Peds, Week 3

I am trying to type this as my left ring finger swells up ridiculously despite Benadryl and ice. I hate yellow jackets. HATE them.

Anyway, I successfully completed my third week of shadowing and wanted to share a few highlights like I did for Week 2:

1) A female burn patient and her pre-adolescent son. I did not have the temerity to ask how they were burned, but did ask when it happened (a month ago). The therapist was so, so good at talking with them while she worked. She examined Mom's burned hand, put some lotion on it, gently stretched it a little, and then wrapped it in bandages dipped in warm paraffin. Next, she examined the son's skin grafts on his back and said they were healing very well. She discussed some exercises he could do at home. Then she removed the paraffin wraps from Mom's hand and had her do some exercises before presenting her with a hand-stretching tool for her to use at home and detailing some exercises for her to do. I was very impressed with both the nuts and bolts of the treatment and the therapist's bedside manner.

2) I saw two OTs working together on a SHUEE (Shriners Hospital for Children Upper Extremity Evaluation) for one of the day rehab patients. It is an interesting test with a variety of tasks to measure upper extremity function. Usually one OT administers the test while the other videotapes it. Later, an OT watches the tape and scores the evaluation. After the test, one of the OTs took us back to the casting area and made the patient a constraint cast (very simple--it's basically a removable clamshell with the closed "hinge" end over the child's hand). She will be in the next Constraint Group starting at the end of this week.

3) I played the most awesome game of dominoes EVAH. The therapist got the patient (a girl with CP) into a hammock suspended from the ceiling. The hammock ran under her midsection so her upper body and her feet were free. She had to push herself forward to a table where I sat to play dominoes with her. Every time one of us had to draw another domino, the patient had to swing 90 degrees to the left of me where the therapist held one end of a rope. The patient had to grab the other end and pull herself toward the therapist hand-over-hand, then extend one arm into the domino bag, which the therapist held high and off to one side. She had to draw a lot of dominoes over the course of the game, so the girl got a very good workout. And it was fun--she was giggling the whole time! This session really made me appreciate the therapist's creativity.

4) I got to see a TENS (transcutaneous electrical nerve stimulation) unit at work and experience it for myself. In OT, TENS units are used to stimulate damaged nerves in the hope of helping them regenerate. The idea is that since nerves are a two-way street (they can receive impulses from the brain and transmit impulses back), stimulating the "return" side might also improve things on the outbound (brain-to extremity) side. The patient in question had some nerve damage in one of his hands, so TENS was applied before the OT and the patient worked on dressing skills (the patient was about to go back to school). When the session was over, the OT taped a lead to my left hand on the fleshy part of the palm just below the thumb and turned up the level until I felt a little tingling. You can actually make the thumb twitch involuntarily if you turn the unit high enough (which she did -- it felt a little staticky, but it didn't hurt per se).

5) The Myelo Clinic. No, not the Mayo Clinic, the Myelo Clinic. I never really understood just what a [insert name of disease or disease grouping here] Clinic was until I saw it for myself. As the PT the OT and I were waiting in the hall with put it, "It's a great idea -- in theory." The idea is that a number of patients with similar disorders all come in on a certain morning and get seen by a whole bunch of specialists in a shortish (2 hours or so) time window. The specialists include everything from OT and PT to orthopedics, gastroenterology, urology, a nutrition specialist--you name it. Each patient gets a little sheet on the exam room door, and each specialist checks his discipline off the sheet after he/she has seen the patient. "Myelo" refers to the spine and/or bone marrow, and both of the patients I saw my OT work with had spina bifida. One was the most developmentally normal kid I saw the entire three weeks--one of her hands was a bit floppy and she had some issues with sitting/standing/walking, but intellectually she was doing quite well. The OT had a fun time working with her. The second patient had a more severe form of spina bifida and was pretty much dragging himself around by his arms instead of crawling like a normal kid. She tried everything to convince him to pull himself to a stand, but he just couldn't manage it. He had tremendous grip strength, though.

So, there you have it--three weeks of observation from the Land of Peds.