Supporting the Mental Aspects of Recovery after an ACL Reconstruction

Supporting the Mental Aspects of Recovery after an ACL Reconstruction

Anterior cruciate ligament injuries (ACL) continue to be a problem in youth sports such as basketball and soccer. Many athletes and families are very aware of the lengthy physical aspect of returning to sport after an ACL injury and surgery. Some are surprised by the mental challenges and demands that come along with an injury. Patients, like Johanna, are supported by our multi-disciplinary team from the moment they walk into our sports medicine clinic.

Watch Johanna tell her story.

Physical therapist Rushi Patel says, “a lot of times people talk about the physical aspect of an ACL initial injury but you could argue the mental aspect is just as hard.”

Upon arrival, our team begins assessing a new patient from the “inside out.” We ask questions about how the athlete was injured, what level of competition they want to return to and what challenges they are facing physically and mentally in addition to the injury. These help us decide who needs to be involved in the athlete’s care from day one. Here are three tools we implement in our care of young athletes:

  • Certified child life specialists assist children and teens in understanding diagnoses and medical procedures, this helps to keep anticipation and fear under control.
  • Psychologists are available to consult when our clinic team or responses to screening questionnaires suggest an athlete may need more individualized guidance on pain management, coping with the injury and fears related to returning to sports.
  • Many of our patients receive stress management and pain management skill instructions to help them navigate day to day moments and the progression of rehabilitation. Download PDF.

Every team member, from nurse to physical therapist is focused on caring for kids and teens all day, every day. We use age- and developmentally appropriate strategies when we talk to kids, formulate treatment plans and create our educational materials.

Johanna says, “Scottish Rite has been like no other care I’ve gotten at a medical facility I truly feel loved and cared for and not just seen as a number or a patient with an issue to get resolved but they truly care about who I am what my goals are and ultimately what I want to accomplish in life.”

Check out how you can help us learn to prevent ACL injuries.

Modern Luxury: Champions for Change

Modern Luxury: Champions for Change

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.

Cerebral Palsy Clinic: Your Child’s Care and What To Expect

Cerebral Palsy Clinic: Your Child’s Care and What To Expect

At Scottish Rite for Children, our experts provide care to the whole child – body, mind and spirit. The Neurology and Rehabilitation Medicine department sees children with orthopedic issues who also have related neurological disorders and neuromuscular diseases. One of the most common conditions seen by this team is cerebral palsy (CP).

Like all conditions, the severity of cerebral palsy can vary depending on the child and requires a multidisciplinary team to determine the best treatment options. With several factors that play into this diagnosis, we understand that as a parent or caregiver it can be challenging to navigate through the care plan for a child with cerebral palsy. Below is what you need to know about our specialized cerebral palsy clinic at Scottish Rite.

Who is part of the CP team?

  • Orthopedic Surgery
    • A pediatric orthopedic surgeon focuses on evaluating and monitoring for operative interventions to address function and pain.
  • Pediatric Rehabilitation Medicine (PRM)
    • PRM focuses on evaluating and monitoring the child for nonoperative interventions, including bracing, casting, tone medications, botulinum injections, equipment and therapies with the goal of optimizing function and reducing pain.
  • Neurology
    • This team treats the active neurological conditions such as seizures.
  • Advanced practice providers (APP)
    • The APPs work with both the neurologists and pediatric rehabilitation specialists to provide holistic care.
  • Nursing
    • This team coordinates and organizes each of the multidisciplinary teams and ensures that education is tailored to the needs of each patient.
  • Orthotics
    • A team of orthotists work with the teams to evaluate, fit and fabricate braces used to help your child’s mobility.
  • Physical Therapy (PT)
    • PT works with the child to improve functional mobility, with or without their needed equipment.
  • Occupational Therapy (OT)
    • OT focuses on activities of daily living, upper extremity function and the use of equipment needed to help your child function.
  • Therapeutic Recreation (TR)
    • TR works with the patient to promote activities and participation through peer interactions and relationships, such as adaptive sports, games and more.
  • Psychology
    • Our team of pediatric psychologists manage the psychological well-being of the child and helps them with strategies to overcome barriers to the treatment plan.
  • Developmental and Behavioral Pediatrics
    • This team optimizes nutrition, feeding and medical comorbidities and manages behavioral differences.

