Incorporating Play in the Clinical Experience: Shiloh's Story

Moses vividly recalls the day his 10-month-old daughter, Shiloh, sustained burn injuries.

“It was Christmas 2022. We had guests over to celebrate. It was just a lovely day,” Moses said.

As the festivities wound down, Shiloh’s mom started a bath for her. She placed the portable tub on a table, not realizing Shiloh could reach it by pulling herself up. Shiloh accidentally tipped over the basin, burning her chest, stomach and hands.

In those panicked first minutes, the house full of holiday celebrants all offered first aid tips. “I realized we didn’t have the knowledge to care for a burn injury and we rushed her to the hospital,” Moses said.

A chance experience a few years later led the family to Shriners Children’s Boston. “We live in Rwanda and the fiancée of my wife’s cousin, Alex, visited from the United States,” Moses said. Although Shiloh’s acute burn injuries had healed, Alex noticed her fingers were contracted from the burn scars, and she had difficulty using them. Alex was familiar with the specialty pediatric care offered at Shriners Children’s, so he helped the family connect with the organization. Arrangements were soon made for Shiloh to receive treatment in Boston.

Shiloh and Moses arrived at Shriners Children’s Boston from Rwanda in the middle of the night. “It was the first time I was in the U.S. I wasn’t sure how things would really go, and I was just following a window that opened for us,” said Moses. The first person they met at the hospital was a security guard. “He welcomed us so warmly. He knew we had a long flight, and Shiloh was likely very tired and hungry. He brought us milk, juice and a meal.”

The next morning, Shiloh and Moses met her care team. Past the acute phase of her burn injuries, clinical staff focused on surgical techniques to improve Shiloh’s mobility and address the contractures of her hands. Physical and occupational therapy were also important components of Shiloh’s care plan.

While the therapeutic services team worked with Shiloh to improve the flexibility of her hands, the surgical team focused on one hand to start. This ensured Shiloh could maintain use of one hand while her surgeon operated on the other. Surgical procedures on Shiloh’s right hand helped soften her scars and reduce their tightness. Future procedures will address scarring of her left hand. As Shiloh grows, the team will monitor her hand use, performing additional surgeries as needed to help her achieve optimal use of both hands.

The therapeutic services staff incorporated play to help Shiloh use her hands. “I didn’t realize play is part of the treatment program – it really is embedded in everything at Shriners Children’s Boston,” Moses said.

Lead child life specialist Rebecca Wildes, MS, CCLS, explained the important role of play in a child’s healing journey. “We incorporate play early on, offering choices during a patient’s admission – for example, helping a patient practice placing an anesthesia mask on her doll as preparation for surgery.”

Child life staff meets with patients having surgery for the first time. “These experiences set the tone for future encounters. I met Shiloh during her initial evaluation in our outpatient clinic. She was shy but easily engaged in play during her exam. This gave the surgeon and physical therapist the opportunity to observe how Shiloh was using her hands, which helped them map out her surgical and therapeutic plan of care,” Rebecca said.

Aimee Chiasson, PT, DPT, was Shiloh’s primary physical therapist. She explained that “a child’s occupation is play, and it’s important to incorporate that into therapy sessions.” Aimee said the physical therapy team takes time to learn about a patient’s interests, identifying activities that align with physical therapy goals. “Shiloh was very interested in Play-Doh, which worked well for getting her hands moving and making them stronger,” she said.

An effective physical therapy program incorporates activities patients enjoy, which lays the foundation for success and gives them a measure of independence because they are helping create their own therapy plan. “Shiloh is a very active young girl and loved to run around in the gym, so we tried to start our sessions at the table and then run around at the end of our sessions,” Aimee said.

Moses said the time with Aimee did not feel like treatment. “Aimee is very thoughtful in the way she handles Shiloh and how she incorporates play in the exercises,” he said.

Moses described Shiloh as an active and outgoing child who loves to swim and connect with people. “Walking on the streets, she would say hello to everyone. She even made friends for me,” Moses said with a laugh. He described an outing to the FIFA fan festival at City Hall Plaza during the World Cup. “A woman complimented Shiloh’s hair, and she responded with a little toss of her head which made us all laugh,” Moses said. The woman was with her husband and two children, and the group struck up a conversation. Moses and Shiloh ended up becoming friends with the family, even attending a barbeque at their home.

Moses said he and Shiloh felt at home in Boston. “I didn’t know anything about Boston so we would just walk randomly and bump into a playground. Setting up those play areas that are public and free is a blessing.”

For Moses, the experience at Shriners Children’s Boston was about far more than medical care. Through surgery, therapy and the power of play, Shiloh gained new opportunities to use her hands with confidence, while father and daughter found a welcoming community that made Boston feel like home.