Happy Halloween!

by Shriners on October 30, 2014

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Halloween Safety Tips

by Shriners on October 24, 2014

Halloween 2014 safety tips

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Tone Management Program

by Shriners on October 21, 2014

Each year, Shriners Hospitals for Children cares for thousands of children with cerebral palsy (CP). Cerebral palsy is a group of disorders affecting movement, muscle tone, and coordination. CP is the most common disorder affecting children up to five-years-old. Children with CP can exhibit a wide range of symptoms that can be mild or severe. Signs of cerebral palsy usually appear before 18 months of age. “Parents often note their child is not achieving normal developmental milestones such as smiling, sitting, crawling, or walking,” describes David Westberry, M.D., pediatric orthopaedic surgeon at Shriners Hospitals for Children — Greenville. He says, “Babies with cerebral palsy can either have very little muscle control or be especially rigid and may sometimes favor one side of their body over the other.” When a child has muscles that are rigid, otherwise known as spasticity, they have stiffness and movement difficulties. Greenville Shriners Hospital knows that patients with spasticity need a wide-range of care and services in order to thrive. This is why the hospital’s Tone Management Clinic offers a clinic setting where patients can be evaluated and treated, all in one location, by a team of specialists.

Shriners Hospitals for Children — Greenville’s Tone Management Clinic is comprised of a multi-disciplinary team consisting of five physicians with specialized training in pediatric orthopaedics, neurosurgery, neurology, physiatry, and genetics. The physicians are supported by occupational therapists, physical therapists, social workers, registered nurses, physician assistants, nurse practitioners, Motion Analysis Laboratory representatives, and an intrathecal Baclofen therapy specialist. The treatment plans that are developed in this very comprehensive clinic are individualized for each patient’s special needs. Examples of these plans of care can include recommendations for oral baclofen, baclofen trials to determine appropriateness of a baclofen pump placement, Botox injections, orthopaedic surgery, stretch casting, and physical and occupational therapies.

Dr. Westberry says, “Each child’s mobility and subsequent quality of life can be improved through the coordination of their comprehensive care. One of the strongest arguments for traveling to a Shriners Hospitals for Children is that, once there, the orthopaedic and rehabilitation services provided are comprehensive, negating the need for families to travel all over town to see specialist after specialist.”

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Meet Cyntell

by Shriners on October 15, 2014

CyntellIt wasn’t Cyntell Logan’s curving spine that was pressing on her lungs that hurt her worst. It was the bullying she received at school. At eleven-years-old, Cyntell was diagnosed with scoliosis, a curvature of the spine. “I noticed as she was getting dressed one morning that her back was twisting,” said Cyntell’s mother, Vonuya. She took Cyntell to her pediatrician who was quite concerned about the curvature and referred her to Shriners Hospitals for Children — Greenville for treatment. When pediatric orthopaedic surgeon Michael Mendelow, M.D., evaluated Cyntell, he discovered her curve had already progressed to a dangerous 103 degrees. In fact, her spine was already curved so much her breathing function was restricted. Dr. Mendelow says, “Without surgery to straighten and fuse her spine, Cyntell’s spine would continue to curve more and more, causing progressive restriction on lung function, as well as increasing change in body shape, physical appearance, and self-image.”

By the time Cyntell was referred to the Greenville Shriners Hospital, her misshapen back was not just noticeable to her parents; the hump on her right side was also obvious to her peers at school. “I was bullied badly. It took away any positive thoughts I had,” says Cyntell. Her mother recalls, “The bullying took away all of my daughter’s confidence. She never wanted to do anything anymore.”

At the Greenville Shriners Hospital, Dr. Mendelow performed a successful life changing surgery to straighten fifteen-year-old Cyntell’s spine. With rods, hooks, and screws in place, Cyntell’s curve was straightened to 42 degrees. Following the surgery, physically, Cyntell’s shoulders and hips were now even and her back was flat.

