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Miles of Motivation: Alice Races Ahead of AMPS

Miles of Motivation: Alice Races Ahead of AMPS

by | Nov 29, 2024 | Psychology, Sports Medicine

12-year-old Alice is racing towards her dreams, confidently managing each day and creating her own path! With a passion for running, she participates in cross country for her school and the Amateur Athletic Union (AAU). After securing fifth place in AAU’s 5K, Alice began experiencing knee pain, which worsened following an injury during P.E. class in 2022. Despite physical therapy and using crutches, her condition didn’t improve. Alice had moments of extreme pain that prevented her from even walking. Unable to find a solution, Alice’s mom, Lindsey, sought help from Scottish Rite for Children in May 2023.

Sports medicine physician Jacob C. Jones, M.D., RMSK diagnosed Alice with amplified musculoskeletal pain syndrome (AMPS). Defined by Psychology fellow Diana Tinsley, Ph.D., AMPS is a chronic pain condition that causes prolonged pain, even though there is no identifiable pain source. “The pain sometimes starts with an injury,” Dr. Tinsley says. “Even though the physical injury heals, the pain persists and can spread throughout the body or even worsen in severity.”

Her condition required a multidisciplinary team of experts in sports medicine, physical therapy and psychology to reintroduce her to her love for running. Lindsey says Dr. Tinsley and physical therapist Ashley Ratliff were key motivators throughout Alice’s care journey. “There were many tears and ‘What if?’ moments during Alice’s treatment,” Lindsey says. “It’s important to truly lean on your care team and follow through with the work they give you to do at home – no matter how hard it may be!”

Alice’s Scottish Rite team worked to create a comprehensive treatment approach that set her transformation into motion. Her goal was to learn how to move through the pain and get back to daily life. Dr. Tinsley provided Alice psychological support through pain management strategies and helped her set manageable goals to work into her day-to-day schedule, such as leaving her crutch at home when doing errands. Soon, Alice went from relying on crutches to walking without assistance altogether. “Her pain had taken over her life,” Dr. Tinsley says. “Pain flares can happen especially when stress increases. We try to put her immense progress into perspective and continue to encourage her.”

Physical therapy for Alice was trickier, as there was no clinical evidence of her injury. However, Ashley’s exercises focused on desensitizing Alice’s knee to decrease the pain signals to her brain and improve Alice’s knee function. Similar to Dr. Tinsley’s approach, Ashley slowly decreased Alice’s use of crutches to help her regain muscle in her knee from not bearing weight on it. “The focus was on making small goals at a time to gradually work to her overall goal of running again,” Ashley says. “This involved a lot of communication between Alice and I to ensure she was being challenged, but also that she had appropriate time to cope and work through new challenges.”

Since Alice was a competitive runner, they alternated between gym sessions and aquatic therapy to improve her pain tolerance for her running return. Alice’s care journey continued at home, with her Scottish Rite care team and family collaborating to decrease her fear of movement. “Alice had such success based on her participation with Dr. Tinsley and being diligent with her physical therapy exercises at home,” Ashley says. “Patients with AMPS need support at home to encourage their progress.” Alice slowly transitioned from running in the pool to the treadmill, eventually running 6 miles without discomfort. Due to her dedication to her passion, Alice made excellent progress and was discharged from physical therapy!

Alice

Inspired by her care, Alice is now encouraging other kids with similar diagnoses. She has published a journal titled “Today is My Day!”, a mindfulness journal dedicated to those who have anxiety or depression. It encourages self-reflection with the goal of taking steps to appreciate life more. Additionally, Alice safely returned to cross country and is continuing to build her strength to achieve her dream of being a professional runner! Her success is a testimony of the support from her Scottish Rite care team and family. “From the smiles we get from the front desk to excellent care, our overall experience has been amazing,” Lindsey says. “Without Scottish Rite, Alice would not be where she is today and doing what she loves!”

Do you have a story? We want to hear it! Share your story with us.

Modern Luxury: Champions for Change

Modern Luxury: Champions for Change

by | Apr 26, 2023 | Press Coverage, Psychology

Scottish Rite for Children is leading the charge to ensure that children’s mental health is top of mind.

By. Abra Garrett

In 2021, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association joined together to declare a national state of emergency in children’s mental health. Drawing on data from the National Survey of Children’s Health, 2022 showed children in the United States to be experiencing unprecedented rates of depression and anxiety. Scottish Rite for Children (scottishriteforchildren.org) has worked extensively treating kids with orthopedic conditions and researching how these disorders impact their mental health. To be seen by their in-house psychologists, a child needs to be an orthopedic patient at Scottish Rite; however, their expertise is useful for all parents, teachers and caregivers.

