Pediatric Services Services Adult Services Assistive Technology Services Rehabilitation Physician (Physiatrist) What are the Pediatric Services The SCCR Pediatric Service consists of 2 specialized, interdisciplinary teams: Neuromotor Team Autism Team Both teams provide on site (at SCCR), outpatient and outreach (off site) services. The Neuromotor Team provides inpatient care which is at the discretion of the Physiatrist. Services are offered in both official languages (English and French) and are accessible to children from birth to adolescence. Autism Rehabilitation Services Neuromotor Rehabilitation Services Neuromotor Speciality Clinics FAQs (Neuromotor) What is the Autism Team? We are an interdisciplinary team specializing in the provision of rehabilitation services for children with Autism Spectrum Disorders. Our team includes professionals in the fields of occupational therapy, dietetics, speech-language pathology, developmental paediatrics, behaviour analysis, social work and education. Our goal is to help children maximize their potential. We work together as a team to find effective and practical solutions for both individual and family’s needs. Who we are Our staff includes: 1 Behaviour Analyst (position not currently filled) 1 Clinical Dietitian 1 Education Liaison 1 Occupational Therapist 1 Social Worker 1 Speech-Language Pathologist 1 Developmental Pediatrician Who we help We have a provincial mandate and therefore serve the entire province of New Brunswick. Service to our clients is provided in their language of choice (French or English). We see school-aged children until their 16th birthday. Our mandate is to act as consultants, providing assistance to caregivers, therapists and teachers who are working with these children on a regular basis. Our team can help by providing consultation or training. We also offer comprehensive interdisciplinary assessments to guide intervention. Services we offer The SCCR Autism Team offers support as a centre of expertise. Children and their families travel to Fredericton for services such as in-depth, team-based assessment, program development or review, or feeding intervention. After the case management interview is conducted and the referral is deemed to be appropriate, family members, therapists, and school staff are encouraged to attend education sessions about Autism Spectrum Disorders and the teaching approach used by our team. Assessment and intervention is then conducted by team members to address priority goals identified through the screening process. Medical appointments in the Developmental Pediatrics clinic are typically scheduled during visits with the team or may be scheduled independently. What to expect when you visit Before a visit, we consult with caregivers and professionals involved with the child. During the visit, designated members of the team work together, focusing on the goals identified by the family. The result is a verbal summary to caregivers, followed by a written report describing our impressions and recommendations. We may also provide treatment or training materials such as pictures and/or handouts. We encourage caregivers and local professionals to attend appointments at the Stan Cassidy Centre in order to optimize treatment planning and to facilitate communication between all of the people involved in the child’s daily life. Video and teleconferencing options are also employed to enhance communication. How to get a referral Form: Rehabilitation Services Request (Paediatric Team – Neuromotor and Autism) We have two separate referral processes, depending on where support is needed. For home-based support, all referrals must be signed by a medical doctor, however, caregivers, therapists or school staff can begin the referral by completing the referral form. All referrals must be accompanied by medical and therapeutic documentation. After we receive a referral, caregivers are contacted in order to help is to understand their child’s needs as much as possible. With permission from caregivers, we may speak directly with those professionals involved with the child on a regular basis. If the referral is appropriate for our team, we then decide which team members would be best able to help the child. For school-based support, schools’ education support services teams (ESS teams) are encouraged to reach out to their district ESS coordinator to discuss further. All school-based referrals must be signed by the district ESS director or designate. All documents can be found on the ONE site, under the Resource section of the ESS Connect intranet page. Contact us Attn: Autism Team Stan Cassidy Centre for Rehabilitation 800 Priestman Street Fredericton, New Brunswick, E3B 0C7 Tel.: 506-452-5225 Fax: 506-452-5727 What is the Neuromotor Team? The Pediatric Neuromotor Team includes the child’s family, caregivers, school, and local clinicians. The goal of the team is to help children maximize their potential. We work together to find effective and practical solutions to meet the child’s needs. Who we are Our staff includes professionals in the fields of: Occupational Therapy Physiotherapy Physiatry (physicians