Skip to navigation

What we're up to

news News Thursday, December 14, 2017 Thursday, December 14, 2017 10:53 AM - Thursday, December 14, 2017 10:53 AM

Social and emotional benefits, and issues of caring for children in halo traction

Lexington Shriners Medical Center and Kentucky Children’s Hospital discuss how they have joined together to provide specialized care to patients in halo traction through a unique partnership

Social and emotional benefits, and issues of caring for children in halo traction

On Friday, December 1, 2017 the University of Kentucky Program for Bioethics and Kentucky Children’s Hospital presented Schwartz Rounds and invited Shriners Hospitals for Children Medical Center — Lexington to participate on the panel. Schwartz Rounds is a multidisciplinary forum where clinical caregivers discuss social and emotional issues. The content of the presentation is provided solely by presenters who have been selected for presentation because of recognized expertise in their field.

The December Schwartz Rounds topic was on caring for children in halo traction and was titled, Hanging on Together: New Twists in Orthopedics. The panelists included Ryan Muchow, M.D., pediatric orthopaedic surgeon and Anna Gayle Parke, DNP, RN, care manager at Lexington Shriners Medical Center along with Sarah McAlister, child life specialist and Sandy Roberts, nursing care tech at Kentucky Children’s Hospital. Each panel member was to discuss their medical experience in caring for a child who has been put in halo traction for six to eight weeks to help straighten their spine prior to undergoing a spinal fusion surgery.

Each patient that has been diagnosed with scoliosis requires different types of treatment at different points in their life. A majority of patients who present with a spinal curve of at least 50 degrees usually find themselves speaking with a pediatric orthopaedic surgeon who has recommended surgery in order to straighten the spine. Patients with a spinal curve of that degree may struggle to breathe, stand up straight, encounter decreased mobility and present with a hump on their back, which can create body image issues.

Pediatric orthopaedic surgeons of Lexington Shriners Medical Center employ the halo traction technique for curves typically greater than 100 degrees. All surgeries have risks, but spinal surgery has the additional risk of damaging the nerves and causing neurological complications. Other complications include problems with the hardware (rods, screws, plates) that are used to straighten the back and hold the new shape in place. As a result, doctors at Shriners Hospitals for Children prefer to try traction first. Under general anesthesia, a metal ring (halo) is attached to the skull with four to eight pins. Traction is achieved by adding carefully selected amounts of weight through a pulley system. The traction gently pulls against the child’s body weight to straighten the spine, stretch the connecting tissues and reduce pressure on the lungs and heart. 

“Families and patients at first can be taken aback when presented with this treatment,” said Muchow. One of the jobs of a care manager at Lexington Shriners Medical Center is to walk through each step of the child’s medical journey with the family. Shriners Medical Center is privileged to have a strong team of care managers as part of the full comprehensive care offered. Parke is one of the care managers at Lexington Shriners Medical Center and part of her job is to meet with families whose child has been recommended for halo traction. Parke shares the benefits, shows pictures, and explains the safety and benefits of the treatment.

“Pictures help tell a story. The initial picture we show is the X-ray of the child’s curved spine. Families immediately recognize the process may be intense, but understand how important it is in the long run. Halo traction is one treatment option that helps decrease surgery risks and create a more successful outcome. Once they hear this they normally get on board,” said Parke.

For more than 90 years, Shriners Hospitals for Children located in Lexington, Kentucky, has enjoyed spending time getting to know the patients who have been put in halo traction as they and their family would live at the facility 24/7 for six to eight weeks. “These patients become the heartbeat of our institution,” said Muchow. On April 17, 2017, Lexington Shriners Hospital moved into a new facility located on the UK HealthCare campus and transitioned into an ambulatory surgery center, meaning the facility is now 100 percent outpatient and no longer doing admissions. Any pediatric orthopaedic admission will be transferred to Kentucky Children’s Hospital. The relationship between Lexington Shriners Medical Center and Kentucky Children’s Hospital is one that has existed for several years as all the physicians on staff at Lexington Shriners Medical Center are also on staff at Kentucky Children’s Hospital. Any patient requiring admission to Kentucky Children’s Hospital will not lose the physician they have come to love and trust because of the long-standing relationship between the two institutions.

“When we learned that KCH would be admitting the halo patients from Shriners Hospital it was a gut wrenching feeling. We all thought to ourselves, ‘Can we really do this?” said Roberts.

Muchow, Parke and Shelley Ryan, physical therapist at Lexington Shriners Medical Center spent numerous hours, days and weeks educating the staff at Kentucky Children’s Hospital on how to not only provide the medical care to these special patients in halo traction, but how to normalize their hospital environment. Since moving to the new model of care, three Lexington Shriners Medical Center patients have been admitted to Kentucky Children’s Hospital for hospitalization during halo traction. Two of the three patients were admitted roughly at the same time and formed an unbreakable bound.

“Hospitalization doesn’t just impact the patient, but the family as well. I was able to watch not only the two female patients become fast friends but their moms as well. They would share meals, daily activities and discus their lives together. They were able to foster a unique relationship and still be teenagers while they were in the hospital,” said McAlister. “I am so thankful that I had a part in their experience and it reminded me why I originally chose the pediatric medical field as my career and why I wake up each and every day to do what I do.”

During the Schwartz Rounds it was evident that Kentucky Children’s Hospital was no longer fearful of providing social and emotional health to the halo traction patients of Lexington Shriners Medical Center. The panelists along with many members of the crowd discussed how they enjoy seeing the patients decorate their walkers, run up and down the hallways in the walker, make a halo train, do a 180 spin while hanging from traction and how wonderful it is for the staff to really get to know these patients. “We had educated the wonderful staff at KCH that these kids cannot get into trouble while in traction. That halo traction is relatively safe, but you have to see it sometimes to believe it,” said Muchow.

Muchow and Parke also spent a good portion of the rounds answering questions regarding the outcome the patient experiences after coming out of traction and undergoing the spinal fusion surgery. “It is a life changing experience. The X-rays alone are dramatic,” said Parke. “A straight spine is 0 degrees. The patients you [KCH] have cared for to date both had a curve of 120 with deformities on their back. Today they can breathe better, have increased mobility and their curves are now in the 40 degree range.”

There are a plethora of emotions that families and patients experience with this treatment from patients missing up to two months of school, parents missing work, time away from other children they may have, some families experience guilt due to the extreme degree of the curve, and on down the list. In addition, being hospitalized has a stigma of being isolated and away from one’s peers. Due to all of this and more, there are only a handful of academic medical centers in addition to Shriners Hospitals for Children that are still performing halo traction. For the most part, patients that present with scoliosis and need to be placed in traction are predominately healthy. It can be hard for an institution to agree to hospitalization of a healthy child for such an extended period of time. “Kentucky Children’s Hospital has learned how to care for these children and build their enthusiasm. I speak on behalf of everyone at Lexington Shriners Medical Center when I say that UK has been all in from the beginning and both organizations are seeing the benefit,” Muchow said. “Institutional buy in is rather unique in this situation in that it doesn’t happen really much anywhere else.”

The Schwartz Rounds was presented to standing room only and everyone that attended from Kentucky Children’s Hospital, University of Kentucky Healthcare and Lexington Shriners Medical Center joined together to celebrate the success and the ripple effect these special, one-of-a-kind patients have across care groups. This is what medical care is all about!

Amazon tracking pixel