub-group B) was also analyzed. The hypothesis of this study is that Group 2 scores higher on the OITE than Group 1. Raw percentage and overall percentile scores for all PGY-2 residents from 2011 to 2016 for the pediatrics subsection, the trauma subsection, and for the overall OITE test in our program were recorded. Group 1 versus Group 2, and Sub-group A versus Sub-group B were compared (Student's t-test). University of Minnesota (Institutional, Tertiary); Gillette Children's Hospital (Institutional, Tertiary); Regions Hospital (Institutional, Tertiary). 48 PGY-2 residents from 2011 to 2016 were included in the study. Group 2 achieved higher raw and percentile scores on the OITE during their PGY-2 year than Group 1. Sub-group B scored higher than Sub-group A on all OITE subsections and overall. This study suggests that raw percentage and percentile OITE scores improve with an additional 3 months of orthopedic training in the PGY-1 year. Clinical exposure, specifically in orthopedic trauma, correlates with higher OITE performance in our residency program.

Safety of weekly adalimumab in the treatment of juvenile idiopathic arthritis and pediatric chronic uveitis.

Weekly adalimumab dosing is used to treat juvenile idiopathic arthritis (JIA), uveitis, and other pediatric rheumatic diseases, but the safety of such dosing has not previously been studied. A retrospective chart review was conducted to assess the safety of weekly adalimumab. Demographic and clinical data were collected. Basic descriptive analysis was performed to assess for adverse events from weekly adalimumab. Sixty-nine patients at the University of Minnesota or Gillette Children's Hospital were identified as treated with weekly adalimumab. Sixty (87%) were eligible for the chart review. Weekly adalimumab was used most commonly to treat uveitis (28%, 17/60) and rheumatoid factor-negative polyarticular JIA (25%, 15/60). Mean age at the start of weekly dosing was 13.9years. The majority of patients were concurrently treated with a non-steroidal anti-inflammatory drug and methotrexate. Fifty-three (90%) patients continued weekly dosing for greater than 3months. The mean duration of weekly adalimumab was 2years. Throughout the duration of weekly dosing, 24/60 (40%) patients had documented minor infections not requiring antimicrobials and 24/60 (40%) had documented infections requiring antimicrobial treatment. Only three patients (5%) had an infection requiring hospitalization. Two patients (3%) developed autoimmune disease. Laboratory abnormalities and injection site reactions were rare. Weekly adalimumab was used most commonly to treat uveitis and rheumatoid factor-negative polyarticular JIA, and mean duration of weekly dosing was 2years. Serious adverse events were rare.

Incidence of tethered cord in toe walking: single center experience at Gillette Children's Specialty Healthcare

Incidence of tethered cord in toe walking: single center experience at Gillette Children's Specialty Healthcare

Incidence of Tethered Cord in Toe Walking: Single Center Experience at Gillette Children's Specialty Healthcare

Incidence of Tethered Cord in Toe Walking: Single Center Experience at Gillette Children's Specialty Healthcare

The Use of Acupuncture in a Pediatric Chronic Care Setting: Clinical Applications

Abstract Background: Children with disabilities have a complex array of distressing symptoms that decrease their quality of life. Many of the mainstays of modern biomedicine can also impose significant side-effect burdens on patients and their families. There has been a paucity of studies examining acupuncture for reducing the symptom burden on these patients. Materials and Methods: This retrospective case series highlights patients referred for acupuncture or palliative care at Gillette Children's Specialty Healthcare, St. Paul, MN. In the past year, 52 unique patients received 136 acupuncture treatments in the clinic or hospital setting. Patients received treatments based upon their backgrounds and presenting complaints along with energetic work, biomechanical treatment (surface release technique, percutaneous electrical nerve stimulation), and/or auriculotherapy. Results: This case series highlights how 9 of the 52 patients with a variety of presentations received benefits from acupuncture. Conclusions...