with a specialty in physical medicine and rehabilitation) Speech-Language Pathology Dietetics Social work Psychology Nursing Education The team is led by a manager and supported by a rehabilitation assistant, secretary and scheduling clerk. Who we help We have a provincial mandate and as such serve the entire province of New Brunswick. Service to our clients is provided in their official language of choice (French or English). We do not carry a caseload of our own. Rather, we provide assistance to caregivers, rehabilitation providers and teachers who are working with these children on a regular basis. Our team can help by providing consultation or training. We support children’s rehabilitation programs by evaluating specialized equipment, providing short periods of intensive therapy or by visiting children in their own school or home. Photo caption: Neuromotor Team occupational therapist observes her patient making pizza with his father in the Paediatric kitchen. Services we offer Children may be seen on an inpatient, outpatient or outreach basis. They could be seen by a single service or by an interdisciplinary team. We cater our services to meet the needs of our clients. Single Service Occupational Therapy Works with you and your child to promote participation, access and safety during daily activities, leisure pursuits, and in becoming a member of their community as a student, volunteer, friend, worker and / or family member. Speech-Language Pathology Assists in the identification of Speech – language and swallowing disorders. Provides recommendations to: promote continued independence, maintain present skills for as long as possible and to create adaptive strategies when needed. Physiotherapy Provides assessment and teaching to promote movement, physical comfort and the ability to breathe and cough. Dietetics Assesses height, weight and what your child eats on a daily basis. Provides guidance when diet changes are suggested to improve health. Psychology Assessment and treatment for children, parents and families Adjustment to change, parenting skills, behavioural and emotional concerns, relaxation and pain management, anxiety, depression, PTSD. Social Work Counseling and support Connects families to resources and services. Liaises and advocates with community partners to support families within their local communities Team Service Screening visits (1 hour to 1 day) Assessment visits (1 to 3 days) Intensives (3 days or more) Photo caption: This young Paediatric Neuromotor patient (centre) sits with his interdisciplinary team during his last appointment at SCCR. What to expect Before a visit, we consult with caregivers and professionals. During the visit, designated members of the team work together, focusing on those areas most needing assistance. The result is a verbal summary to caregivers, followed by a written report describing our impressions and recommendations. We may also provide treatment or training materials such as pictures, handouts, or a videotape of therapy sessions. We encourage caregivers and local professionals to attend appointments as the Stan Cassidy Center in order to optimize treatment planning and facilitate communication between all of the people involved in a child’s daily life. Video and teleconferencing options are also employed to enhance communication. How to refer The Pediatric Neuromotor Team accepts referrals for children with neurological diagnosis (Cerebral Palsy, Neuromuscular Disease, genetic syndromes, Spinal Cord Injuries, brain injuries, etc.) Referrals can be initiated by therapists, school, parents, and other individuals, but must be signed by a physician. All referrals must be accompanied by medical and therapeutic documentation. After we receive a referral, parents are contacted in order to help us to understand their child’s needs as much as possible. With permission from parents, we may speak directly with those professionals involved with the child on a regular basis. Paediatric Team physiotherapist watches his patient use a walker. If the referral is appropriate for our services, we then decide which team members would be best able to help the child. With your help, we also decide the length of visit that is required. The child is prioritized for services according to the urgency of their needs. Contact us For more information on our services, how to refer, the status of your referral, or your appointment, please contact our resource-scheduling clerk at 506-452-5772. General inquiries and mail may be directed to: Attn.: Paediatric Neuromotor Team 800 Priestman Street Fredericton, New Brunswick E3B 0C7 Tel. 506-452-5772 Fax: 506-443-2600 FAQs – The Stan Cassidy Centre for Rehabilitation Paediatric Neuro-Motor Team The Neuromotor Speciality Clinics include the following: Cerebral Palsy Clinic Feeding Clinic Neuromuscular Disease Clinic Orthotics Clinic Tone Management Clinic (Botox, 2D and 3D Gait Anaylsis, Kenisiotaping, Serial Casting & Orthopaedic Clinics) Cerebral Palsy Clinic This CP patient works with Neuromotor Team physiotherapist. This multidisciplinary clinic is to review children with Cerebral Palsy as they develop