Gait Analysis and Mobility Enhancement – PediaCast 580

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Description

We explore the Honda Center for Gait Analysis and Mobility Enhancement. Walking, running, and other forms of movement are essential for childhood development and wellness. Discover how the Honda Center is helping kids with complex conditions improve their movement… and quality of life!

Topics

Gait Analysis
Mobility Enhancement
Honda Center

Guests

Dr Sean Tabaie
Orthopedic Surgery
Nationwide Children’s Hospital

Kirsten Tulchin-Francis
Director, The Honda Center
Nationwide Children’s Hospital

Jessica Lewis
Physical Therapy
Nationwide Children’s Hospital

Links

Honda Center for Gait Analysis and Mobility Enhancement
Orthopedic Surgery at Nationwide Children’s Hospital
Physical Therapy – Sports and Orthopedic – at Nationwide Children’s

Episode Transcript

[Dr Mike Patrick]
This episode of PediaCast is brought to you by the Honda Center for Gait Analysis and Mobility Enhancement at Nationwide Children's Hospital. 

Hello, everyone, and welcome once again to PediaCast. We are a pediatric podcast for moms and dads.

This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It's episode 580.

We're calling this one Gait Analysis and Mobility Enhancement. I want to welcome all of you to the program. So, as you know, getting from point A to point B through walking, running, and other forms of movement are an essential part of childhood development and wellness.

This week, we are going to explore pediatric gate analysis and how the Honda Center for Gait and Mobility Enhancement at Nationwide Children's Hospital is helping children with complex medical conditions improve their movement and their quality of life. From high-tech tools to research, multidisciplinary care, and future innovations, we'll cover all the things related to gate analysis and mobility enhancement for kids and teens, but as I learned during the interview, for adults as well. So, we've got a little bit of something for everyone, and in our usual PediaCast fashion, we have some terrific guests joining us for the conversation.

Dr. Sean Tabaie is an orthopedic surgeon and medical director of the Honda Center at Nationwide Children's Hospital. Kirsten Tulchin-Francis is director of the Honda Center and also research coordinator for orthopedic surgery. And Jessica Lewis is a physical therapist helping kids and families impacted by mobility issues, all of them from Nationwide Children's.

Before we get to our guests, I do want to remind you the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you're concerned about your child's health, be sure to call your health care provider.

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at pediacast.org. So, let's take a quick break. We'll get our expert panel settled into the studio, and then we will be back to talk about pediatric gait analysis and mobility enhancement.

It's coming up right after this. 

Dr. Sean Tabaie is an orthopedic surgeon and medical director of the Honda Center for Gait Analysis and Mobility Enhancement at Nationwide Children's Hospital. He is also an associate professor of orthopedics at The Ohio State University College of Medicine.

Kirsten Tulchin-Francis is director of orthopedic research at Nationwide Children's. She also directs day-to-day operations at the Honda Center. And Jessica Lewis is a physical therapist.

She is on the front lines supporting children and their families as they undergo gait analysis and work on mobility enhancement. That is what they are all here to talk about, gait analysis, mobility enhancement, and the Honda Center at Nationwide Children's Hospital. Before we dive into our topic, let's offer a warm PediaCast welcome to our guests.

Thank you all so much for stopping by today.

[Dr Sean Tabaie]
Thank you for having us, Dr. Mike.

[Kirsten Tulchin-Francis]
Really excited to be here. Thank you so much. Yes.

Thank you for having us, Dr. Mike.

[Dr Mike Patrick]
Yeah, we are really excited to have all of you here. Dr. Tabaie, I wanted to start with you. What exactly is pediatric gait analysis and why is that an important thing?

[Dr Sean Tabaie]
Yeah, again, thanks for having us. We're really excited to talk on this really important topic for all of us. So, you know, I guess pediatric gait analysis falls under just gait analysis in general.

Obviously, as humans, walking is such an important part of our daily routine, and especially for children. Having them walk and play such an important role for us as orthopedic surgeons is to continue to maintain for our children that we take care of. So pediatric gait analysis is just a formal way to analyze a child's walking pattern, to ensure that they're maximizing their efficiency, to ensure that they're as active and healthy as they can possibly be, to allow them to continue to be children and be active as they grow up.

