Introduction and Overview
I currently work in an outpatient setting as part of a neuro rehabilitation team. We take children who have suffered a traumatic event directly from inpatient rehab. We are able to see them at a higher frequency, and with more coordinated care than a typical outpatient setting. Prior to working here, I spent nine years working with pediatric burns in ICU, acute care, and inpatient rehabilitation settings.
Throughout my career, I have been fortunate to be able to watch kids evolve over time. I have seen them on the day of admission, just hours after their injury occurred. I have worked with them in all stages of their healing process, beginning with survival in the ICU, and transitioning to acute care; then returning to function in inpatient rehab, and finally going home and participating in outpatient rehab. Even though it's the same child and the same family, OT intervention evolves over time.
For the purposes of today’s session, I will cover some common conditions which result from pediatric trauma, and discuss how the focus of care changes over the full course of care. Although none of us work in all these areas of care at one time, I think it's tremendously helpful at any point in treatment to know where a child has been, and where they are going. We will not go into detail today on specific treatments (e.g., constraints, Kinesio taping, e-stim, etc.). Those things are the “frosting.” Today, we will discuss “baking the cake.” Baking a solid cake from the basic ingredients -- first things first.
Post-Trauma Continuum of Care
The role of the pediatric occupational therapist is to facilitate participation in age appropriate occupations. This holds true when working with children with complex medical conditions from traumatic events, including any incident which causes significant injury. However, when a child experiences significant trauma, the family must adjust and cope with differences in their loved one, post incident. Changes may range from minor deficits to significant changes in personality, appearance, and/or abilities. Regardless of the nature of the trauma, or its resulting medical conditions, the therapist must be prepared for heightened emotions and rapidly changing needs of the child and caregiver, post trauma.
With this population, the therapist facilitates the child's rehabilitation toward previous function across the continuum of care. This may include the intensive care unit (ICU), acute care, inpatient rehabilitation, and outpatient rehabilitation within the community. The role of the OT may change frequently, according to the child's medical and psychosocial status. The therapist's approach is determined by the child's injuries, his or her developmental stage, and the family's educational needs and priorities.
Post-Trauma Occupational Therapy Interventions
Provision of care for children post-trauma is complex and dynamic, with each child and caregiver presenting of a multitude of therapy needs. To ensure holistic care and support progress, the occupational therapist intensively utilizes different, but intimately intertwined, intervention types. The therapist uses preparatory methods to remediate client factors, including the injured body structures and impaired body functions. He or she uses purposeful and occupation-based activities to rehabilitate the child's participation in meaningful occupation. Both caregivers and children require educational intervention, including supports and problem solving.
It's also important to remember how our interventions come into play in several overlapping areas. We use therapeutic use of self in working with caregivers, providing grief support and education, as well as working with other professionals on the team. Education must also occur with respect to every part of this multi-disciplinary team, and with respect to the stage of grief that the parent or child is in. Grieving waxes and wanes with the impact from interaction with the team, and based on how much information is being provided.
