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Ann Flanagan, PT PCS, and Rachel Galant, MSNM, OTR/L, former rehabilitation co-directors at Shriners Children's Chicago, explain physical, occupational and speech therapy services.

Physical, Occupational and Speech Therapy

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Melanie Cole (Host): Welcome to the show, and our topic today is pediatric rehabilitation, and specifically the rehab department at Shriners Hospitals for Children - Chicago. My guests are Ann Flanagan and Rachel Galant. They're co-directors of the rehabilitation services at Shriners Hospitals for Children - Chicago. Ladies, welcome to the show. So Ann, I'd like to start with you, tell us a little bit about the field of pediatric rehabilitation. What does that involve, really?

Ann Flanagan, PT, PCS (Guest): So at our facility it involves the physical therapy, occupational therapy, and speech language pathology, but then we also integrate with many other staff members throughout the hospital such as the physicians, nurses, social workers, psychologists, dieticians, our gait lab, rec therapists, and community agencies, so just about everybody.

Melanie: And Ann, you're a physical therapist, correct?

Ann: Correct.

Melanie: And Rachel, you are an occupational therapist. Rachel, if you would, explain the difference for the listeners between physical therapy and occupational therapy as it regards to pediatric rehab.

Rachel Galant, MSNM, OTR/L (Guest): Yeah, well I'm happy to do that. Occupational therapists here at Shriners work with children to develop fine motor skills and also choose independence and basic self-care. We use adaptive equipment to help them be independent, we also help them to increase their upper extremity strength, endurance and flexibility, and we also fabricate a variety of different kinds of splints.

Physical therapists here at Shriners work with children on gross motor skills, balance, mobility, transfers, walking, things like strength and flexibility, and also provide sports rehabilitation as well as wheelchair or adaptive equipment evaluation.

Melanie: Ann, what are some of the various ways that you see patients? Do you see outpatients as well as inpatients? Tell us about that.

Ann: We do actually a wide variety, which makes it really fun for our staff members to be involved in all of these areas. So we do see children who are inpatients for rehabilitation, so they may be here for one week up to many, many weeks depending on their needs after an injury or a surgery. We see children for intensive outpatient stays where they come and receive several hours of therapy, and a really intensive one or two week, or sometimes a little bit longer period. And then we also see weekly recurring outpatients who come once a week or sometimes two or three times a week if they're post-operative. And then we also work in the clinic arena, and this is for physical, occupational, and speech therapy.

Melanie: That's so interesting. Rachel, how are your services integrated? As Ann was speaking about all of these different ways that you see patients, how are they integrated as part of a multi-disciplinary care model?

Rachel: Yeah, we really pride ourselves having a multi-disciplinary care model, and having not only our therapists (our physical therapists, occupational therapists, and speech language pathologists), but also we work with our PM&R physicians (our physical medicine & rehab physicians), as well as our care coordinators, our psychologists, social workers, recreational therapists, and child life specialists to really help integrate the goal that the team has for the patient prior to returning home or prior to the end of their plan of care, and really to be as independent and functional as possible in their daily lives.

Melanie: What a wonderful care model. So Ann, tell us about some of the cool devices and the latest technology in pediatric rehab that you have available to you at Shriners.

Ann: Yes, we've been so fortunate. We've had so many great donors over the years that help us keep up with the highest in technology for kids. We have the Locomat, which is a robotic walking assisted device over a treadmill. We have body weight supported treadmill training, we have a variety of functional electric stimulation bikes for the arms and the legs. We have aquatic therapy, so we use the pool quite a bit with children. We have augmentative and alternative communication devices for children who aren't able to verbalize their needs. We have a vibration plate, we have an AlterG treadmill which is a kind of giant blow-up treadmill that acts like you're walking on air or walking on the moon to help take some of that weight off when you're first getting started again or trying to improve your walking. And we have a robotic exoskeleton and a variety of upper extremity devices too, as well as the Tap-It, which is a very large screen where- touch screen for children. So we have a whole lot of really cool latest technology, but we also have a lot of low-tech things also that make therapy a lot of fun and engaging.

Melanie: That's so cool. And Ann, sticking with you a second, because sometimes people don't realize some of these things you're discussing. That treadmill sounds so cool. But tell us a little bit about how PT helps these kids with special needs. It looks a little different than we might expect; swimming, or ball pits, basketball courts. Tell us about some of those more low-tech things you're talking about.

