Rehabilitation Therapists’ Role in a Pediatric Environment

By Leesha Augustine, physical therapist; Hema Desai, speech language pathologist; Erin Keller, speech language pathologist; Adriana Rusch, occupational therapist; and Vicky Vu, occupational therapist at CHOC Children’s

The field of rehabilitation services includes a wide variety of opportunities including hospitals (where therapists can treat patients in any department), schools, and outpatient facilities including specialty facilities in the fields of mental health, sports medicine, wellness programs and rehabilitation/skilled nursing. Rehabilitation treatment can be provided for a variety of reasons throughout someone’s life from infancy through adulthood. The Rehabilitation Services team at CHOC Children’s includes physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs). Each therapy discipline also has licensed therapy assistants.

What training is required to work in pediatric rehabilitation services?

The therapist track for each discipline requires graduate school in order to be licensed by their respective national boards. The Doctor of Physical Therapy (DPT) Program is a three-year post baccalaureate program. The traditional OT program is a two-year master’s degree, with the option to further specialized training with a two-year clinical doctorate (OTD). SLP programs are also a two-year master’s degree, along with completion of a nine-month clinical fellowship following graduation. The assistant track for each discipline require a two-year associate degree including a hands-on practicum and licensing exam.

What does a physical therapist do?

They have the opportunity to work with patients and their families to help them restore function to allow them to return to school, sports, playing with friends, work and family events.

After surgery, physical therapy played a big role in Sydney’s life. Her PT, Robin, is a two-time Olympic medalist and helped Sydney, a fellow athlete, connect with her treatment.

What does an occupational therapist do?

Occupational therapists help others participate in daily activities as independently and safely as possible. They also help children with sensory difficulties, fine motor skill delays, oral motor and feeding skill delays, and dressing difficulties.

Occupational therapists help others participate in daily activities as independently and safely as possible.

What does a speech language pathologist do?

The role of a SLP is to prevent, assess, diagnose and treat speech, language, social communication, cognitive-communication and feeding/swallowing disorders so that individuals can interact with others to the best of their ability.

Nicole, a speech therapist at CHOC, works with patients with feeding and swallowing disorders, speech delays, brain injuries, and vocal cord dysfunction.

Where would you find rehabilitation services in a hospital setting?

The depth and scope of Rehabilitation Services at CHOC Children’s Hospital is vast, with members of the department working within most service areas of the hospital, including: four specialized intensive care units, the hematology/oncology unit, the medical/surgical unit, and the Neuroscience Institute.

Members of the rehabilitation team provide developmental support for many infants in the neonatal intensive care unit (NICU). You may find a SLP or an OT coaching a parent on how to feed their baby for the first time, an OT making custom hand splints to help facilitate improved hand function, or a PT may provide specialized wound care  or assist a patient out of bed for the first time. The rehabilitation team will work with children and families in the pediatric intensive care unit (PICU) so that a parent can feel safe holding their child after a long-term intubation, a patient with a brain injury can say, “I love you” to his family, and play with his favorite toys.

Children with prolonged hospitalizations due to cancer treatment may receive rehabilitation therapy to encourage developmental skills as well as to recover from the effects of their illness and treatment. While they are admitted to the hospital, we work closely with them to help them regain function in a variety of areas: gross motor skills, fine motor skills, daily activities such as dressing themselves and taking steps, feeding and swallowing, eating and drinking safely, and being able to communicate with their friends and family.

As much as rehabilitation professionals love working with children and their families while they’re in the hospital, the primary goal of this team is to facilitate a safe discharge home and to enable our patients and families to participate in the activities that are most important to them.

Our Orange campus also has a multidisciplinary outpatient rehabilitation department including PT, OT, ST, hand specialist, feeding and wound care therapists. Here, our PTs, OTs and SLPs keep working with our patients after they are discharged from the hospital, as well as patients that are referred for pediatric specialty care from their pediatrician. You will also find PTs, OTs and SLPs working in our ambulatory care clinics, and serving as clinical instructors in their graduate and assistant programs.

