Slaloming Through Treatment: Tyler Warner Dreams of Skiing, Thanks to Children's Gait Lab
Gait Lab Patient Trains for Paralympic Ski Team
Just a few breaths of life and Tyler Warner was already navigating a network of trails and challenges - he suffered a stroke in the womb and was born five-and-a-half weeks early. Revolutionary treatment offered by Children's Hospital Colorado ensured Tyler would meet those challenges with confidence and success, for his journey had just begun.
At four months old, Tyler was diagnosed with a Wilm's tumor, believed to develop from immature kidney cells. Tyler's treatment consisted of 15 months of chemotherapy and radiation.
During Tyler's battle with cancer, Kris Warner, Tyler's mom, a physical therapist, noticed his right hand and arm, "weren't quite normal." At the time of his birth, the effects of his stroke were unknown. As he got older his lack of right hand and arm function became apparent, and he was diagnosed with right hemiplegia Cerebral Palsy due to his stroke in utero.
"We were worried about him surviving," said Warner. "But after his successful cancer treatment, our journey with orthopedics began."
And so it began. Tyler spent much of his time with Children's physical and occupational therapists. As a kindergartner, he met Frank Chang, MD, co-medical director of the Center for Gait and Movement Analysis, medical director of Children's Hospital Colorado Sports Program (HSP) and professor of orthopedic surgery, rehabilitation and pediatrics at the University of Colorado.
Dr. Chang recommended that Tyler have an evaluation in the Center for Gait and Movement Analysis - commonly known as the gait lab - to comprehensively evaluate his gait and walking pattern. Children's gait lab utilizes state-of-the-art instruments - like advanced video recording techniques and 3-D motion kinetics and kinematics - to characterize the mechanics of human movement, the timing and intensity of muscle activity, and the forces generated by foot/floor contact.
State-of-the-Art Technologies in Children's Gait Lab
- Slow motion analysis captures digital images of the patient's motion on the front, back and sides using advanced video recording techniques.
- 3-D motion kinematics precisely records three-dimensional limb movement by simultaneously capturing angular displacements, velocities and accelerations from multiple joints.
- 3-D motion kinetics measures ground force reaction with custom force platforms embedded in the floor
- Dynamic electromyography simultaneously records the electrical activity and activation patterns of 16 muscles
"They put electrodes on me and I looked like a robot," said Tyler. "They had me walk back and forth many times, and I remember how cool it was to watch on the monitors what muscles I was using to walk."
According to Dr. Chang, film makers "use the same software and hardware used in our gait lab to create the animation in their films, and other companies use the same software to create the animation for video games."
"This advanced technology helps us better understand our patients' gait abnormalities so we can implement the best treatment for them to reach their maximum potential," he said.
The gait analysis evaluation confirmed a need for multiple surgeries, one of which was to lengthen Tyler's right calf muscle to improve his walking. In addition, Tyler had surgery on his right thumb abductor and pronator to improve hand function.
Tyler spent the next few years in and out of rehab, surgery and wheelchairs, always eager to participate in sports. When Dr. Chang suggested he ski with the HSP, he felt confident he could do it - a direct result of his experience in the gait lab and with Children's staff, according to Tyler.
Tyler thrived in the HSP. At age 10 he won "most creative" at the Year-End Ski Race.
"We teach all our 'kids' to not let their disability interfere with achieving their dreams and goals," said Dr. Chang. "There's a self-confidence they discover when they're on the slopes that improves their self-esteem and affects their entire life."
As Tyler grew and became more competitive, it looked like his leg was turning in. Dr. Chang recommended a gait lab re-evaluation to measure the twisting of his lower leg bone to determine if Tyler needed surgery, and if so, exactly how much to rotate the bone. Ultimately, Dr. Chang recommended rotating the bone to improve its function. Tyler had a surgery called a tibial osteotomy, which adjusts the tibial alignment (the tibia is located in the lower leg), helping Tyler improve his skiing and overall athletic function.
Susan Kanai, PT, OCS, physical therapist in the gait lab, and volunteer HSP ski instructor on Saturdays, encouraged Tyler to consider racing for the Paralympic ski team; he took her advice. Currently Tyler is training - and excelling - with a preparatory Paralympic race team. One day he hopes to race on the U.S. Paralympic Ski Team like Hannah Pennington, a former HSP skier graduate, who just competed in her third Paralympics.
"Children's was his springboard," said Warner. "We have watched him grow beyond a person with a disability. He doesn't let his disability run his life."
"I figured out how to have a normal life. I have come to the point where it's not all about me and my disability," said Tyler. "I have a different role now - to encourage others who are younger than me, to tell them it will all work out some day. They can do it some way or another just like I did."
Learn more about the Hospital Sports Program (HSP).