As every parent knows, it’s hard to stop kids, even when they’re down! Whether they’re recovering from an injury or illness or managing a condition they were born with, the desire is the same: to move past what’s holding them back and live life to the fullest.
That’s what the care providers at Shriners Children’s want, too. And that’s why physical and occupational therapists play an important role in so many of our patients’ custom care plans.
Physical and occupational therapy looks a lot different for kids than it does for adults, said Maya Evans, M.D., medical director of the inpatient rehabilitation and spina bifida programs at Shriners Children’s Northern California. “For you and me, therapy is often squats and pushups,” she said. “But you can’t approach a child that way.” In fact, therapists use play to draw specific movement patterns out of their young patients.
“We work on play skills in order to learn social skills, challenge joint attention and receive sensory input,” said Becky Kelly, an occupational therapist at Shriners Children’s Twin Cities. “Play skills help children work on their strength, improve their coordination and develop fine motor skills.”
The Twin Cities location recently installed a sensory space in their rehabilitation gym, which incorporates play into physical therapy goals. For Scarlet, age 2, a cancer diagnosis in 2021 resulted in an amputation of her right leg. She was referred to Shriners Children’s Twin Cities for a prosthesis and physical therapy. Her favorite activity was using the sensory space to work on her “playground skills” like climbing and sliding, while adjusting to using a brand-new leg.
Through activities such as pinching or gripping toys, or using their hands to control toys or colorful objects, patients make progress. “All of these skills are used to make us more successful in daily tasks, such as getting dressed,” Kelly said.
Alessandro, age 6, comes to Shriners Children’s Twin Cities for physical and occupational therapy. Alessandro, who has Down syndrome, comes to therapy to work on building his strength, improving his mobility and performing the tasks of daily living. One activity his therapists plan is playing with Squigz toys to work on grip strengthening. These are colorful suction cups that can be stuck to each other and to flat surfaces.
“Grip strength is necessary for some of the ‘big picture’ goals, like opening a container or pulling your pants up,” Kelly explained. “Not only is play an important part of childhood for socialization, but it’s the best way to encourage children to challenge themselves and learn new skills,” she added.
Working toward significant milestones
Cadence was 9 when she was injured in a terrible accident near her family’s fire pit. Her two younger sisters experienced minor burns, and Cadence sustained third- and fourth-degree burns over 50% of her body. During a month of inpatient care at Shriners Children’s Boston, Cadence had two skin graft surgeries. She also worked with occupational therapist Jessica Willoughby to regain her independence.
“Jessica gave Cadence the hope of being able to walk, feed herself and play the violin again,” her mother, Angie, said. For Cadence, therapy didn’t look like playing at first. To start, Cadence first had to be able to get up out of bed. With burn injuries to her chest, torso and abdomen, even just trying to sit up caused significant pain and discomfort, Willoughby said.
Incorporating coping strategies and positive self-talk, Willoughby and Cadence slowly tested the girl’s limits and planned to push past them. They began by elevating the head of Cadence’s bed. “This was a way for Cadence to tolerate this positioning with her injuries, but she didn’t have to focus on actively engaging her core and trunk muscles,” Willoughby explained.
Once Cadence could sit up, the goals changed: moving to a wheelchair, walking, dressing and even climbing stairs.
“Burns are painful, and Cadence had to work through that pain to regain her mobility,” said Willoughby. “As occupational therapists, we address ‘activities of daily living,’ and sitting up and getting out of bed is the first stepping stone – a very important part of functional independence. If you can’t get up and out of bed, the rest of the day will be quite challenging.”
Cadence, now 10, returns for rehabilitation at Shriners Children’s Boston every three months for scar management. Willoughby is focused on helping Cadence pursue all the activities she loves, especially her favorite, cheerleading.
“She’s been doing all of the hard work,” Willoughby said. “I’m just giving her the tools to be successful.”
Another Shriners Children’s Boston patient is working through therapy in order to reach her goal: making her mark in the culinary world. Phoenix (previously known as Hasi), first came to Shriners Children’s as a child for life-changing plastic and reconstructive treatment following a burn injury. Now 18, she credits her Shriners Children’s medical team with making it possible for her to pursue her dream of becoming a chef.
After a deep burn injury to the hand, thick scar tissue can limit mobility, explained Lori V. Turgeon, PT, DPT, director of therapeutic services at Shriners Children’s Boston. Over time, this limitation can affect other muscles and tendons, so therapy focuses on an array of skilled interventions such as hold-contract-relax, sustained passive stretch, splinting and strengthening exercises.
Phoenix worked extensively with her physical and occupational therapists to adapt and maximize the use of her hand. Her therapists tailored these activities so Phoenix could reach her goal of working in the kitchen.
“These techniques help the patient gain motion before building back their strength to increase finger range of motion and eventually optimizing grip strength for tasks such as holding cooking utensils or knives for chopping,” Turgeon said. “Now, I am a chef studying culinary arts at a vocational high school,” Phoenix said. “I use my hands in the kitchen daily!”
When a patient is paralyzed, therapy looks different still, Dr. Evans said. In such cases, the therapy team helps patients maximize whatever strength they do have, for activities such as transferring in and out of a wheelchair or to perform self-care activities.
That’s the case with Jalen, a teenager from California. Jalen woke up one morning with chest and back pain, but she did a few stretches and didn’t think anything of it. On her walk to school, the pain intensified, and Jalen called her older sister to come pick her up. Her sister found her sitting helpless on the sidewalk, unable to walk. Within hours, Jalen was paralyzed from the chest down, unable to move or speak.
Jalen learned she had transverse myelitis, a rare inflammation that damages the spinal cord. She spent a month in her local hospital, where treatment helped Jalen overcome the acute phase of her illness and then focused on simple milestones. But Jalen needed more comprehensive, ongoing physical therapy to regain her independence. She found it at Shriners Children’s Northern California.
“Jalen’s team included all her doctors from different specialties. Nurses, a physical therapist and an occupational therapist all met in one room to create a plan for Jalen,” said her mother, Tiffany. “They
had all done their own research about her rare condition and came up with a customized plan, specific to Jalen’s rehabilitation, together. They mapped out exactly what her recovery would look like.”
Knowing Jalen’s goal of regaining her independence, her therapy team introduced activities to strengthen and retrain her body and mind.
“[My physical therapist], Laura, is amazing,” said Jalen. “She made our sessions fun, and physical therapy didn’t even feel like work.” To support social goals, Laura let Jalen schedule her sessions at the same time as a new friend she had made during her hospital stay.
While Jalen eventually regained her ability to walk using braces and arm supports, her occupational therapy team recognized that she would need a custom wheelchair to support her posture and help her get around, especially in situations when she would need more mobility or for longer days away from home. “They really are experts in wheelchairs and helped me pick the best chair for my needs, encouraging me to consider things I wouldn’t have even thought about,” said Jalen.
“It’s fun to watch our patients come out of their shell,” Dr. Evans said. “They come to us, and they can be kids again.”