Transcription:
Pediatric Rehabilitation at Good Shepherd

Caitlin Whyte: Good Shepherd Pediatrics is the only provider in the region offering inpatient rehabilitation with specialized programs to treat children with complex medical and congenital cases. So joining us to talk more about both our inpatient and outpatient pediatric rehabilitation is Dr. Kimberly Kuchinski, the Medical Director of the Pediatric Physical Medicine and Rehabilitation Program at Good Shepherd.

This is Transforming Lives and Inspiring Hope, a Good Shepherd Rehabilitation Network podcast. I'm your host, Caitlin Whyte. So Dr. Kuchinski, start us off with a little bit about you today. What interested you in working with the pediatric population?

Kimberly Kuchinski, MD, MPH: So pediatrics, I've always loved. And I knew from an early age that I wanted to be in medicine. I think kids, they're just always enthusiastic and no matter what, you know, they're facing, they look at it kind of in a bright light, so I always really enjoyed that. And I found physical medicine and rehabilitation actually in medical school with some great doctors there that were pediatric physical medicine and rehab doctors, which kind of combined all my areas of interest. And so really from there, I volunteered as much time as I could with those doctors and then worked to pursue that as I went through medical school.

Caitlin Whyte: So, what would you say differentiates Good Shepherd for pediatric rehabilitation in particular?

Kimberly Kuchinski, MD, MPH: I think Good Shepherd has great pediatric rehabilitation department. And what differentiates us is some of our technology and what we're able to offer the patients, both inpatient and outpatient. I also think that our amazing clinical staff and therapists, nurses, respiratory staff are all not only top-notch in their fields, but super enthusiastic to learn new things, research new things, try new protocols. And I think that makes the experience for the families and the outcomes outstanding.

Caitlin Whyte: So doctor, what types of conditions or injuries do you and the Good Shepherd Pediatrics team see in a child needing outpatient rehabilitation versus inpatient rehabilitation. Tell us about the differences.

Kimberly Kuchinski, MD, MPH: So I see a lot of patients in the acute care. I do consults at local hospitals and, in that setting, I see some of the pretty sick babies that have been in the neonatal intensive care unit, the kids who have suffered a traumatic brain injury, spinal cord injuries, some of those acute more severe issues. And whether it's from the hospitals that are nearby that I consult at or from hospitals further away, some of those more acute traumatic injuries tend to be what comes to inpatient first.

In the outpatient setting, those same kids who've graduated from an inpatient rehab still need outpatient. But then in outpatient, we have our kids with cerebral palsy, kids who maybe had birth injuries and are still, you know, a couple of years older, but are still working to fine tune those things. Concussions typically don't need inpatient and we see them much more often in outpatient. So I think that's where some of the differences are.

Caitlin Whyte: I'd love to also get into some of the technologies that are used in rehabilitation, specifically the Trexo. So, what is the technology behind that? Who does it help? And how does it work?

Kimberly Kuchinski, MD, MPH: So the Trexo is an exoskeleton, like a robotic exoskeleton that's fit on a typical gait trainer frame that the kids would use. The benefit and the cool features of it is that the robotic piece actually has joints at the hips, the knees, the feet, and the ankles to walk the child through the proper gait cycle, to work with gait training and to kind of relearn to walk or to learn to walk a first time.

Part of the benefit is that neuroplasticity that we talk about in terms of training the brain on what the proper mechanics of walking are. Prior to technology like the Trexo, we would do gait training where one therapist would be on each leg for the patient and making sure it goes through the proper movements versus now, the robot is doing that, so the therapist can focus on the quality of the movements.

The neat thing with the Trexo too is as opposed to some similar adult technology, the Trexo, we can walk the patient through what their range is. So if they have tight areas in a certain muscle, the Trexo will not overwalk or overstretch or anything like that. It's really neat too, because it tells us like what percent the child is helping during the gait process. So we can monitor that like they were 18% this week and they're 50% next week, so that really helps as well.

