Pediatric Rehabilitation clinicians helped a young teen, impaired after removal of a brain tumor, relearn how to walk, talk and swallow
Maria was 14 when she started having headaches and throwing up for what seemed to be no reason. Eventually she was found to have a brain tumor. It was safely removed, but in the aftermath, the Fremont, Calif. teen lost her ability to walk, talk and even to swallow.
In August 2005, she came to UCSF Benioff Children's Hospital Oakland for rehabilitation as an inpatient. She worked with Children’s Pediatric Rehabilitation medicine team for nearly three months to regain her lost abilities.
How Maria learned to swallow again illustrates Children’s Hospital’s ability to marry new technology with a laser-like focus on caring for children.
Children’s clinicians helped Maria regain the ability to walk, talk and swallow. Today she is back with her high school classmates, chatting, enjoying lunch and walking across the campus. To ease her transition from Children’s inpatient rehab unit back to school, Maria worked with a home school teacher.
Mom happy with daughter's treatment
Thanks to Children’s rehab clinicians, she’s practically back to normal. “I was happy with the way (the team) treated her,” said Maria’s mother, also named Maria. “Everybody was nice, everybody loved Maria.”
When she regained her swallowing ability, Maria especially enjoyed eating peaches again, said her mother. Though because summer was over, the peaches came out of a can.
Children's OTs use device to stimulate swallowing muscles
Children’s occupational therapy coordinator, Donna Diseroad, OTR, helped Maria relearn swallowing using neuromuscular electrical stimulation provided by a rented VitalStim therapy device, FDA-approved since 2001 and available to clinicians since 2003.
Donna was trained in the machine’s use several years ago and in 2006 Children’s bought its own machine.
Clinicians like Donna, certified by the VitalStim manufacturer, place single-use electrodes on their patient’s neck and throat. The electrodes deliver a small amount of current that stimulates motor nerves in the throat controlling swallowing muscles. A small, handheld unit produces and controls the electrical stimulation.
Donna helped Maria practice using her gradually reactivating muscles, until she learned to swallow again without the aid of the machine. “Maria left Children’s eating a regular diet,” said Donna.
Children’s rehab medicine clinicians now have the ability to help affected children create or re-learn the functional muscle use patterns needed to begin or re-establish swallowing ability.
Three other clinicians in the department, Trang Phan, OT; Karen Hildebrand, OT, and Amelia Foos, OT, have also been trained and certified to use the VitalStim device.
Treating swallowing difficulties (dysphagia)
Dysphagia, difficulty swallowing, is a scary and frustrating condition for children and affects about 15 million people in the United States. Depending on the definition, from 2 to 29 percent of children at one time or another experience feeding or swallowing difficulty.
After referral to Children’s Hospital, a child with swallowing difficulty meets with a Rehabilitation Medicine clinician for evaluation. A Diagnostic Imaging technologist uses video fluoroscopy to do a swallow study, recording what the child’s swallowing ability looks like.
An occupational therapist (OT) reviews the x-ray movie to determine if the child has motor function impairment. Feeding ability is evaluated and clinicians also examine the child for other mechanical or behavioral issues that may be part of the problem.
The rehab team includes physicians called physiatrists, OTs, physical therapists, speech therapists, registered nurses and other physicians called hospitalists. A team of clinicians worked together helping Maria relearn to swallow, and also to walk and talk.
Maria keeps getting better
Maria continues speech therapy twice a week at her high school and works on improving her balance at a physical therapy program based at Fremont’s Glankler Elementary School. Maria’s mother is pleased with her daughter’s progress. “At the beginning I wasn’t sure Maria could come back,” said her mother. “She will get there, and thank God.”
For more information about neuromuscular electrical stimulation used to treat dysphagia, and other Pediatric Rehabilitation medicine services at Children’s Hospital, call (510) 428-3655.
This article, written and photographed by senior writer Tom Levy, first appeared in the August 2006 issue of FYI, Children’s Hospital’s Medical Staff newsletter.