Ann: Sure, we really have a good time when we're with the children and families. So we have lots of bikes and scooters to get kids moving and strengthen. We have ball pits and swings, using lots of mats, and balls, and bolsters, some weights and stretchy bands. We might use shopping carts for the child to go around the hospital and pick up objects and work on their walking. We have small climbing walls, we may use the outdoor playground, there's also an indoor playground, there's a big mall area that's an open space that children can run and play, and also our heated therapeutic pool that we use quite a bit. So a lot of different areas throughout the hospital you'll see us with children. Because obviously when they get home, that's not the- they don't live in a clinic environment. They live in their community, and their home, and their school, and so we want to make sure that they're independent and functional as possible in all different environments.

Melanie: How wonderful that is, what you're doing with kids. And so now Rachel, tell us about the special services that you offer as an occupational therapist. You've described what an OT does, but they don't really know what a session would look like, and what are some of the typical goals that you have when you're working with these kids?

Rachel: Sure, yeah absolutely. So when an occupational therapist sees a patient for, for example inpatient rehab, the patient may have had an injury that has prevented them from being able to complete their basic self-care. So we call that ADL; activities of daily living. So an occupational therapist may go bedside with the patient first thing in the morning for their first session, and actually go through the motions of how to get dressed, how to groom themselves in the morning, how to feed themselves breakfast, and things like that, that we really take for granted. Then an occupational therapist, they have a different lens that they're looking through to think of adaptive techniques, modifications, possible adaptive equipment to help them achieve those goals to be as independent as possible.

We also do things like cooking groups for patients. So if we have patients who are appropriate who may need training in something we call instrumental activities of daily living, that's higher level ADL, things like cooking, or money management, or being able to manage transportation, or getting on a bus. So we have occupational therapists lead a cooking group that really lets them be able to feel independent in meal preparation for the group, it adds socialization, they have a really great time while also trying to meet their goals while they're here for rehab.

We have a wide variety of low-tech adaptive equipment to be able to have them be more independent. We also work on a variety of splinting, custom splints that we provide our patients whether it's after an injury that they need to be immobilized, or if they just need more proper positioning with their hands. We also do lower extremity splinting and we create a multitude of adaptive devices with splinting material as well.

Melanie: Wow, some of these programs sound so much fun for patients to be able to learn. Rachel, I'm going to stick with you for a second because along the OT lines comes speech therapy, and kids sometimes need help with language communication, feeding disorders. Tell us what that kind of a session might look like.

Rachel: Yeah, absolutely. We have wonderful speech language pathologists who really focus on independence in communication, also having feeding disorders, and they look at how they can communicate whether they're nonverbal, they don't have many words, they can evaluate them for low-tech communication boards, or something much more high-tech of a communication device that they need to train with the child, see if it's functional for them, and also sometimes work with the schools on how to integrate that into their daily lives, and at home.

Melanie: Ann, am I forgetting anything? What else would you like to share with the listeners to know about the rehab services at Shriners Hospitals for Children - Chicago? What am I missing?

Ann: Sure, a couple of other areas that I forgot to mention previously is that we have a scoliosis specific exercise program here where children come in who have scoliosis, or curvature of the spine, and maybe they're not- the curve isn't large enough yet that they need surgery, but they might need a brace, or even if they don't need a brace we have a scoliosis program for strengthening and working on their posture, and we've seen some really amazing results with children in this program.

And then the other program that we wanted to highlight is just how much education we do here. We host seminars, we have weekly in-services, a lot of competency, so therapists are always learning, growing, and learning from our patients also, so it's really an amazing field to be part of.

Melanie: Rachel, what about you? Wrap it up for us, what you would like the listeners to take back from this as the message about the pediatric rehabilitation services available at Shriners.

Rachel: Absolutely. We provide such an array of services for children throughout our hospital whether it's through inpatient rehab, intensive outpatient rehab, weekly recurring outpatient therapy. You'll also see us in our clinics, and our therapists get very moved and excited by seeing kids throughout this continuum of care from either beginning of injury, or when they are born and maybe born with a congenital deficiency and see the leaps and bounds that our children really show and grow over the years.

We also have a rehab aide and a rehab assistant who really circle out our team and really help us in our day-to-day with all of our therapists and the good work that they do every day.

Melanie: Thank you ladies so much for being with us today. What an amazing department you have, and you both are really, really good ambassadors for this particular department, and thank you so much for being with us today and sharing your expertise with the listeners. This is Pediatric Specialty Care Spotlight with Shriners Hospitals for Children - Chicago. For more information, please visit www.ShrinersChicago.org. That's www.ShrinersChicago.org. This is Melanie Cole, thanks so much for tuning in.

About the Speaker

Ann Flanagan, PT PCS, & Rachel Galant, MSNM, OTR/L

Ann Flanagan, PT, PCS, is the former co-director of rehabilitation services at Shriners Children's Chicago and a research coordinator at our pediatric hospital. Rachel Galant, MSNM, OTR/L, is former co-director of rehabilitation services at Shriners Children's Chicago.

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