into adulthood Chilren’s skills are assessed by a team, on a regular basis (yearly or bi-yearly), in areas such as mobility, tone, self care, communication, coping, resources/equipment, nutrition and sexuality. The SCCR team liaise with local therapists and school staff who carry out treatment programs and recommendations. Children are referred for specific services following their clinic visit. This may include: spasticity management program, orthotics clinic, team intensive Children who are new to the SCCR, with diagnoses Cerebral Palsy, are seen via the Cerebral Palsy Clinic. CP Clinic FAQ Feeding Clinic The Feeding clinic consists of Speech Language Pathology, Dietetics, Occupational Therapy, Physiotherapy, Psychology and Social Work. Therapists are involved based on the needs of the child and family. Who we help: Children (and their caregivers) with neuromotor and developmental diagnoses who have difficulty at mealtimes Local therapists who are looking for input Difficulties could include: limited food choices (picky eater) chewing and swallowing problems dislike or avoidance of certain food textures anxiety at mealtimes and lack of interest in food trouble going from eating through a tube to eating by mouth poor nutrition poor awareness of food in the mouth Neuromuscular Disease Clinic The Neuromuscular Disease Clinic provides services and support to children and their families affected by a variety of neuromuscular disorders. We use a holistic and family-centered approach to care. Our goal is to help children and adolescents maximize their potential. We work together as a team to find effective and practical solutions to meet your child’s needs. We accept referrals from your family doctor or paediatrician. Orthotics Clinic (on site and outreach) What are they? Orthotic leg braces are made with hard plastic materials, which fit around part of the lower leg and foot. Orthotics can be custom made by a certified orthotist or ordered prefabricated through a reputable company. At SCCR, a team of health care professionals, such as the physiotherapist, orthotist and physician will assess the child’s needs for orthotics. What are they used for? Orthotics can be used to help a child who is already walking to walk better by improving the movement or position of the ankle and foot, or knee. For example, children who walk on their toes may come down on their heels when wearing orthotics. As well, children who drag their feet when they walk may be able to pick up their feet when wearing orthotics. They can also be used to improve the position of the feet for someone who is standing, sitting or walking with feet that are rolling inwards or outwards. Tone Management Clinic (Botox, 2&3D Gait Analysis, Kinesiotaping, Serial Casting, Orthopaedic Clinic) Botox What is it? Botulinum Toxin is a nerve-impulse blocker, delivered by injection. By binding to nerve endings, it prevents signals that would normally allow a muscle to contract. BOTOX is usually used to prevent abnormal or increased muscle contraction. By blocking the nerve impulse, it can lower or possibly eliminate the tightness in certain muscles, and increase function. The injection tends to work within 72 hours to loosen the muscle and lasts for three to four months. The toxin is a very small amount of concentrate and this is diluted with normal saline (salt and water solution). How is it done? Prior to the procedure, a therapist (Physio or Occupational) will evaluate and videotape your child’s motor function. They will also measure flexibility, strength and muscle tone. This will take 1.5 hours. For the injection procedure, you or another family member should be present with your child and the physician. A local anesthetic cream may be applied 1 hour before injections. The procedure takes 10-20 minutes; each injection lasts only 5-10 seconds. The doctor cleans the skin with an alcohol swab. The medication is injected directly into the muscle with a small needle. Depending on the pattern of muscle tightness, several injections may be required. For some children the injections can only be done under sedation meaning that a hospital or may need to be booked. This is decided case by case. 2 & 3D GAIT Analysis What is it? Clinical gait analysis is used in many forms in clinical practice by the physiotherapist, physiatrist and other practitioners involved in analysis of gait. How is 2D GAIT Analysis done? The most common form of gait analysis is observational gait analysis (OGA) which is usually performed in the clinic setting by observing the client walk in the sagittal (from the side) and/or coronal (frontal) planes. Other instrumentation may be used along with this type of procedure including stop watches, videotape analysis (real time or slow motion) and foot markings. It is well known that although this method is the most convenient for gait analysis, there are problems with both validity and reliability in the planes it is intended to measure. In other words, it is very difficult to track what the body is doing during such quick motion in a 2- dimensional field. Also, this type of analysis assumes that the walking motion is