Brief Biography

Following his residency training in the United States, Dr. Narayanan completed a paediatric orthopaedic fellowship at The Hospital for Sick Children. In 1999 he received the Health Services Research Fellowship Award from the American Academy of Orthopedic Surgeons/ Orthopedic Research Education Foundation to complete a Masters degree in clinical epidemiology at the University of Toronto. He received the Claire Bombardier Award for excellence in the clinical epidemiology program in 2001.

He turned down offers in the United States to take up an academic appointment with the Division of Orthopaedics, and the Population Health Sciences Program of the Research Institute at The Hospital Sick Children. His clinical practice, which began in 2002, includes the management of the broad spectrum of congenital, developmental and acquired musculoskeletal conditions in children including deformities, trauma, infection and arthritis.

He has a special interest in the care of children with chronic developmental disabilities, especially cerebral palsy. Dr. Narayanan’s research program involves the exploration of patients’ priorities and preferences, their role in clinical decision making and their impact on outcomes. He has a keen interest in evidence based orthopaedics, and the evaluation of clinical interventions and health care technologies in randomized clinical trials.

A significant proportion of his time is devoted to teaching medical students, orthopaedic residents and paediatric orthopaedic fellows at The Hospital for Sick Children and the University of Toronto.

Clinical Care Activities

• Cerebral Palsy
• Paediatric trauma and fracture management
• Deformity correction
• Clubfeet

Areas of Specialty:

• Paediatric orthopedic surgery
• Clinical epidemiology

Academic Background

Degree/Fellowship:

M.B., B.S.
University of Madras, India
1981 to 1987

Surgical Internship
University of California, Davis
1991 to 1992

Orthopaedic Residency
University of Minnesota
1992 to 1998

Paediatric Orthopaedic Fellowship
The Hospital for Sick Children,
University of Toronto
1998 to 1999

MSc Candidate
Clinical Epidemiology
University of Toronto
1999 to Present

Research Interests

1. Defining priorities and preferences of patients and parents, in the management of paediatric musculoskeletal conditions
   My research seeks to define the concerns, desires and expectations of parents/caregivers and patients with orthopaedic conditions and to contrast their priorities with the objectives of currently available treatments. This research will lead to better informed and more shared decision making.
2. Patient-based outcomes research in cerebral palsy
   Cerebral Palsy is one of the leading causes of chronic childhood disability. My team will develop and validate outcomes instruments that measure more meaningful outcomes, such as health related quality of life and use these measures to evaluate the effectiveness of various interventions in longitudinal cohort studies and randomized trials.
3. Clinical trials and evidence based paediatric orthopaedics
   Designing and conducting clinical trials of treatment interventions and health technologies in cerebral palsy and other musculoskeletal conditions in children.
4. Gait analysis

Research Activities

1. Concerns, desires and expectations of surgery for adolescent idiopathic scoliosis: A comparison of patients', parents' and surgeons' perspectives.
2. Development and validation of a disease-specific measure of quality of life in children with severe hypertonia due to cerebral palsy or acquired brain injury. Children with severe developmental disabilities are often subjected to major interventions primarily to improve their quality of life and to facilitate caregiving. Such a validated instrument will be useful in evaluating more meaningful outcomes following interventions for this population.
3. Development and validation of a spasticity measurement system.
   Children with spastic cerebral palsy often receive interventions designed to reduce spasticity, which in turn, is expected to improve function. Current methods of quantifying spasticity are not very reliable. A practical system to objectively and reproducibly measure spasticity is being developed with engineers at the Motion Analysis laboratory at the Bloorview MacMillan Children’s Centre.
4. A randomized controlled trial comparing a removable ankle brace versus below-knee cast for low-risk ankle fractures in children.
5. Utilization of gait analysis in the management of ambulatory children with spastic cerebral palsy: Clinical uncertainty and area variation in North America. This project involves a survey of pediatric orthopaedic surgeons across North America to estimate the current perception of the value of this health technology in decision making in the management of ambulatory children with spastic cerebral palsy. This study will be a precursor to a randomized trial to answer this question definitively.

Future Research Interests

1. A randomized controlled trial of intra-thecal baclofen for the management of spasticity in children with severe hypertonia in children with total body involved cerebral palsy and traumatic brain injury.
2. The epidemiology of paediatric femoral fractures in Ontario.
   Geographic area analysis of fracture rates, mechanism of injury, treatment methods, length of stay and adverse outcomes.
3. Patient and parental preferences/utilities for the different methods of treatment of paediatric femoral fractures.A randomized controlled trial to evaluate the effectiveness of gait 
4. analysis in surgical decision making on functional outcomes following surgery for children with ambulatory cerebral palsy.
   

Achievements

1. United Cerebral Palsy Research and Educational Foundation Cerebral Palsy & Gait Analysis Fellowship award NIH Training Grant, Department of Orthopaedics, University of Minnesota
   Motion Analysis Laboratory, Gillette Children's Hospital.
   1996 - 1997
2. Best Resident Research Project Award for "Refining the estimation of Femoral Anteversion - a cadaver study",
   University of Minnesota, Minneapolis, Minnesota.
   1998
3. American Academy of Orthopedic Surgeons/ Orthopedic Research Education Foundation Health Services Research Fellowship Award. 1999
4. American Academy of Pediatrics: Best orthopaedic paper for “Complications of elastic stable intramedullary nail fixation of pediatric femoral fractures, and how to avoid them.”
   1999
5. Clinical Epidemiology Research Award: Best Research Poster.
   2000
6. University of Toronto Open Fellowship Award.
   2000
7. Claire Bombardier Annual Award: Most Promising Clinical Epidemiology Student.
   2001

Publications

Narayanan UG. Flexible intrameduallary nailing of paediatric femoral fractures. Bulletin of the Canadian Orthopaedic Association.

Narayanan UG, Wright JG: Evidence-based medicine: a prescription to change the culture of pediatric orthopaedics. Journal of Pediatric Orthopaedics 2002: 22(3): pp 277-8.

Narayanan U, Howard A. Selective dorsal rhizotomy in the management of children with spastic cerebral palsy. [Protocol] Cochrane Movement Disorders Group Cochrane Database of Systematic Reviews. Issue 1, 2002.

Schutte LM, Narayanan U, Stout JL, Selber P, Gage JR, Schwartz MH: An index for quantifying deviations from normal gait. Gait & Posture; 11(1):25-31, Feb 2000.

For more recent publications see PubMed