Shriners Children's Medical Leaders Educate and Learn at Prestigious National Cerebral Palsy Conference

Shriners Children's physicians, advanced practice providers, therapists, social workers, engineers and scientists contributed their expertise and knowledge at the 78th American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) Annual Meeting. Over 30 Shriners Children's staff members presented scientific discoveries and led instructional courses on a broad range of topics related to children with cerebral palsy (CP) and other developmental conditions at the meeting held in Quebec City, Canada.

A Shared Mission to Advance Research and Treatment

"Cerebral palsy is the most common cause of motor disability in children, both in the U.S. and worldwide," said Vedant Kulkarni, M.D., assistant chief of staff and vice-chair of orthopedics at Shriners Children's Northern California. "The missions of both Shriners Children's and the AACPDM are in perfect alignment - to improve the health and well-being of individuals with cerebral palsy and other developmental conditions through multi-disciplinary discussion and engagement."

Shriners Children's physicians hold leadership roles in the AACPDM. Dr. Kulkarni served as the scientific co-chair of the 2024 AACPDM Annual Meeting. Jeremy Bauer, M.D., pediatric orthopedic surgeon at Shriners Children's Portland, serves on the AACPDM board of directors.

Showcasing Exceptional Research and Care at AACPDM 2024

At this year's AACPDM Annual Meeting, physicians, clinicians and researchers from Shriners Children's led 17 sessions, including six podium presentations that highlighted extraordinary advances in the field.

HipScreen AI: Artificial Intelligence Algorithm Accurately Measures Migration Percentage on Hip Surveillance Radiographs Acquired from a Mobile Device - Vedant Kulkarni, M.D. and Marie Villalba, BS.

Children with cerebral palsy are at high risk for developing hip problems. With an early detection "hip surveillance" program, these problems can be identified on an X-ray at an early stage when more effective treatment is possible. However, experts are required to properly interpret and measure the X-rays for hip problems, which may not be available in many communities worldwide. Teaming up with computer scientists at UC Berkeley and University of Michigan, Dr. Kulkarni created and tested an artificial intelligence program to automatically measure hip surveillance X-rays. He shared the results of a scientific study that found that the program had expert-level measurement on a large and diverse set of X-rays from around the world.

"This artificial intelligence program we are calling 'HipScreen AI' could allow more children to have access to much-needed expertise," Dr. Kulkarni said. "We can make it dramatically easier to detect hip problems early, helping to reduce pain and improve function in children across the globe." The research study was honored as a "Top 10 Scientific Presentation" at the meeting.

Morphological Variations in the Talus and Calcaneus Following Lateral Column Lengthening in Adults with Cerebral Palsy - Karen Kruger, Ph.D.

Motion analysis centers at many Shriners Children's locations are utilized to provide additional data and guidance both pre- and post-surgery for a child's care team, particularly in neuromuscular conditions such as cerebral palsy. Kruger, research director at Shriners Children's Chicago's motion analysis center, has a particular focus on the impact of care for complex foot conditions. At AACPDM she presented a study on flatfoot, one of the most common foot deformities in patients with cerebral palsy, and specifically the impact of surgical correction of flatfoot on the shape of bones of the subtalar joint (calcaneus and talus). This study involved patient alumni who had lateral column lengthening surgery at Shriners Children's.

Compared to a control group and adults with CP who did not have the surgery, the study found notable changes to parts of the foot bones, including changes to bone shape and joint surface. "This surgery to the calcaneus resulted in adaptations (changes) to adjacent bones, suggesting potential adaptations associated with this surgery," said Kruger. She added that larger studies across more age ranges and surgical options are needed to further evaluate the findings.

Impact of Treatment for Children with Idiopathic Toe Walking on Gait Abnormalities - Jon Davids, M.D., Mark L. McMulkin, Ph.D., Bruce A. MacWilliams, Ph.D., Susan Sienko, Ph.D., Jeremy Bauer, M.D.

While toe-walking is common in healthy, developing children, and toddlers usually grow out of it, if a child is still toe-walking after their second birthday, a doctor should be consulted. The condition is often diagnosed as "idiopathic" when the cause is unknown. But in some instances, toe-walking may be attributed to other diagnoses. In some patients with cerebral palsy, toe-walking may be caused by abnormal development, problems with movement or muscle tone. Muscular dystrophy may be to blame if the child started out walking normally before the toe-walking began. It has also been linked to disorders on the autism spectrum. Children who are toe-walkers may also have an increased risk of falling and could face ridicule in social situations.

Jeremy Bauer, M.D., orthopedic specialist at Shriners Children's Portland, calls treatment of idiopathic toe-walking a great research opportunity and is leading a multi-location study to do just that. "It's sometimes hard to tell the difference between causes; they all look very similar," he said.

This collaborative research project will help inform pediatric orthopedic specialists in making care plans for children with toe-walking for whom the cause is unknown. Mark McMulkin, Ph.D., NW market director, motion analysis system engineer, added, "We will take a look at how the child is doing, and use our research study to help differentiate between neurological causes versus idiopathic toe-walking." The study involves eight Shriners Children's locations, which allows for an incredible reach and patient diversity available through the Shriners Children's healthcare system and will help ensure the optimal results for patients.

The study will enroll about 90 patients from across the Shriners Children's system. Each child will receive both a motion analysis assessment and a genomics evaluation, and then will be reevaluated after one year. The researchers will examine surgery versus casting for the treatment of idiopathic toe-walking. The genomics portion of the study will examine whether there is a genetic link to idiopathic toe-walking. The Shriners Children's specialists recognize that there are gaps in understanding why some treatments work and others don't. "This will help us determine the best treatment plan for each of our patients," said Dr. McMulkin.

