Shriners Hospitals for Children in Shreveport supports the research mission of the Shriners Hospitals by conducting medical and outcomes research among various patient populations including cerebral palsy, limb deficiency, osteogenesis imperfecta and spinal deformities. Through investigator-initiated projects as well as collaborative efforts with other Shriners Hospitals and affiliated institutions, the Shreveport Hospital maintains active research protocols focused on measurable outcomes and improved patient care. Current research efforts involve innovative medical treatments, outcomes assessment, and psychosocial analysis.

CEREBRAL PALSY RESEARCH PROJECTS

Efficacy and Functional Outcomes of Botulinum Toxin A Injections to Hamstrings in Flexed Knee Gait in Cerebral Palsy: A Double-Blind, Randomized, Pacebo-controlled Trial

This is a Shriners COSAB (Clinical Outcomes Studies Advisory Board) funded research project comparing Botox (BTX-A) injections to placebo in the hamstrings of children with cerebral palsy, ages 3 to 18, who have spasticity and walk with a flexed knee gait pattern. Participants are blinded to their treatment group and receive either BTX-A injections or placebo injections at their baseline visit (first visit). Participants will be followed for six months, making three follow-up visits to the clinic at 1 month, 3 months, and 6 months post-injection. Outcomes assessments as well as clinical data will be collected at these follow-up visits, but no further injections will be administered. Among several assessments, this study utilizes a Goal Attainment Scale on which the parent and child identify their primary goals of treatment and how they hope the treatment will help them. The purpose of this study is to determine if BTX-A is useful in decreasing muscle overactivity in comparison to placebo; to learn if BTX-A treatments is related to how the child walks or related to how strong the legs are; and to evaluate the family�s perception of changes in the child�s walking and other daily functions.

Comparison of Functional Outcomes of Tendon Transfer Surgery, Botulinum Toxin Injections (BTX-A) and Regular Ongoing Treatment in Hemiplegic Upper Extremity Cerebral Palsy (UECP)

This is a Shriners COSAB funded research project comparing three treatment groups, including surgery, Botox injections and ongoing treatment (therapy and home exercises). Qualifying participants are aged 5 to 15 who have cerebral palsy with one arm involved and are candidates for surgical management. Treatment groups are randomly assigned, and participants in each group will receive eight sessions of therapy at Shreveport Shriners over a 3-day period during the study. Participants will be followed for one year with assessments conducted at 6 months and 12 months. Assessments include clinical examinations as well as outcomes measures. The purpose of this study is to determine if surgery works better than BTX-A injections or regular ongoing treatment in treating cerebral palsy that affects one arm, and to learn if the efficacy of BTX-A injections lasts longer than 6 months.

Multidimensional Outcomes in Single Event Multi-level Orthopaedic Surgery with Intensive Rehabilitation in Ambulatory Diplegic Cerebral Palsy: A Prospective, Controlled Trial

This is an outcomes study that is open for follow-up purposes, but not open enrollment. Participants are children with cerebral palsy who were enrolled in the study at their baseline visit and are now being seen at 12 month, 24 month, and 36 month visits in order to collect outcomes measures and clinical and gait data to be entered in the database for analysis. There are currently over 400 participants in this database project. The purpose of this study is to follow participants for a three-year period in order to determine what treatments result in improvements in overall functioning in children with cerebral palsy.

LIMB DEFICIENCY PROJECTS

Development of an International (USA & Canada) Registry of Children with Acquired and Congenital Limb Deficiencies

The International Registry of Children with Acquired and Congenital Limb Deficiencies is being established to gather more information about children who have limb deficiencies. At the present time, there is not much data regarding how many children with these problems exist in the USA and Canada. Therefore, the Association of Children�s Prosthetic and Orthotic Clinics (ACPOC), a non-profit organization, is trying to collect this data, and the Shreveport Shriners is a collection site. Any child with a limb deficiency, either congenital or acquired, is welcome to complete the registry data sheet and become a participant in the registry. No identifiers such as name or other identifying data will be submitted to the registry. This registry is being developed in the hope that government agencies will be able to provide more assistance to these children, and in hope of improving environmental factors so that accidents resulting in amputation do not happen as frequently.

SCOLIOSIS PROJECTS

Humanitarian Device Exemption (HDE) For Synthes� Vertical Expandable Prosthetic Titanium Rib (VEPTR)

The Vertical Expandable Prosthetic Titanium Rib (VEPTR) has been approved by the FDA as a humanitarian device to treat thoracic insufficiency syndrome (the inability of the thorax to support normal growth of the ribs and lungs). Other conditions for the use of this devise include rib fusion and progressive scoliosis of congenital or neurogenic origin with or without rib anomaly. (Any hospital using a humanitarian device exemption must have the Institutional Review Board (IRB) approval prior to instituting use.)

This study involves the use of the VEPTR device with progressive follow-up examinations for children from the ages of six months to 15 years with these specific conditions. Subsequent lengthening or expansions will be preformed as needed. Children will be followed until they reach skeletal maturity.

PSYCHOSOCIAL RESEARCH PROJECTS

The Use of Distraction Techniques to Reduce Preoperative Anxiety in Hospitalized Children: A Pilot Study

This is an investigator-initiated research project for children aged 4 to 17 who are scheduled to undergo any type of surgery at the Shreveport Shriners. Participants will be given the choice of a distraction method to be used before they undergo surgery. They may choose a Gameboy to play with, a DVD to watch, or a CD to listen to on the day of their surgery up until they are given anesthesia. Children will complete assessment scales measuring their level of anxiety before and after they begin using the distraction method. The purpose of this study is to determine what methods of distraction, if any, help in reducing a child�s anxiety prior to undergoing surgery.