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Introduction to Paediatric Rehabilitation
Welcome to the start of your child’s rehabilitation journey. You will receive a lot of information in the coming days. Caregivers, well-meaning friends, the internet, support groups and other families are all good sources of information, but it’s a lot to take in. Don’t try to learn everything at once. Rely on your professional team to guide you through the steps, day by day.
Because recovery is unpredictable, it can be very frustrating. Answers may seem hard to come by right now and all the medical facts can be very confusing. We will do our best to support you and your child through this phase of the rehabilitation process.
You will be attended to by a full rehabilitation team which consists of:
- A Doctor
- Nursing staff
- Occupational Therapists
- Speech Therapists
- Social Workers
- A Dietician
- A Rehabilitation Programme Manager (RPM)
Please note that depending on your child’s condition and the need for certain types of therapy, your child may not be seen by all the members of the rehab team.
What you should bring to rehabilitation for your child?
- Suitable clothing is needed for therapy. Your child is advised to wear comfortable, loose clothing such as trousers or tracksuit pants, takkies/trainers and socks. Pyjamas, boxer shorts and slippers are not suitable or safe for exercising. Please ensure your child has enough clean clothing at all times, including underwear/nappies.
- With regards to shoes/ takkies/ trainers, it is often helpful to provide shoes that are one size larger than your child normally wears, to make it easy for him/her to put them on and take them off. If walking is a rehab goal, the shoes should have rubber soles to prevent slipping.
- Toiletry items such as a toothbrush, toothpaste, comb, brush, shampoo, soap, deodorant and face cloths.
- Bottles, teats and dummies/pacifiers
- Familiar items such as photos of parents, siblings, family and friends.
- Comfort items, such as a favourite pillow, blanket, toys or music with headphones (but please be cautious of bringing valuable items to hospital).
During your child’s first three days of rehabilitation, the therapists will evaluate what your child can and cannot do by him/herself and how they engage in play. For babies and infants, this may include aspects like their ability to calm and their sleep / wake cycles. Therapy may take place in a variety of settings, including the ward, the gyms and outdoors. All of these environments are used to optimally prepare your child for the challenges ahead. The assessment is an important part of therapy and helps the team to determine how to assist your child, and you as parents in returning to your own environment as quickly and as independently as possible. The assessment is essential for setting your child’s rehabilitation goals and determining the recommended length of stay in our facility.
Key principles of paediatric rehabilitation
Rehabilitation is a complex process. The two major therapeutic approaches being used for children is Neuro Development Therapy and Sensory Integration Therapy. Much of the process is based on the principles of normal child development, learning to move again and acquiring a new or developmentally expected skill. The building blocks to success include:
- Integrating your child’s senses in order for them to better understand the external world around them
- Actively attempting to perform a variety of tasks/exercises
- Using play and playfulness as a way to actively engage your child in therapy
- Being motivated to persevere with training
Learning is enhanced by a lot of repetition and practise. Therapists and nurses provide the knowledge and the skills to enable your child to do particular tasks, which then need to be practised repeatedly. You will need to practise the skills learnt with your child as much as possible in your own time as well. Independent practise allows for increased social stimulation and interaction throughout the day, rather than just in your prescribed therapy sessions. Planning to practise every day is essential. Please ask the staff and therapists to assist you in fitting your own independent practise times into your daily routine.
Therapy times for the week will be communicated to you, or you may be assisted to complete your child’s own timetable. Although every attempt is made to keep to the set times, they may need to be amended on the day as schedules can be affected by your child’s ability to engage at the time, emergencies and other unforeseen circumstances.
Your child’s active participation in each therapy session is very important.
Visiting hours in the hospital are between 10h00 and 20h00. Please understand that should your child’s visitors arrive during their therapy times, therapy takes priority. It is, at times, beneficial for family members to be present in therapy, but it can also be very disruptive to have many visitors in the gyms. Please allow the treating team to guide when your child’s visitors are allowed to observe or participate in therapy sessions; this will also be done with your best interests in mind. Remember that resting between therapy sessions is also very important.
A family meeting is usually arranged in the first two weeks following admission, depending on your family’s availability. The purpose of this meeting will be to give you feedback on your child, explain the progress and goals of therapy and start planning for discharge. It is a good opportunity for you and your family to ask questions so please feel free to do so.
Apart from the two major paediatric therapeutic approches, there are a variety of additional special services available in the hospital. These are prescribed by your child’s treating therapists as and when necessary.
A home visit will be done, when appropriate, usually prior to your child’s first day or overnight trial at home. For logistical reasons, homes outside of a 50km radius from the hospital are generally not able to be visited. The family will then be asked to provide pictures of the home environment and take measurements, as requested by the therapists.
As part of the rehabilitation process, children are encouraged to visit home over the weekends. The team will decide when this is appropriate for your child and how long the visit should be. We generally do not recommend a visit in the first week of admission as we will probably not yet have an accurate picture of how safe such a visit would be. An indemnity form will need to be completed and signed prior to your child leaving the ward. In order to benefit from the full daily therapy sessions, children may not leave for a weekend before 15h00 on the Friday and must return to the hospital on the Sunday afternoon/early evening.
Weekend therapy is not a standard part of our rehabilitation programme. Weekends are an essential time for children to rest, be with their family and be involved in normal social and recreational types of activities. It is also an ideal time for your family to spend time with your child and for you to practise the skills learnt in therapy during the week. However, for certain children it is necessary to have therapeutic intervention on a Saturday and/or if there are restrictions on length of stay. This will be determined by the treating therapists who will prescribe a specific intervention for that day. The session provided will not be as intense as the therapy offered during the week. Emergency and chest physiotherapy is provided on Sundays if required.