Practitioners Need Rapport with Kids

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By Judith Phillips Otto
The LeapFrog Learning Table (right) is the perfect height to evaluate patients age nine months-two and a half years in double support stance, while children ages three-seven are seen at the larger table and chairs (left). An assortment of
The LeapFrog Learning Table (right) is the perfect height to evaluate patients age nine months-two and a half years in double support stance, while children ages three-seven are seen at the larger table and chairs (left). An assortment of "active distraction tools" line the bookshelf.

"As a business owner/practitioner, I have interviewed many practitioners for employment; most candidates do not have adequate training or experience in pediatric patient care," says Lisa Urso, CPO, Albuquerque Orthotics & Prosthetics, Albuquerque, New Mexico. "I have frequently seen practitioners beeline for the affected leg to be casted without easing into a working relationship with the child. The result is a scared little person who is labeled uncooperative or bratty."

Toys Essential

To establish that initial rapport and make friends with a child, Urso resorts to the toys she refers to as her "Craftsman tools."

"I couldn't practice without them. Kids that are sight-impaired love anything that's musical or has touchable texture. I have talking books' that sing or make noises at appropriate moments in the story, pop-up games that have buttons or levers to manipulate, Magna Doodles", and a furry purple hand puppet named Squak, a bird with a big orange beak."

What else is in her arsenal? Bubble guns, retractable tape measures, bean bag chairs, riding/walking toys--all have a practical purpose that allows Urso to observe and evaluate her young patients.

"Often, I will plump up the bean bag on top of the exam table and let the child sink comfortably into it. The child feels hugged all over as the bean bag conforms to his body, and I can get a nice 90-degree hip/knee relationship to decrease extensor tone in casting for AFOs.

"Riding or walking toys are especially useful," she adds. "They have to be wide-based and have a handle on the back for the child to walk behind, and have something to hold onto while they push it. It's just another way for me to do gait analysis. When they sit on the riders, it helps to increase hip abduction and decrease hip adductor tone. I want as much relaxation of their excessive muscle tone as I can get before casting them!"

Evaluation Play

Urso takes time to get to know each child, getting down to their eye level with a toy. "My job, first and foremost, is to assure them that they are in a safe and even fun environment. When I'm playing,' my mind is going a million miles an hour picking out gait deviations, sit-to-stand balance abnormalities, spastic tendencies, and compensatory movements that they make as I have them alternate which hand they use to reach for something or how much time they spend on the affected limb and what position their entire body is in to compensate for weakness. The list of what I am evaluating during play' is almost endless."

"Being a good pediatric practitioner," Urso observes, "you always have to stay one step ahead of your kids, anticipate their needs, and lovingly guide them in the direction you want them to go. Children appreciate the safety you give them in setting boundaries. As practitioners, it's our job to be in control of the environment where we are working with our pediatric patients. The trick is to never let them know that we are the ones in control!"

More Facility Design Info Coming!

When The EDGE asked about experiences from the field in custom-building or extensively remodeling O&P facilities, the response was overwhelming! So, much more will be coming from The EDGE in the near future on this vital subject.

Says writer Judy Otto, "What really astonished me was the overall enthusiasm almost everyone had. They said what a FUN project it was and how pleased they were with the process and the results. Even with problems some of them had, such as architects who just didn't get it' regarding the needs of an O&P facility, code and other building regulations, and ripping out and doing over, they still said it was a great experience!

So stay tuned--more valuable information will be heading your way to help YOU if and when you build or remodel a facility.

Judith Philipps Otto is a freelance writer who has also assisted with marketing and public relations for various clients within the O&P industry. She lives in Holly Springs, Mississippi.