[Dr Mike Patrick]
Yeah, yeah, absolutely. As we embark on our journey here today, the other thing that's important is, of course, pediatric gait analysis. But the other thing is the Honda Center, which is a pretty cool program.

Kirsten, as the director of the Honda Center, can you tell us a little bit more about what it's all about, how you got started? You know, how long you've been around and who it is that you guys are helping?

[Kirsten Tulchin-Francis]
Sure. So, we started in 2018 after a very generous donation from Honda. So, gait analysis is it's a formal way to do it with motion capture.

So, when we started the lab, we had three people in the lab. We had a medical director. This was before Dr. Tabaie had joined the team. We started with a therapist, and that was Jessica. And then we started with an engineer. And those three people bring three different pieces to the team, obviously.

And we started taking referrals from a clinical side, meaning internal referrals from nationwide as well as others from the community, to do an evaluation of a patient for gait analysis for the beginning of our kind of time as the GAIM Center. And then we began doing some prospective research projects where we bring patients in. And we'll talk about that, I think, a little bit later from a research standpoint in 2022.

[Dr Mike Patrick]
All right. And what kind of technology do you guys use at the center? You mentioned video gait analysis.

Tell us a little bit more about that. And are there other technologies that are also involved in the evaluation?

[Kirsten Tulchin-Francis]
Sure. So true instrumented motion capture. You might be familiar with it already, actually, but from a different field, from the entertainment side.

So, this is the same technology that they use to make video games and movie special effects. You've probably seen pictures where you'll have like an actor having a whole bunch of little stickers on their body. Those basically little balls reflect camera light.

It goes back into the cameras and then the cameras can determine exactly where in three-dimensional space each marker is. So, when we have a patient in the lab, Jessica spends a lot of time putting those markers on very specific landmarks. So, from a motion capture medical side, we have to be very precise with what we do.

That technology then tells us how the body moves in three dimensions. So, each part of the body that we track, we put markers on those. We also have special plates in the floor that as you walk, you exert a force on the ground.

And if you think back to your physics classes, that's an equal and opposite force back up on your foot. So, we measure that force and then we combined it with all of the marker data so that we can determine not only how each joint moves, but also how much power that you generate at each joint. We also have special footprint mapping that we can see where the high- and low-pressure areas are under the foot.

And that can tell us particularly people who have difficulty with their feet and the positioning of their feet. And then the last big part of what we do is called electromyography. And this is kind of similar to an EKG.

It measures electrical signals in the body, but it measures it in the muscles. So, it tells us when muscles are on or off and if they're firing, when we think they're firing in order to propel you forward.

[Dr Mike Patrick]
First, I have to say, this has got to be a ton of fun for these kids, right? I mean, getting the little stickers on them and they have probably also seen, you know, on TV and, you know, how these things are used in the movies. So that's that I think is really cool.

So really, you're combining a whole lot of data. One, their movement to the force that they're when they take a step that's really being put down on their foot and where that force is taking place. And then the third one is the footprint mapping.

And so, you are combining all of that data to come up with, you know, a plan that's going to help them in terms of mobility, maybe less pain, being able to have better function. So, Sean, how does that all come together? Is there like a computer program that analyzes all that data, or do you have to sort of sort through all of those different data sets and put it all together in your head?

[Dr Sean Tabaie]
Yeah, that's a great question. That's definitely over my pay grade. Might be great if it was, but I mean, luckily, we have very technologically advanced computer programs.

There are able to analyze that data and not only give graphical analyses of what we see or what the computer sees, but also kind of picture representations of how the child is walking again. All that data comes together and gives us true, quantifiable, objective numbers that we could put to how we observe them walk. So traditionally, you know, we just watch these children walk.

We do a physical exam. And I would say most, you know, practitioners are very good at that. But ultimately, there is an element of subject subjectivity to that.

So, this data truly gives us objective information to allow us to make those informed clinical decisions moving forward.