Learning From the Memories of the Happy Wanderer

In interview passages placed as a found poem, Marie, a U.S. gold medalist skier and Paralympian, and transpelvic amputee, speaks directly and eloquently about her intense efforts to maintain her abilities, her independence, and her joyful self-direction over three decades of gradual disability. To this she brings her love of life and family, ingenuity, spiritual insight, and desire to live a meaningful, contributing life. Marie’s voice originates in interviews from a qualitative study undertaken at Gillette Children’s Specialty Healthcare during and after the fittings of her transpelvic prosthesis, from 2007 to 2013. During this time, Marie shared her remarkable experiences and interest in encouraging others. Through the use of narrative in poetic representation, our intent is to share Marie’s story to inspire readers of all abilities, to see themselves and each other more positively, holistically, and compassionately, within the context of their evolving stories.

The Pediatric Nurse Practitioner Workforce: Meeting the Health Care Needs of Children

The Pediatric Nurse Practitioner Workforce: Meeting the Health Care Needs of Children

Discordance of Neonatal Herpes Encephalitis Clinical Improvement and Disease Progression

Two cases of neonatal herpes encephalitis that showed an apparent uneventful recovery had concurrent severe, diffuse cerebral imaging abnormalities, in a report from Gillette Children's Specialty Healthcare, St Paul, and Children's Hospital, Minneapolis, MN.

Book Review: J. R. Gage, M. H. Schwartz, S. E. Koop, T. F. Novacheck (eds): The identification and treatment of gait problems in cerebral palsy

Book Review: J. R. Gage, M. H. Schwartz, S. E. Koop, T. F. Novacheck (eds): The identification and treatment of gait problems in cerebral palsy

Poster 214 injected contrast study fails to demonstrate catheter-pump connector tear: A case report. Linda E. Krach, MD (Gillette Children’s Specialty Healthcare, St. Paul, MN); Michael D. Partington, MD, e-mail: lkrach@gillettechildrens.com

Poster 214 injected contrast study fails to demonstrate catheter-pump connector tear: A case report. Linda E. Krach, MD (Gillette Children’s Specialty Healthcare, St. Paul, MN); Michael D. Partington, MD, e-mail: lkrach@gillettechildrens.com

Comprehensive Treatment of Ambulatory Children With Cerebral Palsy

A retrospective study was used to evaluate the outcome of treatment of 135 ambulatory children with cerebral palsy. Diplegic subjects were selected from the existing database at the Gillette Children's Specialty Healthcare Motion Analysis Laboratory. All subjects had undergone gait analysis before and after intervention, which included orthopaedic surgery, selective dorsal rhizotomy, or both treatments. Outcome was based on gait pathology, gait efficiency, functional walking ability, and higher-level functional skills. Gait pathology was assessed using 16 clinically relevant kinematic parameters. Gait efficiency was assessed with steady-state oxygen consumption. Walking ability and higher-level functional skills were based on patient report surveys. Improvements were seen in all outcome measures. A significant majority of subjects (79%) improved on a predominance of outcome measures; only 7% of subjects worsened. Within the restrictions of this study design, the results indicate that surgical intervention, guided by preoperative gait analysis, is effective and safe for children with cerebral palsy.

Comprehensive Treatment of Ambulatory Children With Cerebral Palsy

Summary: A retrospective study was used to evaluate the outcomeof treatment of 135 ambulatory children with cerebral palsy. Diplegicsubjects were selected from the existing database at the Gillette Chil-dren’s Specialty Healthcare Motion Analysis Laboratory. All sub-jects had undergone gait analysis before and after intervention, whichincluded orthopaedic surgery, selective dorsal rhizotomy, or bothtreatments. Outcome was based on gait pathology, gait efficiency,functional walking ability, and higher-level functional skills. Gait pa-thology was assessed using 16 clinically relevant kinematic param-eters. Gait efficiency was assessed with steady-state oxygen con-sumption. Walking ability and higher-level functional skills werebased on patient report surveys. Improvements were seen in all out-comemeasures.Asignificantmajorityofsubjects(79%)improvedona predominance of outcome measures; only 7% of subjects worsened.Within the restrictions of this study design, the results indicate thatsurgical intervention, guided by preoperative gait analysis, is effec-tive and safe for children with cerebral palsy.

