Most of our patients now are being treated for leukemia or brain tumors , says Lola Cremer
, a physical therapist and director of St. Jude's rehabilitation services.Each treatment , tumor type , and individual patient has unique rehabilitation needs.
Children being treated for leukemia present the broadest range of challenges.One problem Cremer frequently sees is ischemic bone pain-which can make a child reluctant to walk.Later , chemotherapy can cause peripheral neuropathy and degenerative joint changes.Without help , these kids can lose mobility and independence unnecessarily , says Cremer
After limb-sparing surgery , rehabilitation is actually longer and more complicated than it is after amputation.The endoprosthesis must be periodically lengthened as a patient grows , which often requires additional physical rehab work to stretch the soft tissues.Also , the presence of an endoprosthesis can permanently sideline patients from some activities , such_as contact sports.Some patients ( usually athletic teenage boys ) choose amputation for these reasons , and in some cases , amputation is unavoidable.
Upper and lower extremity amputations present very different challenges.
Children treated for brain tumors can face seemingly insurmountable cognitive and emotional setbacks , but Cremer
is constantly impressed by how much they regain and how fast.We've had patients who couldn't sit_up a month ago , and now they're walking.A child's brain is so much more adaptable than an adult's.We can't predict their outcome , but they always do better than a similarly treated adult..
When I say rehab , says Cremer
, I don't just mean that the patient can walk or go_back to school.Rehab is complete when children can fully return to everything that's important to them-family , friends , home , school , recreational activities. She
recalls a teenage limb salvage patient who was afraid she'd
never be able to bathe in private again.She
couldn't bend her
knee enough to clear the side of the tub.Her
whole outlook changed when Cremer
how to get in and out of the bathtub unassisted.
We've worked with children who are now cheerleaders , who ride horses , who play football and golf , who water ski and snow ski , notes Cremer.One little girl who'd had an above-knee amputation asked me if I'd teach her
to do cartwheels in her
prosthesis.Our kids are not limited at all..Lola Cremer
( left ) works with patient Toby Miller.
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