[Dr Mike Patrick]
That really makes a lot of sense because AI in particular is really in its infancy, believe it or not. And so, when we think about, you know, computer analysis and machine learning and all of these things, that was not something that was present, you know, even five, 10 years ago. And yet you did help kids who needed gait analysis and maybe were having difficulty with mobility all along.

And so, you do have some idea of what to do, but this really does standardize things a little bit better. And as you say, you know, there may be some subjectivity from practitioner to practitioner, depending on patients that they've seen in the past. But I'm sure this is based on data from large sets of patients to sort of have a standard.

Is that correct?

[Dr Sean Tabaie]
It is correct. I mean, really, the basis of the motion analysis is normal motion, normal motion. And every gait lab, gait center has a large library of, you know, data from normal patients, you know, quote, normal patients walk.

So, you're really basing it on those, those normative values. And I think that's really important that I also understand our body is the ultimate machine, right? So, when we walk, there's multiple different levels that are contributing us to propel us forward, our feet, our knees, our hips.

So, it's how it works together. And oftentimes it's hard. You know, we focus on one anatomical area.

However, there's multiple levels that are contributing to that. And the motion analysis really allows us to hone in to everything together versus focusing on one area. That's, you know, sometimes just more obvious to us.

Yeah.

[Dr Mike Patrick]
Yeah, absolutely. And one of the things I would imagine that becomes important is that kids might have pain and difficulty at a location that is not necessarily where their mobility issue is. Because let's say you're, you know, you have difficulty moving your left foot, then you may put more stress and strain over on the right side.

And so, it's really important not only to get all this data, but I guess the fourth piece of data that's really important is hopefully for the patient to be able to tell you, hey, this is where it hurts. This is what's happening. And then you can kind of make an inference based on the data that you're getting and what the computer spits out.

So then how is it that you use that data and what the patient is telling you to then make clinical decisions on what to do to help them?

[Dr Sean Tabaie]
I think that's a great question. So, you know, everything that we do, or at least I, I do for a good subset of my population is based on research that has come out. It's more, it's called a diagnostic matrix.

And it's really different components that help us make our decisions. You know, we ultimately want to do a surgery that has the maximum benefit. So, the data analysis portion is part of that diagnostic matrix.

It goes along with our physical exam. It goes along with our history as well as x-rays and even an exam under anesthesia to truly allow us to make that best, most informed decision. So, you know, without the motion analysis, I don't have any quantifiable numerical values, any data, but this really adds that final component for me to confidently go to the family and say, you know, I really feel that we need to do these surgeries to improve your child's walking ability.

And without it, ultimately, where there's a little bit of a guessing game, and this really brings and wraps up.

[Dr Mike Patrick]
Yeah, it's really, really cool. What makes the Honda Center unique in terms of collaboration? So, I'm sure that at a lot of institutions, there may be a gait analysis lab that's, you know, sort of a simple lab.

It's just collecting the data. And then that goes over to orthopedics, and then they make it a refer someone over to physical therapy. In terms of collaboration, having a center that sort of houses a program and you guys can all work as a team, how is that different than other places?

And what is the advantage of that for patients and families?

[Dr Sean Tabaie]
You brought that question up because I spent eight years at Children's National Washington, D.C. And one reason I came here was because of the Honda Center. And what makes it unique is the multidisciplinary approach. Having experts in areas outside of orthopedics that I can work with to really identify the pathology we're seeing in these children to make informed decisions but also having colleagues that not only do clinical work, but research.

You know, the basis of anything in medicine, as we know, is research and having a foresight to think of ideas ahead of time so we can come up with answers and hopefully apply it to our clinical populations. And that's the great thing about the Honda Center. There are experts in different aspects that I'm not really familiar with.

And we come together, and we make these decisions together. So, and that's what I try to relay to families is that, you know, I'm hopefully good at what I do, orthopedic surgery, but in order for us to get the maximum results, I want to bring in everyone else that allows us to make, you know, a shared informed decision.

[Dr Mike Patrick]
Yeah, absolutely. So just a couple of follow-up questions to that. First, what do you think of Columbus compared to DC?

It's a little easier to get around, right?

[Dr Sean Tabaie]
Oh yeah, very much, very much easier. Columbus is great. I love that it's, you know, still a city, but has a small-town feel.

