Janet L Walker

University of Michigan, Ann Arbor, MI, United States

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Publications (9)14.27 Total impact

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    ABSTRACT: Ponseti serial casting is the most commonly used method in North America to treat children with clubfeet. Despite initial correction, recurrence is common. tibialis anterior tendon transfer (TATT) is commonly used to treat recurrent clubfeet. Recurrence can occur after TATT, and patients at risk of recurrence may benefit from closer monitoring. We studied the rate of second recurrence (recurrence after TATT) and studied the predictive factors for this recurrence.
    Journal of pediatric orthopedics 07/2014; · 1.23 Impact Factor
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    ABSTRACT: Involvement of osteochondromas in the spinal canal occurs in patients with multiple hereditary exostosis, but the exact prevalence is unknown. A recent study found an incidence of 68%, with 27% of these lesions encroaching into the spinal canal. We studied MRI findings of 27 patients with multiple hereditary exostosis and found only six (23.1%) patients with osteochondromas arising from the spinal column and three (11.5%) patients with encroachment into the spinal canal. We also found three (11.5%) patients with an incidental syringomyelia. Only five of the nine (55.6%) patients with positive findings on MRI had symptoms prompting the MRI and two patients had significant symptoms that required surgical excision. Although the incidence of spinal osteochondroma in our population is lower than that of previous studies, we found a relatively high incidence of syringomyelia in these patients, which has not been previously reported.
    Journal of pediatric orthopedics. Part B. 06/2014;
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    ABSTRACT: Spinal deformity, a common problem in children with myelodysplasia, is associated with alterations in pulmonary function and sitting balance. Sitting imbalance causes areas of high pressure in patients already at high risk for developing pressure ulcers due to insensate skin. We asked: Does spinal deformity affect pulmonary function tests in children with myelodysplasia? Does the magnitude of spinal curvatures and pelvic obliquity affect seating pressures? Does spinal deformity and seated pressures correlate with a history of pressure ulcers? We retrospectively reviewed 32 patients with myelodysplasia and scoliosis (mean age, 14 years). The mean thoracic scoliosis was 64° with a mean pelvic obliquity of 15°. The mean forced vital capacity was 59% of predicted. The mean of the average and peak seated pressures were 24 and 137 mm Hg, respectively. We examined spinal radiographs, pulmonary function tests, and seated pressure maps and evaluated correlations of spinal deformity measures, pulmonary function, and seated pressures. The thoracic scoliosis inversely correlated with lung volume and weakly related with only the forced midexpiratory volume parameter (R(2) = 31%). The curve magnitude was associated with % seated area with pressures of 38 to 70 mm Hg while lesser degrees of pelvic obliquity were associated with % seating area with pressures of less than 38 mm Hg (R(2) = 25% and 24%, respectively). A history of pressure ulcers did not correlate with any spinal deformity or seated pressure measures. All patients displayed a reduced forced vital capacity, but this reduction was not related to increasing scoliosis. The smaller scoliosis curves and lesser degrees of pelvic obliquity were associated with larger areas of low seated pressures.
    Clinical Orthopaedics and Related Research 12/2010; 469(5):1302-7. · 2.79 Impact Factor
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    Janet L Walker, Shelley W Ryan, Tonya R Coburn
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    ABSTRACT: Electrical stimulation is an established treatment for muscle weakness. However, traditional tectonic stimulation is poorly tolerated in children as a result of discomfort. Threshold electrical stimulation performed at night reportedly increases muscle strength in a variety of neuromuscular conditions and has been well tolerated in children. We asked whether threshold electrical stimulation treatment at night would increase strength and function in children with myelomeningocele. In a pilot study we prospectively followed 15 treated children who served as his or her own control. The patients were provided with a stimulator and instructed to use it on areas of muscular weakness during sleep, six nights per week. Followup phone calls at 2 weeks and then monthly were performed by a physical therapist to address patient concerns. Assessments of muscle strength, monofilament sensation, and physical function using the Functional Independence Measure for Children were to be performed at 3-month intervals up to 12 months and compared with the pretreatment assessment. Only seven of the 15 subjects completed 9 months of treatment and none finished the 1-year study. The most frequent complaint was the treatment schedule was too intensive for the benefits received. We found small gains in muscle strength, gait, and bowel continence but no changes in physical function. Although threshold electrical stimulation made small improvements in muscle strength, the currently recommended treatment schedules are not practical for patients with myelomeningocele.
    Clinical Orthopaedics and Related Research 09/2010; 469(5):1297-301. · 2.79 Impact Factor
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    ABSTRACT: Structural bone allografts are used in a variety of surgical procedures, but only a few investigators have examined their use and associated complications in the pediatric population specifically. In a retrospective review of pediatric foot procedures, we sought to determine types and rates of complications associated with structural bone allografts as well as time to incorporation of these allografts. Minimum follow-up was 12 months. Eighteen patients with 31 structural allografts were reviewed. The total complication rate was 7.1%, and the allograft incorporation rate was 90% (mean time after surgery, 9 months). Mean follow-up was 22 months. There were no pseudarthroses, nonunions, or fractures at the bone-graft sites. Structural bone allografts can be safely used in foot procedures in pediatric neuromuscular patients without major risk for complications, and their use can reduce autograft-harvest morbidity in pediatric patients with neuromuscular conditions.
    American journal of orthopedics (Belle Mead, N.J.) 05/2010; 39(5):238-40.
