Eat, Run and Play: How to Maximize Your Child s Therapies

Transcription

1 Eat, Run and Play: How to Maximize Your Child s Therapies Presented by Cynthia Bozarth, MS, CCC-SLP Ana Maria Jara, PT, DPT Janet Willoughby, MS, OTR/L Mildred Dones, PT M.S

2 Specific Interventions related to HLHS and Other Single Ventricle Heart Defects EAT: Speech Language Pathology RUN: Physical Therapy PLAY: Occupational Therapy 10/28/2015 2

3 EAT: Speech Language Pathology -Speech language pathology focuses primarily on feeding/swallowing skills throughout continuum of repairs -Feeding and nutrition is a vital component to the healing process following surgical interventions 10/28/2015 3

4 Why is feeding so hard? -Infants and children with medical complications have an increased risk for feeding difficulties or dysphagia (swallowing difficulties) -If it s hard to breathe, it s hard to eat -If the body is using more energy to pump blood throughout the body, the body isn t going to have the energy to eat 10/28/2015 4

5 Complications related to oral feeding -Prolonged respiratory support -Feeding intolerance/reflux -Vocal cord paralysis 10/28/2015 5

6 10/28/2015 6

7 First Stage Surgery-Newborn Before surgery: -If medically stable, provide limited oral feeds to help baby learn to suck and swallow -Monitor respiratory rate, oxygen saturation, and digestion After surgery: -Monitor feeding readiness -Help with oral feeding 10/28/2015 7

8 Second Stage Surgery-Infant After surgery: -Assist with progression to oral feeds and monitor feeding skills -Facilitate early language skills -Assist with transition to spoon feeding 10/28/2015 8

9 Third Stage Surgery- Preschool Following surgery: -Monitor feeding and developmental skills -Refer to appropriate outpatient services 10/28/2015 9

10 RUN: Physical Therapy -Physical therapy assists with the development of gross motor skills and function, strength and endurance, and motor learning. -Pediatric physical therapy helps children gain functional independence and maximize participation in home, school, play and community settings. 10/28/

11 First Stage Surgery-Newborn Prior to surgery: -How to nurture your baby if you can t hold -How much is too much stimulation? -How to calm your baby and provide comforting boundaries during procedures -Positioning and handling to facilitate sleep 10/28/

12 First Stage Surgery- Newborn After surgery (on ventilator support): -Positioning to support respiratory improvement to help weaning off ventilation -Calming to promote sleep, breathing and relaxation -Parents hands on education with their baby to help them and support bonding -Assist with non-pharmacological pain intervention 10/28/

13 First Stage Surgery-Newborn After surgery (off ventilator support) -Positioning progression for early mobility -Calming to promote sleep, breathing and relaxation -Teach localized infant massage techniques -Assist parents with holding to support bonding, when medically able 10/28/

14 Second Stage Surgery- Infant After surgery (on ventilator support): -Teach nurturing and calming techniques for baby with multiple lines -Facilitate appropriate sensory stimulation -Positioning to support respiratory improvement to help weaning off ventilation -Promote sleep and relaxation -Provide non-pharmacological pain intervention 10/28/

15 Second Stage Surgery-Infant After surgery: (off ventilator support) -Positioning to help coughing and clearing of the lungs -Activities to relax and decrease need for sedation -Developmental support and parent education in preparation for discharge -Appropriate referral to outpatient 10/28/

16 Third Stage Surgery- Preschool After surgery: -Positioning to support respiratory improvement and early mobility -Assistance with sitting activities/standing -Initiation of walking after surgery -Parent education along the way and preparation for discharge -Appropriate referral to outpatient 10/28/

17 Play: Occupational Therapy -Occupational Therapy helps children gain independence and promotes development of fine motor skills, sensory motor skills, and visual motor skills that children need to function and socialize in their home, school, play, and community environments. -In the case of an injury or debilitating illness, our services focus on rehabilitating children, allowing them to return to their daily routines at their highest level of function. 10/28/

18 Sensory Integration -Increased sensitivity to sounds -Decreased tolerance for being touched (prefer deep pressure to light touch) -Decreased ability to self-calm (often not allowed to let baby cry, so unable to work on self-soothing) -Decreased tolerance for new sensations (decreased exposure and negative experiences while hospitalized) 10/28/

19 First Stage Surgery-Newborn -Positioning for comfort and development -Monitor and educate family on sensory development -Encourage eye contact, visual tracking and reaching/grasping -Refer to appropriate outpatient services 10/28/

20 Second Stage Surgery-Infant -Positioning for comfort and development -Assess and provide strategies for self-calming -Continue to encourage eye contact, toy manipulation, supported/independent sitting -Refer to appropriate outpatient services 10/28/

21 Third Stage Surgery-Preschool -Positioning for comfort -Assess fine and visual motor skills and attention to task (i.e., crayon grasp, puzzle skills, direction following) -Encourage returning to play and performing self care skills out of bed as soon as able -Refer to appropriate outpatient services 10/28/

22 What to consider as approaching school-age -Fine motor deficits in 48%, gross motor deficits in 39%, and speech deficits in 30% -Children with HLHS fell within the normal range for full scale IQ but scored lower than children with other single ventricle lesions -Patients with HLHS had more problems with visual-motor skills, expressive language and attention -Deficits due to multiple operations requiring bypass and circulatory arrest, decreasing cerebral oxygen delivery 10/28/

23 Eat, Run, Play A Partnership Between Families and Therapists Rehab plays a vital role during the hospital stay Home therapy programs are provided by therapists of each discipline upon discharge Referrals are made to outpatient therapy centers on an individual basis Families follow through with therapies and home programs integral in child s success 10/28/

24 References: Mary T. Donofrio and An N. Massaro, Impact of Congenital Heart Disease on Brain Development and Neurodevelopmental Outcome, International Journal of Pediatrics, vol. 2010, Article ID , 13 pages, doi: /2010/ /28/