So the age ranges for the Trexo, normally we can get down as early as about one year or so, where a child would be expected to be standing and starting to walk. And there's three sizes, small, medium, and large, which can take us through teenage years, depending on how tall the child is. So some of the kids might be a little too tall and might wind up needing some of the adult's technology at that point, but we could do most kids from one to mid-teenagers with the Trexo, and those three sizes are available in our inpatient unit and we have all three sizes in our outpatient center.

Caitlin Whyte: Let's also talk about Good Shepherd's Bridge To Home Program. Tell us about the goal of that program and what type of patient would best benefit from it.

Kimberly Kuchinski, MD, MPH: So the Bridge To Home program, really the concept there is that there's some very medically complex kids that really need themselves from a medical point of view and the family from a training and a comfort perspective, that nice helpful bridge to home. A lot of the kids would be like our neonatal intensive care unit children that have a lot of technology and a lot of needs that those families did not plan on, they can come here and learn about the tracheostomies and the ventilators and the G-tubes, and also spend lots of time with the therapist, getting comfortable with handling their baby and handling all the equipment and then getting them set up for that nice kind of bridge to homes for a successful discharge.

Some of the other kids are some maybe more complicated kiddos that have gone home, but then back to the hospital and wasn't really successful. Again, they tend to be the more kind of complicated kiddos and the real benefit here is they get therapy every day that really does help them with their overall strength and endurance. But there's also tons of training that goes on to help those families so it is as successful as a discharge as possible.

Caitlin Whyte: Well, it sounds like there's just a ton of great programs at Good Shepherd. Wrapping up here, can you tell us about the Inpatient Jump Start Program and what makes that so specialized?

Kimberly Kuchinski, MD, MPH: Oh, sure. So that's a program that we're really proud of and we've been utilizing for quite a while. It's for the kiddos that whether they have chromosome anomaly, cerebral palsy, they had a brain injury in the past and they're home and they're doing outpatient therapies, but maybe they just are not getting that next milestone or they've done a lot of outpatient therapy and maybe are actually like backsliding a little bit for some reason or even their feeding skills, they can't get past purees, things like that. We do a full team evaluation with myself, physical, occupational and speech therapy, and talk to the families about what their goals are, see how realistic we think some of those things are and bring them in as an inpatient for a jumpstart program where they get at least three hours a day, usually more of physical occupational and speech therapy. We have rec therapy. We work with assistive technology and different types of devices. A lot of these kids use that Trexo technology. And the concept is just to figure out what goals the family has. Some of them is mobility, some people really want to work on the upright and the walking. Some of them is eating and trying to get off of a G-tube and really focusing on those families' goals and bringing them in from home to try and achieve that in a really intense therapy environment.

Caitlin Whyte: Great. Well, doctor, anything else we didn't touch on that you want people to know about the pediatric rehabilitation options at Good Shepherd?

Kimberly Kuchinski, MD, MPH: Just that we're here to help any kids reach their best functional outcome, whether it's in the inpatient or the outpatient. And we do absolutely have contacts with liaisons who if families just aren't sure if there's something we could do for them, we're always happy to make that contact and talk to them and see how we could help them or how we could best advise them.

The age range for our inpatient unit is basically from birth. We absolutely take some kids from the NICU who have either feeding issues or strokes or breathing issues, all the way up through typically 18, but we are licensed and can go up to 21, sometimes for those older teenagers or young twenties who have some different developmental delays or, every once in a while, it's family preference that a teenager would prefer to be on a pediatric unit rather than an adult unit and we're happy to help with that.

Caitlin Whyte: Well, thank you, doctor, for joining us and sharing all the brilliant work you do here at Good Shepherd. To learn more, call 1-888-44-REHAB or visit goodshepherdrehab.org.

This is Transforming Lives and Inspiring Hope, a Good Shepherd Rehabilitation Network podcast. I'm Caitlin Whyte.

Kimberly Kuchinski, MD, MPH: Stay well.