For children and families who go through the process of surgery to correct chest wall deformities, there’s a lot to consider. That’s why there’s a large team of professionals who work together to help each family and child prepare and achieve the best possible outcome. One key component of University Surgical’s Pectactular! Program is physical therapy.
Previously, patients who had chest wall reconstruction only interacted with a physical therapist after the procedure – first in the hospital, and then in outpatient therapy around five or six weeks later. Now, everyone who goes through the Pectactular! program meets with a physical therapist before surgery to begin conditioning and strengthening to help make recovery from the procedure go more smoothly.
Lisa Smith, M.D., pediatric surgeon with University Surgical Associates
Corrie Large, PT, physical therapist with ATI Physical Therapy
“Physical therapy has always played a huge role in recovery after surgery for chest wall deformities in my practice, but another important element of our process is called pre-hab,” says Lisa A. Smith, M.D., pediatric surgeon with University Surgical Associates who performs chest wall reconstruction. “Pre-hab focuses on strengthening the muscles of posture, and was aptly named Posture School by Corrie Large, the physical therapist who helped develop and implement this program.”
What is Pre-Hab?
“Pre-hab is a series of exercises that are recommended before a patient goes through surgery. We focus on flexibility, postural and core strength, working on flexibility in the chest wall and ways for patients to transfer without the use of their arms immediately after the procedure and during the six weeks before they come back to therapy,” says Corrie Large, DPT, physical therapist at ATI Physical Therapy. “We also work with parents to teach them how to help their child to sit up and get them out of bed.”
A big part of pre-hab is centered on posture. Many children who need chest wall reconstruction have rounded shoulders because of their physical problem, leading to weak shoulder and back muscles. Stretching inside a doorway or corner stretches – or others that pull the shoulder blades together – help lengthen the anterior chest wall and the pectoralis muscles. Deep breathing is also very important to expand the chest wall and increase flexibility before the procedure.
“Due to their deformities, some of our children had a very low activity level. It was really difficult from them to do some of the basic movements needed after surgery – like standing up without using their arms,” says Dr. Smith. “Pre-hab has been a game-changer for my practice and my patients because they can get back to activity faster and do better after surgery than ever before.”
Collaboration Makes A DifferenceOne of the great things about the collaboration between physical therapist and the surgeon is that the program can be tailored to each individual child. Some families are really busy, so the emphasis is on teaching home exercises. Others need a more structured program of three times a week for 6 weeks to get prepared. Still athletes have different needs. What’s important is that they’re prepared for surgery and are as strong as possible to aid in their recovery.
“It’s really great to know that we have such experts in rehabilitation on our team – they know what my patients need after surgery, and their understanding of body mechanics is such an asset,” says Dr. Smith “They love watching the transformation, and it’s amazing to see a child go from being dented in the chest and slumping posture to standing up strong.”
Corrie notes that seeing the transformation her patients go through is really rewarding, like with her patient Matthew Deckman who had surgery in June 2016. Many times, these kids don’t have confidence in themselves and are insecure with their deformity. After surgery, that change is evident and they present in a much more positive way.
“Aside from the physical or technical aspects of working with patients, it’s the relationships that are the most important to me. We spend so much time together before surgery helping families understand what they to do and how to prepare,” says Large. “We think about them during and after the procedure, and it’s like a reunion when they walk through the door to complete their rehabilitation. It’s really rewarding to see how all the hard work they’ve done has made an impact. Getting to be a part of that is awesome, and it’s one of the things I love most about my job.”
If you’re considering chest wall reconstruction for your child, we understand what a big decision this is for your family – and we want to answer every question and help in any way possible. For more information, visit our Pectacular! page or call (423) 267-0466 to schedule a consultation.