The Monday Memo
May 28, 2018 PITT DPT STUDENTS
A Sample of Pediatrics
I am currently in the pediatric setting for the first time for my first 6-month clinical rotation. Over the past month, each day has been vastly different. Not only are the patients and their diagnoses different from session to session, but the patients’ behaviors vary each session, and sometimes even within session, as one can imagine with ages 0-18. I certainly have not been bored!
I believe physical therapists are naturally adaptable humans; we have to be in this health care environment, no matter the setting. As I’ve observed so far in the last month is that in pediatrics, especially, adaptability is vital. You have to be on your toes, and I mean the very tips of your toes, at all times. It certainly has made every day exciting and has allowed me to quickly develop my skills in a new setting.
With a new setting and experience, comes new diagnoses. One in particular that we learned about in the classroom is Reflex Neurovascular Dystrophy, or RND. In short, it is a condition that leads to pain in the musculoskeletal system in children, females typically affected more often than males. In this short month I have seen a large number of children that are being treated for this condition. Each presents differently, with varying locations of pain and wide ranges of pain. Despite medical tests showing normal results, the pain that these children are experiencing is absolutely real, and cannot be helped with pain medication. The pain can be so intense that these patients are limited from their previous activities such as sport, ADLs and even school.
Physical therapy and aerobic exercise is effective, but to treat RND, a psychological approach in combination with PT needs to be taken. While they are referred to psychology, everyone on the medical team needs to be on the same page and take the biopsychosocial approach to treatment. Pain is not discussed during PT except for initial evaluation and recurring reevaluations. These patients are educated on pain management and stress reduction strategies to “power through the pain”. As a PT, it is important to establish a comprehensive program of aerobic and general strengthening and conditioning exercises, but perhaps most importantly, to educate the patient and family to tackle this condition together. It is more common that one may expect, and is something that can recur throughout the lifetime. Even if you are not working in pediatrics, being aware of this diagnosis is helpful, because inevitably, the child is going to grow up to be the adult we see in all settings. It is vital to establish a program and psychologically informed PT strategies so that this chronic pain can be dealt with throughout the lifetime and won’t hinder the patient from living a full, active life.
So far the experience has been unique and I’m excited to continue to learn so much more.