Dallas Morning News: Breaking bones, barriers
Scottish Rite for Children hosted 40 high schoolers as part of an outreach program to expose girls to orthopedic surgery and engineering.
Concussion Balance Study
Learn how we use our Movement Science Lab to evaluate balance testing in sport-related concussion management.
Balance testing is commonly used to assess impairment and recovery after a sport-related concussion in the clinic setting. Measuring imbalances while going through various stances combined with both a firm and foam surface can provide valuable information in the evaluation of a concussion. Scottish Rite’s study, recently published in Brain Injury, was designed to look at how balance performance differed from diagnosis to return-to-play among athletes recovering from a concussion. A standardized test called the Balance Error Scoring System (BESS) is easy to perform in a clinic setting, but it may not provide the level of detail needed for a research study evaluating balance after sustaining a sport-related concussion. By conducting balance testing using the Movement Science Lab’s force plates, or special areas built into the flooring that are sensitive to the weight and force applied, researchers could correlate the BESS results with a highly objective center-of-pressure (COP) measure.
Principal investigator and director of movement science Sophia Ulman, Ph.D., explains the differences between these tests. “The BESS is a subjective test that requires clinical training and practice,” she says. “Alternatively, the force plate used to assess COP provides very specific, multidimensional measures that allow for discrimination of small differences in balance performance.”
It has been well established that there is an increased risk of prolonged symptoms as well as potential for compounding injuries if an athlete returns to play too soon after a sport-related concussion. Although balance is not the only measure used to determine readiness for sport, the proper assessment of balance is an important factor in this decision making. After reviewing data for these two tests in 40 patient-subjects, our team noted that the commonly used BESS test may not provide the information needed to assist with balance assessment as symptoms improved.
What does this mean for providers managing sport-related concussions?
Despite the volume of studies on the topic, the Sports Medicine team is continuing to learn about managing sport-related concussions in young and growing athletes. Pediatric sports medicine physician Shane M. Miller, M.D., says, “Until there is a better test to use in the clinical setting, we will continue to use tests like the BESS to do our best to assess balance improvement and identify the right time to return athletes to their sport. I suspect this will be a conversation for many years.”
The study, “Improvement in balance from diagnosis to return-to-play initiation following a sport-related concussion: BESS scores vs center-of-pressure measures,” was published in July 2022 in Brain Injury, the journal of the International Brain Injury Association.
Share Your Story: Take Flight
Meet Levi – a patient who is seen in the Luke Waites Center for Dyslexia & Learning Disorders. Learn more about his journey below.
Blog written by Levi’s dad, Josh.
My wife Kelly and I have eight children, as young as five and as old as 24. We have homeschooled our children since our oldest daughter was in first grade.
Around the time our second oldest daughter, Grace, was in kindergarten and first grade, my wife noticed that Grace was having difficulty reading. At that time, we were living in Austin. Grace was evaluated with a local diagnostician and diagnosed with dyslexia. We worked with a local language therapist, and Grace was provided her the tools she needed to learn to read. Grace will graduate college in about a year.
Levi is seven years old and our second to youngest child. When Kelly started teaching kindergarten with him, she noticed almost right away that he was having similar struggles, like Grace did when she was younger. By now, we had moved from Austin to Arlington, and we reached out to Scottish Rite for Children in Dallas.
They evaluated him, and Levi was diagnosed with ADHD and dyslexia. We were looking into finding private language therapy for him, just like we had done for our daughter, Grace. It turned out that there was an opening for Levi to do the Take Flight program at Scottish Rite starting in fall of 2021. We jumped at this chance.
We have seen a great deal of progress since Levi started this program. We thank God for connecting us with Scottish Rite. He loves everyone who has taught him, and he loves to learn!
Last December, Levi fell while playing basketball. He came to his Take Flight class with his arm in a sling, from the ER visit the night before. The leaders of his class were able to get us connected with some of the orthopedic experts and he was able to get the care that he needed. Turns out he had broken in his arm in three places, and Scottish Rite was just the place he needed to help treat his arm.
The Luke Waites Center for Dyslexia and Learning Disorders at Scottish Rite has been a blessing to our family, and we are incredibly thankful for the impact they are making on Levi’s life.
DO YOU HAVE A STORY? WE WANT TO HEAR IT! SHARE YOUR STORY WITH US.
Does my child need surgery to fix a clavicle fracture?
Pediatric orthopedic surgeons Henry B. Ellis, M.D., and Philip L. Wilson, M.D., along with colleagues from the multicenter study group Factors Associated with Clavicle Treatment Study (FACTS) have published another set of findings in the American Journal of Sports Medicine. This group, like many others in pediatric orthopedics and sports medicine, merges the experiences and data from across institutions to provide the best evidence for care in the pediatric population. This group focuses their efforts on collarbone (clavicle) fractures and injuries in children and adolescents.
Here are some highlights from the publication. You can also visit the journal’s website to read the full article.
- Midshaft clavicle fractures most often occur in adolescents, yet, most medical evidence is in adults until now.
- More than 400 patients (10 to 18 years) with 100% displaced clavicle fractures were included in the study.
- After two years, there was no difference in outcomes between those that had surgery and those that did not.
- Those who underwent surgery had more nerve damage (loss of sensation on their chest wall) and more second surgery to remove plates and screws.
- The study conclusion states, “Surgery demonstrated no benefit in patient-reported quality of life, satisfaction, shoulder-specific function or prevention of complications after completely displaced clavicle shaft fractures in adolescents at two years after injury.”
So, the answer to the question, “Does my child need surgery to fix a clavicle fracture?” is not yes. But, that also does not mean it is no. The study describes the general experience of a large group patients who have and have not had surgery for this condition. The individualized assessment of the patient is still important and necessary, but the study does show that there is not an obvious answer that applies to all patients. “This work is new and very important for the growing body of evidence in caring for this population,” Ellis says. “We can confidently tell families that one path is not yet obviously better than another.” In our individualized patient care, it is important for us to provide evidence-based recommendations, and in our research, we aim to define the recommendations.
This study, Two-Year Functional Outcomes of Operative vs Nonoperative Treatment of Completely Displaced Midshaft Clavicle Fractures in Adolescents: Results from the Prospective Multicenter FACTS Study Group, was published in the American Journal of Sports Medicine in September 2022.
On The Move: Unstoppable
Article previously published in Rite Up, 2022 – Issue 2.
It is not uncommon to see Michael, of Redmond, Washington, posing like his favorite superheroes. He loves playing Minecraft™, riding his bike, swimming, wearing costumes, acting, dancing and singing. In January 2021, this highly active and vivacious young man had a life-changing surgery performed on his left forearm by pediatric orthopedic experts from our hand and limb lengthening and reconstruction teams at Scottish Rite for Children.
“I have no words to describe the blessing it has been for Michael and myself,” Berenice, Michael’s mother, says. “Scottish Rite is simply amazing.”
Michael was born premature at 23 weeks and stayed in the NICU for four months. At 3-months-old, the family realized he had a bump on his left arm and worked with Michael’s doctors to investigate the issue. Following a biopsy, it was determined that Michael had congenital pseudoarthrosis, which caused a deformity in the bones in his left forearm.There are very few teams that could successfully manage the complexities and intricacies of Michael’s treatment, but Scottish Rite for Children could. “To me Scottish Rite is a place where miracles happen, where the prayers of many parents come true,” Berenice says. “The doctors really care, and all the staff understand you and want to help in any way they can. Somehow you know your child is in the best hands, and you trust they are going to be okay.”
Watch Michael’s Story and learn more about Scottish Rite’s extraordinary care.
Read the enitre issue.