Small beginnings can have huge potential benefits.

SickKids is sustaining this tradition with its New Ideas Program, which provides an outlet to test “out-of-the box” thinking. Once an idea is formed, an important next step is finding a donor to support it. Many program initiations, the hiring of a bright student or new ideas depend on the generosity of donors, who bring their own vision and confidence to risk-taking initiatives. Thanks to their charitable kindness, SickKids is able to encourage its scientists to think, “what if?” and reap the benefits of the extraordinary work that follows.

Once such idea turned into a study called the “Fat Fly” project.

The fruit fly – a model that may help us counter childhood obesity

Gabrielle Boulianne is a geneticist who uses fruit flies as a model system for understanding the development and function of the nervous system. Her novel idea was to use this model to identify genes involved in obesity and diabetes, a growing health concern in children. Environmental factors certainly play a role in causing obesity, but so do genes. Put two people on the same diet and one will have a greater disposition to gain weight than the other – that’s the impact of genes.

About 70 per cent of genes that cause disease in humans are also found in fruit flies, so it is likely that if there is an obesity gene, the fruit fly will have it. But how to identify the genes?

Dr. Boulianne had to first develop a screen for identifying ‘fat flies’ and ‘lean flies’ – because you can’t spot an obese fruit fly looking through a microscope. However, the obese, both human and flies, have high levels of triglycerides. Dr. Boulianne and colleagues analyzed the test group of fruit flies for triglycerides, looking for mutant flies either super fat or really skinny. Using this approach, they were able to identify several genes that lead to obesity in flies. They are now screening chemical compounds and have identified two drugs that might make the fat flies leaner again.

This has led to a five-year Canadian Institutes of Health Research (CIHR) grant for the “fat fly” project, which is good news indeed! Their first paper is in preparation (as of July-August, 2009), and Dr. Boulianne will also write a review article on using fruit flies to study human obesity. Future steps include tests in the lab and eventually, clinical trials.

Dr. Boulianne has turned her novel idea into a serious scientific study that could one day benefit humans – especially children suffering from obesity.

How it came about:

When the SickKids Atrium was receiving its finishing touches in 1992, the construction firm faced a challenge. Streams of people continually poured through the doors at SickKids and needed to be directed around construction, or onto alternate pathways when a whole section was closed off (like Main Street, down the centre of the hospital, while it was being finished). 

How to show them where to go? A creative assistant came up with the answer. Lay acrylic footprints where you want people to go and have someone at the information desk instruct people to “follow the footprints.”

Messias Farias, now a project manager in Facilities Development at The Hospital for Sick Children, was then working for the contractor finishing the Atrium.  It was his task to lay the footprints and to remove and re-lay them as work zones moved. 

The idea worked. The footprints were easily seen and easily followed, and, thanks to Messias’ hard work, fairly easily moved for re-direction.

They were also a hit. Small children coming to the hospital would step their way along the footprints – it became a favourite game. When construction was finished, Mike Strofolino, then President and CEO of SickKids, asked that they be placed permanently down Main Street.

Messias was the man for the job.  He says he wanted to make the permanent prints spaced for a child and considered bringing in his little girl to space them.  But no, all the footprint moving – including the permanent installation – had to be done late at night, too late for a little one to be out of bed. So Messias improvised by imagining his daughter’s little steps and peeled and placed the vinyl where she might have trod, one print at a time.

How they are made to last:      

The footprints are a 3M product that was specially made for SickKids. They had to be especially tough to endure the heavy traffic. Today they cost $13.75 apiece.

They have, in their 17-year life (1992-2009), had to be replaced five times, and they have just been renewed yet again. The hospital’s Housekeeping team does the job – removing layers of wax and sealer, then the footprint and laying the new one. Then a fresh coat of sealer finishes the job.

The multicoloured footprints in Main Street are the first laid – later others in a plain orange were added leading the way to the food court in the Hill wing. 

The Footprints and Philanthropy

Besides bringing delight to our little visitors (and most staff admit they have traced the walk as well) the footprints continue to serve our philanthropy. For a series of telethons in the mid 90s, they helped volunteers find their way to their dinner!  The phone bank where the volunteers were working was some distance from where food was set up, so the instruction to volunteers was, “Follow the Footprints.”  

