Presenter: Changing lives every day through innovative pediatric specialty care, research, and outstanding medical education, that's Shriners Hospitals for Children — Chicago, proud to present another episode of our podcast series pediatric specialty care spotlight.

Presenter (Virginia García): Welcome to another episode of Pediatric Specialty Care at Shriners Hospitals for Children — Chicago. My name is Virginia García and I invite you to listen to our debate on cerebral palsy and spasticity management. Today we have Dr. Gabriela Martínez, who is a doctor in physical medicine and rehabilitation at Shriners Hospitals for Children — Chicago. Dr. Martínez, it is a pleasure to have you here today. Thank you for joining this debate. We are going to start from the basics... What does a doctor like you do, who specializes in physical medicine and rehabilitation? What do you do in your field specifically, doctor?

Dr. Gabriela Martínez (guest): A physical medicine and rehabilitation physician, also known as a physiatrist, is a specialist who manages several neurological and musculoskeletal disorders that impair mobility and daily activities, and these may be congenital disorders, meaning that the person is born with them, or acquired disorders, either as a result of trauma or other reasons.

Presenter: I understand, doctor, that you have a personal story related to this field and this specialization. Why is it important to you to provide the best care for children with cerebral palsy?

Dr. Gabriela Martinez: Well, my younger sister has cerebral palsy. She was born premature at 24 weeks or the equivalent of six months, and she was diagnosed early and, fortunately, she was able to start receiving therapies very quickly with early intervention. Also, she had a team of very good doctors and therapists who helped her develop to what she has achieved today, and although at that time I did not know, as I was only five years old, over time I realized the great impact that these people had on her life, and that is why it became important to me to help other children with cerebral palsy. She has actually been the driving force behind my entire career.

Presenter: Very impressive. Also, you mention a strategic and key point in all this, that is early intervention in children. I believe that we can all feel the love in your words, in your voice, and we understand why this is a true vocation and a call for you. What do you think, doctor, if we talk a little more about cerebral palsy now? What causes spasticity? What happens at that moment?

Dr. Gabriela Martinez: Spasticity results from injury to the brain or spinal cord above a certain level, and in cerebral palsy specifically, that injury occurs very early, before the brain is fully developed. And that injury to the brain essentially results in hyperactive, unbalanced contraction of certain muscles. So, those are constantly contracting and the muscles that are overactive are usually working against opposing muscles that tend to be weak, causing that some joints stick to certain positions. Over time, this can result in contractures, which is when the muscle tendon shortens, and this may cause several complications; for example, it can cause pain, it can cause difficulties in walking, or it can make it difficult to achieve a good position when sitting, for example, in a wheelchair. Because of this, having a good spasticity management is important.

Presenter: It is important to understand, right? Understanding how we can help these people in our circle of life. Doctor, in your field, could you tell us about the rehabilitation of hospitalized patients and those who are receiving outpatient medical care? How does all this type of multidisciplinary therapies help them have a better quality of life? And what is done specifically in each of these therapies?

Dr. Gabriela Martinez: The rehabilitation specialty involves a large team and, among them, the physical medicine and rehabilitation doctor or physiatrist is included, as well as the rehab nurses and, of course, the physical, occupational or speech therapists. And we also work very closely with dietitians, psychologists, social workers, and with this great team we really provide complete care. At our cerebral palsy clinic in Shriners [Children's], physiatry doctors try to help our patients have a good management of spasticity using medications, sometimes also with Botox shots, and also providing splints or inserts or medical equipment. We work closely with our orthopedic surgeons. Besides, if they have the complication of contractions due to spasticity, sometimes they need surgical intervention and that's when our colleagues from the team of orthopedic surgeons help us out. After these surgeries, we have the possibility to admit the children so they can receive intensive therapies and regain their mobility more quickly after them. In short, the great team, the physical, occupational and speech therapists help with these therapies.

Presenter: It really is a system that works, isn't it? A group of professionals with expertise on their fields and can help these children. Doctor, what are the results of all these interacting practices? Which results are observed on the children?

