18 August 2011

The Secret to Therapeutic Success: Pants

It may seem like a small thing to you, but I got to wear pants today . . . at work!  So in my book, that makes for a good day.  Granted, they were the deep kelly green hammer pants that I feel a bit ridiculous wearing, but hey, pants are pants and my rebellious nerve was satisfied.

Okay, so I wasn't intending to talk about my ongoing-rebellious-towards-having-to-wear-skirts-all-the-time attitude, really I wanted to tell you about the super interesting case I'm currently treating . . . well, at lest I find it interesting.

Last week a little girl was admitted with full thickness burns on her right buttocks and posterior thigh and calf.  The corresponding burns on the left side have already healed and the keloid scars are begin to mature.  The tricky part is, the burns happened so long ago that her right knee has already contracted at about 125 degrees of flexion.  It's as if someone threaded a thick rope pulling her hamstrings to her gastroc . . . leaving a gap the width of my thumb in the joint space of her knee.  Not a position conducive to walking.

But it's my job to keep 8 year old little girls moving (although, truth be told, I'd like to get her running . . . far away from the old man in the bed across the ward who her mom said she's going to marry once they are both out of the hospital).

Since her left knee isn't contracted, my first clinical assessment led me to assume that she'd be able to stand.  What I hadn't considered was the same position that resulted in the knee contracture, also resulted in mal-alignment of her pelvis which caused contractures of her hip adductors (the tiny muscles in the groin) and other pelvic stabilizers (my guess is both sides are involved in that one).  So when she goes to stand, her left leg sort of scissors and winds up under her right side.

We tried standing with a kiddo-sized walker bedside in the ward yesterday . . . which was a CATASTROPHE, as all ambulation training on the ward turns into a community affair . . . often ending with the elders pushing me out of the way and my patient being dragged, all in the name of 'walking'.

So today I picked her up in a wheelchair and told her mom we'd be back later.

Alone in my office, my magic HammerPants were free to work their magic.  We sat on the floor for a little bit and I showed her a few times what I wanted her to do, while utilizing my vast Hausa vocabulary: i haka . . . haka . . . hanu . . . hanu . . . balotta . . . kaffa . . . tashi . . . akwai kayau! (Do like this . . . like this . . . hand . . . hand . . . foot . . . my ball . . . foot . . . stand . . . that's great!)

Taking advantage of the Theraball AuntieBarb has loaned us for the summer, H. and I turned and swiveled, placed our hands on the oversized orb, planted a good foot and stood up.

I thought it went well.  She cried.

Eventually we moved from stabilizing with the ball to standing all the up with hands on my new treatment table to hanging on to the walker.  She tried taking a few 'steps' . . . but the scissoring of her left side made 'balance' wishful thinking.  I had to pick her up each time she tried to step, but she was moving her leg through the right motion, so I'm counting it as a win.

The good news is she's agreed to try again tomorrow . . . and so have the HammerPants.


Shal said...

Poor thing! She is a brave little one to push through all that pain. Is it too late for the doctor to do a surgical release on the left? I'm so glad she has you to help her, Deb.

Chip said...

You gotta love Hammer Time...it will be fun to hear of this girl able to DO the Hammer Time. I'll pray for her. It is interesting how the body just takes over and compensates. Crazy stuff!

Deb. said...

We have an Ortho coming next week for a month . . . hoping he can do it . . . problem will be the laxity in the knee and the position of her pelvic bones . . . but I'm hoping she'll be mobile before long.

Deb. said...

Thanks for praying, Chip!