The sports scene, even though there's not many professional teams, it's still great. And everyone is very friendly, and we have a family, three children. So, you can't beat Columbus.

Compared to the hustle and bustle of DC. But saying that I love DC, that always be a special place in my heart, but I'm happy.

[Dr Mike Patrick]
And you can always go visit and vacation or go back and see friends and family.

[Dr Sean Tabaie]
It's an hour away to drive, so it's not that far.

[Dr Mike Patrick]
Yeah, yes, that's right. And then a more important follow-up question is, do you see folks from outside of central Ohio at the Honda Center? So, you know, you may be living in Washington, DC, but, you know, we have this center with a collaborative team.

Is that something, do you see folks from outside of our immediate area?

[Dr Sean Tabaie]
Oh, we do see folks, patients from almost all states, even international patients. And, you know, the, we have the technology here. We have the expertise here.

And the goal is that we'll even grow that to make the Honda Center a true destination center for children that have issues that would necessitate being seen in our motion analysis lab.

[Dr Mike Patrick]
And so, we will put a link in the show notes to the Honda Center's website at Nationwide Children's Hospital. So, folks can head over to pediacast.org and look for the show notes for this episode, which is 580. And then we will have a link to there.

And I'm sure you guys have contact information for patients and also for providers to sort of make referrals happen if folks are interested in traveling to central Ohio to see you guys. Now, so what patients are we talking about? So, we've been really talking in generalities of gait issues, mobility problems, difficulty moving from point A to point B.

So, Jessica, what are the typical patients that you see? Like, what kind of medical conditions are they dealing with that mobility could be an issue? Who are you seeing?

[Jessica Lewis]
I would say the largest population that we see for gait related diagnoses is a neuromuscular population. So, a lot of children with cerebral palsy, myelomeningocele, traumatic brain injuries, maybe muscular dystrophies. And then you kind of touched on it a little bit before, but we see some patients that are just having pain, and that pain is driving some kind of problem with their walking and their gait.

And that might be in their back and their hips and their knee, their feet or all of the above. Another big population is foot deformity. So, this might be someone with a pathological flat foot or pes plano valgus.

We might see someone with a really high arch or cavovarus, children with clubbed feet. We see a diagnosis called Charcot-Marie-Tooth, which causes a lot of problems with foot deformity. And then some newer populations that we've been seeing, we've been seeing children with spinal deformities or spinal problems.

So, like some kind of scoliosis, whether it be AIS or adolescent idiopathic scoliosis or maybe a neuromuscular scoliosis. So, we've been seeing those children. And then something really exciting coming up that we will be doing soon is we're going to be seeing children with upper extremity problems.

So, we're going to be seeing children with upper extremity problems. So, we're going to be seeing children with something, maybe something like a brachial plexus injury and be able to look at the motion of their upper extremity too. So that's really exciting and something coming up.

And then ultimately, when these kids come in, we just need to have some kind of decision that needs to be made that necessitates more than just like an office visit or an outpatient physical therapy evaluation. So, this might be like conservative management, like bracing or physical therapy. It might be some kind of medication management, like tone or spasticity management.

Maybe they might need Botox injections to muscles, not the face. And then there might be some surgical decision planning that needs to be made as well.

[Dr Mike Patrick]
Yeah. Yeah. And so, folks understand Botox paralyzes muscles and that's how it helps to get rid of wrinkles.

But in this case, we may want to keep, you know, especially if there's like a muscle spasm, then there's going to be a lot of issues relaxing that and using that muscle appropriately. And so, Botox by paralyzing a particular muscle can help with mobility. Did I sum that up correctly?

[Jessica Lewis]
That's correct. Yeah. Some children have just overactive muscles or spasticity, and the Botox injections can definitely help kind of control those muscles, relax those muscles so they're not on all the time.

And that helps with mobility.

[Dr Mike Patrick]
Now, there are a lot of kids with mobility issues. And so there may be some parents like, oh, this is something that might be able to help my child. Are there particular criteria for what kids are really the best candidates for the kind of work that you do in terms of helping them?