Dr. Jill M. West, the director of psychological services at Scottish Rite for Children and a licensed pediatric psychologist, as well as the parent of two young children, understands the importance of talking about mental and behavioral health, both personally and professionally. “The rates of mental and behavioral health needs of children and adolescents have steadily increased since 2011,” West explains. She says this change corresponds with the growing availability of smartphones and daily usage becoming a ubiquitous part of being an American youth.

“COVID-19 undoubtedly exacerbated an already building problem,” West says. “It’s not all bad, though—kids and teens appear to feel more comfortable sharing what they are experiencing and reaching out for help.” She says this helps to decrease stigma around mental and behavioral health needs and is serving as a catalyst for efforts to attempt improving access to care.

“Unfortunately, the demand for mental and behavioral health services presently has outpaced the number of clinicians available to offer support in most places, yielding long waiting lists and sometimes leaving parents feeling helpless,” West says. Tools like the Stress Management Workbook, created by the staff at Scottish Rite for Children, give families access to strategies they can begin to implement on their own.

For additional help, West had suggestions for healthy ways for parents and children to interact with digital media together. “Another one of my favorite strategies is the idea of co-using screens with your kids,” she says. “For instance, if your child loves TikTok or loves playing Minecraft, make a point to view it with them for 15 or 20 minutes per day.” She explains this gesture can take an activity that is usually done independently and make it an activity that becomes more social. “Spending time engaging with your child in something they enjoy is important, and it may naturally spark conversation or interest in what they are doing,” West says.

Parenting-related stress is an important variable to attend to as well. “You may be feeling as though every time you look at social media, there is another recommendation about how to be a ‘better’ parent,” West says. “That can be overwhelming and confusing when you know you are already doing your best.” She recommends setting aside some time each day that is screen-free, for you and your children, to give everyone a chance to reset and focus on real-life connections. “Remember that your pediatrician’s office is also a good place to bring up concerns about your child’s mental or behavioral health,” she says. “Primary care practices increasingly have access to embedded or co-located behavioral health services and can make a referral for services.”

Meanwhile, in Houston, Texas Children’s Hospital (texaschildrens.org) announced in December of 2022 the implementation of a communitybased approach to the rising pediatric behavioral crisis. One of the nation’s largest children’s hospitals, Texas Children’s raised over $11 million to launch several behavioral and mental health initiatives, which include the following priorities: training frontline pediatricians on behavioral healthcare, embedding psychiatrists and psychologists in Texas Children’s Pediatrics clinics, building an intensive outpatient program, increasing emergency center staff and safe treatment spaces, and implementing specially designed programs to help employees identify warning signs of suicide and tools for navigating these challenging situations. “These services are desperately needed, and we are committed to providing them because we believe that the behavioral and developmental health of children, adolescents and teens is just as important as their physical well-being,” says Dr. Kirti Saxena, chief of psychiatry at Texas Children’s Hospital and associate professor of psychiatry and behavioral sciences at Baylor College of Medicine.

While the statistics can be daunting, if not downright discouraging, it is vital to note that some of the most celebrated experts in the state have made it their mission to address head-on the issues that our children, teens and young adults are facing today. With their commitment to normalize the conversation and proactively address the challenges that have accompanied the last decade plus, parents and caregivers will have access to guidance and expertise to help navigate these unprecedented times.

Read the full issue.

Ten Ways To Manage Pain Without Medication

Ten Ways To Manage Pain Without Medication

by | Aug 15, 2022 | Psychology

Whether following an injury or a surgery, pain management is an important factor in many orthopedic conditions. Our psychology experts provide our patients with the necessary techniques and skills to manage their pain, preventing the need for extensive medications. Much of pain management is based on mental perception. Pediatric psychologists Emily Gale, Ph.D., L.P., ABPP, and Emily Stapleton, Psy.D., explain how to manage pain using psychology.
 
Importance of Pain Management
 
Nobody wants to be in pain, and ongoing or chronic pain can lead to mental health issues, such as anxiety and depression. Pain management is important to prevent increased stress levels and improve comfort in daily life. “Non-pharmacological pain management interventions are important because they allow patients to increase comfort for continued function, therefore supporting overall quality of life and allowing them to stay involved in the activities and sports they love,” Stapleton says. “Individuals who use these strategies also tend to rely on medications less, thus experiencing fewer side effects, decreased drug dependency and have reduced health care costs.”

