Caitlin Whyte (Host): Welcome to another episode of In Their Words. Today, we have the privilege of introducing you to Dr. Dunn, a Doctor of Physical Therapy with the Infant Development Program at UPMC in Central PA. She's about to share with us a story. A story that profoundly impacted her work, her life, and solidified the knowledge that she was indeed making a difference in the lives of her patients.

Dr. Dunn's journey is a testament to the transformative power of healthcare, and it's her personal experiences and dedication that we're about to uncover. As we dive into her story, we invite you to sit back. Listen, and be prepared to be moved by the extraordinary impact of her work in the field of infant development.

Dr. Jessica Dunn: my name is Jessica Dunn, Doctor of Physical Therapy with the Infant Development Program at UPMC. I've been working with UPMC for 14 years and a Pediatric Physical Therapist for 19 years. I first became familiar with this family when I was working with their older brother who was born slightly premature and required some physical therapy assistance. And he is now four, going to be five. And then about 17 months ago, they had another little boy. So, Owen's family was given the diagnosis of tibial hemimelia, which is congenital absence of the lower leg, during his 20 week anatomy scan when his mom was pregnant, and he was born missing the lower portion of his left leg, and his foot was attached at his knee. Physical therapy through UPMC's infant development program began when he was 6 months old, and I was Owen's physical therapist. I was there to guide the family through typical motor milestones, sitting, crawling, and standing, all with just one leg. And when Owen was 15 months old, he underwent a through-the-knee amputation surgery, which removed his foot and then allowed him to be fitted with a prosthetic limb.

Owen's journey began standing and walking when he received his first prosthetic leg two months after his surgery. And so, since then, I've supported and assisted Owen's family. We're working on standing and walking, and now with two legs. I've been able to serve as a resource for his family, providing strategies, modeling activities, and improving his strength and balance. We've monitored his growth and his development in all areas. I've collaborated with his family, his prosthetists, his medical team. We've explored the uses of walkers and other assistive devices. Recently, he started taking about seven or eight steps independently. He's now actually being fitted with his second prosthetic limb. So, this one's even more advanced with new fittings and should give him even more independence. It's been really exciting seeing the pride and joy and excitement in Owen and in his family as he reaches new milestones, taking independent steps. It's one of the true joys of being a pediatric physical therapist. His family is a great advocate for him. They're working to start a support group for children with residual limbs or use of prosthetic limbs.

Host: For many people who choose a career in medicine, there's a driving reason, a personal motivation that propels them into the field. In the case of Dr. Dunn, there was undoubtedly a compelling reason that guided her on her path.

Dr. Jessica Dunn: So, I have a cousin who is 30 probably now who was born premature and was later diagnosed with cerebral palsy and autism. And so, I was able to help him learn to walk and I remember just spending time with him. He had braces on his feet and oxygen, and I just really enjoyed working with him and thought, "Wow, someone has a career that they can teach little kids that are struggling to be able to succeed." So, that started part of my journey.

I also had an injury myself that led me into physical therapy. And so, going through physical therapy myself. was part of realizing what the profession of physical therapy is all about. You're like part of the family, because you're going into their house once a week. In Owen's case, I go twice a week for an hour. So, I didn't realize that I arrive in the morning. Sometimes everyone's still in pajamas. You know, I'm coming into their home. I go into their homes or into a daycare, if a child's in a daycare setting or a preschool setting. I started as a pediatric PT before I had kids. I say that being a mom taught me almost as much as my seven years of physical therapy school. Part of the program and the aspects that parents really like is that they have someone to talk to. They have someone just to bounce ideas off of. I mean, there's so much more to just physical therapy when we're in the house that, you know, people might want ideas on potty training, on breastfeeding, on getting rid of the bottle, and that's part of early intervention. We look at the child as a whole.

So usually, I'm always asking, how are they eating? How are they sleeping? We're always keeping our eyes on other developmental milestones. So, it doesn't seem like they're making enough sounds. Should we look into having someone to come in and help them with some of the communication skills?

Host: In the vast world of healthcare, it's often the individual stories that touch our hearts the most. For Dr. Dunn, one of those stories belongs to a child named Owen ?

