Peds Shadowing, Week 2

I'm not going to list out every patient I saw last week because it would just take way too long, and because some of the stuff was the same (two more screaming kids in serial casting, for example). So let me just give you five "highlights":
1) I watched a treatment session with a young girl who had Aicardi syndrome, characterized by an incomplete or missing corpus callosum, the structure that allows the two hemispheres of the brain to communicate with each other. You can imagine how devastating it would be to a baby's growth and development to have the two halves of the brain forever separated. In this session, the focus was on having the patient sit up with less support (unassisted was still not possible), reach for and grab small objects such as cones or toy penguins (she sometimes knocked them over but was rarely able to pick them up), and grab suction balls stuck to a mirror (again, several knock-offs, but only one grab that I remember). The patient had pervasive severe developmental delays, but was indeed progressing, if only in very small increments.
2) I got to watch and then try out a fluidotherapy machine. An adolescent male with arthritis in his hand and wrist inserted his forearm into the machine and performed squeezing/stretching exercises with some spongy blocks that the OT had inserted into the machine while the warm air was blowing the corn husk bits (the size of large grains of sand) over and around the boy's hand. The OT indulged my curiosity and let me try it after the boy was done. It felt much nicer than I expected. The air is warm but not uncomfortably hot, and it blows the corn husk material all around so it is making contact with your hand from all different angles and directions. I was expecting the corn husks to be quite abrasive and pelt my hand like pea-sized hail, but they were actually gentle and soothing.
3) I learned about a new kind of casting. Last week I wrote about serial casting, which aims to straighten or fix a limb. This week I went to Constraint Group, where there were several kids being treated with constraint casting. Constraint casting involves putting a removable cast over a child's dominant arm/hand so that he/she is forced to use the weaker hand to do things. I guess it's the equivalent of putting an eye patch over your good eye so you have to use the weaker one. Some kids actually end up in Constraint Group after they finish serial casting, which makes sense when you think about it: you've had your left arm in a cast for six weeks to straighten it, so it is now weaker because you haven't been using it. So you get a cast put on your right arm to force you to use Lefty again. (I love that pediatric OTs constantly refer to Righty and Lefty, i.e., "I want to see Lefty help pull your shoe off, okay?" This morning a little boy even said to the therapist, "Righty's tired. He stayed up late watching SpongeBob last night!")
4) The zipline. In addition to the Rehab Apartment, there are two gyms in the rehab area, and one of them has an honest-to-goodness zipline affixed to the ceiling. It runs about ten feet across the room and ends over a pit filled with fluffy padding. As part of the afternoon social skills group (I wrote about it last week), the kids all used the zipline to simulate blasting through space. We also read a Dr. Seuss book about space and made planets with a spaceship and an astronaut orbiting them, and we practiced pretend zero-gee walking (where you have to move reeeaaaallllly slowly), which provoked many giggles. I paired up with one of the "my engine is running fast" kids and engaged him for pretty much the whole hour. I think it helped.
5) I got to see an initial hand evaluation on Thursday. The patient was a preadolescent boy who had suffered a friction burn by sticking his hands in a treadmill belt as a baby. (Not uncommon, apparently. Be careful with your treadmill if you have small children!) He had fairly thick scar tissue along the sides of his pointer and middle fingers, and since he had been experiencing a growth spurt, he had difficulty straightening those two fingers. The fingers were growing, but the scar tissue wasn't budging. You can see how this could create a problem. The OT examined the boy's fingers very carefully, asked about his ADLs (he was still able to do everything he wanted to do, fortunately, including throwing a baseball and taking tae kwon do), tested his strength and range of motion (good), and finally decided to make him a splint for night wear in addition to recommending regular massage and application of lotion to the scar tissue to loosen and soften it. I talked to the boy and his sister and mom while the OT made and fitted the splint. It was a very interesting and enjoyable session.

It's hard to believe this is my last week already. I've seen and learned quite a bit and hope to experience a few more things before it's over and done with.