planar which is a false assumption. How is 3D GAIT Analysis done? 3- dimensional gait analysis uses sophisticated technology to track motion, in this case walking, in order to carefully examine how the body segments move in space. Highly reflective markers are placed on the patient’s skin at specific anatomical points over the patient’s body. Electromyography (EMG) markers may also be placed to measure muscle activity. The markers are not painful in any way. 8 infrared cameras are placed around the gait laboratory in order to pick up reflective signals from the skin markers, and in this way track movement. Force plates are imbedded in the floor in order to measure forces from the foot. This gives us further information on joint torque and power as the patient walks. Kinesiotaping What is it? A child’s left arm is taped using Kinesiotape. Kinesio Tex® tape is a woven tape that stretches length-wise. It is made of cotton and does not require the use of an under wrap. Kinesio Tex® tape does NOT contain latex. Why is it done? The tape is used to assist a joint to hold a position, so an overstretched muscle is provided time to shorten. Overstretched muscles are at a disadvantage to work and therefore are often very weak. Once the muscle is given time to return closer to a typical length, it can be recruited for use more efficiently. This type of taping is also used: to provide tactile input and increase proprioception or awareness of a muscle or joint. As sensory awareness increases, more attention is given to an area of the body, which increases use and in turn increases strength. to assist in the release of facial restrictions or to relax an overused muscle. This allows more optimal alignment and decreased pain in an area. to position a part of the body in better alignment and allow muscles to contract and work in a better position – as these muscles contract in daily activities, they gain strength and control. to decrease swelling, edema and bruising – this will allow for more rapid healing and decreased pain. Serial Casting What is it? Children who have lost joint movement may be treated by using plaster or fiberglass casts to apply a slow stretch to the muscles and soft tissues around this joint. The casts are typically worn for 3 to 5 days and then removed. The following casts incorporate whatever gain in movement that has been achieved by the previous cast. Most children require 3 to 4 casts in a series, which may take several weeks. Why is it done? Paediatric physiotherapist casts a patient. Serial casts are used to help decrease muscle tightness and allow for better function and movement of a joint. It is the next step to use if stretching routines have not been effective for the child. Serial casts are often used after a growth spurt. How is it done? Serial casts are usually done with a child sitting on an examination table, or lying on their stomach. The body part being casted will be wrapped in padding and cotton layers before applying the cast material. The therapist will hold the desired position of the body part until the cast is set. In the case of a foot cast, the therapist will finish the cast by applying a heel. Usually, children are asked not to walk on the cast until it has set unless using rigid fiberglass. This is stronger material than a standard plaster cast and allows the child to weight-bare sooner. Orthopaedic Clinic (on site) The Orthopaedic Clinic is a multidisciplinary clinic, in partnership with the orthopaedic department at the IWK in Halifax, Nova Scotia. Children are assessed by SCCR clinicians, physiatrists and by visiting an IWK orthopaedic surgeon. Clinics are run multiple times throughout the year at the SCCR. Children may be referred to the Orthopaedic Clinic by SCCR physiatry. Neuromuscular Disorder (NMD) Clinic Frequently Asked Questions What is the age range of clients we see? We provide services to children and families with neurological impairments from birth to adolescents. We have not defined an age for “adolescents” as we feel that every child is unique and their readiness for transfer to adult services is dependant on many things. When the staff and the family feel the transfer is timely, the adolescent is seen jointly by both adult and paediatric services to establish future goals and plans. I’m new to New Brunswick We provide rehabilitation to children with neurological impairments in New Brunswick. We are a consultative service that provides assessment, consultation, education, equipment and some treatment to children and their local team. We offer Tone Management (Botox, Serial Casting, Kinesiotaping, etc.), Orthotic Clinics, and Intensive Treatment (1-2 weeks of intensive treatment post op or if there is an emerging skill that we’d like to capitalize on). We also have an Adaptive Seating Service and an Assistive Technology Service (which includes Augmentative Communication) here at SCCR. Unfortunately we do not have a Neurologist on staff. We do however have Physiatry. We do require a signed physicians referral to gain access to our services. For new families to the province how do we get referred to the Stan Cassidy Centre? We