[Jessica Lewis]
Definitely. So, the biggest criteria for the gait lab is ultimately, can they walk? So as long as your child's able to walk around like 10 to 15 feet at a time, that is what we're looking for.

And breaks are OK if they can walk short distances but then need to sit and rest. That's totally fine. Mobility devices are also OK to have as long as they're not so like all-encompassing where they're covering hips, where we would have to have the marker placement.

But for the most part, mobility devices can be OK. And they can always call and ask if this specific mobility device that they have would work in our lab or not. Children that have a little bit more difficulty in our lab maybe would be super young children who are just not old enough yet to follow the instructions or to be able to sit for the marker placement.

Or those kind or children that have some major sensory problems that they don't like to have things on their body because we do place the markers all over the body with like kind of like a little sticky tape. And so, some children really aren't able to tolerate that. And that's totally fine.

But yeah, those are some of the children that have a little bit more difficulty participating in our assessment.

[Dr Mike Patrick]
Yeah. Now, Dr. Tabaie, you know, you talk about the team approach and all the collaboration. And we are also an academic medical center and affiliated with the Ohio State University College of Medicine.

How does research play a role at the Honda Center?

[Dr Sean Tabaie]
Well, research is invaluable because it allows us to develop new protocols for patients. So just to touch on this, we see a wide range of patients. A big portion is this neuromuscular seeking population.

But we also want to see patients with, you know, scoliosis issues with patients that are undergoing sports specific surgeries like ACL. So, research allows us to develop these new protocols. One new area, for example, is sports performance, returns to sport after injury.

And it's through research we're able to develop the pathways so we can bring patients in and actually evaluate them and give them some meaningful. So, you know, a lot of what we do has been established from work that was done by our ancestors years ago. But now through our research endeavors, we're trying to utilize the motion analysis lab for even more education.

[Dr Mike Patrick]
And Jessica, what are some of the key populations then that you are studying through research?

[Jessica Lewis]
We have a lot of really exciting research studies going on in our lab, and I would say they primarily fall under five big areas. The first area that we see a lot of research being done in is our neuromuscular and musculoskeletal population. So, these may be research projects with children with cerebral palsy, myelomeningocele, muscular dystrophies, different syndromes.

We see rheumatology patients, patients with Charcot-Marie-Tooth, arthritis, hip disorders. A second group would be limb difference and limb deformity. This might be congenital amputations, traumatic amputation, limb length differences.

The third group is our injuries group. So, this is a lot of our sports population. So, this might be ACL injuries.

We're looking at return to sport. Are they ready to go back safely? Might even be looking at surgical outcomes for some of the sports injuries.

The fourth group is our spine group. So, this might be scoliosis, like I touched on before. This might be idiopathic, congenital, neuromuscular.

And then we're kind of looking and comparing treatment modalities and surgical outcomes, looking at fusion levels, things like that. And then our fifth big group is our control group. So, this is bringing in children without known diagnoses.

We bring them into the lab all the time so we can collect what we can call our control data, which Dr. Tabaie talked about a little bit ago. And then that's the data that we're able to use to compare clinical and research data too. So, five really important big groups, lots of research happening.

Some exciting outcomes, I think, to come. So, I'm on the lookout for that.

[Dr Mike Patrick]
You know, I think about with all these various populations that you're studying, that there are these are disease processes oftentimes that go from childhood into adulthood. And a lot of patients continue to see their pediatric providers even after they're 18 to 21 years of age. Do you see adult patients if they are followed by folks in, you know, in a pediatric setting, or do you have a hard limit at 21 years of age and then you can't be seen?

[Jessica Lewis]
We see anyone and everyone. A lot of our research studies, it's basically birth or walking to 99. So, if you fall in that category, if you just turned 100, then sorry, you're out.

But we actually see a lot of adults with maybe more pediatric conditions. We also see have a nice relationship with Ohio State and their physical medicine and rehabilitation program there. So, we've seen some adults with adult-onset dystonia or just different conditions that may kind of hit more in adulthood.

So, we definitely are not just limited to the kids, even though that's a large part of our population. We see adults as well.

