Intro: This is Weekly Dose of Wellness, brought to you by Memorial Care Health System. Here's Deborah Howell.

Deborah Howell (Host): All children need medical care, and a good share of them need specialty medical care. Today, our panel of occupational therapists will talk to us about pediatric hand therapy and its benefits.

Janessa Lowe is an occupational therapist and certified hand therapist with experience in both pediatric and adult hand therapy. She's also an adjunct professor at Stanford University for the Masters of Occupational Therapy program. Cynthia Hinshaw is an occupational therapist with advanced hands specialty and 21 years of experience including upper extremity robotics.

Together, they have built the Pediatric Hand Therapy Program at Miller Children's and Women's Hospital Charisse Marie Lawler Children's Village for patients ranging from 0 to 21 years of age. Janessa and Cynthia have specialties in fabrication of custom orthotics made at the Children's Village and pediatric specific hand interventions.

Welcome, Janessa and Cynthia!

Cynthia Hinshaw, OTR/L, HTC, PAMS: Hello, thank you.

Host: Let's jump right in, Jennessa, with you. What is pediatric hand therapy?

Jennessa Low, OTR/L, CHT, CPAMS: All right. So, pediatric hand therapy, we are a specialized area in rehabilitation. We focus on treating children with hand and upper extremity conditions. Cynthia and I understand the complex anatomy and biomechanics of the upper extremity, which of course takes in account growth plates and growing bones, fine motor coordination, and milestones as well. Our goal is to help children from 0 to 21 years of age to achieve their maximum potential for hand functioning in daily activities, to promote independence, and also improve quality of life. Here, our program at Miller Children's is newer. Dr. Acosta, being our hand surgeon, has been here at MCH for about six years now, and requested to have specialized hand therapists to help build her program. Cynthia spearheaded the program back in 2019. And soon after, I jumped on board to collaborate and continue to grow the program.

Host: Wonderful. And what are some of the common issues hand therapists treat?

Cynthia Hinshaw, OTR/L, HTC, PAMS: We treat a bunch of actual issues. Some of our issues are congenital hand injuries and conditions, sports injuries, traumatic injuries like burns or blast injuries.

Host: Got it. And how early can hand therapy interventions begin and why is early intervention so important?

Cynthia Hinshaw, OTR/L, HTC, PAMS: For early intervention, it kind of depends on the situation. So, some of our kids have congenital issues where they're just born with hand differences. And most kids with hand differences function normally. But sometimes when they get a little bit older, especially like in their teenage years, or they go into sports, they're looking at maybe some more adaptive equipment, and Jennessa and I can actually fabricate splints to help them with those kind of things.

And then, we have the other cases where you actually were on the football field and you had an injury based on a really bad tackle. So then, we have kiddos that might go into surgery. And Dr. Acosta, she's our brilliant surgeon who takes care of the surgery aspect. And then after that, we see them for rehab. So, depending on the type of injury, we start seeing them as soon as we can. So, we can help promote early range of motion and then getting them back to what they were leaving possibly back there to their sport.

Host: Right. That early getting everything moving is so key.

Cynthia Hinshaw, OTR/L, HTC, PAMS: It is so key. And honestly, if we get things moving earlier, the kids tend to have less pain.

Host: Right. That's great. Kids may be concerned, speaking of pain, they might be concerned that hand therapy will hurt. So, how do you ease their anxieties about this?

Cynthia Hinshaw, OTR/L, HTC, PAMS: Our goal for therapy is never to hurt anybody. Because you're a kiddo, that's a big deal. Most of the kids come in and they're actually quite scared because they don't know what to expect. Half the time when they go to a doctor's office, they think we're going to give them a shot, but we're not. And then, we have modalities, just simple ones, like a heat modality, especially like if you're a fresh finger fracture and you're really stiff because you got out of the cast. And what we do is we work slow motion and we always listen to the kids. And then we explain what the injury is going to entail, like what is normal pain, maybe what is too much pain, and then we back up. So, we really listen to what the kids are saying to us.

Jennessa Low, OTR/L, CHT, CPAMS: They really have no idea what to expect. So, just journeying along with them to help them understand what's normal, that they won't re-injure themselves if they do the right things. and many times when they figure out that they won't hurt themselves, the pain is usually much diminished.

And the best part of it is we're pediatric hand therapists and so, hand therapy is fun. Most of the experience is mild discomfort during stretches as they regain strength. Sometimes there's maybe some temporary soreness, kind of similar to after a workout, and they may need an adjustment period as well, just to get those normal movement patterns reestablished.

Host: Sure. And speaking of, what types of exercises or therapeutic techniques are typically used in hand therapy?

Jennessa Low, OTR/L, CHT, CPAMS: Oh, we have so many, and they are a lot of fun, like we mentioned. We have something called paraffin wax dips, which is a great modality for warming up the soft tissues, just to prepare them for range of motion and scar mobilizations. On top of that, kids tend to love to peel it off, peel off that wax, and even use that as a therapeutic exercise. And I offer them the opportunity to mold it into fun shapes like hearts and stars, footballs, whatever brings them joy, whatever is important to them.

We also have soft tissue and scar mobilizations, just to massage everything and improve motion, as well as cosmesis of the scars too, because that's important as a child grows, in conjunction with promoting gliding of all the tendons. We also do custom thermoplastic splinting, which is a highlight. And we always include our children in having them choose their favorite colors and strapping, and even add some funky decals just to make them really proud of what they're wearing as they heal.