Con: Interobserver Variability of Gait Analysis

From Gillette Children's Specialty Healthcare, St. Paul, Minnesota. Address correspondence and reprint requests to James R. Gage, M.D., Gillette Children's Specialty Healthcare, 200 East University Avenue, St. Paul, MN 55101 (e-mail: [email protected]).

Acute postoperative pain control for children with chronic disabilities.

Children have historically been undertreated for pain. Children with chronic disabilities may face multiple, complex surgeries that cause severe postoperative pain. In addition, underlying problems with increased muscle tone can cause painful postoperative spasms. Gillette Children's Specialty Healthcare treats children with chronic disabilities. Our orthopaedic surgeons have developed a single surgical approach referred to as "multiple lower extremity procedures" (MLEPs) to correct the patient's primary, underlying orthopaedic deformities all under one anesthesia. Because of the intensity of postoperative pain caused by this approach, Gillette Children's uses epidural analgesia or patient-controlled/nurse-controlled analgesia to manage postoperative pain.

Reliability and Validity of the Gillette Functional Assessment Questionnaire as an Outcome Measure in Children with Walking Disabilities

A 10-level, parent-report walking scale encompassing a range of walking abilities from nonambulatory to ambulatory in all community settings and terrains was developed at Gillette Children's Specialty Healthcare (GCSH) as part of the Gillette Functional Assessment Questionnaire (FAQ). The reliability and validity of the walking-scale portion of the FAQ were tested on a group of individuals seen in the Motion Analysis Laboratory at GCSH between May 1996 and January 1997. A complete data set on 41 individuals with neuromuscular conditions represented the community ambulation levels (6-10) of the walking scale. Good test-retest reliability among parents and good interrater reliability between parents and community caregivers was demonstrated. Content and concurrent validity were also high, as assessed by correlation to standardized functional outcome measures, energy expenditure, and gait-analysis information. A reliable and valid scale specific to the task of walking such as the FAQ can assist clinicians in documenting functional change in children with chronic neuromuscular conditions.

Metal mania: fact or fiction?

In 1960, when I was a second-year resident in orthopaedic surgery, I was sent to Gillette Children's Hospital in St. Paul, Minnesota, for a six-month rotation in children's orthopaedics. Dr. John Moe was the Chief of Staff and also the Chief of the Spine Service. About eight weeks after I began my rotation, I had the opportunity to scrub in on an operation on the first patient with idiopathic scoliosis at Gillette Children's Hospital to be managed with Harrington instrumentation. The operative team consisted of Dr. Paul Harrington, Dr. John Moe, Dr. Walter Blount, Dr. Verne Nickel, Dr. William Bickel (the Chief of Scoliosis Surgery at the Mayo Clinic), and me. The operation was performed by Dr. Harrington, and a beautiful correction was safely achieved. From that moment onward, Harrington instrumentation with a Moe facet arthrodesis became the standard of care for scoliotic patients at Gillette. We quickly learned that, in a well fitted Risser localizer cast, scoliotic patients who were managed with this instrumentation could walk immediately, a far cry from the six months in bed that had been the norm previously. Instrumentation for scoliosis has advanced to the point that most patients do not need a brace or a cast; they now leave the hospital in five days and return to school in two weeks. All of this marvelous advance in patient care was achieved without a single prospective, randomized, controlled clinical study. At the same time, however, I have seen surgeons who are so enamored of the new implant technology that they have forgotten the basic purpose of the operation, which is to achieve solid fusion. Another dramatic evolution in orthopaedic …

We Hold This Treasure-The Story of Gillette Children's Hospital

We Hold This Treasure-The Story of Gillette Children's Hospital