Pediatrics from a Continuity-of-Care Perspective
BABY SLEEPING: ISTOCKPHOTO.COM/GREG801
Eddie DeLaCruz, PTA, currently represents the Townsend Rep Group in the western United States and South Texas. But for much of his career, he worked as a physical therapy assistant supporting clients from birth to age 21.
DeLaCruz is not a stay-in-your-lane kind of guy when it comes to creating the best outcomes for a special needs child. Instead, he embraced a continuity of care in which he learned the goals of other members of the healthcare team and incorporated them into his physical therapy routines. In a conversation with Mobility Management, DeLaCruz shared some key ideas.
DeLaCruz is a huge believer in using all resources available. That includes the tendency of children, from a very young age, to imitate behaviors around them.
“Apparently, there’s some software that’s already downloaded into the brain,” DeLaCruz chuckled. “It’s not always a clean slate. Children essentially emulate us. So if we have more opportunities as a team, a family or a nursing unit to continually [demonstrate] positive things, you’ll have this carry over. [Children] want to react, they want to recreate what you’re doing.”
DeLaCruz said it can be helpful to model actions: “Even if they can’t do it, you can show them how to achieve crawling with assistance, how to achieve movement with their tongue for speech or partial words or syllables.”
Of course, to be most effective, DeLaCruz said it’s important to know “different goals of the team members, such as the OT [occupational therapist]. I would ask, ‘What kind of grasp do they have? Oh, they have the raking grasp, and you’re working on the pincer grasp?’”
If the speech team was working on words associated with getting dressed, DeLaCruz would ask for a handful of terms to focus on: shirt, pants, socks. While chatting with the child during therapy, he incorporated those words: “I like your shirt! Are you learning to put on your socks?”
“It goes back to being a living example to the child,” he said. “Where are there opportunities to recreate therapy?”
Meet Child & Family Where They Are
Social intelligence is key to building strong relationships with families so that communication keeps flowing through good times and challenging ones. DeLaCruz spoke of needing to “meet people where they are,” but the first step toward that goal is determining where, in fact, a family is.
For instance, parents dealing with a new diagnosis can resist the idea of seating and wheeled mobility.
“I like to compare [a wheelchair] to a compensatory strategy that I might use: I wear glasses because my sight’s not the best,” he said. “Yes, [the child] can walk 10 feet. But how many times can they do that? Well, usually just one or two times, then they’re wiped out and need a nap. How many times do they need to walk that distance in a realistic setting? Well, maybe five. We could increase their activity level and interaction with the family if the child had the ability to move themselves through space.”
Nervous parents need to know their kids will be safe if they do try out equipment such as a power wheelchair. DeLaCruz has shown videos of other kids using wheelchairs, and he’s borrowed equipment from loaner pools to show to families. He’s also taught parents about safety features, such as kill switches for power chairs, to ease their concerns.
“It’s imperative that we as therapists keep up with the technology that’s going to facilitate this mobility and this community interaction,” he said.
Embrace the Process
Working with kids and their families has taught DeLaCruz to appreciate progress and the many forms it takes.
“People think, ‘I got a gait trainer, they have to be walking,’” he said. “I put kids in a gait trainer just to see what they do. They won’t move the way that books tell us we should move, but you’ll see hopping, you’ll see the strong leg kicking, you’ll see utilization of their reflexes to move their body. Then you see the fatigue, so you have to prepare for that with some support.
“It goes back to quality over quantity. If I can get five to 10 minutes of active standing and what I call pre-gait activities — weight shifting, trunk righting, head righting — that’s success. It’s easy to think ‘I have my goals and have to work on them all session.’ But you just constantly have to look at the building blocks in the hierarchy of development.”
And just as you should meet parents where they are, “You can meet an 8-year-old who doesn’t know how to roll or come to sit, but you can’t say, ‘You should have learned that a long time ago,’” DeLaCruz pointed out. “You have to meet them where they are. Sometimes the family will say, ‘We went to clinic, and we saw a kid doing this and that. How come [our child] is not doing that?’ I say, ‘Well, this is something we have to really work on.’”
In This Together
Ultimately, DeLaCruz also embraces working as a team because of the positive results it can have.
“As a PT assistant, I’m not the one deciding the goals,” he said. “But I’m being collaborative. That’s my favorite component of this whole continuity of care, because we’re better as a team. It doesn’t matter how good a PT or PT assistant is if they’re working in a vacuum and they’re only achieving their goals and haven’t looked at speech, they haven’t looked at ADLs. Many of these things overlap. It’s the continuity of care and finding resolutions to the goals.”
This article originally appeared in the June 2019 issue of Mobility Management.