The surgery not only made a difference in her appearance; it also made a difference in her outlook in many ways. Cyntell explains, “Before my surgery, I did not have an outlet for my emotions. Through my recovery, I discovered a whole new side of myself. I found out I like writing poetry, music, and singing.” With her newfound confidence, when Cyntell returned to school, she discovered that many other kids at her high school also had scoliosis, but had been hiding it to avoid bullying. “Cyntell began telling the other kids about her journey. She explained what she went through, and the kids began treating her like a celebrity! She’s on top of the world now,” says her mom.

Poised, articulate, and exuding confidence, Cyntell sums up her experience saying, “Shriners Hospitals for Children — Greenville and Dr. Mendelow really changed my life. At the hospital I met other children with the same condition, I was healed, and I got my confidence back. Greenville Shriners Hospital is so different from anything you can imagine. They welcome you with open arms. You feel safe. This hospital gives you love.”

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Patient Ambassador Wins Homecoming Queen

by Shriners on October 13, 2014

Logan4We would like to congratulate patient Logan Hopper. Logan was named her high school’s Homecoming Queen! Logan says the Greenville Shriners Hospital isn’t just a place where she feels at home; it’s a place that has changed her life.

Logan was born three months early and weighed just one pound and fourteen ounces. She was diagnosed with cerebral palsy (CP) early on and because of her small size at birth, spent four months in a neonatal intensive care unit (NICU).

Logan began receiving treatment here at the Greenville Shriners Hospital for her diagnosis of quadriplegic CP with bilateral foot deformities when she was two years old. Cerebral palsy (CP) is a group of disorders affecting movement, muscle tone, and coordination. Signs of cerebral palsy usually appear before 18 months of age. Logan had been diagnosed at four months. “Parents often note their child is not achieving normal developmental milestones such as smiling, sitting, crawling, or walking,” describes David Westberry, M.D., pediatric orthopaedic surgeon at Shriners Hospitals for Children — Greenville. He says, “Babies with cerebral palsy can either have very little muscle control or be especially rigid and may sometimes favor one side of their body over the other.”Logan

Greenville Shriners Hospital knows that patients with CP need a wide-range of care and services in order to thrive. Therefore, early interventions for Logan consisted of Botox injections in her muscles, wearing orthotics, physical and occupational therapy, and a visit to the Motion Analysis Laboratory in 2008 where her gait (walking pattern) was measured and evaluated by an interdisciplinary team to develop the optimum care plan for her individual needs.  After surgery when she was eleven to have her hamstrings lengthened and toes fused, she was fitted for AFOs (leg braces) at the hospital.

Today, Logan no longer walks on her toes and is able to engage in the kinds of activities that she used to watch from the sidelines. She enjoys karate, modeling, and is an enthusiastic participant in Miracle League sports. “I don’t walk on my toes anymore,” she says, “so I can walk and run faster and I don’t get tired as easily. Shriners Hospital changed my life!”

The right interventions at the right time is the key to helping a child thrive. In Logan’s case, she credits the hospital for more than her physical progress. “I used to cry every night because my legs were so tight they hurt. Not anymore!” she says, smiling.

Logan may have been born small, but she definitely dreams (and achieves) big. Her future plans include learning to drive a car and college. Her career goal…radiology, of course!

Logan5Logan3

 

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CJ and CarolynnChildren with CP have a wide range of impairments and disabilities, and many of them require a wide range of services.  To best meet their needs, our hospital favors a multi-disciplinary approach, utilizing a team consisting of pediatric orthopaedic surgeons, nurse practitioners, physical therapists, occupational therapists, orthotists, and care coordinators.  This team interfaces with the child, the family, community-based therapists, and consulting physicians such as neurologists, geneticists and neurosurgeons.

Did you know?

  • The needs of children with cerebral palsy are based primarily upon their age and the severity of their CP
  • One of the hallmarks of CP is delayed achievement of motor developmental milestones, such as sitting and walking.  Children with CP may not begin to walk until they are between 3 and 5 years of age
  • Another characteristic of CP is increased muscle tone with the development of spasticity and fixed shortening of the muscles with growth

Treatment for children under five years of age

  • The hospital provides orthotics to maintain optimal alignment of the upper and lower extremities as the child is growing.  In some cases the orthoses also help the child to walk by providing stability.  The hospital also provides assistive devices, such as walkers and Loftstrand crutches that help the child develop his ability to walk.
  • Children with spastic CP are managed by serial stretch casting and the judicious use of botulinum toxin A (botox), which is injected directly into the muscle in order to relax it and facilitate stretching by a therapist, with a cast, or with an orthotic.

