RT300 Aids Rehabilitation in Cerebral Palsy
Neurological Rehabilitation
KAITLIN CLARK, PT, DPT
Tell us a little about your background and how you came to work in the Phoenix Children's Hospital?
I graduated in with my doctorate in physical therapy from A T Still University in 2011 and joined the Phoenix Children's Hospital outpatient rehabilitation department part time until July of 2011. At this time I moved for a job opportunity to St. Paul Minnesota working at an inpatient rehab facility where I saw adults with stroke, amputation and general deconditions. After my contract completed that year I found myself missing Phoenix and returned to PCH as a full time therapist in the outpatient rehab department. Currently in addition to daily patients I am a clinician for specialized clinics including NICU, Cerebral Palsy, Muscular Dystrophy and am participating in the development of Neuro Rehab Program and Concussion Clinics within the outpatient department.
Tell us about the work of the Phoenix Children's Hospital
With a Medical Staff of nearly 1,000 pediatric specialists, Phoenix Children’s provides inpatient, outpatient, trauma and emergency care across more than 70 pediatric subspecialties, the most comprehensive pediatric care available in the state. The Hospital’s six Centers of Excellence have grown in size and expertise to place them on par with some of the most prestigious of their kind in the US.
Where do you work within the Phoenix Children’s ?
I work within the Frances H. McClelland Rehabilitation Program at Phoenix Children’s in our new center which opened in January 2014 bringing together the comprehensive, multidisciplinary care that helps children achieve their optimal level of independence. With this new center we have the dedicated space and technology improvements to match the expertise of our staff. The new center has includes innovative technology including the Restorative Therapies RT300 and RT600 integrated therapy systems.
What range of neurological disorders are you able to assist in the rehabilitation center?
We see children with a wide variety of diagnoses ranging from orthopedic injury to neurological presentation and addressing developmental delays.
You recently used RT300 with a CP patient, tell us about that, and how the patient responded?
This patient presented following surgical intervention to both legs for de-rotation of the femurs and indirect lengthening of attached musculature. Initially he presented with contractures, muscular limitations for movement, of greater than 40 degrees of flexion, bending, at both knees and greater than 20 degrees at the hips. Prior to surgery the patient had participated in standing frame and ambulation activities in a gait trainer. As a result of surgery the patient was no longer able to participate in good positioning in prone, on stomach, to prevent further contractures that would limit his ability to sit in wheelchair for prolonged periods.
The rehabilitation included a combination of manual stretches, therapeutic activities for facilitated weight bearing while supported by a harness and sessions on RT300 in an attempt to produce increased available range of motion and assess patient ability to create a power output. The patient initially was unable to tolerate participation in RT300 due to setting parameters for increased amplitude of electrical stimulation and significant tissue restriction at bilateral lower extremities. A representative was contacted from Restorative Therapiesy and settings were reviewed verbally with clinician to adjust for increased tolerance. Under the new parameters that patient increased his level of tolerance without increase in the level of power output, which was minimal initially and continued at this level. The patient completed 20 sessions while spending additional remained of treatment session increasing range of motion with manual stretching program, and support standing in harness with rhythmic rotation to reduce spasticity.
At the completion of the rehabilitation the patient was able to achieve hip extension to neutral zero degrees following manual stretching and prolonged positioning on his stomach. Additionally the patient presented with increased available motion at both knees to less than 15 degrees of flexion contracture. This increased range of motion was sufficient to enable the patient to resume use his gait trainer and to lie in a prone position.