What can a parent/child expect when come to the CP clinic?

  • The child will first be seen by our motor control nurse who will go over medications and safety questions.
  • One of the neurology/rehabilitation medicine APPs will continue the visit.
  • A video recording will be conducted of the child for their gait to be analyzed so the team can compare changes that occur throughout time.
  • The pediatric rehabilitation medicine specialist and the APPs will then complete the visit and explain the plan to the patient and parent/caregiver.
  • Depending on the clinic and specific needs, the patient may also be seen by a pediatric orthopedic surgeon, orthotist, physical and/or occupational therapist, pediatric psychologist or a recreational therapist. When appropriate, referrals are also made to the other cerebral palsy experts.

How often are clinic appointments?

  • Children younger than 5 are typically seen every three to four months. Since this is a period of rapid growth and development, our team of experts want to make sure that they are monitoring the patient’s growth closely and intervening in any way needed to promote healthy and happy development.
  • Children between ages 6 to 12 are seen about every six months but may require visits more often if they are in the middle of a growth spurt.
  • After a child has completed their growth spurt, the team typically sees them between every six months to a year.

Pediatric rehabilitation medicine physician Fabiola I. Reyes, M.D., works closely with this patient population. “I am honored to have the opportunity to provide care to these kids,” Reyes says. “In the CP clinic, we pride ourselves in making sure that both the child and parent/guardian understand and feel comfortable with every step of the treatment plan. Although your child may have several specialists caring for them, which can be overwhelming, our team is here to walk you through the process – making sure the patient remains our priority.”

Learn more about the Neurology and Rehabilitation Medicine department.

Ten Ways To Manage Pain Without Medication

Ten Ways To Manage Pain Without Medication

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.

Helping Young Athletes Manage Stress

Helping Young Athletes Manage Stress

For all kids, managing stress is important. However, young athletes have an added layer of pressures and our team is here to provide tips on properly managing those stressors. Pediatric psychologist Emily Stapleton, Psy.D., works closely with our young athlete population at our Frisco campus. As a former athlete herself, she has a passion for supporting athletes’ mental health for optimal performance, injury prevention and rehabilitation outcomes.

Below are a few tips to help parents, athletic trainers and coaches of young athletes manage stress.

CONNECT and help problem solve.
When overwhelmed, teens may struggle to break down a situation into manageable pieces. Talk to them and help them take one step at a time.

TIME your conversations wisely and keep it positive.
Let emotions from games or practices settle before talking about performance or outcomes. Waiting a couple of hours to discuss these topics allows athletes to reflect on their performance with less stress.

REFRAME success.
Expectations from parents and coaches can unknowingly increase pressure to perform and negatively affect self- confidence. Encourage athletes to focus on putting forth their best efforts and measuring personal progress rather than only focusing on end results or winning.

TEACH coping skills for life.
Coping skills can help an athlete learn to self-manage when stress starts to take over. Expose your athlete to yoga, taking walks, diaphragmatic breathing (i.e., deep breathing), progressive muscle relaxation (i.e., tensing/releasing muscles) and other techniques to relax.

MAKE ROOM for breaks.
Teach athletes the importance of down-time for rest and recovery. Helping athletes develop time-management skills and minimize over-scheduling will improve stress management.

ENCOURAGE life outside of sport.
Making time for other interests and hobbies apart from the primary sport, including fun activities and time with friends, helps create balance and build resiliency. Allowing athletes to have a breadth of interests and hobbies to draw from when experiencing distress.

PROMOTE healthy sleeping and eating habits.
Stress is easier to manage and less likely to build up with healthy habits in place. A balanced, sport-appropriate diet and quality sleep (at least eight hours for teens) support young athletes in academic, sport and social settings.

ASK for HELP when you need it.
Talking through stressors with a licensed psychologist or mental health counselor can be a healthy outlet for chronic stress and help athletes learn positive coping strategies to use in the future when experiencing negative stress.

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Learn more about pediatric sports medicine.