Between 5 and 7 years of age, it becomes clear which children with CP will be able to walk, and which will require a wheelchair for mobilityphoto

For kids that don’t walk:

  • We have a seating team that develops a plan for a seating system that best meets the child’s needs.  With such a prescription, families can contact a vendor in their own communities for the manufacture of the wheelchair.
  • This seating team will also evaluate existing seating systems and make recommendations for modifications to accommodate the growing child.

For kids that can walk:

  • Their gait pattern is frequently disrupted by muscle spasticity and contracture, skeletal malalignment, and deficits of balance and motor control
  • The gait pattern can be significantly improved by the proper use of therapy, orthotics, and orthopaedic surgery.
  • Clinical decision making for these children is based upon our understanding of the biomechanics of normal gait and the pathophysiology of gait disruption associated with CP. The central component to this approach is the use of quantitative gait analysis, which utilizes computers and cameras to precisely measure how a child walks.  With this information, the gait deviations can be identified, which leads to the selection of the appropriate treatment options. Quantitative gait analysis is also utilized to assess the outcome following an intervention such as surgery.  Quantitative gait analysis is performed at the Motion Analysis Laboratory (MAL).

Orthopaedic surgical options:

For the non-ambulatory child, surgery is focused upon the hips, the upper and lower extremities, and the spine

  • Soft tissue and skeletal surgeries may be performed about the hips to prevent the development of painful dislocation that can occur due to muscle imbalance.
  • Soft tissue and skeletal surgeries are frequently utilized to correct foot and ankle alignment for these children in order to facilitate orthotic and shoe wear.
  • Children who are non-ambulatory may develop scoliosis, which compromises sitting balance, and in severe cases, may be life threatening due to inhibition of heart and lung function.  In these cases, correction of the spinal deformity by posterior fusion is performed.
  • Soft tissue and skeletal surgeries for the upper extremities are utilized to promote hygiene, and in some cases, to improve function.

photoFor children that can walk, surgery is primarily focused on the upper and lower extremities

  •  Soft tissue and skeletal surgeries may be performed about the hip, knee, and ankle to improve range of motion and positioning of these joints.
  • Soft tissue and skeletal surgeries for the upper extremities are utilized to promote hygiene, and in some cases, to improve function.
  • Soft tissue and skeletal surgeries are frequently utilized to correct foot and ankle alignment in order to facilitate orthotic and shoe wear as well as improve the loading pattern of the foot.
  • Skeletal surgery on the lower extremity may be necessary to correct common gait problems such as in-toeing or out-toeing.

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Dr Westberry and Gibson Through partnering with other organizations, pediatric orthopaedic surgeons at Shriners Hospitals for Children — Greenville are changing lives thousands of miles from home. Most recently, David Westberry, M.D. and T. Whitney Gibson, D.O. performed orthopaedic surgeries during a mission trip to Honduras with the Baptist Medical & Dental Mission International. What made this mission trip even more special was the surgeons were joined by two scrub techs also from the Greenville Shriners Hospital, Ashley Carpenter and Renee McMahon. Led by Drs. Westberry and Gibson, the team performed a total of forty-five surgeries during their four day trip. Having participated in several mission trips in the past, Dr. Westberry says, “It was very helpful to have a fellow Shriners Hospitals for Children physician and our hospital’s scrub techs take part in the same mission trip as me. We were able to work and perform as a team, just as we do here in the states.”