Dr. Jessica Dunn: I mean, I can be honest. Owen is the first child that I've worked with a residual limb difference or prosthetic limbs. And so, when the family reached out to me, they said, "Do you have any history of this?" And I said, "I don't, but I would love the opportunity to work with him." And they confided in me afterwards saying, we know you don't have any history with the limb difference, but you've worked with our oldest and really feel strongly that that's more important than the bond and seeing me work with the older brother, that that's more important than any knowledge of using a prosthetic limb. You know, it's eye opening to walk in and even just learning to sit with one leg weighing significantly less than the other leg. He really had to work on balancing. At that point, he still had the foot attached to his knee. But then after the amputation, we worked on making sure that his skin was healthy and that the wound and skin integrity was all okay, and other things, finding shoes and clothing, adaptive clothing and everything that kind of goes along.

And then, there's the whole emotional part of the parents have said it took a long time to accept, even at the 20-week ultrasound, not knowing what that was going to look like and starting to realize the challenges that will continue to face him when he gets to school age and other things. But there's a lot of Owen that he really embraces himself without the leg or the foot that is his normal. So sometimes, he really doesn't want to wear the prosthetic because he can get around faster without it. You can be in a bad mood, you can have a rough morning. But then you get to these kids' houses that you're treating, and these families' houses, and that all doesn't matter. Just to see the babies get excited and they recognize you so quickly, like just a few visits in and they know who you are and can recognize you across the room and all that kind of stuff.

Host: The journey doesn't end when a child ages out of the Infant Development Program at UPMC in Central PA. In fact, this exceptional healthcare institution has a comprehensive plan in place to ensure that these children continue to receive the care and support they need as they grow and develop.

Dr. Jessica Dunn: So, typically, for services to continue, it would be through what's called the Intermediate Unit, the Capital Area Intermediate Unit. And so, they take over services when a child turns three, if they continue to qualify. So, there are certain qualifications that a child will be evaluated on, and then determined if they continue to qualify for therapy services. So, that would be one route if he were to continue. That is an educational-based model. So, his delays have to be impacting his education. It's one of the harder areas to grasp, because sometimes if a child is mobile and able to move around their educational environment, whatever that looks like at the time, it might mean that they don't qualify for physical therapy services. There also is a medical model. So, either way, he would continue to be able to be provided services through a medical model where he would go to like an outpatient physical therapy.

Host: When asked if there was one moment that encapsulated why she does what she does, Dr. Dunn shared a poignant insight.

Dr. Jessica Dunn: I was able to attend with the family one of the fittings for his first prosthetic leg. And so, we brought a walker with us. And mom and dad were there and the prosthetist and we got to see him take the first steps. And even something as simple as I was videotaping so mom could truly enjoy the moment of getting to see him or to help. I was able to videotape mom helping him take those steps and things like that. And even just like, Owen gets excited, but then to see, even just his parents get so excited just to see him take his first steps. And the excitement they have over this new leg coming and how much better it's going to be than this other leg that he's only had for six months and he's already ready for his second leg.

I mean, the cost of the prosthetic limbs is astronomical. And so then, to get a second limb six months later, and the cost of that, well, thankfully, for the medical assistance program, you know, such limitations, he qualifies for medical assistance. So, that covers whatever medical insurance through parents employees. So, it's just so exciting to see him be able to be independent and see him thrive and be so, proud of himself for taking the steps and those were just his first few steps. And now, he can walk almost across a room independently. And independence is just going to keep growing.

Host: Dr. Dunn knows the reasons why her work is so meaningful, but she wants you, our listeners, to understand why physical therapy is so crucial for babies. Here's what she had to say

Dr. Jessica Dunn: It's so important when they're young and their brains are learning and malleable and absorbing just everything that he learned these skills and just give a little bit of assistance through some therapy. And the other important thing is teaching the parents. So , a large, large portion of what we do is teaching the parents what to do. Because when we're not there, they're then able to carry over the strategies and the concepts that we've taught them to continue to work with the children.

It's a large portion of letting the parents kind of lean on you for support, but giving them some time to grasp the concept and give them any guidance. We try to give them community resources anything that we can to kind of help along their journey physically, mentally. I was able to help the family understand that they could get medical assistance. And so before I was in there, they had not realized that they could qualify for medical assistance. And that way then, they were able to apply and be accepted.

In a lot of situations, well, I mean, early intervention is the same way. People don't know what's out there or that they even could qualify. A lot of cases, yeah, people don't know about it, so like in Owen's case, he has private medical insurance. So, no one was really aware that he could have also medical assistance and private insurance.

Host: Patients in need who receive care at UPMC in Central PA have the option discuss applying for assistance from the UPMC Pinnacle Foundation through their healthcare provider. However, it's essential to note that patients being seen at other medical systems also have options available to them.