Functional Independence of Children with Arthrogryposis - Lauren C. Hyer, M.D., Emily Shull, Ph.D., Lisa V. Wagner, OTR/L, David E. Westberry, M.D.

Along with cerebral palsy, other childhood-onset disabilities highlighted at the AACPDM Annual Meeting included arthrogryposis multiplex congenita (AMC). Shriners Children's is the medical home of a continuously growing influx of patients diagnosed with AMC from across the country and around the world. Offering multidisciplinary treatment composed primarily of rehabilitation, orthotics and orthopedic surgery, the world-class program at Shriners Children's Greenville is led by Lauren Hyer, M.D. - who contributed both a presentation and poster at AACPDM.

"During her tenure at Shriners Children's, Dr. Hyer has become a highly regarded leader in the AMC community," saidDavid Westberry, M.D.,chief of staff, Shriners Children's Greenville. "She has built a program that not only addresses the patient's immediate needs, but also positions each child individually to achieve the greatest level of independence possible as they enter adulthood."

Dr. Hyer's presentation, Functional Independence of Children with Arthrogryposis, described the purposeful independence of children with AMC through the lens of the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) and observational activities of daily living (ADL) tasks. Outcomes from the study provided a reference to help gauge the results of nonoperative and surgical treatment toward improving functional independence in the AMC population.

Shriners Children's Contributions to AACPDM 2024

4 Hour Instructional Courses:

• PC5: Learning to Read and Interpret Gait Lab Kinematics and Kinetics: Testing Your Skills - Ross Chafetz, D.P.T., Ph.D., Jon Davids, M.D.

1-2 Hour Instructional Courses:

• MINISYMP08: Knee Surveillance in Children with Diplegia - Jon Davids, M.D.
• MINISYMP18: Translating the NINDS Cerebral Palsy Common Data Elements (CP CDEs): Discover Ways to Advance Your Research, Clinical and Educational Productivity While Shaping the Next Generation of CP CDEs. - Susan Sienko, Ph.D.
• MORNSEM35: HipScreen App: A Validated Tutorial for Teaching Hip Surveillance X-Rays Measurement to the Radiology Novice - Vedant Kulkarni, M.D., Jon Davids, M.D.
• MINISYMP35: Neuro-Orthopedic Journal Club: Top 10 Articles in the Last Year Relating to the Orthopedic Management of Children with Neuromuscular Disorders - Jon Davids, M.D.

Podium Presentations:

• C1: HipScreen AI: Artificial Intelligence Algorithm Accurately Measures Migration Percentage on Hip Surveillance Radiographs Acquired from a Mobile Device - Vedant Kulkarni, M.D., Marie Villalba, BS. Selected for "Top 10 Scientific Study."
• D2: The Impact of Dosing Schedule on Motor Skill Acquisition in Children with Bilateral Cerebral Palsy (BCP) - Susan Sienko, Ph.D.
• G10: Morphological Variations in the Talus and Calcaneus Following Lateral Column Lengthening in Adults with Cerebral Palsy - Karen Kruger, Ph.D.
• I10: Single Cell RNA Sequencing Reveals Disrupted In Vivo Transcription of Stem Cells in Muscle Contractures of Children with Cerebral Palsy - Vedant Kulkarni, M.D., Marie Villalba, BS, Jon Davids, M.D.
• L2: Impact of Treatment for Children with Idiopathic Toe Walking on Gait Abnormalities - Jon Davids, M.D., Mark L. McMulkin, Ph.D., Bruce A. MacWilliams, Ph.D., Susan Sienko, Ph.D., Jeremy Bauer, M.D.
• L7: Functional Independence of Children with Arthrogryposis - Lauren C. Hyer, M.D., Emily Shull, Ph.D., Lisa V. Wagner, OTR/L, David E. Westberry, M.D.

Poster Presentations:

• SP08: Upper Extremity Function in Hemiplegic Cerebral Palsy - Functional and Patient Reported Outcomes - Alyssa Barré, M.D., Anita Bagley, Ph.D., Henry Iwinski, M.D., Donna Oeffinger, Ph.D.
• SP26: Bilateral Coordination and Balance Profiles of Children with a Diagnosis of Idiopathic Toe-Walking - Cathleen Buckon, OT/L, Susan Sienko, Ph.D., Jeremy Bauer, M.D.
• SP61: Gait Abnormalities in Children with Idiopathic Toe Walking (ITW) - Jeremy Bauer, M.D., Mark McMulkin, Ph.D., Bruce MacWilliams, Ph.D., Susan Sienko, Ph.D., Jon Davids, M.D.
• SP62: Idiopathic Toe Walking (ITW): Are Parents Able to Accurately Report? - Jeremy Bauer, M.D., Bruce MacWilliams, Ph.D., Susan Sienko, Ph.D.
• SP87: Does Tranexamic Acid Reduce Blood Loss for Children Undergoing Reconstruction for Neuromuscular Hip Dysplasia - Lauren Hyer, M.D., Emily Shull, Ph.D., David Westberry, M.D., Brittney Southerland, BS, Daphne Lew, Ph.D.
• SP170: Effect of Proximal Femoral Guided Growth on Hip Subluxation in Cerebral Palsy - Sean Waldron, M.D., Vedant Kulkarni, M.D.