Pediatric physical therapy addresses the development of gross motor skills, including rolling, sitting, crawling, and walking as well as balance and coordination. Physical therapy rehabilitates musculoskeletal deficits occurring with physical disabilities, or after accidents, sports and orthopedic injuries, and surgeries.

Patients Play Their Way Through Treatment
by Angela Havrilla

"Kids don't want to work," explains owner and physical therapist Lisa Mackell, "and they say, 'You're not going to make me do any work today are you?' We'll say, 'No, we're not going to do any work.' Pretty soon, Mackell relates, they'll ask to play with play-dough, not even realizing that it's part of their treatment. Before long, "We've got them playing with play-dough and pulling it apart and working on their hand/eye skills and coordination by jumping to get it," she laughs.

With approximately 50 employees including therapists and administrative staff, Theraplay sees patients from birth to 21 years of age. Youngsters and their parents come to Mackell's facilities seeking treatment for a broad range of problems: conditions related to prematurity or developmental delays, stuttering or serious and debilitating neuromuscular diseases. Some come to Theraplay for remediation of extremely poor handwriting, disorganized behavior in school or difficulties playing sports. Others come to rehabilitate after devastating injuries. Theraplay also treats children with autism, Down syndrome and cerebral palsy.

Mackell founded Theraplay in 1991 as a homecare organization. She opened it as an outpatient center in 1996 in Malvern, PA. Theraplay then opened a second office in Horsham in 2000 and moved its first office from Malvern to West Chester in May of 2002. The West Chester center is Theraplay's corporate headquarters, although staff therapists often travel between the two facilities - and even to some of their patients' homes. Theraplay also has contracts with local schools and offers six-week playgroups to patients.

Mackell, who graduated in 1988 with a Master of Science in Physical Therapy from Philadelphia College of Pharmacy and Science (now University of the Sciences, Philadelphia), says that even as a student, she knew she wanted to provide unique services for young patients. "I knew there were no other providers out there really treating children the way I believe they need to be treated -- not only as individual patients, but as members of families," she explains. "If it is an injury, we work to maximize that child's rehabilitation. If it is a child with a disability, we see how to make that child a valuable and accepted part of the family while getting therapy and working on their goal."

In keeping with Mackell's mission to treat the whole family, Theraplay facilities are open six days a week, with extended hours Monday through Thursday. "This [operating schedule] gives the opportunity for not only Mom to come, but for Dad to come, too, and learn some of the activities, " she explains.

"A child could come to my office three times a week," Mackell continues, "but if the family doesn't carry it over at home, what we do has very little, if any impact. They've [parents] got them for 24 hours a day all the other days. Hopefully, what we're going to do is use our sessions to start the goals, start the tasks and learn what we need to teach the families so that they can carry it over."

She offers specific examples of how family involvement enhances treatment. "If it's the infant with torticollis [a deformity in which the head tilts towards one shoulder and the chin points to the other], we're telling them, 'Don't let them lean to this side in the car seat. Roll up this towel to put on this side of the head so that they're not only looking to the right.' Maybe we're saying to the parent, 'You know what, Mom? His arms are really weak, or his trunk is really weak, [so] let him carry the laundry basket downstairs.' These are little things that may become chores for [the patient], but sometimes, the parents just feel sorry for their kids and they compensate [for the child's disability] so much that they're working against themselves."

Theraplay PT Heidi Woolard illustrates Mackell's point more by giving another example. "In PT, when we work with babies as little as a week old, all of those parents come and are active during the session because I am also educating the parent on how to do the exercises and stretches the proper way. I may only see this child one, two, or three days a week, but they need [to do] the therapy everyday," she says. Woolard says that one of the greatest challenges of her job is trying not to become too attached to the children she treats. Woolard, who has worked at Theraplay for two years, has a particular interest in children with Erb's palsy. Still, she has no plans to limit herself professionally: "I will continue to research and learn more about all pediatric diagnoses," states Woolard.

Mackell shares her employee's enthusiasm for continuing education. Theraplay pay for continuing education seminars or conferences that enable employees to increase their knowledge and hone their therapy skills. This year, Mackell plans to bring various guest speakers to Theraplay for two all-day workshops.

