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The ISPO System for Cerebral Palsy Treatment Recording (SCePTRe)

Condie, David N. BSc, MI Mech E, C Eng; Cochrane, Paul BEng

JPO Journal of Prosthetics and Orthotics: December 2002 - Volume 14 - Issue 4 - p 136-142
SELECTED TOPIC: CEREBRAL PALSY
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The System for Cerebral Palsy Treatment Recording (SCePTRe) Database has been designed to provide clinicians treating children with cerebral palsy with an easy to use but comprehensive method of recording in a standardized manner information regarding both the status of their patients and the nature of the treatment they receive. The current version of the system, which is available on CD-ROM, is designed to be run on virtually any computer on the market today and may also be used as a multi-user system. The system is currently undergoing clinical evaluation and a SCePTRe user mailing list has also been established. Work is in progress to permit users of the system to transfer data to the SCePTRe website using the Internet and a shared database of patient records is planned.

DAVID N. CONDIE, BSc, MI Mech E, C Eng, is affiliated with the Dept. of Orthopaedic and Trauma Surgery, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland.

PAUL COCHRANE, BEng, is affiliated with Tayside Rehabilitation Technology Services (TRES), Tayside University Hospitals, NHS Trust, Ninewells Hospital and Medical School, Dundee, Scotland.

Correspondence to: David N. Condie, BSc, MI Mech E, C Eng, Dept. of Orthopaedic and Trauma Surgery, University of Dundee, Ninewells Hospital and Medical School, Dundee DD19SY, Scotland; E-mail: d.n.condie@dundee.ac.uk

Copyright © 2002 American Academy of Orthotists and Prosthetists.

The SCePTRe Database was developed in response to one of the recommendations contained in the Report of the International Society for Prosthetics and Orthotics (ISPO) Consensus Conference on the Management of the Lower Limb Problems of the Cerebral Palsied Child. 1 This recommendation noted that the majority of current research on this topic was “seriously scientifically and experimentally flawed…. ranging from non-randomized current cohort comparisons to case reports” and suggested that one of the principal reasons for this situation was the absence of a generally accepted standard method of recording details of the status and treatment of these patients. It was therefore proposed that ISPO should undertake the development of such a “protocol.”

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PATIENT RECORDS

The System may be considered as comprising three types of patient records: basic patient descriptions, assessment records, and intervention records.

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THE BASIC PATIENT DESCRIPTION

A basic patient description must be completed when each patient is initially registered on the database (Figure 1). At this time the patient must also be allocated a unique identi-fication number, which is used to link together all the information regarding them that is subsequently recorded.

Figure 1

Figure 1

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THE ASSESSMENT RECORDS

Details of three types of assessment may be recorded: physical examination, assessment of functional independence, and gait assessment.

The physical examination module enables the practitioner to record details of: the passive ranges of motion of the joints of the lower limbs, their bony alignment, any fixed foot deformities, lower limb muscle function, and some neurological test results.

Several different methods are used to record this data. For example, the user is required to enter the specific ranges of motion for each of the specified joint movements (Figure 2). In contrast, radio boxes and drop-down lists are used to facilitate the recording of muscle function (Figure 3).

Figure 2

Figure 2

Figure 3

Figure 3

The functional independence module comprises a list of 16 functional activities considered relevant for this group of patients (Figure 4). In each case, the user is required to “click” on the appropriate radio box to indicate whether the patient is able to perform the activity without technical aids or adaptations, with technical aids or adaptations, with the assistance of another person, or is, in fact, unable to perform the activity.

Figure 4

Figure 4

The gait assessment module which was specially designed for SCePTRe by Tayside Rehabilitation Technology Services allows the user to record the position of the trunk, pelvis, and lower limbs of a patient at the undernoted instants in the gait cycle in all three orthogonal planes:

  • Ipsilateral initial foot contact
  • Contralateral foot-off
  • Ipsilateral hip over ankle
  • Contralateral initial foot contact
  • Ipsilateral foot-off
  • Contralateral hip over ankle
  • Ipsilateral initial foot contact

The orientation of the body at any of these instants is represented by a mannequin the position of the segments of which may be adjusted using the computer mouse (Figure 5). This module has a number of features designed to assist this process. These include the ability to copy the body orientation of the previously recorded instant, the ability to maintain the alignment of a specific joint from one instant to another, the ability to set the alignment of the mannequin to “normal” for a particular instant, and the ability to “lock” the settings for a particular instant to avoid accidentally disturbing views that have already been set.

