Rehabilitation Medicine/Intensive Care: Pablo’s Near-Drowning

Pablo’s Miracle Recovery after Near Fatal Drowning

A Terrible Accident

Teenagers playing nearby saw Pablo ride his Big Wheel into Discovery Bay. They pulled him out of the water as quickly as they could. But it still took paramedics performing CPR more than 45 minutes to revive him. Pablo was airlifted to John Muir Medical Center. He was soon brought to UCSF Benioff Children’s Hospital Oakland so he could be seen in the most active designated Level I pediatric trauma center in Northern California. Children’s transport teams travel by land and air to bring patients to Children’s Hospital Oakland; in Pablo’s transport team was a pediatric resident, intensive care unit nurse, and a respiratory therapist. They provided the critical care he needed, from the moment they picked him up.

First Days of Intensive Care

When Pablo arrived at Children’s Pediatric Intensive Care Unit (PICU), he was in a coma. Natalie Cvijanovich, MD remembers being worried about possible brain injury. “Basically, for the time he was in the water, no oxygen was getting to his brain, which can cause permanent damage.”

After one week in the PICU Pablo was still nonresponsive but he was stable, so he was transferred to the Rehabilitation Medicine unit.

Responding to Treatment

“We all know him as the miracle child,” said Pediatric Rehabilitation specialist Mai Ngo, MD, She provides full-time care for patients staying in the 12-bed unit, the largest pediatric inpatient rehabilitation unit in Northern California. “When he first arrived from intensive care, his body was rigid from muscle spasms,” Dr. Ngo continued. “He wasn't sleeping for more than a few seconds at a time. Early on, you’d expect this, but his spasms went on for awhile, despite all the medical management.”

Spasticity is a central nervous system disorder causing muscles to continually tighten and contract. Pablo’s spasticity was particularly severe, lasting several months. Children’s is one of a handful of spasticity centers in Northern California, providing diagnosis, treatment, and management for children with movement disorders like Pablo’s, through collaboration between our Neurosurgery and Rehabilitation Medicine departments.

Pablo was given a medication to treat spasticity through his feeding tube, with little result. Finally, the medication, baclofen, was injected directly into his spinal canal, and this had a significant impact. After the procedure, his body relaxed, and he slept for the first time.”

A Week Later - The First Smile

pablo-palying blocks in rehabilitationIt had been six weeks since his accident and six weeks of agonizing waiting.

“Pablo’s first reaction was a smile,” his mother Leticia remembered, beaming. “After he started responding, the nurses and doctors were with him constantly, monitoring him and working with him to improve his functioning.”

The goals for pediatric rehabilitation are to maximize the child’s functional capabilities, given their particular situation. The most important thing is to give every kid a chance, and continue to push them to improve. Rehab did that for Pablo-and he did fantastic. For the next two and a half months, Pablo saw a team of rehabilitation therapists for three or more hours of intensive therapy each day.

Rehabilitation - Relearning How To Use His Body

On this particular Wednesday, after breakfast, Pablo’s morning routine began with senior speech pathologist Donna Minkler, MA, CCC-SLP. Donna is fluent in Spanish, and was encouraging Pablo to use nonverbal modes of communication, like sign language. After big hugs, Donna and Pablo set to work. Using the Picture Exchange Communication System, Pablo was presented with six pictures of favorite activities. By handing the picture of his chosen activity to Donna, Pablo was learning a powerful communication alternative to his voice. “We start nonverbally, and then use more and more sounds,” Donna explained. “Our goal is to give him the tools to communicate—signs, gestures and words—while he’s relearning how to talk.”

Next, Pablo went to work with Karen Hildebrand, senior occupational therapist She set up a little bench for Pablo to use as a desk and poured out colorful blocks. Pablo immediately set to work stacking the blocks. “We’re working on visual and fine motor skills now,” Karen said. “When I first saw him, he couldn't sit up by himself, couldn't get his hands together—he couldn't use his hands for anything functional. Now we’re working on helping him eat and get dressed by himself.” After drawing with crayons and playing a game of fetching stuffed frogs with Karen, Pablo’s rehabilitation continued with physical therapist Teresa Gill, PT. Teresa took Pablo over to a cabinet full of toys and let him pick one. Teresa placed the chosen toy on top of a large exercise ball, forcing Pablo to balance on his feet to play with it. She explained, “He’s working on his balance and strengthening his hips.”

He looked like any 3-year-old playing happily with one toy after another. But for Pablo, this was the work of relearning how to use his body after an accident causing significant neurologic damage. Pablo’s team of therapists met every day to share their observations of his progress and how each of them is helping him. Children's provides multidisciplinary care through a team approach. Pablo’s successful rehabilitation can be credited to his initial care, his care in our ICU, our team in rehab, and a lot of luck and prayers. Much of the credit also goes to his family for their willingness and desire to stay at Children's for so many months and work with us.

Going Home

pablo-leaving PICU-rehabilitation“Goodbye Pablo, goodbye Pablo, goodbye Pablo, we’re glad to see you go!” sang the 4th floor rehabilitation team and nursing staff. Another patient baked cupcakes in the Rehabilitation Department’s kitchen as part of her own therapy, and shared them to celebrate Pablo’s departure from the hospital. Pablo’s mom held both of his hands as he stepped slowly down the hall, one foot after another. Pablo grinned his familiar wide smile as he saw the large group of clinicians, patients and their families who lined the hall for his going home party. Pablo still has a lot of work to do and will continue his rehabilitation therapy at UCSF Benioff Children’s Hospital Oakland and with a local therapist closer to his home. He was sent home with a red toy rocket ship, lots of hugs and kisses, and a binder full of information about his medications and exercises to continue at home.

 “Words are not enough to express our gratitude for all of the doctors and nurses and therapists who cared for my son,” said Leticia. “For all of his care here at Children’s, from intensive care to rehabilitation, I’ll always carry this gratitude in my heart.”