Dr. Gabriela Martinez: Well, the truth is that we see good results when they receive early therapies, as I mentioned, early intervention is really important, because the truth is that they contribute to their development, as it happened with my sister. From the very beginning, we were told that it was most likely that she would not be able to walk, but with time and with her therapies, she managed to walk at first with splints and a walker, but months later, without either of them. So, these therapies actually have a great impact; after certain surgeries as I mentioned with orthopedic surgeons, the intensive therapy that we can provide to these patients have a great impact. They can regain the ability to walk and we also help parents so that they can have the education and skills to help their children in a way they need, such as helping them move around the house, whether it is from a bed to a wheelchair, if they use a wheelchair, and other things that they have to do in their daily lives.

Presenter: Therapy and love, medical science and the family. There is a lot of involvement of the whole family, as the doctor told us; as it happened in your personal case, that you saw it first-hand with your little sister. How can families be involved in a timely manner at home? Please tell us about how you work with families so that they can follow the treatment and work that begins at Shriners Hospitals for Children — Chicago when they are back home.

Dr. Gabriela Martinez: Yes, a big part of the work of a physiatrist is to educate the family; teach them how they can follow the therapies at home. That is, they come to the hospital and receive therapies for an hour, two hours, three hours, maybe one, two or three times a week, but truly what has the long-term impact is what the families can do with their children. The therapists here have a lot of experience; well, many of them have been here for several years and teach them a stretching and mobility schedule that they can continue at home. Then, we also educate them on how long they have to wear their splints and how long they have to be working in different positions; for example, support them to be in standing position. Actually it requires a long-term therapy, for a lifetime, to actually have a long-term impact.

Presenter: You mention and highlight a very interesting aspect, Dr. Martínez; that it is something treatable, but not curable, and also the fact that it is an extremely joint effort; on the one hand, the hospital with all the medical team and all that medical love, but also the continued work that must be done at home, right? Because otherwise, the results will not be observable. Thanks for mentioning this. And as we get closer to the end of this episode, of this podcast, could you please mention the ways in which the Shriners Hospital for Children in Chicago is providing such care for children with spasticity. You spoke a little earlier about this multidisciplinary approach. And please, I would like you to take a few moments to tell our audience, to tell them, what the hospital does and why you would recommend that they bring their children to Shriners Hospitals for Children — Chicago to get help with the necessary medical care at an early stage, in these cases of cerebral palsy.

Dr. Gabriela Martinez: Yes, here at Shriners [Children's] Chicago we have a great team of specialists and we offer comprehensive multidisciplinary care for your children and constant support to help your son or daughter have a better development and be as independent as possible. And also, we do that with therapies, with good spasticity management, and with accommodations or medical equipment to facilitate daily life. We have the ability to be in close communication with our colleagues; orthopedic surgeons are close to us at the same clinics and that allows us to see a patient at the same moment, even if we do not have an appointment with them. For example, if our colleagues at orthopedic surgery see a patient and think it would help them to see one of us (I work with Dr. Mukherjee at physical medicine and rehabilitation), any of us can see that patient at that moment. We also have therapists who can see a patient at the same clinic, without an appointment, and we also have specialists who manufacture splints or prostheses that can see a patient at the moment. So we try to give this complete treatment as a team and we can also do it in one visit, so that families do not have to come and go. We also have a lab where ambulation is evaluated in a very extensive way and that gives us detailed information on how best we can help your son or daughter, either with different orthosis or splints, and also help with surgical planning, if needed.

Presenter: Is it really a "dream team," huh? A dream team, so the children get a commendable job from all of you. This is impressive, doctor. Thank you very much for taking the time to explain it to us in such detail so that parents who are listening to you understand that this is really a joint effort, and just by listening to you with such pride and with such passion, we can imagine what this means to you and your team. It is something amazing, helping other human beings so young, in the pediatric field, so that they can have a better quality of life. I imagine that you are an extraordinary doctor. Thank you so much for taking the time to talk with us and what you are doing at Shriners Hospitals for Children — Chicago. We’d like to remind everyone that to make an appointment you can call 773-385-KIDS; this is 773-385-5437, or to get more information you can also visit the portal at Shrinerschicago.org. This is S-h-r-i-n-e-r-schicago.org; from there you will be able to contact one of the medical providers. We conclude this episode about the specialized medical and pediatric care of the Shriners Hospital for Children in Chicago. Please remember to subscribe, give us a review of this podcast and also of the other episodes about Shriners Hospitals for Children — Chicago. Thank you very much, doctor. My name is Virginia García, we hope to see you next time with more information.