[Dr Mike Patrick]
Yeah, that is really, really cool and a great service for everyone. And then, Jessica, how does the research part of the Honda Center and the clinical support part of the of the Honda Center help each other?

[Jessica Lewis]
So, at the GAIMS Center, I'd say research and clinical services really go hand in hand to enhance patient care and then to advance our scientific knowledge. So, our clinical evaluations that generates high quality data that both informs the individualized treatment plans and potential research studies. And then the research findings in turn, they help refine our gait and motion analysis strategies, as well as our surgical recommendations, orthotic design and then approaches to rehab.

So, our clinicians and researchers collaborate very closely to form these clinical and then also research questions. And then we're able to apply those research questions directly to practice to help practitioners. So, I feel like the integrated model that we have really helps support evidence-based care.

It facilitates longitudinal data collection. And it really creates that interdisciplinary education and innovation and pediatric mobility.

[Dr Mike Patrick]
Yeah, all very important things. And they really do help each other. It's a symbiotic relationship, for sure.

Kirsten, you know, we talked a little bit about some of the technology that you guys are currently using. What's on the horizon? Are there new technologies coming forward?

Are there different ways that we're going to be able to use the data that we have? And especially as AI becomes more and more sophisticated, what do you see in terms of the future of gait analysis?

[Kirsten Tulchin-Francis]
Well, I think you've really hit it on the head there that the artificial intelligence is going to be driving changes in motion capture in the next probably decade. You know, right now, everybody has a smartphone on them. They can pull out their video camera.

They can take a video. They can slow it down. But what instrumented gait analysis provides is that three dimensional.

You know, you can't get that video from above. You can't see the rotations. So having multi-camera systems is really imperative still.

The single camera smartphone apps, and there's hundreds of them out there that you could download. They're not valid yet, especially not for clinical care. It might be good for a coach to use to improve someone's baseball swing, but they're not there to provide clinical feedback and decision making.

There is an intermediate, though. We're getting there, and that is a multi-camera markerless system. So, you've heard us talk about putting the markers on.

Now we do have the technology where we have, you know, eight cameras around the room that are all integrated with each other. And combining that information through artificial intelligence can get us closer to what we can get with markers. It's still being validated.

We actually have a system here at Nationwide that we are also on the forefront of this, trying to develop these algorithms. The software that comes with it is based on AI of 500,000 images of what they call humans in the wild, which is just random photographs that they've had. The problem with that is, is it's not specific enough to be able to identify some things in clinical populations.

So, the best example of that is someone who is an amputee and is missing a lower limb and is using a prosthesis. Those AI algorithms have not quite gotten there to be able to identify those key points it needs on an artificial limb. So, we're moving in the right direction.

And I think in the next decade, we're going to make huge strides using AI to do this.

[Dr Mike Patrick]
Yeah. You know, we are here in central Ohio. It does seem like this could be the kind of technology where maybe someone could go to an offsite, let's say in Nebraska, and have a multi-camera system, then could those images somehow go to computers at Nationwide and then get sort of the evaluation and maybe a physical therapy or operation plan that then could be communicated back to the home place?

Do you see stuff like that in the future, or do you think it'll always be, no, you've got to travel to Columbus to use our services?

[Kirsten Tulchin-Francis]
Yeah, I think that's a great point. Going forward into where we're doing the markerless motion capture, I definitely can see that as an option. Right now, with the marker-based data, we still need experts in the room, putting on markers, Jessica, for example, who's got a lot of experience doing this, and then we need the, obviously, interpretation part.

But I think having that camera system in a clinic, in a kind of a more remote area, more rural area, that's certainly a possibility. The biggest things that we drive our technology right now is the cameras. Cameras have great resolution now, so that's not a problem, but we still need space, we still need the expertise.

So, I do think that's a possibility in the future.

[Dr Mike Patrick]
Yeah, yeah. It may be a little ways off, but I'm just thinking in terms of accessibility and getting more kids and families the help they need, even if it's not convenient for them to be able to travel. If you can travel, though, as we have said earlier in this program, Columbus is a great place to travel to and pretty easy to get around compared to a lot of large cities.

