Pediatric Physical Therapy

If I Knew Then…

Really smart kids can be so annoying. Mainly because they can be so – correct.
One of my favorite high school freshmen is due to have his wheelchair adjusted for growth because like so many adolescents out there, he went and grew. After our twelfth friendly chat about his posture this school year, I suggested we speak with the seating people about some additional chest support. Then, as long as we were talking to them, maybe we should inquire regarding hip guides, because as he was leaning into his left lateral trunk support, he had a tendency for his seat to slide to the right. The crazy kid had the audacity to start questioning me. “If I need these things, why didn’t we get them in the first place when the chair was new?”

Pediatric Physical Therapy -Standing FramesI started out by talking around in circles about some of the malalignment being related to his recent growth spurt and blaming those troublesome advanced placement classes for making him too fatigued to sit up straight. But, being an honest person, I had to tell him the honest truth. “I know that’s what you need now, and I didn’t know that before. I’m always learning, just like you are.”

At the same school there is another young man with a diagnosis of Spina Bifida. He uses a manual wheelchair for mobility, and until recently had no sensation or voluntary movement below his level of impairment. In September he started telling me about some aching in his thighs. In early October, he could tell where his leg was being touched. In late October, he had some control over the movements in his hips and ankles. There are traces of muscle activity around his knees, but unfortunately the joints are so severely contracted he is unable to move them. His medical team is not sure why he has experienced this change in his sensation and neuromotor control, and we cannot know whether it is realistic to expect increased strength. However, we could make a lot more of the strength he has if we had functional range of motion to go with it.

Experience is the best teacher. Unfortunately, experience is one of those things that take time to accumulate. Apologies to the patients I worked with very early in my career that I didn’t look at with the most discerning eye. Of course, when I have missed the boat on an intervention, I am not sure if it is comforting or disturbing to realize that a number of others did not catch it either.

Parents, teachers, durable medical equipment providers, therapists, doctors, nurses, orthotists, personal care attendants, family members – keep learning. Keep asking questions of each other. Push each other to make sure that everyone is looking at the big picture and the best possible outcome for each individual.

Do you have a similar story to share? An example of how you continue to educate yourself to provide the best outcomes your clients?

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