Emotions and Pain Management
 
Our emotions and behaviors can directly impact our perception of pain. “The experience of pain is a multifactorial experience in our brains — multiple centers, including the limbic system, which is involved in emotional processing, help us understand pain,” Gale says. “In fact, the International Association for the Study of Pain defines pain as ‘an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.’ Therefore, emotion management is a critical part of managing pain. Specifically, negative emotions often amplify the intensity of pain while positive coping skills can mediate the experience of pain.” Different psychology methods can allow patients to regulate their emotions and work through painful situations.
 
Pain Management Techniques
 
Our team of experts have many tips to help patients cope with pain. The following techniques can help manage pain:
 

  • Eat healthy meals at regular times throughout the day.
  • Be sure to get plenty of sleep to refuel your body.
  • Stay active and exercise regularly.
  • Address any concerns with mood (i.e. poor mood, irritability).
  • Use skills such as:
    • diaphragmatic breathing
    • progressive muscle relaxation
    • guided imagery
    • positive self-talk
    • stress management

 
Diaphragmatic Breathing
Diaphragmatic (belly) breathing is a technique that strengthens the diaphragm while deeply breathing.

  • Use the diaphragm and expand your belly instead of the upper chest muscles.
  • Diaphragmatic breathing can help you relax, breathe more easily and strengthen your diaphragm.

Diaphragmatic breathing does not take the place of medicines or other treatments, but it can help you breathe more easily in certain situations. Learn how to use diaphragmatic breathing in our Pain Management Workbook.
 
Progressive Muscle Relaxation
Progressive muscle relaxation (PMR) or “Tense and Relax” is the simple practice of tensing, or tightening, one muscle group at a time followed by a relaxation and release of tension in that muscle group. Practicing this skill helps you get better at recognizing and reducing tension in your body and decreasing stress, anxiety and discomfort. PMR practice allows the muscles to relax more thoroughly after releasing, which makes letting go of physical tension more effective and increases relaxation.
 
Guided Imagery
Imagining a relaxing place or thinking relaxing thoughts can reduce pain and decrease stress. You can use imagery to imagine you’re somewhere else as a distraction from your pain and to feel more relaxed.
 
Positive Self-Talk
Self-talk is the inner voice or internal conversation that we have with ourselves. The way you talk to yourself can have a big influence on how you feel and act. Negative thoughts or self-talk increases stress, so with practice, you can learn to shift negative thoughts to positive ones and decrease stress using this cognitive-behavioral technique.
 
Learn more about the skills and psychology approaches used to manage pain in our Pain Management Workbook to assist patients and others with managing their pain. Download it now to get started. Learn more about our Psychology services.

Fear-Avoidance in Athletes

Fear-Avoidance in Athletes

by | Aug 9, 2022 | Psychology

What is Fear-Avoidance?

Athletes who experience an injury often struggle with fear-avoidance once they are physically cleared to return to sports. Out of fear of pain or injury, fear-avoidance is when a person develops and maintains chronic pain due to avoiding certain motions or behaviors. “Fear-avoidance is a model that describes how movement and pain-related fear can impact the development and maintenance of chronic pain and increased sensitivity to pain,” pediatric psychologist Emily Stapleton, Psy.D., says. To avoid perceived pain or injury, athletes may believe they cannot complete some rehabilitation exercises and as a result, the athlete may:

  • hesitate when completing exercises
  • not put in effort
  • hold back in training or competition
  • increase their dependency on family, coaches or medical team

The more the athlete does these things, the greater the anxiety becomes about pain, movement and reinjury. This fear-avoidance cycle is shown below:

What Does Fear-Avoidance Look Like in the Athlete?

“In athletes, fear-avoidance may look like hesitation when completing necessary exercises for recovery or decreased effort in rehabilitation exercises,” Stapleton says. “You may also see athletes skipping certain physical therapy exercises, discontinuing exercises early, or not completing the number of reps or recommended time due to pain or pain-related fear. Outside of rehabilitation, athletes may avoid social activities or sports where they anticipate the need to engage in increased physical activity, or actions they perceive as unsafe or as likely to increase pain, such as walking long distances or standing for extended periods of time.”

Part of the fear-avoidance cycle includes catastrophizing, or assuming that the worst possible outcome or event will happen. “This pattern of thinking increases distress and is linked to both anxiety and depression,” Stapleton says. In athletes, catastrophizing can manifest in many ways:

  • Constant or invasive thoughts about the pain of injury.
  • The athlete might think their injury is the worst possible injury and that they will never get back to their pre-injury performance level.
  • Believe nothing can be done about their pain or injury, and they will never recover.

