Movement laboratory: big data in motion

The assessment of motor function is central in developing a management plan for patients with cerebral palsy. In addition to functional clinical scales, the characterisation of the organisation of posture and movements of each patient can be achieved by the three-dimensional analysis of movement coupled with the analysis of muscle activation and the forces developed during these movements. Movement analysis can be used to make an accurate diagnosis (topographic, functional and physiopathological) of the motor disorder in order to optimise the overall management of the patient by providing a physical therapy programme and possibly the creation of orthosis or prosthesis, intramuscular injection of botulinum toxin, surgery, the setting up of an intrathecal baclofen pump, etc.

In some clinical contexts, successive movement analysis may be needed to clarify the evolution of the motor disorder. In clinical practice, the movement most often analysed is the walk. Recording of the walk is carried out using an optoelectronic system consisting of 6 digital stereoscopic infrared sensitive cameras, producing a three-dimensional reconstruction of the subject being filmed, 2 digital cameras providing synchronised front and profile images, 8 tele-electromyography channels measuring the muscle activities during movement and 2 recording force platforms recording ground force management, including depreciation and propulsion.

Auto-reflecting markers are glued to the skin of patients at standard anatomical reference points. The cameras placed around the scope of the examination send an infrared light and record the reflection of the markers. The computer reconstructs the three-dimensional movements of the markers from the information recorded in real time by the cameras. At the same time, muscle activity is recorded using adhesive electrodes, transmitted by telemetry to the system and integrated into the kinetic data.

This motion analysis is a tool for clinical and basic research on the physiology and physiopathology of movement. In particular, the precise and multimodal gathering of motor parameters can provide scientific data showing profiles that can be statistically analysed, reflecting, for example, the motor control mechanisms specific to a selected population or the effects of various treatments.

From minimal invasive surgery to robotic surgery, this is the story of a revolution

1988: Two French surgeons present a film in Paris showing the removal of a gallbladder with virtually no scarring.  There was total incomprehension among most university departments where it was a well-known fact that “major surgery leaves major scars.”  It was also a phenomenal success in women’s magazines in Paris, all of which will featured cover an article on no-scar surgery on their cover..

Pioneers will gradually take over this new technique, collaborating with companies to develop instruments and new surgical environments. Just under 25 years ago, a fantastic adventure started all over the world. Scientific studies gradually contributed a building block by showing that minimal invasive surgery drastically decreases ruptures, postoperative adhesions and wound infections. The decrease in postoperative pain due to muscle preservation was impressive. Foremost, this technique uses systematic magnification, allowing for a significant reduction in blood loss and a more precise dissection, often reducing mortality rates.

All of the above helps to diminish hospitalisation periods even for major surgery and sometimes allows for the operation to be carried out in a day hospital. This surgery will grow quickly and become popular – American surgeons stated it was the “Second French Revolution” !

However, this type of surgery is more difficult because of the reduced two-dimensional view (looking at the screens) and due to restricted motion of the wrist because of the trocars. Not a problem: Silicon Valley developed a surgical robot that solved the problem of the quadrature of the circle. We use a console recreating the third dimension (like at the cinema). We use all the mobility of the wrist by a complex miniaturised mechanism created at the end of each instrument. We can even operate at long distance (see the Lindbergh operation performed by Prof. Marescaux in New York on a sleeping patient in Strasbourg!). Even instruments that intersect, if we want to do everything via the same hole (often the belly button) are not a problem for the robot because the instrument will place the right instrument in the correct hand whether it is on the left or right-hand side.

Robotics and fully integrated operating rooms offer many opportunities still unknown. University professors were very wrong; it wasn’t just a concern over a scar, although to undergo a removal of the spleen and to not see a scar is still an amazing feat. Perhaps at present, a great surgeon leaves small scars! For our young patients minimal invasive approach must become our priority.

Pr Henri Steyaert

Want to learn more about robotic surgery? Join our doctors on April 18 during the Day of Innovation (only for professionals) or participate to our Kid’s Day on May 28 and train your skills on a real surgical robot.