Plenty of Payoffs When Post-Transplant Rehab Is Tailored for Kids

“I think there’s still a significant number of young transplant recipients who don’t come to rehab who could benefit from it,” says Michael McHugh, MD, Medical Director of Cleveland Clinic Children’s Hospital for Rehabilitation.

About one-third of pediatric patients who receive organ transplants at Cleveland Clinic undergo postoperative rehabilitation therapy, he notes, and those who do are most often kids with heart or liver transplants. The underlying organ failure in those particular types of transplantation tends to leave these children highly debilitated and in need of extensive functional recovery. But many more young transplant recipients, regardless of transplant type, stand to achieve better outcomes with specialized pediatric post-transplant rehabilitation.

Building stamina, restoring function

“The main objectives of rehab therapy in pediatric transplant patients are building stamina and restoring muscle and joint function,” says Dr. McHugh.

While goals and techniques are similar to adult rehab, treatment approaches are distinctly pediatric. And they involve more than just child-sized walkers and other therapeutic equipment.

Advantages of specialized pediatric rehab

One of only about a dozen freestanding children’s rehab hospitals in the nation, Cleveland Clinic Children’s Hospital for Rehabilitation is staffed exclusively by pediatric specialists. This offers several distinct advantages for young transplant recipients:

• Deep familiarity with kids’ developmental milestones. “Our therapists have spent their whole professional lives working with children,” says Dr. McHugh. “They know how and why to treat 8-year-olds, 14-year-olds and 18-year-olds differently from one another. They vary their approaches to fit young patients’ capacity to understand and their development of self-identity.”
• Expertise in overcoming kids’ refusal to participate. Many children don’t want to participate in therapy because it hurts or they’re disillusioned and want to give up. “Our pediatric therapists know how to work kids through the crying and temper tantrums – and work adolescents and teens through other emotional frustrations – when adult-care therapists might not,” says Dr. McHugh.
• Experience working with parents. Providing efficacious yet empathic rehab therapy while keeping both the child and parents satisfied is a skill honed over time. “Adding a parent into the relationship may change the therapy approach,” says Dr. McHugh. “You have to educate the whole family on the importance of movement and restoring strength.”Family engagement is a factor in all pediatric care, but especially with inpatient rehabilitation, where families can “room in” with patients. “We do what we can to keep families involved,” says Dr. McHugh. “In many ways, it’s an extension of the philosophy at Cleveland Clinic Children’s main campus.”

Outpatient options meld intensive therapy and home stay

Patients also can take advantage of the day hospital at the Children’s Hospital for Rehabilitation, where they come two to five days a week for intensive physical and occupational therapy, returning home each night. “This way, they can receive a significant amount of therapy while still reintegrating into family life,” says Dr. McHugh. “Seeing young patients regularly is a major benefit when working to rebuild their function.”

Most patients undergo two to three weeks of day hospital therapy, though some are treated longer. They then complete a period of outpatient physical therapy as needed.

Why integrated services matter

“Even though we’re a stand-alone rehab hospital, our services are integrated with Cleveland Clinic Children’s,” says Dr. McHugh.

Hospitalists cover children’s rehab as well as Cleveland Clinic Children’s inpatient service. This consistency means that many transplant rehab patients are cared for by the same physicians that cared for them before their transplant.

“A deeper understanding of the patient’s condition and transplantation can aid in rehabilitation,” Dr. McHugh adds.