Figure 5

Figure 5

It is also possible to move among views of the mannequin at the same instant in all three planes during the process. Finally, when the process is complete, it is possible to animate the mannequin to obtain a dynamic view of the gait pattern.

It is thought that in most instances, the user will perform this process while viewing a video-recording of the patient’s gait.

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THE INTERVENTION RECORDS

Details of four types of interventions may be recorded: surgery, neurological treatment, physiotherapy, and orthotic treatment.

The surgical intervention module comprises a number of pages, which are selected using tab boxes to permit information regarding soft tissue procedures, muscle tendon transfers, and bony procedures to be recorded.

For example, the soft tissue procedures page uses tick boxes to record which muscle has been operated upon and whether a lengthening or a release has been performed (Figure 6).

Figure 6

Figure 6

The neurological interventions module uses a combination of tick boxes and drop-down lists to allow the user to record, when appropriate, an anterior branch obturator neurectomy, a dorsal rhizotomy, injections and/or the use of Baclofen, and, where relevant, the muscles treated (Figure 7).

Figure 7

Figure 7

The physiotherapy module requires the user to indicate both the objectives of the therapy and the methods used to achieve them. For example, when the objective is to reduce or prevent contractures, radio boxes are used to identify the muscle groups being treated and whether passive stretching, active movement, muscle strengthening techniques, and/or plaster casts are being employed.

The orthotic treatment module uses tab boxes, first to allow the user to select the category of orthosis supplied as either shoes or shoe adaptations, foot orthoses or insoles, ankle-foot orthoses, knee/knee-ankle-foot orthoses, or hip/hip-knee-ankle orthoses, and then to specify the exact type by selecting from a drop-down list of options. For example, the ankle-foot orthoses page allows the user to indicate the type of AFO, when appropriate, its description, and whether it contains neurological or tone-reducing features using a combination of drop-down lists and tick boxes (Figure 8).

Figure 8

Figure 8

Where considered appropriate for all assessment and intervention modules, help notes have been provided that may be accessed using the F1 key on the computer keyboard.

A summary of all the data on record for an existing patient may be easily accessed and a particular record selected for detailed scrutiny or editing (Figure 9).

Figure 9

Figure 9

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RUNNING SCEPTRE

Virtually any computer on the market today running Windows 95/98/Me, Windows NT4, Windows 2000, or Windows XP should be capable of running SCePTRe. However, a minimum specification would be a slow (100 MHz) Pentium processor, with 32 MB of memory and around 100 MB of free space on the hard disk.

SCePTRe may be used as a multiuser system with more than one person accessing the database at the same time, provided all the computers are attached to a network. The system has been used successfully with Novell, NT, and Linux Samba networks; however, the preferred option would be a Novell network.

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FUTURE PLANS

The system is currently being evaluated at a number of clinical centers in five different countries. Technical assistance to these centers is provided (by e-mail) and a SCePTRe users e-mail list has been established to allow users to send messages to (and seek advice from) all other users.

A facility to permit users to transfer data to the SCePTRE web site using the Internet to commence the creation of a shared database of anonymized patient records accessible only to SCePTRe users is planned shortly. This facility will also be used to update the system.

At the present time, SCePTRE does not include a facility to analyze data from a selected group of patients; however, after the current evaluation phase, should there seem to be a demand for this feature, a further software development phase will be considered.

For further information regarding SCePTRe, contact sceptre-help@tortc.tuht.scot.nhs.uk.

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Reference

1. Condie DN, Meadows CB. Report of a consensus conference on the lower limb management of cerebral palsy. Copenhagen: The International Society for Prosthetics and Orthotics; 1995: 15–19.
Keywords:

Cerebral palsy; team management; clinical records; computerized database

© 2002 Lippincott Williams & Wilkins, Inc.