orthotic (brace) based on sensor technologies to treat pediatric flat foot. (See the accompanying sidebar, “Tech4Pod at a glance,” for a description of all eight projects.) Tech4POD’s well-established collaboration of respected researchers and clinical practitioners makes for an unusually large and productive clustering of research and development projects. “All of those involved in Tech4Pod are individually recognized for the work they are doing,” Harris says. “It’s a long line of accomplishments. So people in the field trust us. If this group does a study, they know it’s reliable.”

Tech4POD’s well-established collaboration of researchers and clinical practitioners makes for an unusually large and productive R&D cluster. Patient-centered problem-solving Smith says almost all of the patient population at Shriner’s, which specializes in the treatment of pediatric orthopaedic conditions, is affected by this research. “We have several thousand active patients and more than 15,000 clinic visits each year,” he says. “(This research) helps the entire hospital, not just those kids who participate.” Smaller but significant numbers of Milwaukee-area children also participate in Tech4Pod studies. The research and development projects under the grant will directly help patients such as 12-year-old Grace Doyle from Byron, Ill. In many ways, she is a typical seventh-grader who likes country music, loves books by Kate Klise and has a part in her middle school play, Ugly Duckling. But Grace has osteogenesis imperfecta, or brittle bone disease, a genetic disorder characterized by fragile bones. She endured three fractures before she was 2 and broke her wrist once simply by squeezing a tube of toothpaste. In addition to receiving her clinical care at Shriner’s, Grace participates in studies that track long-term patient outcomes. “It makes me feel good that by participating in the studies I can help other people,” she says. “I want to show that even though you

have (osteogenesis impefecta), you can still do whatever you want to do. You’re a normal kid. You just have to do things more carefully.” The first research project under Tech4Pod looks at predicting the probability of a bone fracture, information that could significantly help children. “We have new technology to look at crack propagation right now,” says Harris. “What if you could predict a fracture ahead of time and intervene?” The project also looks at modification of activities and the timely use of assistance devices such as crutches, walkers and wheelchairs. “Once our database is big enough, an OI patient will come into the gait lab and we’ll do an analysis and use that to determine the probability of a fracture — determine where the patient is on a fracture scale. We could give that information to the clinician to improve care.” According to Harris, the same information provided to a surgeon could lead to an early intervention to realign the bones. “The combination of material information with functional activity information and finite modeling — to give an ultimate estimate on when a bone would fracture — is unique and it’s what we’re doing right now,” he says.

Sharing the information, winning the race The sharing of information between researchers and clinicians is one of the main components of the Tech4Pod grant and one of the most intriguing parts for Harris. “We have just as much in the training and dissemination part of this grant as we do in the R’s and D’s,” says Harris. The training system is online at tech4pod.org to educate patients and their parents and include them in the design and development process. The team will also provide researchers, engineers and clinicians with information and demonstration videos about the new studies and methods of care as they become available. “With a child, it’s a race. Our knowledge and clinical applications with their maturation,” says Harris. “The more you do to win the race, the more function they have when they mature — to develop more normal gait patterns, to develop more normal muscle function, to train and strengthen. And that means they can do more of things that they want to do. “The more you’re involved in it, the less satisfied you are,” he says. “You’re always wondering what more could we have done to provide more function.” And that question is what will keep Harris looking for new ways to use technology to improve the clinical care of these children.

Tech4Pod at a glance Tech4Pod’s eight groundbreaking research and development projects, funded by a $4.75 million grant from the U.S. Department of Education, are aimed at improving the care and quality of life of children with orthopaedic disabilities. Research projects R1: Nano- and microstructural characterization of tissue from children with osteogenesis imperfecta and severe clubfoot deformity, enabling researchers to recommend activity modifications, design better devices to absorb forces and prevent fractures, better direct surgeons about high load areas, and assess the efficacy of casting options in infants. R2: Diffusion tensor imaging to determine changes in brain activity from surgery and robotic-assisted therapy, supporting restoration of upper- and lower-limb function in children with cerebral palsy. R3: The use of home-based robot-guided therapy with teleassessment and interactive game elements in the rehabilitation of joint impairments in children with cerebral palsy. R4: Advanced mobility modeling of upper and lower extremities to determine the relationship between internal joint forces, assistive devices, ankle implants and longer-term tissue level effects as they relate to pain and function in children with orthopaedic disabilities. Development projects D1: A pivoting-sliding elliptical motion system with an interactive gaming element to improve off-axis neuromuscular control in children with orthopaedic disabilities. D2: Three-dimensional pediatric roboticassisted gait training — incorporating a less restrictive, more affordable cable system — to improve locomotor function in children with cerebral palsy. D3: A biplanar fluoroscopic system for dynamic in vivo foot and ankle motion analysis, supporting better-fitting and more effective shoes and braces customized for individual patient’s needs. D4: The use of three-dimensional fluoroscopy in creating customized, pressure-validated braces for children with flatfoot. Training and dissemination Activities include online training, distribution of publications, educational courses, conference workshops, symposia and presentations, newsletters, accessible registries, and state-of-the-art information for clinicians, parents, participants, other health care professionals and researchers. Read more at tech4pod.org. November 2011 // 16