suggest that you have a referral from a Family Physician, Paediatrician or Neurologist. This could include: Your new Family Physician here in New Brunswick A Paediatric Neurologist (there are 2 in Saint John – Dr. Meek and Dr. Wendy Stewart) A Paediatrician We will accept referrals from your current physician, even if you are not yet in the province. A referral for services for regular therapy; either EMP (Extra Mural Program) if the child is school aged (they will be seen in school – EMP has OT, PT on staff) or if the child is not in school, they should be referred to their local hospital for rehab. Because we are a tertiary care centre, we like for services to be in place in the individual’s home town so that when we do see the child, we have someone to consult to and offer recommendations to. The Stan Cassidy Centre Physiatrist would want to see the child soon after moving to the province. They can help to navigate the system and ensure that your child is receiving all of the services required. Our Paediatrics team will also see your child at the same time in order to meet the family (we’ll likely be involved in his/her care periodically throughout his/her life in New Brunswick). Once the SCCR team receives the referral, we pass it on to our nurse, who will call you to get an idea of your goals. She also calls the local therapists to see how we can help and support them (in new cases, the local team may not be established yet, so getting a copy of therapy notes and medical information from former rehab providers would be helpful). A “plan” is then developed. This includes information on how long should your child should come to Stan Cassidy in order to best meet his needs (we have on site accommodations to make things simpler for families). Essentially we try to provide care (this includes equipment) to satisfy the child’s needs. How long is the waiting list to see the team at Stan Cassidy? Our wait time varies and is dependant on your child’s needs. Once your child is seen, we will make recommendations and develop treatment plans that we pass on to the local clinicians. Wait times also vary depending on the services that were determined would best meet your child’s needs as well as on the disciplines required for your child’s visit (physiotherapist, occupational therapist, physician, etc.). Our typical wait time varies from 2-8 months from the date of referral. What do I need tog do to get my child referred? The referral process is as follows: a referral is received (with doctor’s signature & indication of a clear goal) referral is given to the case manager case manager contacts parents and local team, school, physician, and others as required to establish goals case manager presents referral at intake meeting (held biweekly) with recommendations — representatives from each discipline decide on priority and length of stay client is issued an appointment by the scheduling clerk case conference is held 2-5 weeks prior to your visit for planning, completion of schedule, discussion disciplines contact their local counterparts on-site visit (your appointment day at Stan Cassidy) post visit follow-up with local team by teleconference, videoconference outreach, report What is the cost these services? There is no cost for our services. We are funded by the public system (Department of Health, NB Government). Funding for special equipment is however unique to each child. Some families have private insurance if not; families can apply to the Dept. of Social Development to be granted a HC (Health Card). Some HCs are financially based and some are both financially based and needs based. HCs pay for equipment (but not all equipment, and sometimes not at 100%) – these HCs are really dependant on the family’s financial situation and the needs of their child. What does SCCR look like? Parking SCCR is equipped with disabled parking spaces at the front of our building for visitors/patients with mobility restrictions. If you do not have an issued disabled parking sign for your vehicle, you may obtain a temporary one from our front desk receptionist for the duration of your visit to SCCR. Visitors without mobility restrictions need to use the main Dr. Everett Chalmers general visitor parking area and pay the appropriate fees. Accommodations We are equipped with Transitional Living Suites (TLS). The TLS is an accessible, self-contained living space on site at the Stan Cassidy Centre for Rehabilitation. They are designed for patients requiring intensive assessment and/or rehabilitation but who do not require intensive nursing care. New accommodations are scheduled to be built in 2012 – the new Kiwanis House is to be built adjacent to the Stan Cassidy Centre for Rehabilitation. What should I bring for an appointment? You should bring along any specialized equipment, orthotics, your child’s favorite toy/blanket (comfort items). A visit leader is assigned to each visit; this person will always be a therapist involved with your child’s upcoming visit. You will be contacted prior to your visit to discuss any specific details of the visit and advise you of what you need to bring to your appointment.