Dr. Jessica Dunn: So, they can call themselves. This is a program that is contracted through local communities, counties, state, federal funding. So, they are able to contact their county that they are living in, residing in, and be referred. You can also talk to your pediatrician but you don't need a pediatrician's referral. You can call yourself with your own concerns with your child. And that will start with a phone call where they will take your concerns and kind of an intake phone call, and then from there, set up an evaluation, where again, the evaluator comes to your home or over Zoom and will evaluate the child as a whole, so all areas of development to determine if there's any needs in any areas of development

Host: But back to our main character, Dr. Dunn's experiences with Owen and his family have left a lasting impression and hold a special place in her heart.

Dr. Jessica Dunn: That's one of the hardest parts of when the child turns three, is the parents, or when services end, the parents have a really hard time letting go. I mean, the therapists do as well but, you kind of miss, you miss seeing them often. They miss having you come into their home. it is a hard transition, but yeah. No, you get very close with the whole family. I mean, in Owen's case, his grandmother's there because she watches him during the day. A couple weeks ago I was with dad, so, older brother, he's always there. Part of the session. All the medical terms I learned in school, I no longer use because it has to be family friendly.

Caitlin Whyte (Host): The invaluable work, compassion, and the positive impact on the lives of children like Owen would not be possible without the Infant Development Program, a program supported in part by the UPMC Pinnacle Foundation and state, local, and federal funding

Dr. Jessica Dunn: so UTMC's infant development program has been around for over 40 years. tHroughout Dauphin County, Cumberland, Perry, York, and Adams County. It is the only hospital based public early intervention program in Pennsylvania to specialize solely in serving infants and toddlers. So we work with children age birth to three. And the Infant Development Program is the largest provider of therapeutic support services to infants and toddlers in the Capital Area.

We are funded through with state, local, and federal government. And in the past 20 years, Infant Development Program has doubled the amount of services it provides to families in the greater Harrisburg community. During any given month we provide over 425 infants and toddlers with early intervention therapy and developmental evaluations.

And over 1, 600 infants and toddlers are served by the Infant Development Program each year. I Would not change what I do because I just enjoy going to work every day. I enjoy seeing, the children, the families, the people that I work with, and seeing the change that we make every day in, in the children's lives, in the family's lives in the community as a whole, and we just are there to support the parents and the children. And to this day, I run into families that I have served years and years ago, and they will recognize me in the grocery store and tell me what the child is up to then, what they're doing now and, how things are going. And I just, I love that.

I say all the time. I wish I kept a list. Because there'll be, a time that I'll be like driving through a neighborhood and I'll be like, oh, I used to come see this kid right here. What was her name? You know, Like, I wish I had like a running list or remember that time when I saw, so and so who was doing this or at any given time I have probably 20 to 25 kids on my caseload.

Caitlin Whyte (Host): Dedication to her work in infant development doesn't go unnoticed at home. Her own children take pride in knowing that their mom is making a positive difference in the lives of other kids.

Dr. Jessica Dunn: Yeah, they love asking stories, hearing stories of, kids taking their first steps. In the world of HIPAA, they don't know, but there have been classmates of theirs that I have treated. I once treated a, little one at my daughter's daycare, and so I used to have to duck under the door so she couldn't see that I was there to get to a little, another little one at the same daycare. and sometimes the, parents will come right up to me, at a school function and be like, Oh, how are you?

And don't mind that, everyone knows that I treated their child, but other cases, it's more like, it's a little secret.

 Seeing them, for the last time, right before they turned three, it's so hard to imagine what they would be like at five, or ten, or eighteen. And it's crazy to think that some of the kids that I first saw when I got to the Infant Development Program are now fourteen.

That's who I ran into at the grocery store. It's probably one of the first kids that I treated. And when I was at the Infant Development Program,

I had someone reach out because they saw that I was in this tibial hemomilia support group on Facebook. And so they reached out and said, I saw that you were in the Harrisburg area. I would love to connect. Well, they must have assumed that I was a parent.

So I said, Oh, I'm a physical therapist. And she said she just had her 20 weeks.

So, I then connected her with my family and educated her on the early intervention system just so that she was aware, because a lot of people don't know that we would come to your home. I mean, when you have a six month old, you don't want to be carrying them in the winter, in the flu season, to go to therapy, where someone can just come into your house, whether you're having a good day or a bad day.

