"Physical medicine and rehabilitation (PM&R), also known as physiatry /fɨˈzaɪ.ətri/ or rehabilitation medicine, is a branch of medicine that aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. A physician having completed training in this field is referred to as a physiatrist or rehabilitation medicine specialist. Physiatrists specialize in restoring optimal function to people with injuries to the muscles, bones, tissues, and nervous system."
Tessa had a follow-up appointment with her physiatrist on Friday, 8.7.2015. I like to document these visits here on my blog, but honestly, it gets a bit overwhelming. It is a lot of information that we have to cram in our heads and then ultimately come to a decision on for what's best for Tessa. Dr. Wright drew some diagrams at this last appointment and they are really helping us process everything.
The graph below helps outline our treatment options to consider for Tessa
Focal vs. Generalized and Reversible vs. Irreversible:
Focal and Reversible:
1. Botox injections
2. Phenol injections
3. Casting
Focal and Irreversible:
1. Orthopedic Surgery
Generalized and Reversible:
1. Oral Medications (Baclofen)
2. Baclofen Pump (Surgical procedure)
3. DBS - Deep Brain Stimulation
(performed at Cooks in Ft. Worth)
Generalized and Irreversible:
1. SDR - Selective Dorsal Rhizotomy
The illustration below is slightly more complicated and I won't attempt to explain in super specific detail. I have to admit though...the term "GABA" was definitely a new one on me ;)
The overall summary of what we learned above is that Tessa could receive Botox injections in her Hamstrings, Gluteus and Adductors in order to help reduce overall hip thrusting, which would allow her more functional movement and better positioning, leading to the potential for more weight bearing opportunities which could in turn improve the approximate 1/3rd subluxation in her left hip.
Phenol injections could be done in her Hamstrings and Adductors as well, but would have to be performed under anesthesia at OU Medical.
Botox and Phenol injections fall under the Focal and Reversible treatment options and at this point are what we feel most comfortable doing, as a starting place. Tessa currently takes 45 mg of Baclofen orally a day to help manage her spastic cerebral palsy. If we have success with the Botox injections, ideally we will be able to reduce the amount of oral Baclofen. That's a huge plus because a side effect of Baclofen is seizures...so any chance we have to improve upon that, we would definitely like to consider it!
Here is a basic and helpful diagram of the Baclofen pump. This is just another option for us to potentially start wrapping our heads around.
Dr. Wright has clinics at the JD McCarty center the first Thursday and Friday of each month. The first of September felt a little too quick to try to process everything and also with school just starting, so we're planning on BOTOX injections either the 1st or 2nd of October.
~Whitney
No comments:
Post a Comment