Of his time in Honduras, Dr. Gibson says, “This was one of the most rewarding trips both professionally and spiritually that I have ever taken. It was absolutely wonderful to work with others throughout the country and provide medical care for the people of Honduras.” Dr. Westberry says he enjoys taking part in mission trips because it gives him “the opportunity to serve the less fortunate. People who live in the area of Honduras we went to have very few health care options or resources. By working with other organizations, I am able to help provide a health care service that these people otherwise wouldn’t get.”Photo

“Anyone who ever believes that they have it bad in this country needs to visit any third world country and they will then realize how truly blessed we are here,” Dr. Gibson says. That sentiment is echoed by Dr. Westberry, “If given the chance, everyone living here should experience what third world culture looks like. You learn to appreciate and be thankful for what we have here in the states.”

Dr. Gibson has also participated in mission trips to Haiti and Bosnia. This mission trip was Dr. Westberry’s fourth to Honduras. He has also participated in mission trips to Kenya, Russia, and Nicaragua.

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Patella Dislocation

by Shriners on October 1, 2014

A common injury among athletes, a patella dislocation, otherwise known as the knee cap slipping out of place, causes significant pain and swelling. A direct blow or a quick twist of the leg can cause the patella to dislocate. A dislocated patella often slips sideways and around to the outside of the leg, causing the ligaments holding the patella in place to stretch.

Most dislocations can be put back into correct positioning by a medical care provider. However, if a patella dislocation reoccurs, it is time to visit an orthopaedic surgeon. Shriners Hospitals for Children — Greenville’s pediatric orthopaedic surgeon, T. Whitney Gibson, D.O., says “After a patella dislocation has occurred more than once, the chance it will happen again rises to 50-60%. Multiple patella dislocations leave the patient in extreme pain, with severe swelling of the knee, and often causing poor balance. It is at this point, we begin looking at surgical options to stabilize the knee cap.”

In order to stabilize the knee cap, the loose ligament allowing the knee to dislocate, the medial patellofemoral ligament (MPFL), must be replaced. Dr. Gibson explains, “In medial patellofemoral ligament reconstruction, we are re-creating the anatomy of the knee. We use the patient’s hamstring tendon and secure it through a hole drilled in the patella and femur, thereby recreating the anatomic medial patellofemoral ligament. This stabilizes the knee cap preventing it from dislocating again and allows patients to return to their active lifestyle.” For six to eight weeks following MPFL reconstruction, patients wear a knee immobilizing brace. This is followed by extensive rehabilitation before returning to normal activities.

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Straight from our patients …

by Shriners on September 29, 2014

Thank you olivia's messageThank you

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What is Ponseti Casting?

by Shriners on September 24, 2014

Ponseti castingClub foot is a one of the most common birth defects seen in the lower extremity.  It is characterized by the foot being turned to the side. The foot may even appear to be lying on its side with the bottom of the foot facing in towards the middle. Severe forms of clubfoot affect 5,000 babies (about 1 in 735) born in the United States each year. Shriners Hospitals for Children® — Greenville has two physicians who are trained in the non-operative treatment of club foot called the Ponseti Method. David Westberry, M.D., says he practices the Ponseti Method because “casting provides a slow, controlled correction of the clubfoot deformity and helps to avoid the need for extensive surgical releases which can lead to scarring and stiffness of the foot.”

A certified physician initiates the Ponseti Method of serial casting very soon after the baby is born when the baby’s ligaments, joints and tendons are the most flexible. The method includes gentle massage and moving of parts of the foot to stretch the tight or shortened structures slowly into a good position. A long leg cast then holds the foot in place for about a week. During this time, the muscles and ligaments stretch enough to allow a little more correction in the foot’s position. The cast is taken off and the foot is again massaged or stretched and moved into a more correct position. A cast is then reapplied. Dr. Westberry says “the cast is changed weekly for 5 to 6 weeks. After the sixth cast, a minimal surgical procedure is done to lengthen the heel cord tendon. A final cast is left in place for 3 weeks, and then the child is placed in a foot brace, until age four, to maintain the correction and prevent recurrence.”Dr. Westberry

Currently, the Ponseti method is an effective treatment for greater than 90% of idiopathic clubfoot. For most children, the Ponseti Method casting results in a foot which is near normal in shape, is comfortable in a standard shoe, and functions comfortably.

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