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    ABSTRACT: Fibular deficiency results in a small, unstable foot and ankle as well as a limb-length discrepancy. The purpose of this study was to assess outcomes in adults who, as children, had had amputation or limb-lengthening, commonly used treatments for fibular deficiency. Retrospective review of existing data collected since 1950 at six pediatric orthopaedic centers identified 248 patients with fibular deficiency who were twenty-one years of age or older at the time of the review. Excluding patients with other anomalies and other treatments (with the excluded group including six who had had lengthening and then amputation), we identified ninety-eight patients who had had amputation or limb-lengthening for the treatment of isolated unilateral fibular deficiency. Sixty-two patients (with thirty-six amputations and twenty-six lengthening procedures) completed several questionnaires, including one asking general demographic questions, the Beck Depression Inventory-II, the Quality of Life Questionnaire, and the American Academy of Orthopaedic Surgeons Lower Limb Questionnaire including the Short Form-36. A group of twenty-eight control subjects completed the Beck Depression Inventory-II and the Quality of Life Questionnaire. There were forty men and twenty-two women. The average age at the time of the interview was thirty-three years. There were more amputations in those with fewer rays and less fibular preservation. Lengthening resulted in more surgical procedures (6.3 compared with 2.4 in patients treated with amputation) and more days in the hospital (184 compared with sixty-three) (both p<0.0001). However, when we compared treatment outcomes we did not find differences between groups with regard to education, employment, income, public assistance or disability payments, pain or use of pain medicine, sports participation, activity restriction, comfort wearing shorts, dislike of limb appearance, or satisfaction with treatment. No patient who had been treated for fibular deficiency reported signs of depression. The only significant difference between treatment groups shown by the Quality of Life Questionnaire was in the scores on the Job Satisfiers content scale, with the amputees scoring better than the patients treated with lengthening (p=0.015). The American Academy of Orthopaedic Surgeons Lower Limb Module did not demonstrate differences in health-related quality of life or physical function. The patients who were treated with lengthening had started out with more residual foot rays and more fibular preservation than the amputees. They also required more surgical intervention than did those with an amputation. While patients with an amputation spent less of their childhood undergoing treatment, they were found to have a better outcome in terms of only one of seventeen quality-of-life parameters. Both groups of patients who had had treatment of fibular deficiency were functioning at high levels, with an average to above-average quality of life compared with that of the normal adult population.
    The Journal of Bone and Joint Surgery 04/2009; 91(4):797-804. · 3.23 Impact Factor
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    ABSTRACT: Children with upper extremity amputations are particularly challenged in sports and other recreational activities. Many find that a prosthesis is of no benefit in their routine daily activities. Although a number of recreational terminal devices are available for prosthetic modification, it is unclear how effective they are at improving a child's performance in sports or hobbies. We evaluated the usefulness of 15 recreational terminal devices for upper extremity prostheses in 11 children by chart review and patient survey. All patients had functional elbows, and all but one was a unilateral amputee. All patients were instructed in their use by a prosthetist, and 3 patients received occupational therapy. Nine of 15 recreational terminal devices prescribed improved performance. However, they primarily were the adaptations for weight lifting and violin bows, where their use was obligatory for participation. The wholesale costs for the terminal devices ranged from $120 to $957, and many patients also required the construction of a prosthesis just for the activity. Only 4 of the 9 successful recreational terminal devices were still in use at average follow-up of 3.9 years because patients had lost interest in the activity or had designed something that worked better. Recreational terminal devices available for weight lifting and violin bows uniformly improved the child's ability to pursue those activities. These prosthetic adaptations are expensive and must be weighed individually by the family in light of children's fleeting interest in individual hobbies. Level IV.
    Journal of Pediatric Orthopaedics 04/2008; 28(2):271-3. · 1.16 Impact Factor
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    ABSTRACT: Electromagnetic fields (EMFs) have been demonstrated to enhance mammalian peripheral nerve regeneration in vitro and in vivo. Using an EMF signal shown to enhance neurite outgrowth in vitro, we tested this field in vivo using three different amplitudes. The rat sciatic nerve was crushed. Whole body exposure was performed for 4 h/day for 5 days in a 96-turn solenoid coil controlled by a signal generator and power amplifier. The induced electric field at the target tissue consisted of a bipolar rectangular pulse, having 1 and 0.3 ms durations in each polarity, respectively. Pulse repetition rate was 2 per second. By varying the current, the coils produced fields consisting of sham (no current) and peak magnetic fields of 0.03 mT, 0.3 mT, and 3 mT, corresponding to peak induced electric fields of 1, 10, and 100 microV/cm, respectively, at the tissue target. Walking function was assessed over 43 days using video recording and measurement of the 1-5 toe-spread, using an imaging program. Comparing injured to uninjured hind limbs, mean responses were evaluated using a linear mixed statistical model. There was no difference found in recovery of the toe-spread function between any EMF treatments compared to sham.
    Bioelectromagnetics 06/2007; 28(4):256-63. · 2.02 Impact Factor
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    ABSTRACT: This retrospective study included four patients with transfemoral amputations who had undergone six lengthenings of their residual femurs. Initial femoral bone lengths averaged 15.5 cm with a mean final length of 21 cm. The average gain of limb length (ischium to end of soft tissue), however, was 2 cm (15%). Second lengthenings resulted in only 17% additional bone length, compared to 50% for first lengthenings. Treatment time was protracted and complications resulted from infection, bone healing, and pin migration. However, all patients reported substantial improvement in walking function and prosthetic use.
    Orthopedics 02/2006; 29(1):53-9. · 1.05 Impact Factor

Publication Stats

19 Citations
14.27 Total Impact Points

Institutions

  • 2010
    • University of Michigan
      • Department of Orthopaedic Surgery
      Ann Arbor, MI, United States
  • 2008–2010
    • Shriners Hospitals for Children
      Tampa, Florida, United States
  • 2006–2010
    • University of Kentucky
      • Department of Orthopaedic Surgery and Sports Medicine
      Lexington, Kentucky, United States