Children with cerebral palsy frequently undergo invasive surgeries — lengthening tendons, rotating bones, transferring muscles to new locations — in hopes of improving their physical ability to walk or move.

While the surgeries work beautifully for some patients, other children see little to no improvement after those operations.

Researchers from the 91Ě˝»¨â€™s Department of Mechanical Engineering, in collaboration with partners from Gillette Children’s Specialty Healthcare, have developed a new quantitative assessment of motor control in children with cerebral palsy called Walk-DMC, which could help predict which patients are — or are not — likely to benefit from such aggressive treatment.

The new measure is based on electromyography (EMG) data, a tool already commonly used to evaluate patients with cerebral palsy that uses electrodes placed on the skin to monitor muscle activity.  Historically, doctors have relied on experience and more subjective clinical measures to evaluate a patient’s motor control.

In one of the largest studies of treatment outcomes in cerebral palsy to date, the team found that a patient’s Walk-DMC score before treatment was significantly linked with how much the patient’s gait, walking speed and function improved after surgery. The was published online Apr. 21 in .

“Only about 50 percent of children have significant improvement in their movement after these highly invasive surgeries,” said , a 91Ě˝»¨assistant professor of mechanical engineering. “Our motivation has really been to figure out how we can push up these success rates.

The team recently won a $1.5 million grant from the National Institute of Neurological Disorders and Stroke to further evaluate Walk-DMC’s potential in clinical settings.

Cerebral palsy is caused by an injury to the brain that happens near birth, and affects about three in 1,000 children. But as every brain injury is unique, individuals with cerebral exhibit a wide collection of symptoms and conditions and respond to treatment differently.

Doctors had theorized that patients with better motor control — the brain-to-muscle connections that allow someone to coordinate movement— prior to surgery were likely to fare better after surgical interventions. Common surgeries for individuals with cerebral palsy typically fix musculoskeletal or anatomical issues that limit physical movement but don’t necessarily address how well a patient can control those muscles.

So far, however, there has been no standardized way to quantify motor control in cerebral palsy.

In a , Steele and her colleagues demonstrated how to analyze muscle synergies — or patterns of coordinated muscle activity — in individuals with cerebral palsy from data already commonly collected in the clinic. They found that children with CP employ motor control strategies that are similar to adult stroke survivors, and are considerably simpler than the strategies employed by unimpaired individuals. In both CP and stroke, this impaired motor control is thought to contribute to impaired movement and function during daily life.

The team then developed algorithms to translate the complexity of a patient’s motor control strategies into a single number, which represents the patient’s Dynamic Motor Control Index During Walking, or Walk-DMC.

Two cerebral palsy patients may have exactly the same score on the Gait Deviation Index, a commonly used assessment that measures joint angles to evaluate how “normally” a patient walks. But the researchers found those two patients may actually have widely different Walk-DMC scores, which measures their underlying muscle coordination and motor control.

In the current study of 473 children with cerebral palsy who had undergone surgical treatment, the researchers found that children with higher walk-DMC scores prior to surgery had better treatment outcomes – even after controlling for other factors like age and prior treatment.

“Two individuals can walk very similarly but have very different motor control strategies,” said Steele, who directs the . “These results suggest that motor control is uniquely and independently associated with outcomes and can help us decide when you might recommend surgery and when you might be more conservative in treatment.”

The team’s next steps include analyzing whether motor control can change after treatment, and working to expand options for children who are less likely to be good surgical candidates.

“The kids with good motor control are likely to get better once you fix their musculoskeletal issues because they have the capacity to control their muscle groups and limbs,” Steele said. “The big question is: What can we do for the other kids? If muscle control can change, that opens the door for more rehabilitation options. And if it can’t, that’s good to know so we can help optimize their movement and quality of life.”

The ongoing research is funded by the National Institute of Neurological Disorders and Stroke within the National Institutes of Health.

Co-authors include , director of biomedical engineering research at Gillette Children’s Specialty Healthcare, and Adam Rozumalski, an engineer at Gillette Children’s Specialty Healthcare in St. Paul, Minn.

For more information, contact Steele at kmsteele@uw.edu.