This negative thinking can lead to fear of pain, movement, further injury and result in avoidance of anything that might cause pain, make the injury worse or result in another injury. As a result of increased anxiety and avoidance, one can become fixated on monitoring physical sensations in their body and very sensitive toward anything that increases discomfort, even physical therapy exercises that are needed for recovery. This often leads to sedentary behavior and will stop or greatly reduce physical activity levels. “Avoidant behavior is expected and healthy in the immediate acute phase post-injury, as following injury rest is often needed for recovery,” Stapleton says. “However, when returning to activities is appropriate or engagement in physical therapy exercises is necessary to recovery and rehabilitation, avoidance of these activities can actually be harmful, leading to increased pain, chronic pain, and/or declines in mood.”

In athletes, deconditioning often triggers more negative thoughts about their abilities, which can lead to depression and disability. Concerning signs and symptoms of depression include:

  • changes in appetite
  • changes in sleep
  • irritability
  • anger
  • sadness
  • frequent crying or emotional outbursts
  • lack of motivation, a decline in academic performance
  • disengagement and/or social withdrawal
  • substance abuse

It is important to learn strategies to cope with the anxiety so that rehabilitation and recovery are not significantly impacted.

How to Provide Support
There are ways that you can help support your child and work through their range of emotions and fears:

  • Help them to identify exercises or activities that increase negative emotions, or triggers. Look for when an athlete becomes distressed, avoids or hesitates prior to certain exercises for clues of triggering activities/exercises.
  • Create a hierarchy of the identified triggers and rate them from least to most fearful.
  • Start with the least feared exercise and have the athlete perform the task in a controlled and safe environment. Challenge the athlete to increase speed, repetitions and/or difficulty until they are performing without worry.
  • Use goal-setting techniques, such as setting SMART goals (specific, measurable, attainable, relevant and timely), to create daily, weekly and monthly goals for building tools to manage anxiety and stress, as well as to do the identified fear exercises.
  • Build coping skills to handle fear and worry triggered by pain and movement. Diaphragmatic breathing, positive self-talk and imagery techniques have all been shown to help reduce levels of distress, increase comfort and build confidence during rehabilitation and return to sport.
  • Provide education about how fear and decreased confidence can increase their pain and get in the way of their ability to return to their sport.

Learn more and download tips for helping young athletes manage stress.

Psychology Services at Scottish Rite for Children
Our Psychology department has teams of pediatric psychologists at both our Dallas and Frisco campuses. Pediatric psychologists are embedded in the care of each patient, providing support to our sports medicine patients throughout their care and treatment. Learn more about our psychology services.

Emily Stapleton, Psy.D., is a pediatric psychologist at the Frisco campus of Scottish Rite for Children. She specializes in pain management, rehabilitation, coping with acute and chronic illness/injury and sports medicine. She has a particular interest in supporting young athletes following a sport-related injury.

Get to Know our Staff: Psychology Department

Get to Know our Staff: Psychology Department

by | Jan 18, 2021 | Psychology

What role do psychologists play at Scottish Rite for Children?
We play many roles. At Scottish Rite, our providers treat the whole child – this includes children’s physical and emotional health. Specifically, our psychologists are trained in the many pediatric medical conditions treated here. This means we can help patients and families understand and adapt to their diagnoses. It also means that we can help patients and their families understand their treatment options and support families throughout medical decision making. 

If surgery is recommended, we help patients and families to become as knowledgeable and prepared for surgery as possible, including prepping patients for any post-operative expectations. We also assist patients in supporting their adherence to any treatment recommendations, such as brace wear, medication or physical therapy. 

Why is psychology involved in patients’ pre-surgical preparation?
There are many psychosocial and behavioral factors that may impact a patient’s readiness for surgery, as well as their recovery post-operatively. Psychology’s involvement in pre-surgical evaluations helps to proactively address any concerns that may impact a patient’s recovery and rehabilitation, which in turn helps to mitigate post-operative challenges. 

Additionally, we provide patients and their families significant, developmentally appropriate education, to ensure that they fully understand the surgical procedure, as well as what is expected from them throughout the recovery process. Having this information ahead of time helps to provide patients with a roadmap of what to expect and allows them to feel in control. These evaluations are also used to answer any questions the patient and family may have. 

How is psychology involved in pain management?
Our team is uniquely trained to support children and adolescents with pain concerns, whether from acute injury, surgical pain or chronic pain complaints. Scottish Rite psychologists play an important role in assessing psychological, social and environmental factors that may impact a patient’s experience of pain and by providing targeted intervention. Our team has expertise in evidence-based psychological pain management interventions, like cognitive-behavioral approaches, including relaxation skills training, distraction techniques, cognitive restructuring and parent training.

