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Johns Hopkins

Johns Hopkins Pediatric

Physical Therapy for Cancer Therapy

November 13, 2013

Will Standiford, MD

Faith Tittle, with a therapist,
works on her balance.

Faith Tittle was a “completely normal child” until one month after she turned 4, notes her mother, Deborah Howe of Odenton, Md. The usually active child started suffering fevers, fatigue and frequent vomiting. Her pediatrician suspected a virus but after a few more days with no improvement in her symptoms, Howe brought her to the emergency department at a hospital in southern Pennsylvania, where she was visiting relatives. There she discovered her daughter had leukemia. If that diagnosis wasn’t bad enough, Howe then learned firsthand that the very treatments designed to curb the cancer’s growth—chemotherapy, radiation therapy and two bone marrow transplants—would take a toll as well.

“She was feeling very sick and extremely weak, she didn’t want to get out of bed,” says Howe. “It was hard to get her up and moving.”

This is where pediatric physical and occupational therapists step in, with the goal of improving patients’ strength, balance and endurance, as well as fine motor and cognitive skills. To facilitate independence and a smooth transition back to the community and school, occupational therapists help patients focus on daily living skill. But these goals are challenging as patients like Faith may suffer severe deficits from weeks and even months of inpatient and outpatient cancer treatments, explains Hallie Lenker, a physical therapist at Johns Hopkins.

“Facing balance problems and body weakness that arise during cancer treatment, they experience a lack of energy and ability to participate in the things they would be doing in the community,” says Lenker.

Deborah Howe notes that her daughter had to relearn how to walk after her second bone marrow transplant. Three-times a week physical therapy got her back on track.

“It took a while but she was really tough, and in a couple of months she was walking again on her own,” says Howe. “The physical therapists were extremely helpful in figuring out ways to motivate her.”

Part of the therapists’ work involves tracking deficits caused by cancers and cancer treatments to better predict the type of deficits patients will experience. That knowledge helps them tailor physical and occupational therapy to the patient’s individual needs.

“Of course, we’re thankful when these children are doing well medically, but we haven’t thought enough about the deficits these treatments cause in strength and endurance,” says physical therapist Julie Quinn. “Now we’re looking specifically at measures for balance and endurance, and collecting data to determine specific progress for patients who are in and out of the hospital, which will help us develop a more cohesive program for both inpatients and outpatients.”

Having a comprehensive physical therapy (PT) and occupational therapy (OT) program for both pediatric inpatients and outpatients in the new Charlotte R. Bloomberg Children’s Center building helps, notes Quinn. Physical and occupational therapists are familiar with the patient’s in-hospital experience and their specific PT/OT needs, which helps ensure a seamless transition to outpatient care. Also, PT and OT appointments can be scheduled easily to coincide with follow-up medical appointments.

Howe agrees: “It’s nice for your child to have the same place for inpatient and outpatient care, to have that familiarity and not have a lot of change going on.”

And where does she see Faith today?

“She is very resilient, she is a miracle— she’s pulled through many times and has surpassed doctors’ expectations,” Howe says. “She’s surprised us all.”

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