And last, they provided an opportunity to honour the generosity of one of SickKids leaders and best friends. Jim Pitblado, a long-serving board member at SickKids, had made numerous, generous gifts to SickKids, culminating in funding for the first research Chair at the SickKids Research Institute.  There was nothing in the hospital or Research Institute that acknowledged his long history of philanthropy and leadership. So, on February 23, 2004 – six years to the day after the inauguration of the Pitblado Chair in Cell Biology (February 23, 1998) – SickKids Foundation dedicated the Jim Pitblado Footpath in his honour.

On Friday, June 19, the Epilepsy Classroom at SickKids packed up for the summer.  That last day of term was one big party: a water fight on the lawn, a pizza party followed by ice-cream cake, computer games, playing pool in Marnie’s Lounge, (a SickKids hang-out for older patients and used by the Epilepsy Classroom for lunch, a cooking program and special occasions like this one), and No Classes.

Summer and the end of term are always great reasons to celebrate.  But the kids in the Epilepsy Classroom have their own special reasons – for five months, under the guidance of experts, they had been achieving, where before they had not.    Christina Williams is one of the kids who graduated from the Classroom on that Friday, and her mother Lisa can give you chapter and verse on the difference it has made.  

“Christina has gone up a whole grade level in five months which she hadn’t done in the last seven years.”

  Christina’s academic progress had stopped, and the stress of that was helping bring on seizures.  At the end of 2008 she had a history of struggle and frustration at school.  At the end of five months in the Epilepsy Classroom she was able to proudly display a report card showing real progress.   What makes the Classroom so effective?  Lots of things.  Lisa Williams lists (in Christina’s case) freedom from seizures!  Christina went from seizures every week to none at all in the five months she was in the Classroom.  As well as this amazing indicator of stress reduction there are:  

• Being in a smaller group;
• A straightforward academic day, without all the extra-curricular busy-nesses that go with regular school;
• Lessons geared to her learning level, where she could learn and be proud of her progress; and
• Teachers who gave her one-on-one attention and who were there to keep her focused on what she was doing.

Her mother is so proud:  

“Christina now has a better sense of what she needs to do as far as her learning goes.  She knows how to tell the teacher when things have gotten too far ahead of her and why she needs to go back – and start again if necessary.  In other words, she knows how to advocate for herself.  Which is what the kids have to do when they get into high school – advocate for themselves.” 

Miriam Riches is the Special Education Teacher responsible for the day to day programming of the Classroom.  The method of teaching is Direct Instruction, an approach that is founded in research conducted in the Classroom itself.  It is intensive and done in small groups, so Miriam develops unique Individual Education Plans for each of the students.  This is one reason why the Classroom can only take eight students each term, younger ones (Grades 1-5) in the fall and older students (Grades 5-8) in the spring.  The children have significant academic needs, as well as the medical needs related to their epilepsy.   

To qualify for the Classroom’s special services a child has to have intractable epilepsy, that is, persistent seizure activity despite maximal medical treatment, and be followed by a neurologist.  Academically they must be underachieving in at least one academic area on standardized testing, or show persistent underachievement on a daily basis in their home school classroom.  

The eight students who qualify on these grounds go into an experience enriched by enormous care and support. 

Besides Miriam, there are two classroom assistants who instruct and oversee the children each day; a social worker and psychologist who provide services to the classroom each week, a developmental paediatrician who provides an assessment for each student during the term, a neurologist who is available on an as needed basis and support staff, students and volunteers.

Psychologist Elizabeth Kerr heads up the Epilepsy Classroom.  She coordinates referrals and is involved in intake assessments of students. During the term, she conducts neuropsychological assessments of the students to gain a better understanding of their learning profiles and needs. 

It may look like a huge team for eight kids, but with the challenges these kids are facing, that’s what it takes.

  And yes, they do research.  Activities of Daily Living in Children with Intractable Epilepsy, for instance, is a recently published study that sought to learn how best to assess the problems presented to children with intractable epilepsy by the simple activities of daily living.  Activities such as shoelace tying, fastening zippers or buttons, printing or writing cursive, independent self-feeding and preparing backpacks for school. This is a first round study. Once the methods for assessment are established, the study will progress to looking at larger groups of children and zero in on those daily living activities.  The understanding gained will help clinicians and researchers determine the best way to help these kids both acquire these basic skills and achieve more independence at school and at home.   Rather, as Lisa Williams put it, it’s like giving kids the confidence and savvy to advocate for themselves in the classroom – and everywhere.   And what do the kids think?  Christina took a minute from playing pool in Marnie’s (she’s getting good!) to answer that question.  Asked if she enjoyed the Classroom this year she said “Yes,” because she got A’s.  And when asked if that was fun, she said firmly: 

“It’s sure better than failing.”