In your pajamas, and work with the, in the setting that they're already used to. So, we play with the toys that they are already playing with. We are right in the living room where they're spending their day anyways. And we work into their routines. We work into your routine. So if they need a snack when we're here, we've worked that into what we're doing in therapy. If there's a routine that's tough and it's when we're not there, we either work on it when we're there or try to come, if bath time's tough. We'll reschedule and try to do a session during bath time when I explained it to Owen's family that this family had reached out, I think Owen's family really was like, we know what that's like. She needs a little bit of space. Like, I'm going to wait until she. Reaches out to me, but they were able to connect and say, well, this is the surgeon we used.

Here's the location we went to. And I think you have that connection which is so helpful knowing when to give space and when to offer advice. I don't think parents always know what to expect when they have a therapist coming into the house for the first time. You never know. Is it gonna be like, okay, we've gotta do leg lifts and squats and, I think parents can be a little bit nervous about, do we have the right setup? Is my kid gonna cooperate? And it's not like that at all. We really work into whatever the child's already doing.

So, like in Owen's case, loves cars, loves trains. So we work on standing at the ramp and putting the cars down the ramp. And we put the cars on the couch and then the cars on the ramp and we have to walk back and forth. And the parents see that it's easy. Easily, something they can carry over, and they can work already into the games and toys and things that the kids are already playing with,

Caitlin Whyte (Host): When asked about her vision for the future, Dr. Dunn's response reflects her deep commitment and the wealth of knowledge and experience she possesses.

Dr. Jessica Dunn: I mean, this is like opened a new area for me with the residual limb and prosthetic limb. I would love to be able to. Keep working in that area. It's always interesting to get new cases.

It kind of keeps you on your toes and keeps you thinking. So, there are often diagnosis that I haven't heard of that I start working with and it's kind of a fun challenge. But every kid is so unique that really, everything we do is adapted to the uniqueness of the child and their interests and their ability.

The families resources. So it's almost like every case is a new adventure, a new challenge.

I Started with two new kids yesterday, so you're going into a house that you've never been into. They've never met you so there's always that, like, little bit of nervousness of like, okay, what's this story going to be like?

you know, and then it's funny to think two years later, oh, wow, I've been there for two years. It's amazing. Even years later, I think sometimes the older siblings will still remember you and you're familiar. So when you go to school for physical therapy, it's just physical therapists. It's not pediatric or geriatric or sports medicine. Your, degree covers that. you kind of pick your own trajectory. So, after I graduated, I did do one year of outpatient orthopedic just in my local town.

I enjoyed it because that is an area that I was also familiar with having been in physical therapy myself. Plus during your school work, you do clinical affiliations they're called or like a, residency kind of thing. So I did do one in pediatrics. I did school age. I did geriatrics in a nursing home.

I did inpatient and orthopedic that usually you did at least one, if not two orthopedic ones. So you could have, you could go in any of those areas. I did about one year in outpatient and then got the opportunity to try pediatrics so quickly. Yeah. Moved from outpatient to pediatrics and haven't looked back

so we at, UPMC Infant Development Program, we provide developmental therapy or special instruction, behavioral therapy like myself, behavioral support services, we have speech therapists, occupational therapists we have therapists who are specialized in infant massage, I don't think you can put a monetary value on helping these children get to their fully developmental capacity and helping the families support them. That's even more important because we're only there until they're three, but parents are learning these skills and techniques and strategies to continue to help their child develop for a lifetime.

Caitlin Whyte (Host): And so, we conclude this episode of In Their Words, featuring the remarkable journey of Dr. Dunn and Little Owen. We want to thank you, our listeners, for lending us your ears as we share the incredible stories and work being done at UPMC in Central PA.

This podcast is brought to you by the UPMC Pinnacle Foundation and UPMC in Central PA. UPMC in Central PA 160 beds, 160 licensed beds, over 160 outpatient clinics and ancillary facilities, and more than 2, 900 physicians and Allied Health Professionals, and approximately 11, 000 employees in Central PA. It is a healthcare hub serving Dauphin, Cumberland, Perry, York,

Lancaster Lebanon, Juni, Adda, Franklin. Adams.

Caitlin Whyte (Host): and parts of Snyder Counties. The UPMC, the UPMC Pinnacle Foundation exists to provide resources to meet the needs of our most vulnerable patients, promote health and lifelong wellness in our communities, and support our workforce so we can attract, train, and retain the best and brightest talent at UPMC in Central PA.

To make a difference and join their philanthropic mission, visit UPMCPinnacleFoundation. org.