No matter the setting for rehabilitation services, treatment goals always have the same common theme― helping kids enjoy doing the things they like best like riding a bike, drawing, or even being able to eat a cupcake!

Learn more about rehabilitation services at CHOC

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The Importance of Early Sensory Experiences in Development

By Erin Karavedas, occupational therapist at CHOC Children’s

As a baby crawls around a room touching objects, playing with toys, listening to their mother or father sing songs, or putting things in their mouth, they are doing much more than simply playing. They are using their senses to learn about and explore their environment. Parents can enhance this learning by providing positive sensory experiences.

Sensory play or experiences are activities that allow your baby to interact with their surroundings and learn about their world. Through this type of exploration and play their brains grow and mature as connections are made in the brain.

When a child is born, their brain is ready to absorb information about their environment. They’re already learning long before they are walking and talking. This learning takes place through touch, hearing, sight, taste, smell and movement. They hear our voices, chew on toys, love bouncing and touch anything they can.

The more positive sensory experiences a baby has, the stronger these connections become.  By providing your child with a wide range of experiences that involve their senses, they develop strong brain pathways. Sensory play not only positively impacts your baby now, but the connections that are made help to support learning and development even into adulthood. A baby who is not given the same diverse set of opportunities and is kept in a swing all day or is kept in a very dark quiet environment can have their learning and brain development stunted by lack of exposure to sensory stimuli.

Parents can have a direct impact on the development of their baby’s brain through providing a variety of positive sensory experiences such as:

  • 0-3 months: Singing, bouncing, talking, swinging, bath time, massage, hanging a colorful mobile for the baby to look at, placing rattles in baby’s hand for exploration
  • 3-6 months: At this point you can add tummy time, play with food (purees), reading, encourage baby to touch fabrics with different textures, and shaking rattles
  • 6-9 months: Now you can start to blow bubbles, play in different positions on the floor, play with cause and effect toys and games such as play peek-a-boo
  • 9-12 months: Now is the time to add water play, crawl/walk/play on grass or sand, play on swings and slides, tasting and exploring a variety of foods, finger painting, play-dough

It is important to note that children can become over-stimulated or overwhelmed when given too much sensory input. A child might enjoy some sensory play and become very uncomfortable with another type of sensory play. If your child is having a hard time tolerating an activity, don’t avoid it altogether. The best option is to take a break and then try to gradually expose your child to that specific input. For example, some children have a hard time with messy play (this can be playing with food, finger painting, shaving cream, wet sand, etc.). Instead of forcing them to engage in messy play you can start in the bath tub, with just a small amount of shaving cream where they have the ability to wash it off; or you can just put 1 drop of paint on the paper and encourage them to touch it as opposed to pouring it all over the paper and placing their entire hand in it. Your child’s behavior will let you know how comfortable they are with an activity.

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Occupational Therapy Celebrates 100 Years

By Lauren Francis, occupational therapist at CHOC Children’s

Occupational therapy is turning 100! The specialty’s roots formed in 1917 as “reconstruction aides” who helped rehabilitate wounded soldiers returning from battle in World War I. Today, occupational therapists apply a holistic approach to help children and adults engage in meaningful activities.

Occupational therapists are experts in addressing any and all areas that “occupy” one’s time. For infants and children, occupational therapy (OT) includes play, learning to move and explore, feeding and eating, and bonding with parents and caregivers. For children and teenagers, this can include gaining independence with self-care, being successful in school, and playing with friends. Pediatric OT sessions often look like play to the untrained eye – most children really enjoy therapy!

CHOC’s occupational therapists (OTs) are highly skilled and trained to help children of all ages who have unique needs. Some key components of OT are:

Feeding Specialists

For a variety of reasons, children may have trouble getting the nutrition they require to grow and develop. CHOC’s occupational therapists help treat a wide range of feeding issues, including babies who have trouble with breast and bottle-feeding, children who have oral motor or sensory difficulties and cannot manage textures of food, and teenagers who may have had an injury or procedure that affected their ability to eat. OTs at CHOC are also highly skilled in specialty therapies such as feeding tube weaning and swallowing therapy.

