The science of movement

20 October 2020

Scoliosis patient and UCL student Yaning Wu interviewed Dr Nachiappan Chockalingam, a researcher based at Staffordshire University. His most recent work, titled “How does curve type and magnitude affect locomotor function in adolescent females with scoliosis?” is being funded by the BSRF and holds exciting implications for the future of scoliosis monitoring and treatment. Here is a summary of their conversation.

What is this research about and how is it being done?

Dr Chockalingam is studying the biomechanics of scoliosis, or the science of how patients move. His hope is that the modelling that he and his colleagues develop will lead to new surgical techniques and instrumentation.

There is a current gap in our knowledge of gait and its relation to spinal curvature; gait analysis is commonly used only for children with cerebral palsy and other musculoskeletal disorders. The use of similar techniques with a more common condition will drive the clinical world, including surgeons, physiotherapists, and medical device developers, forward.

Dr Chockalingam’s research focuses on 10 – 16-year-old male and female patients with all types of adolescent idiopathic scoliosis (AIS) and with a Risser sign of 0-4, meaning that their bones have not completely developed. He chose to study AIS patients for this project because the condition is the most common type of scoliosis, affecting 80% of those with scoliosis, and it is easier to classify AIS patients into separate groups. His original plan was to obtain data in the USA; Utrecht, the Netherlands; and Cardiff, Wales, but because of the changes brought by COVID-19, he is now shifting to centres in Sweden and the UK. Given that his research is observational (ie, without any clinical interventions), ethical issues were virtually non-existent. The study is both qualitative and quantitative, with initial stages involving a questionnaire being sent out to participants asking them about what activities of daily living (ADLs) are important to them.

ADLs w an important consideration in Dr Chockalingam’s research because of his belief in individualised treatment plans. When determining functional disability, he avoids using standard frameworks to assess the young people he is studying, but will instead use their experiences of physical activity to determine what their greatest needs and difficulties are. He gave the intriguing example of a person in a tropical country who might include climbing a coconut tree as one of their ADLs. If this individual were included in his study, Dr Chockalingam would have to consider how to help them achieve this unique type of motion!

To visualise back movement in the upper and lower thoracic and lumbar regions of the spine. Dr Chockalingam and his colleague Dr Tom Shannon used a cluster-based marker approach, which is a technique that creates greater freedom in analysing joint motion, and Microsoft Connect, software that allows for multiple-device projection, to innovate surface typographic tools that are simpler and less expensive than what is available on the market. They are now testing these kinematics technologies in Serbia and Bulgaria. Whereas previous research only hinted at total range of motion in degrees, Dr Chockalingam’s research can investigate in more detail what happens when segments of the spine (eg, upper thoracic) interact with each other.

What experience does Dr Chockalingam have with conservative and traditional scoliosis management strategies?

Although his primary research interest is not the clinical management of scoliosis, Dr Chockalingam has worked on a Cochrane review of spinal bracing for adult trauma patients and has also done a systematic review on cervical collars. He has collaborated with both spinal fusion surgeons and those practising the innovative technique of VBT (Vertebral Body Tethering), studying the effects of surgery on patients’ range of motion. When asked about the effectiveness of these procedures, he insisted that better patient data are needed for new approaches – only then could we make accurate and representative conclusions.

Why scoliosis?

Although Dr Chockalingam doesn’t have personal experience of scoliosis, he has been studying scoliosis and its related conditions since his PhD years, when he submitted a thesis on the topic. He enjoys this area of research because it is full of unknowns, especially on the biomechanics side, and sees the potential his work has to contribute substantially to improving patient outcomes. In recent years, computing and IT tools used to analyse body movement have rapidly developed, making Dr Chockalingam’s work ever more exciting. He wants to raise the profile of scoliosis research in the biomedical engineering and biomechanics communities because the subject is still relatively unknown and underfunded.

How has COVID-19 changed this research?

Dr Chockalingam’s in-person work has paused during lockdown, and his team are now working virtually. However, he hopes to continue obtaianing patient data from early October, sending written questionnaires to study participants in the meantime. There will be a substantial logistical challenge with spinal fusion recipients, who are required to self-isolate for 2 weeks before and after their procedure. This means that Dr Chockalingam must modify his study design – by, for example, measuring patients’ body motion a month before surgery instead of closer to the date as previously planned. Post-fusion measurements should not be affected by these restrictions.

What is in the future?

The eventual aim of this research is to develop patient-specific interventions that don’t come off the shelf. The interventions include spinal instrumentation, bracing, and other technologies that affect range of motion. He is also considering taking the study to low-income and middle-income countries in the global South, whose clinicians can take advantage of affordable technologies to address the treatment gap in their communities.

In a separate sphere, Dr Chockalingam is interested in investigating the use of ultrasound and less invasive techniques to assess spinal curvature.

Yaning would like to thank Dr Nachiappan Chockalingam for having this conversation with her about his intriguing research. Read more about other BSRF research projects here: http://www.bsrf.co.uk/bsrf-research/bsrf-research-bsrf-research.

 

 

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