The CRC has created a low-cost solution to providing expert services locally. Fiona Tyrrell reports.
Capitalising on technology designed for a Nasa zero-gravity project, the Central Remedial Clinic (CRC) has launched the world's first mobile gait laboratory in Limerick, which will help children and adults suffering from walking disabilities in the south eastern and mid-western regions.
For the past 15 years the CRC has been offering specialist gait or walking analysis services from its national centre in Clontarf, Dublin. The service is for people with walking difficulties, such as those suffering from cerebral palsy, spina bifida and genetic disorders, and is used to identify conditions and to recommend surgical or medical treatments.
Now, thanks to advances in telemedicine technology, people with walking disabilities can avail of the exact same service in Limerick and Waterford at CRC's mobile gait analysis service.
Essentially gait analysis involves electronically tracking the patient's walk to help decide upon surgical or medical intervention.
By attaching light-emitting sensors to various parts of the body, specialists can track the patient's movement with infrared light and reconstruct it on graphs for scientific analysis.
Far faster than the human eye, the electronic movement analysis involves a 3D reconstruction of how a person walks.
The data provided enables doctors and surgeons to differentiate between a number of medical conditions and to make confident recommendations for surgical and medical treatments.
It also provides excellent pre- and post-treatment records allowing for objective analysis of the success of any therapy or surgical intervention.
The service in Dublin is operated by two senior specialised physiotherapists, who carry out the assessment, and a lab manager.
On average around 260 people, mostly children, are referred to the Clontarf-based lab by their consultants. There is a waiting list of around three months. However, this list is prioritised on clinical need.
One full gait analysis can take up to six man hours. However, as the decision being made can mean the difference between a child using a wheelchair or walking independently, this amount of time is entirely justified, according to Mike Walsh, manager of the gait laboratory.
Until now the technology used in the service was not advanced enough for such a service to be anything other than laboratory-based. Children and adults with walking disabilities had to travel to Dublin for assessment.
Families had to endure an early start and long journey to avail of the Dublin service.
Children were often tired and tight in their muscles by the time they began their analysis, leading to difficulties in capturing representative data, Walsh says.
However, recent advances in technology have allowed the motion analysis technology needed for the service to work from a laptop, thanks to groundbreaking work for a Nasa experiment on perceptual motor skills in zero-gravity environments.
Now people with walking difficulties in the Waterford and Limerick area can benefit from gait analysis via innovative telemedicine technology and receive specialised assessment with full medical recommendations from an expert team based in Dublin via video conferencing.
CRC has simply taken the data acquisition process and made it mobile, keeping the medical interpretation centralised.
The first pilot of the mobile lab was conducted last summer in Limerick, where the CRC owns a large building.
A live clinical reporting session was done between Limerick and Clontarf where staff, led by orthopaedic director of the lab, Prof Tim O'Brien, were able to view 3D graphs, video data and examine doctors' referral letters via video conferencing.
Prof O'Brien was then able to give his medical and surgical recommendations, also via video conferencing.
The decision to take the technology on the road was prompted by the fact that 50 per cent of the patients attending the lab in Clontarf were from outside Dublin.
It is envisaged, however, that once the service is based locally, more people will use it.
The response to the service has been overwhelming from parents of children with disabilities, Walsh says.
"We have been developing this service for the past number of years and to see it coming together and making a difference to people's lives is satisfying.
"The positive feedback from parents is enormous as they are delighted not to have to travel to Dublin for this assessment," he says.
Linking in with local therapists and clinicians is another bonus of the outreach programme.
This allows the gait analysis team to share their specialised knowledge.
A series of regular workshops and educational lectures will also form part of the outreach service.
This telemedicine technology, which allows for medical recommendations to be made centrally by an expert team based on data captured remotely, is a low-cost solution to providing expert services in local health executive areas, according to Walsh
It would be very expensive to set up and run gait laboratories in every region and the number of people requiring the service would make it difficult to justify the investment, he says.
It would cost in the region of €5 million to set up a gait lab and cost around €300,000 to run every year.
This is compared with the €230,000 capital outlay for the mobile lab and the €800 cost per clinic session.
Mr Walsh believes it is a good model and may work in other areas.
CRC hopes to roll out the service to other areas in the country, with the north west region being the most obvious area to target next.