So, Jessica, as we wrap up, what would your message be to families whose kids might benefit from motion analysis?

[Jessica Lewis]
Yeah, so I'd say if your child is having any kind of difficulty with walking or movement, our motion analysis lab can be a really valuable tool in helping to determine what the best plan of care might be for your child. We have a really amazing team here. It includes orthopedics, physical medicine, engineering, neurosurgery, physical therapy.

We have orthotists, everyone on our team. They're really great and they're dedicated to helping improve the quality of life and care plans for kids that we see. So, we would love for you to be here.

We'd love to be a part of your kid's journey, especially towards better mobility. And then we have exceptional care that is science-based and personalized. So, if you think any kind of analysis might be beneficial, talk to one of your child's care providers and then come and see us.

[Dr Mike Patrick]
Great, great. Well, we really appreciate all three of you stopping by today. Once again, in the show notes over at pediacast.org, look for episode 580 and we will have a link to the Honda Center for Gait Analysis and Mobility Enhancement. We'll also have a link to orthopedic surgery and physical therapy at Nationwide Children's Hospital. So be sure to check those links out. So once again, Dr. Sean Tabaie, orthopedic surgeon at Nationwide Children's Hospital and Kirsten Tulchin-Francis, director of the Honda Center, and Jessica Lewis, physical therapist. Thank you all so much for stopping by today.

[Dr Sean Tabaie]
Thank you, Dr. Mike.

[Kirsten Tulchin-Francis]
Thanks for having us and letting us share what we do. Yes. Thank you.

[Dr Mike Patrick]
We are back with just enough time to say thanks to all of you for taking time out of your day and making PediaCast a part of it really do appreciate that. Also, thanks again to our guests this week. Dr. Sean Tabaie, Kirsten Tulchin-Francis, and Jessica Lewis, all at the Honda Center at Nationwide Children's Hospital. Don't forget, you can find PediaCast wherever podcasts are found or in the Apple podcast app, Spotify, iHeartRadio, Amazon Music, Audible, YouTube, and most other podcast apps for iOS and Android. Our landing site is pediacast.org. You'll find our entire archive of past programs there, along with show notes for each of the episodes, our terms of use agreement, and that handy contact page.

If you would like to suggest a future topic for the program, I also want to mention over at YouTube, we are doing a series of videos. They're pretty short, you know, three to five minutes each on important pediatric topics. Really just the most important tips about things that parents really face almost daily, depending on your family and how active your kids may be in terms of injuries and then also illnesses and all of those things.

So please do check out our YouTube channel. You'll find a lot more than just the audio podcasts there. We do have some videos for you, and we are adding to that collection every week.

Also, reviews are helpful wherever you get your podcasts. We always appreciate when you share your thoughts about the show, and we love connecting with you on social media. You'll find us on Facebook, Instagram threads, LinkedIn, X, and Blue Sky.

Simply search for PediaCast. If you are a pediatric provider, a medical provider, and even if you're not, you probably, if you're listening to this podcast, I'll bet you have a pediatric medical provider. So please let them know that we do have a podcast for them, too.

It's called PediaCast CME. It is similar to this program. We do turn the science up a couple notches, and we offer free category one continuing medical education credit for those who listen.

That's what the CME stands for, continuing medical education. And we not only offer credit for physicians, but also nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists. And since Nationwide Children's is jointly accredited by all of those professional organizations, it's likely we offer the exact credit you need to fulfill your state's continuing medical education requirements.

Shows and details are available at the landing site for that program, PediacastCME.org. You can also listen wherever podcasts are found. Simply search for PediaCast CME.

And then one additional podcast that I host is called FAMEcast. That's F-A-M-E-C-A-S-T. It is a faculty development podcast from the Center for Faculty Advancement, Mentoring, and Engagement at The Ohio State University College of Medicine.

So, if you are a teacher in academic medicine or a faculty member in any of the health sciences, then this is a podcast for you. And you can find FAMEcast at FameCast.org. And wherever podcasts are found, simply search for FAMEcast.

Thanks again for stopping by. And until next time, this is Dr. Mike saying, stay safe, stay healthy, and stay involved with your kids. So long, everybody.