Cynthia Hinshaw, OTR/L, HTC, PAMS: And we tend to be the slime queens. So, we make slime and actually you can use it very functional for hand therapy and the kids love making slime. So, it just kind of depends on the kid's age. We have our little ones and then we have our teenagers. And they like particular things. And then, we also have some interactive type games that provide some biofeedback, and they get to actually play a video game, but actually still working on hand strengthening or range of motion of the wrist.

Jennessa Low, OTR/L, CHT, CPAMS: Cynthia's actually been incorporating some virtual reality games as well to just help decrease pain, distract, focus on the outcomes and especially have fun. It's something different.

Host: Wow, therapy's come a long time. I want to go to slime therapy. That sounds really fun.

Jennessa Low, OTR/L, CHT, CPAMS: You're welcome anytime.

Host: So, are there other healthcare professionals that hand therapists collaborate with during treatment?

Jennessa Low, OTR/L, CHT, CPAMS: Oh, absolutely. So, like Cynthia mentioned, we frequently collaborate with our pediatric hand surgeon, Dr. Acosta. We often come and see her patients in clinic. And we help out with patient education, show exercises, make splints at those times as well. And sometimes children will come in with other special needs like feeding and swallowing issues or gait imbalances, sometimes speech delays as well, which then cue us to include our other OTs, PTs, or speech language colleagues to consult with them.

Host: Got it. It takes a village.

Jennessa Low, OTR/L, CHT, CPAMS: It does. We're at the village.

Host: And what goals do you set during therapy sessions and how do you measure progress?

Cynthia Hinshaw, OTR/L, HTC, PAMS: So, goals are set basically on what important to them. We have a lot of athletes that are actually hoping to get scholarships for college, and some of them actually do have college scholarships. So, we try to make the goals functional to what they're doing. And then sometimes we have little kids, their functional goal is playing. We always write them tailored to what they're doing as age appropriate.

So, one of our kiddos was actually a pretty accomplished celloist. And his goal, because it was his last senior year and he was planning to transfer to university. He had to make sure he was ready to go. So, our goal was actually working on the cello, and we had him bring the cello here as part of therapy, so we could practice the strengthening in the hand that he needs specifically, so he can accomplish that.

Host: That is awesome. I have not heard of that. That is amazing.

Cynthia Hinshaw, OTR/L, HTC, PAMS: We do incorporate a lot of, like, if they're returning back to softball, we practice that. Football, sports, and we practice those types of actions to get them ready to go.

Jennessa Low, OTR/L, CHT, CPAMS: You know, we make sure to definitely ask them. I mean, we're specialists in this. And so, we help them break down each activity. So, it's not just, you're cut from the sport and, all of a sudden, now you're playing competitively. We break down each of the tasks and break down each of the movements and kind of gently slowly reintegrate into that sport. So, we've also had softball players that are signing on to colleges with something called the TFCC tear. And after the repair by Dr. Acosta, we walk alongside of them pretty soon after surgery. And we work on different types of throws, underhand, overhand, certain distances, certain frequencies and durations as well, just to give them the confidence too, because it's scary to be pulled out of a sport mid-season, have this injury and then be expected to go back at that same level.

Host: I was going to say it's at least half mental, you know, to just get that confidence back.

Cynthia Hinshaw, OTR/L, HTC, PAMS: They have a lot riding on what they've been trying to achieve most of their young adult lives, and they're really excited to go to their college of choice and to have that taken away from them would be devastating. So, it's our goal to try to get them back to that situation and to be safe and strong.

Host: We've been focused almost exclusively on the kiddos, which of course is what this is all about today. But do you have any advice for parents seeking pediatric hand therapy care for their child?

Jennessa Low, OTR/L, CHT, CPAMS: Absolutely. Yeah. Being a parent myself, seeing your child get hurt is very scary. And even being in the specialty that we're in, taking myself out of that, it could be startling. And it's important for parents and children to feel safe and comfortable in the process. To feel like the process from seeing the doctor to therapy to discharge is a smooth process along the way.

A huge part of the battle after injury is working through that fear and guarding. And so, working with hand therapy, both family and patient because we see and treat them both, help them understand what's happening, what to expect, and mostly, more importantly, to empower them to know what they are capable of doing and returning back to.

Host: And this last one is for both of you. What makes the Pediatric Hand Therapy program at Miller Children's and Women's unique to the area?

Cynthia Hinshaw, OTR/L, HTC, PAMS: I think Long Beach is a unique community, and we have a lot of diversity within this community, a lot of growth. I believe where it's located, it serves the city well. It's kind of like in the middle of Los Angeles between Orange County and L.A. And I think that because we, Jennessa and I, truly love what we do, the way of the name of this place, the village, it really takes a village to really treat a person and a patient and a family as a whole, that I think that's very special to us. And we are happy that we can serve this population and have the resources to do so.

Host: And where can people learn more about the Pediatric Hand Therapy Program?

Cynthia Hinshaw, OTR/L, HTC, PAMS: We actually have our website online that you can look into occupational therapy, and we have a little section on hand therapy. We're still a new program. I mean, we're almost like six years into it. So, I think a lot of people are still learning about us. And then, most of the time people get to learn from us because their pediatrician will seek a specialty from ortho hands and then they get to get seen by Dr. Acosta. They learn about us that way as well.

Host: Sounds good. And you can visit millerchildrens.org/childrenvillage or call 714-377-6993. Cynthia and Jennessa, thank you so much for your time and your expertise today. I love that you're just changing lives for the better every single day, and we really enjoyed having you on the show.

Cynthia Hinshaw, OTR/L, HTC, PAMS: Thank you so much for the opportunity. This was fun for us.

Host: And for more info or to listen to a podcast of this show, please visit memorialcare.org. That's memorialcare.org. That's all for this time. I'm Deborah Howell. Have yourself a terrific day.