“Gait” Keepers
Physical Therapists Help Children Stand Tall

Destinee Richardson’s eyes light up as she walks into a brightly colored room full of toys at Shriners Hospital for Children in the Texas Medical Center. Wasting no time, she sticks a yellow circle onto a window. The 14-month-old then bends her knees, reaches for a red heart and does the same as she laughs with her physical therapist, Janet Dawson.

Despite what looks like fun and games, Destinee’s standing and redirecting are helping her accomplish weight shifting. Born with arthrogryposis, a condition that causes multiple joint contractures, Destinee has worked with Dawson since the age of 3-weeks. At birth, Destinee’s legs were bent so severely that her feet were over her shoulders and her knees only bent to 40 degrees.

Douglas Barnes, M.D., an expert in arthrogryposis and assistant chief of staff at Shriners Hospital, worked with Dawson to organize a physical therapy plan aimed at helping Destinee reach her full potential. Dawson taped and splinted the infant’s legs, and regularly stretched her muscles. The therapy paid off quickly – Destinee’s legs were in a better position after a month of therapy. Today, she is standing straight with braces and beginning to walk.

Fun and Games

Because convincing a child to perform awkward and painful exercises is easier said than done, physical therapists at Shriners Hospital have a few tricks up their sleeves. They rock sleeping infants in a chair as they carefully move the babies’ legs, working on range of motion. From Barney to bubble-making machines, the physical therapy department is loaded with toys and activities for active toddlers and older children.

“Physical therapy for children involves a lot of playing and challenges therapists to keep the child’s attention,” said Dawson. “The key is having age-appropriate activities that help the child focus on play, rather than the repetitive motions they must perform before seeing results.”

Empowering Patients

Cute toys won’t work for 18-year-old Jesus Escamilla, who knows he will experience pain during his visits to the physical therapy department. Jesus was born with proximal femoral focal deficiency and fibular hemimelia, causing his right leg to be shorter than the left. Surgeons fitted Jesus in an Ilizarov device to help lengthen the leg and Jesus must come to physical therapy every day to maintain motion in his knee.

“Dobla,” physical therapist Rebecca Case says in Spanish, instructing Jesus to bend his knee. The teenager breathes heavily and begins to perspire while trying to bend his knee to a 75-degree angle. Jesus looks up and notices the new, red highlights in Case’s hair, and the two chuckle as he gives her new hair a thumbs-up.

Therapists at Shriners Hospital say older patients respond better when given options, empowering them to determine how their physical therapy session will transpire. Jesus can bend his knee with or without a hotpack, in the hospital swimming pool, or on a table – the choice is his.

“We have a goal we must accomplish every day, but Jesus decides how fast we get there,” said Case. “Physical therapy is very painful for him, but we pass the time talking about sports, movies or helping me brush up on my Spanish.”

The therapists reward everyone’s hard work with a party each Friday. The group rounds up the patients and treats them to ice cream sundaes, Mexican food, or whatever everyone is in the mood for. The relaxed gathering strengthens the relationship between the therapists and patients, in addition to giving the children an opportunity to socialize with others struggling with similar health issues.

A Family Affair

In addition to encouraging children to complete their physical therapy regimens, the physical therapists at Shriners work heavily with patient families. Therapists say parents must completely support the physical therapy plan to achieve a successful outcome.

Felicia Peters came to Shriners Hospital seeking treatment for her son, Isaiah, who was diagnosed with cerebral palsy. The 4-year-old’s legs were turned in, and he walked on his toes, with bent knees and hips. Dawson helped Isaiah work on his range of motion and his ability to stand on one foot and climb stairs. Another challenge for Dawson was to ease Felicia’s anxiety about Isaiah’s medical condition and the potential of undergoing a complicated surgery.

“I was terrified when they suggested a surgery that required 10 to 12 incisions ... I kept thinking about how hard it would be for a 5-year-old to take,” said Felicia. “But the physical therapy team felt Isaiah was ready and that it was the best option. I probably would not have chosen the surgery if she had not recommended it.”

Barnes, a recognized expert in cerebral palsy, performed 10 procedures on Isaiah during the same operative session. They physical therapy team worked closely with Isaiah after his surgery, strengthening the bond between Shriners and the Peters family. Isaiah is now 10 and has been recognized for his performance in gymnastics and karate. Felicia says, the self-confidence Isaiah gained during his physical therapy sessions allows him to try new activities, despite some of his physical challenges.

Making the Connection

A special connection blossoms while physical therapists at Shriners Hospital help patients work through their pain and witness their progress every step of the way. The relationship that begins as physical therapist and patient transitions into friendship and family along the way.

“The children work so hard despite tremendous pain and we do everything we can to make things more manageable,” said Dawson. “We really get to know them and their families during the time we spend together.”

Therapists at Shriners Hospital are rewarded every time they help improve a child’s ability to walk and get around, but the emotion is mixed when patients complete their treatments. They no longer come on a regular basis, yet keep in touch through letters, photographs and visits. Many children who graduate from the physical therapy department return to encourage new patients, bringing their journey full-circle.

Shriners Hospitals for Children-Houston provides specialized care to children with orthopedic conditions that affect the bones, joints and muscles. Located in the Texas Medical Center, Shriners Hospital does not charge patients for its services. Many of Houston’s finest doctors with premier private practices and university affiliations volunteer their services to help young patients at Shriners Hospital. The care provided at all Shriners Hospitals is the same level of care provided by doctors in private practice – the only difference is, it’s free.

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©2006 Texas Medical Center

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