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Our Children's House: The Best Care Right Out of the Gait

November 06, 2018

Highly specialized equipment, thanks to a Crystal Charity Ball gift, has kids back on track

By Patrick McGee

Selene Gonzalez could not move. A rare and sudden bacterial infection had stripped the Dallas 14-year-old of all ability to move her arms and legs. She could not move her head or talk; she could only communicate by blinking.

It was such a desperate situation, that her mother, Maria Gonzalez, found herself in church praying for any kind of mercy He could give.

“I told God, ‘If you’re going let her live, let her live. If you’re going to take her, take her now because I don’t want to see her suffer,’ ” she recounted, with tears running down her face.

Selene was sent to Our Children’s House, Children’s Health’s rehabilitative inpatient facility. Physical therapists placed her in a new piece of equipment called Erigo Pro, which held her upper body in place with a chest strap. Each leg was strapped into leg braces that could move each limb, and small stickers were taped to her skin to deliver safe electrical stimulus to her muscles. The machine was turned on, and something of a miracle happened.

“My muscles started to wake up,” Selene said.

It was the beginning of a nearly full recovery. She walked out of Our Children’s House. Her ability to walk and move continued to improve at home. Selene showed a cell phone video of the at-home recovery with her father holding her like they are dancing as she struggled to take each step.

Now she can do nearly everything she was able to do before the bacterial infection hit her without warning. She said the only hold over from the ordeal is slow handwriting. She returned to school and to playing softball. Now a high school sophomore, Selene participates in Junior ROTC, with the goal of someday serving in the Army.

Selene and her family enjoyed a success story of biblical proportions, and it happened just 2½ miles from Children’s Health’s flagship campus, Children’s Medical Center Dallas. The new, 40,000-square-foot facility replaced the former Our Children’s House that Children’s Health acquired from Baylor Scott & White Health in 2015. And it happened because the Crystal Charity Ball in 2017 provided $1.1 million for the Erigo Pro and three other new pieces of state-of-the-art equipment that helps patients with gait, balance, muscular endurance and other mobility issues.

“It’s the full spectrum of equipment that we wanted to have, that worked on all access of gait and mobility and could be used for kids who are very low-level cognitively all the way up to kids who are active and can fully participate,” said Dr. Robert Rinaldi, Children’s Health’s division chief of pediatric rehabilitation. “We’re addressing all aspects of mobility: balance, sensory input, motor control, strength, endurance and nerve recovery.” Dr. Rinaldi is also an associate professor of physical medicine and rehabilitation and of pediatrics at UT Southwestern.

In addition to the Erigo Pro at Our Children’s House that helped Selene walk again, the Crystal Charity Ball grant also enabled the purchase of three pieces of equipment for the new Children’s Health Specialty Center, located one-half mile from Children’s Medical Center Dallas. In the one year that it has been open, more than 4,000 patients have been treated in the 13,000-square-foot facility.

One of those high-tech items, the NeuroCom Balance Manager, safely holds patients in place with a harness while the base wobbles underfoot and a landscape scene moves at eye level. An attached computer shows highly precise data on the patient’s balance, helping therapists tailor therapy to a patient’s precise needs and ability.

Another piece has robotic leg braces that help children with little or no ability to walk. There’s also a pool which has a wide treadmill for a floor, an underwater video camera and bubble jets to provide varying levels of resistance.

Each piece of equipment can be adjusted to the needs of the tiniest, weakest child. The pool floor can be elevated, making it as deep or as shallow as necessary, accommodating patients as young as 6-months-old.

Water rushes in from all sides when the pool floor is lowered, and patients like 4-year-old R.H. Barnett get excited at the sight of it. Standing on the pool floor, he gleefully crouches down to meet the heated water as it floods in around him.

“He loves how the floor goes down. He thinks it’s magic,” R.H.’s mother, Jessica Barnett, said. Her son uses the therapy to beat back the limits of cerebral palsy, but it seems like he’s having fun more than doing work. His mother said the pool provides for therapy not possible any other way.

“Because he’s more weightless than he is on land, he’s working on walking backward, on his static balance and on pushing off of something,” she said.

R.H.’s therapist has him working on mobility, stepping on and over a submerged box and working his way toward a beach ball floating in front of him.

Dr. Rinaldi said the pool provides patients with a sense of where they are in space that differs from walking on land. It’s valuable sensory information that builds new abilities.

“It’s part of retraining the nervous system to provide that information to the brain,” he said. “That kind of feedback from the water is enormously important to understand. It’s that sensory aspect of mobility and motion that we rarely ever think about.”

The Lokomat, the robotic gait trainer, has robotic leg braces that move a patient’s legs while a treadmill moves at a controlled pace at the patient’s feet. This is a huge improvement from having patients on a treadmill with a therapist trying to manually move each leg, said Dana Walsh, senior director for rehabilitation and therapy services.

“Consecutive stepping is something we can only replicate for so long if we’re manually doing it,” she said.

This method requires only one therapist, and that therapist can monitor a computer screen full of data on the patient’s progress. This is time better spent because therapist can make immediate adjustments to the treadmill speed and how much the robotic legs are assisting to nudge the child toward greater mobility.

To the children, though, it doesn’t seem like work. The treadmill is in front of a large screen that shows a cartoon robot trying to out run them in a race to grab gold coins. It’s an incentive to keep kids moving, and it’s wildly popular. Patients often point to the robot yelling, “Make him go faster!”

Each piece of equipment can be adjusted to the child’s size and challenges. Each addresses several issues so their use can be mixed and matched to meet countless patient needs. Therapists said they are just beginning to learn the new abilities they have to help patients.

“That’s what makes this program distinct,” Dr. Rinaldi said. “It really provides so much more opportunity and promise to help these kids that we didn’t have before.”

 

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