Grant Number: NIH: R01 NS091056

Inspired by the DIY movement, these communal spaces with soldering irons, laser cutters, saws, duct tape, pegboards full of tools, butcher paper, crayons and other “making” tools are popping up across the country. They enable a broader array of people to tinker, create, crochet or prototype whatever invention they can dream up.

To ensure those spaces are truly inclusive, a team of 91Ě˝»¨researchers has released new to people with disabilities.

The effort is part of a broader National Science Foundation-funded initiative, which supports students with disabilities in pursuing engineering careers and promotes accessible and universal design in engineering departments and courses.

“A lot of universities are creating these more casual prototyping spaces where students can have more of a DIY experience, as an alternative to a traditional machine shop,” said AccessEngineering co-principal investigator , a 91Ě˝»¨assistant professor of mechanical engineering whose focuses on developing tools for people with cerebral palsy, stroke and other movement disorders.

“Because this is a big growth area for engineering schools, we wanted to help with some best practices and guidelines so that as these new spaces are being created they can be accessible to the widest group possible.”

On a recent tour of the UW’s , students with an array of disabilities — from cerebral palsy to vision impairments to autism — found a lot to like. The open spaces worked for people in wheelchairs, and floors were free of wires that could trip people or snag wheels. A wide range of materials and tools allowed people with differing abilities to find things to work with. Quiet rooms around the perimeter of the space offered a refuge for people with hearing impairments or neurodevelopment disorders who have trouble filtering out background noise.

During a prototyping challenge that allowed them to test the tools, though, they ran into some unique challenges in sketching, building and sharing their ideas. Items on their wish list to make the makerspace more usable — which helped inform the new accessibility guidelines — included:

• large print and braille labels for tools
• adjustable-height tables with push-button adjustments to accommodate individuals using wheelchairs
• eliminating tiny drawers that store screws, nuts, bolts and electrical equipment that are difficult for people with motor impairments to open
• multiple mouse and keyboard options
• guards on sharp objects so people who use their fingers to “see” won’t inadvertently cut themselves
• high-contrast, large-print instructional and safety signs
• making all tools and safety equipment accessible from a seated position
• having tactile prototyping tools available, such as clay that can be used to quickly “sketch and share” ideas

Incoming 91Ě˝»¨freshman Hannah Werbel, who is legally blind and participated in the 91Ě˝»¨ program that helps students with disabilities prepare for college, found the bright yellow electrical outlets hanging from the ceiling — which are designed to keep wires off the floor — were at just the right height to be hazardous.

“Those outlets are my arch nemesis — I can’t tell you how many times I’ve been bonked in the head or chest,” Werbel said. “Even if they’re right in front of my face, I can’t see them because of depth perception issues. And a cane wouldn’t pick them up because they’re not on the ground.”

Work tables on wheels were a plus, since they allow people to reconfigure the space as needed and move if people accidentally bump into them. But the students suggested that makerspaces keep equipment — 3-D printers, laser cutters, tools, sewing machines — in the same location.

“The everything-on-wheels thing is really good for people in wheelchairs,” said 91Ě˝»¨sophomore Kayla Wheeler, a congenital amputee who was born with no legs and one arm. “But I could see how it would be really hard for people who can’t see and are trying to make a mental map of the room if everything keeps moving around.”

The UW’s AccessEngineering program helps from across the country in universal design, which means designing spaces, curriculum or environments that work for the widest possible array of people. The program also to help engineering schools incorporate those principles.

The program has previously released checklists and guidelines for making , , and inclusive of people with disabilities. Many of those recommendations, from large print labels to clutter-free workspaces, wind up benefiting everyone.

The idea for makerspace guidelines arose, in part, because so many new computer-aided design tools — such as 3-D printers or laser cutters — are making it easier for people with disabilities to explore their creativity, prototype ideas and invent.

“It’s really important to make sure these spaces are accessible precisely because these technologies are so enabling,” Steele said. “Engineers are problem solvers, and the more diversity we have in the field the more problems we’ll be able to solve, because everyone comes to that process with different life experiences and priorities.”

The project was funded by the National Science Foundation. Other AccessEngineering leadership includes principal investigator , director of the and centers, and co-principal investigator , assistant professor of computer science and engineering.

Grant number: NSF EEC-1444961.

For more information, contact Steele at kmsteele@uw.edu or AccessEngineering project coordinator Brianna Blaser at blaser@uw.edu.