How are you different from a counselor or therapist a patient may see in the community?
That’s a great question. Our team is different in that we are focused specifically on supporting patients and their families as part of their medical care at Scottish Rite. We know that having a medical condition may elicit feelings of stress, anxiety, worry or sadness. We also know that stress, anxiety, worry or sadness can exacerbate certain medical conditions and make treatment more difficult to manage. We support patients and families in understanding those relationships and how to cope with them. 

That said, we greatly value mental health providers in the community and will frequently partner with them. For example, if a patient is working with a counselor in their community, we may ask to speak to that counselor to help coordinate care. Or, if appropriate, we may recommend that a patient work with a local counselor or psychiatrist to receive additional, longer-term support. 

In addition to seeing patients, what other roles do you play at Scottish Rite?
In addition to clinical care, our team is also very involved in research. We have partnered with many of the surgeons and physicians throughout the institution on active lines of research and regularly present at national conferences. We also have a Pediatric Psychology Fellowship training program, where we provide training, education and supervision for post-doctoral fellows in pediatric psychology. Additionally, we are involved in numerous committees within Scottish Rite, and we are engaged in nation-wide psychology organizations such as the American Psychological Association. 

MEET THE TEAM

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Area(s) of expertise – I have the pleasure of getting to work with numerous departments, including the Neurology and Rehabilitation Medicine team, the Hand team, as well as multiple orthopedic providers. Specifically, I work with patients with scoliosis and spine conditions, hip conditions, complex foot and ankle conditions, lower extremity conditions and patients requiring limb lengthening and/or reconstruction.

Special interests – I am particularly interested in the provision of interdisciplinary care, the role of the family in supporting pediatric patients and transitional care. 

I like working in pediatrics because: The patients I get to serve. Children are curious, insightful, honest, funny, adaptable and resilient. It is incredibly rewarding to support a patient in their medical journey and assist in making it as positive an experience as possible.

Area(s) of expertise – I work with a variety of departments and teams, including Rheumatology, General Orthopedics, Prosthetics and scoliosis teams. I love the variety of the clinics I support and being able to meet families with an array of medical conditions. 

Special interests – I particularly enjoy working with children and teens who are experiencing chronic pain. Psychology plays a critical role in chronic pain management and I enjoy seeing children and teens return to the activities they enjoy. Recently, I have developed expertise in the emotional and psychological needs of patients with a prosthesis.

I chose to work at Scottish Rite because: The mission is consistent with my training of treating the whole child and family. I was eager to join a team who cares about giving kids more than a positive medical outcome, but also a positive emotional outcome for the patient and their family.  

Area(s) of expertise – I have gained extensive training in integrated health settings, specifically in providing interventions for pain, adherence and treatment related mood difficulties. At Scottish Rite, I support the Sports Medicine department and provide care to young athletes throughout the course of the treatment and return to sport.  

Special interests – I enjoy working with and supporting young athletes throughout the course of their medical treatments, especially related to coping with anxiety and pain related to treatment and addressing barriers to adherence and return to sport. 

Scottish Rite is special because: The organization stands true to its mission in “treating the whole child and never just the condition.” The provision of wholistic, interdisciplinary care is what is so special. Every staff member cares so deeply about each patient and works tirelessly to ensure the best possible outcomes, both medically and psychosocially.

Area(s) of expertise – Pediatric psychology and childhood trauma are my main areas of focus. 

Special interests: Childhood trauma, providing coping assistance to those with acute and chronic illness/injury, pain management, behavior management, providing integrated behavioral health care and providing trauma informed care

I chose my specialty because: Throughout the course of my training and clinical practice, I have developed a passion for working with children and adolescents, along with the team around them, in helping them strive to become the best version of themselves as they process and cope through difficult traumas in their life. Working with childhood trauma and physical health related issues has become a primary focus for me over the course of my early years as a psychologist. I believe that providing education and intervention to children, families and fellow medical providers on how emotional and physical functioning can be connected is one of the most important interventions to begin the healing process for the whole child.

Area(s) of expertise – I have undergone extensive training in early childhood assessment and intervention, developmental delay/disability, multicultural psychology, trauma, behavioral management and integrated health psychology. At Scottish Rite, I work specifically with teams treating a variety of spine conditions, including scoliosis.

Special interests – I love working with preschool populations and children on the autism spectrum, as well as teaching parents new techniques to improve their child’s behavior. I also enjoy training and educating others on culturally humble and sensitive practices we can employ to be more respectful in our approach with diverse patients.  

How do you help your patients feel comfortable: I enjoy working with younger populations because I get to bring out my inner clown and be comical. Therefore, I use a lot of humor and comedy in my interactions with children and adolescents. It often helps them see my humanity first, as opposed to my professional hat.