The Real World

When Collin Thompson was a sophomore at Juniata College in Huntington, Pa.,
 
a friend suggested she might make a great occupational therapist. Thompson did
 
some investigation and volunteer work and decided the profession was right for her
 
Now in the home stretch toward graduation, Thompson is completing fieldwork at The Children’s Institute. Her previous experiences at the Western Pennsylvania School for Blind Children affirmed her love of working in pediatrics, which continues with her assignment at the Children’s Institute. Additional experiences have included working with stroke patients and those with spinal cord injuries on an outpatient basis at UPMC Southside Centers for Rehab Services (CRS).
 
On this day, she is working with Colton, a two-year-old who was born with Arnold- Chiari Malformation, a compression of the spinal cord or brain stem. This congenital anomaly consists of elongated peg-like cerebellar tonsils that are displaced into the upper cervical canal. One of the symptoms of the disease is difficulty swallowing or dysphagia.
 
“Colton has difficulty eating and was severely undernourished,” says Thompson. “Rather than inserting a feeding tube, he was admitted to the Functional Feeding Program about a month ago. We introduce him to a variety of foods, different textures, in an effort to get him to eat more and gain weight.” As an example of some of Colton’s eating issues, she notes he has late dumping syndrome, so he doesn’t feel hungry. On a more personal note, he doesn’t like to get messy so pudding didn’t appeal to him, although now, after participating in the Functional Feeding Program, he delights in pushing it around his plate.
 
“One of the first things I did with Colton was to make funny faces out of the food. We’ve also added pasta to the repertoire because it has a different texture,” she imparts. Playing with food is one way to help make eating fun, something that is often missing for children with eating disorders.
 
The Children’s Institute takes an integrated team approach with patients like Colton. Before he arrived for his rehabilitation session with Thompson, Colton had breakfast with his mother and a behavioral psychologist, who helps the family understand Colton’s therapy so they can continue with it when he goes home. “Children can fall back to their old eating habits once they leave therapy, so it’s important that we teach Colton’s mother to reinforce what he’s learned once she’s back in the driver’s seat,” says Leslie Paat, an occupational therapist at the Children’s Institute and a co-supervisor and mentor to Thompson.
 
Colton’s meals have been prescribed by the team clinical dietician, who makes sure his daily nutritional and caloric intake are optimal. Colton also sees a speech-language therapist and the entire team works under the direction of a pediatrician.
 
Another side effect of Arnold-Chiari is ataxia, the lack of coordination and unsteadiness. Unlike average kids who love to swing, spin, and twirl, Colton does not like these sensations. To help Colton feel more comfortable with these motions Thompson puts him in a swing, “We want him to feel comfortable in the swing and help improve his vestibular movement,” she notes.
 
As part of Thompson’s fieldwork, she has devised a new twist for Functional Food Therapy, Play Picnic. She remarks that Play Picnic is based on earlier European work designed to make children comfortable with food. “The ‘picnic’ lasts about an hour and is totally directed by the kids, most of whom are two-year-olds – with adult supervision of course,” she smiles. “It’s anything goes for 60 minutes. They can throw the food, they can eat the food, they can play with the food, the sky’s the limit.”
 
But Thompson’s fieldwork at the Children’s Institute hasn’t all revolved around the Functional Feeding Program. “I’ve had the opportunity to work with young patients with brain injuries, burns, tumors, and those in the RND (reflex neurovascular dystrophy pain) program.”
 
Before graduation, Thompson has one final fieldwork assignment at UPMC Presbyterian Hospital in acute care. “I’m looking forward to the experience because it will be so much different from my current fieldwork.” But count on Thompson to end up in pediatrics “I really find working with children incredibly rewarding.”