Clinical Cases
Pediatric Case #1
14.9 year old female p/s Anterior Scoliosis Correction in an Acute Care Setting
My first case is a based on personal experience. My 14-year-old daughter has severe rotatory scoliosis, and in 2014 she needed correction surgery. We were blessed to find a new procedure that is motion saving vs. the traditional rods. On 9/9 we traveled to New York City and on 9/10 she underwent Anterior Scoliosis Correction (ASC) surgery. She became one of the early patients with this type of procedure.
The patient was Dx with progressive idiopathic thoraco-lumbar scoliosis, spondylosis with foraminal stenosis and rib cage deformity and severe hypokyphosis and rotation. For the past two years she was treated with postural training, exercise, and the activity suit. She presents with both low and upper back pain. Family would like to avoid posterior spinal fusion. She is a gymnast, and this is a goal of hers. X-rays from 5/2015 show a 57-degree thoracic curve and a 48-degree left lumbar curve. On forward bending she has severe trunk rotation in both thoracic and lumbar spine, measuring 22 degrees on the inclinometer thoracic and 22 degrees in the lumbar region. She is a Risser 1, Sanders early 4. Developmentally, she falls within the adolescent (13+) group. Many scoliosis patient's curves will increase in size during times of rapid growth which occurs during adolescents. Based on Erikson's Stages of Psychosocial Development, she would fall into the Identity vs. Confusion.
Prior to the surgery the patient spent two years completing treatment including postural training and exercise, mechanical traction, and use of an activity suit. Many of the treatments helped in neuromuscular re-education and retaining flexibility of the spine. During in office treatments, patients were provided with movies and area were set up with devices to hold phones and tablets, again giving young patients something to do. The staff was also very engaging with the patients and provided a fun atmosphere. One of the challenges with adolescent patients is in the compliance of the home exercise program, she was required to complete 20 mins of postural training daily.
After the surgery, in the acute care setting the physical therapy goal was to get her up, moving and released to go home. As a parent and now looking back as a SPTA, I was disappointed on how the PT came in and demanded she get up. While we were at a Children's hospital, she did not explain or use the empathy needed for a 14-year-old who just had major surgery. This caused the patient to be defiant and uncooperative, however she did get up to walk. She was asked if she could walk to the nurses' desk, so she marched quickly to the desk leaving the PT behind and matched back, telling the PT she did it and was done. Looking back, I can see how if the PT changed her approach she would have kept better control of the situation.
Pediatric Case #2
Ethan 11 year old hockey player
I was working at our local YMCA as a personal trainer and met Ethan. Ethan was a 11-year-old who was small in stature, but who loved playing hockey. His Mom asked me to work with him on sport specific goals.
Ethan was in the Later School Age (9-12 years) in motor development, he is maturing in his gross movement patterns and is becoming competitive. In Erickson's Stages of Psychosocial Development, he may be in the industry vs. inferiority stage.
Because he has a personal goal of working on his hockey skills, it was easier to engage him in the workout. Many of the skills we worked on were balance, coordination, and strength specific to hockey. I needed to make sure I was treating him as an 11 year old, not too young but not over doing it.