She considers such an investment in her staff's education worthwhile because she holds them in high regard. "We're very fortunate with our staff. You don't go into pediatrics unless you know you want to do it, because it can be extremely time-consuming, extremely exhausting, and you need to be willing to play all day long," she says. "It sounds like the dream job, but you have to really be ready to be up for that all day long. There is no 'I need a break. I've got a headache.'"

Since Theraplay participates in most of the local university and college affiliation programs, Mackell has her pick of talented therapy interns to hire. "We have everybody from one or two years of experience to people with 10, 15, 20 years of experience in the field who come to work with us," she says. She adds that they are attracted to Theraplay's philosophy of pediatric therapy in a play environment and the practice's family-centered treatment model.

Another special feature of Theraplay's treatment is that patients get a chance to form relationships with more than one therapist. Each time a child comes to Theraplay, he or she may have a different therapist than they saw during the previous appointment. Mackell says she and her staff have found that this approach promotes "faster progress with goals and better carry-over.

"Let's say you have a child who is very shy or who has a hard time learning from people or dealing with people," she explains. "If he or she always comes to see me, I've increased [that child's] contacts by one, and what good have I really done?" In addition to helping children develop their social skills, having more than one therapist on each case also means a more innovative treatment plan for each patient. Mackell says each therapist has a unique perspective that enriches the program, and each session is documented so the next therapist will know what the previous one accomplished with the patient.

Theraplay's Clinical Coordinator, Maureen Hugel, a PT with 19 years of experience, agrees with Mackell that this approach works well. "It is a dynamic learning environment with highly skilled therapists who have a wide variety of backgrounds coming together to meet the therapeutic needs of children and their families," she says. "I am always learning from the staff and the children and their families despite my number of years as PT and administrator. We are the only entity of its kind in the area that provides comprehensive services to families with children with therapeutic needs."

Theraplay also goes the distance to help families with their health insurance concerns. "We've had parents who have come here and said there was no way their insurance company was going to pay for the child's therapy because they had tried to get it covered before," Mackell says. "I'll tell them to give me their information -- I'll call the insurance company and work with them on why the child needs therapy in order to get the therapy covered." Mackell stresses that in order to win and maintain coverage, careful documentation of both treatment and measurable progress is crucial. For families who are uninsured or underinsured, Mackell and her staff stay updated on available state and county programs so they can direct families in need to them. In fact, Mackell and her billing staff strive to get daily updates on the latest developments with various insurance companies in regard to what is and is not being covered. This practice helps Theraplay staff educate families on what options their particular insurance coverage offers.

In pediatrics, the ratio must always be one therapist to one child. This is a cost-intensive requirement, because most insurance companies do not differentiate between pediatric and adult therapy-in which patients may be treated in a group setting. This can create obstacles to families getting coverage for treatment at Theraplay."

Mackell and some of her staff make time to meet with local doctors' groups in order to keep lines of communication open regarding healthcare and insurance issues and to keep physicians informed about new developments at Theraplay. Theraplay is active in the community as well. "We try to do a lot of community fairs, community walks, continuing education conferences, staff luncheons, and family information seminars," Mackell says.

She plans to keep Theraplay vibrant and growing, with plans to open a new center in nearby Delaware County, and perhaps another in the state of Delaware after that. She is also excited about the West Chester facility's recent acquisition of an Interactive Metronome® (IM). This instrument enables children to work on language and attention skills. Mackell and her staff also believe in supporting hospital-based clinical research. Although they are not involved in research themselves, Theraplay helps promote local hospitals' research by referring certain patients to their studies.

Mackell knows, however, that the true test of Theraplay's success lies in the willingness of young patients and their families to follow their treatment plans. As surely as the proverbial spoonful of sugar helps the medicine go down, a sprinkling of play helps the PT exercises get done. Mackell gets direct feedback from the comments of children, siblings and parents. One comment made during the summertime by the sister of a patient who had managed to break his arm two years in a row stands out in her memory. "The sister said, 'Next summer, I'm breaking my arm so I can come [to Theraplay]!'" she recalls. "Well, we must be doing something right."

Theraplay Inc. provides physical, speech, and occupational therapy for patients 21 years of age and under. Centers are located in West Chester, PA, and Horsham, PA.

Angela Havrilla is a freelance writer from Pottstown, PA. She is on the editorial staff of NEWS-Line for Physical Therapists.