Sensory & Developmental Specialists

CHOC’s occupational therapists have advanced expertise and techniques to offer children and families with an assortment of developmental challenges as well. From supporting a child to stay strong and active through chemotherapy to helping a child recover from a neurological disorder or brain injury, occupational therapy can be a crucial part of a multidisciplinary care team. Children who have difficulty with sensory processing, learning delays, challenges with self-care, visual motor or visual perceptual deficits, difficulty coordinating their arms and hands, or who aren’t meeting developmental milestones, can all be excellent candidates for occupational therapy intervention.

Parent/Caregiver Collaboration

Perhaps one of the greatest roles occupational therapists play is working with the parents and families of the children we serve. Parent education and involvement in therapy is an essential component to ensuring a child meets his or her goals. Through CHOC’s commitment to patient- and family-centered care, our OTs closely partner with parents to create individualized treatment plans, offer customized home programs unique to each child’s needs, and engage them in all aspects of care.

Preventative Care

CHOC OTs work tirelessly as part of an advanced team to screen children who may be at risk for developmental delays. They apply years of clinical experience and expertise along with standardized testing to assess a child’s movement, mobility, hand use, interaction with the environment, and feeding skills. For children who require a long hospital stay, OTs help provide developmentally appropriate stimulation to help each child continue to grow and develop during their hospital stay.

If you think your child would benefit from occupational therapy, speak to your child’s primary care doctor.

Learn more about rehabilitation services at CHOC.

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April is Occupational Therapy Month

The occupational therapy program at CHOC helps children develop or improve important skills for daily life. In honor of National Occupational Therapy Month, we spoke to Chelsey Kaufman, an occupational therapist at CHOC Children’s. Kaufman works with acute hospitalized patients on building or re-building fine and gross motor skills and developmental milestones, as well as feeding and swallowing disorders.

Q: Why did you want to become an occupational therapist?

A: I always knew that I wanted to work with kids in the medical field, but I wasn’t sure in what capacity. I first discovered occupational therapy when I was in high school. I used to babysit a child with a medical condition, and I would accompany him to occupational therapy. I found it so amazing to watch a young child regain the strength and independence needed to do all the activities that just getting to be a kid encompasses. It was so special to observe his parents watch him have experiences that are innate and natural for most children. In watching and observing sessions, I realized occupational therapy was what I wanted to do with the rest of my life. Now, as an occupational therapist, I get to help children rebuild foundational skills they need for functional tasks, and help them maximize their independence during these activities.

Q: What part of being an occupational therapist are you most passionate about?

A: I am most passionate about the families and children I am lucky enough to work with. Working in acute care, I meet families and children at what may be one of the most stressful and vulnerable times in their lives. To be let into that time and to help give a child the tools to grow and develop and regain independence with daily activities, or to help a baby learn to feed and swallow safely is a privilege. I feel so lucky and fortunate to get to do that every day.

Q: What advice would you offer someone considering pursuing a career in occupational therapy?

A: I think it is such a special, unique and rewarding profession no matter what area you practice in. Because there are so many different areas and settings, it is important to research all the different opportunities as well as volunteer or get an internship in specific areas of interest.

Q: What attracted you to CHOC?

A: I had always wanted to work in a pediatric hospital setting. I was specifically attracted to CHOC because of the multi-disciplinary inpatient feeding program as well as the incredible opportunities to enhance and expand my career.

Q: What else should people know about occupational therapy?

A: A lot of people are unfamiliar with occupational therapy. I think one of the most important things to know is that there is so much diversity and variety within the profession in terms of populations, settings, and specialties. The profession is also expanding rapidly due to the large amount of growing research and evidenced-based practice. There are so many opportunities for professional growth and the ability to expand knowledge.

Occupational therapy may be recommended if a child has delayed developmental skills, abnormal muscle tone, limited movement, swallowing or feeding issues, or is not able to do age-appropriate self-care activities. Learn more about CHOC’s occupational therapy program.