LEXINGTON Comprehensive. Challenging. Compassionate. Rewarding. Pediatric outpatient services at Cardinal Hill Rehabilitation Hospital in Lexington implements therapies and outcomes for the most tender patients, children. It’s a fair question to ask, “Who benefits more from successful outcomes, the patients or the providers?”
Cardinal Hill Rehabilitation Hospital (CHRH) started in 1950 as a hospital for children with polio and has evolved to provide various programs that address down syndrome, cerebral palsy, muscular dystrophy and motor limitations, ADD/ADHD, overweight children, autism, language delays, picky eaters and sensory aversions, congenital disorders like scoliosis and spina bifida and many more, providing Occupational Therapy (OT), Physical Therapy (PT), and Speech Language Pathology (SLP) services for children birth to 18 years old, treating some of the more rare genetic disorders and conditions.
Jenna Johnson, MCD, CCC-SLP, Outpatient Therapy Coordinator – Pediatrics, explains “Each child we see has unique circumstances, including their diagnosis, their background, their family dynamics, or their therapeutic needs.” Cardinal Hill has the ability to treat pediatrics in both an inpatient and outpatient setting, which allows for continuity of care using a multidisciplinary approach, says Johnson. Patients are required to have a referral order from a physician.
Leann Kerr DPT, DHS, CBIS, works with neurologically involved pediatric patients, and her primary focus is the restoration or development of functional movement. Creating neuroplasticity, changes in neural pathways, requires high repetition of the set movement pattern over a period of time. A robotic gait trainer, like the Lokomat®, assists in providing the same exact motion repetitively, resulting in a new functional movement pattern. This improves recovery measures for patients with all types of diagnosis and is vital to a successful recovery.
“We are very fortunate that Cardinal Hill is committed to providing advanced technology. It is amazing to see an individual come into the facility in a wheelchair or walking with the assistance of devices and leave walking out on their own, without any restrictions. The level of functional improvement would not take place in the same amount of time with more traditional approaches to intervention,” says Kerr.
Much More than Playing in the Pool
The unique design of the Cardinal Hill Aquatic Center offers not only the opportunity for typical aquatic sessions focusing on motor development and performance, but also the opportunity to satisfy the various sensory needs of specific patients. Pediatric patients who receive therapy in the pool have medical diagnoses including but not limited to, autism, juvenile arthritis and neurological conditions, osteogenesis imperfecta type III and reflex neurovascular dystrophy. The patients benefit from the decreased gravitational impact as well as the unique thermal desensitization provided by the various pools.
Addie Burnham MOT, OTR/L, works with autistic children, who benefit from the rich sensory input of the pool that increases eye-contact, reciprocal interaction, and participation in structured activities. Therapeutic activities that might cause meltdowns are easily achievable in the pool and patients display increased play schemes, social interaction, fine motor skills, and tactile processing as a result of the input provided through skilled services in the water.
Children who have significant motor limitations have increased active and passive range of motion with aquatic therapy and can develop improved typical movement patterns in a gravity eliminated environment, says Burnham. “I also like to transition to aquatics with children who have plateaued with traditional therapy approaches. Often a simple transition for a session can facilitate progress once again.”
You Can Say That Again
Kristen Wheeler, MS, CCC-SLP, is a speech language pathologist who sees children diagnosed with a variety of communication delays, genetic syndromes, autism, and developmental delays.
When appropriate, Wheeler works with children in co-treat sessions with OT where the child’s occupational therapist addresses their sensory needs, and she targets communication goals in a more structured way. Co-treat sessions may occur in a traditional therapy room, sensory gym, or in the pool.
All patients have the potential to progress in speech-language therapy, says Wheeler. Children with caregivers who actively participate in the therapy process and follow-through with home programs typically demonstrate excellent progress and carry-over of skills learned in therapy. Every situation is unique, Wheeler continues, but each child has the potential to be a functional communicator. Some children may become independent verbal communicators, while others may use picture symbols or augmentative communication devices to communicate. “Whatever their mode of communication, my goal for them is to become a functional independent communicator,” says Wheeler.
Activity & Nutrition with a Dash of Self-Esteem
Fit Kidz is geared toward the overweight and obese child population. Typically these children perform well in the program because they participate in physical activity for 60 minutes on two different days of the week. Additionally, children and parents receive nutrition and healthy lifestyle information to incorporate in their everyday lives. The majority of the lifestyle changes come in the home environment. Unfortunately, without parental support, the child is usually not successful in the program.
Self-esteem plays an important role in Fit Kidz therapy, says Jennifer Robinson, BS, exercise science, Fit Kidz coordinator. “The most challenging aspect of my work is having a child believe in his or her self. Many of these children are bullied in school, so when they come in for Fit Kidz, they are emotional and have a lot of self-doubt,” says Robinson.
Robinson encourages her patients to eat healthy, be physically active, and understand they are not the only ones with a weight problem. In the group setting, each child gets to know others of the same age who are also dealing with weight issues. While this is the most challenging aspect, Robinson says it also becomes the most rewarding aspect as well.
“Over the course of 10 weeks, each child begins to see themselves in a new light. It is amazing the transformation a child undergoes. They make new friends, learn healthy lifestyle changes, but more importantly, begin to see the positives in themselves and gain confidence in the things they can do,” says Robinson.
Yuck! – Food Aversions
Heather Roach, OTR/L, has worked in pediatrics for 14 years with children of all ages and abilities with extensive training in feeding using a sensory based approach, as well as behavioral strategies. A sensory based approach works by helping children accept a variety of foods through play and exploration. Children learn best through play, which makes this approach so successful. Parents are also taught strategies to use at home to improve the child’s acceptance of new foods and textures, which is essential for success in the program.
“To have a family say that meal times are no longer a battle, and they can go out to eat without worrying that the child won’t be able to eat or sit through the meal is very rewarding,” says Roach. Also seeing children gain height and weight and not rely on their feeding tubes for nutrition is very rewarding. When needing to use a more behavioral approach, it can be challenging to find the best reward for the child, says Roach.
Flexible Therapy Fuels Movement
Alexandra (Allie) Turner, MS, OTR/L, CBIS, used Kinesio® taping in adult patient to alleviate pain and assist with joint stability for patients with normal movement patterns to increase their independence with occupation based tasks. She now employs Kinseo® taping with pediatric patients to increase their acceptance of weight-bearing positions. Patients respond by showing increased movement, decreased pain, or decreased swelling, dependent on the technique utilized and the intended goal for the movement, says Turner. As Kinesio® tape is a non-invasive treatment method, it is easy to apply and is flexible to encourage active movement while assisting with normalizing movement patterns.
Unanimously, the OT, PT, and SLP providers at Cardinal Hill Pediatric Outpatient Services say the most rewarding aspect of their work is the improvement, large or small, that their patients achieve during therapy.