Therapist is seeking your suggestions and strategies for treating an autistic patient with JRA, and Total Hip Replacement

Samantha Posts:

DEAR ERI COMMUNITY: I am a relatively new physical therapist and have an interesting patient that I would appreciate tips/suggestion for treatment techniques. I work in an acute care setting. I typically work with orthopedic patients (adults), those both who have recent TKA/THA and orthopedic trauma patients. I have a new pediatric patient, age 8 accelerated and progressive JRA and a history of hip dysplasia. This patient had received prior physical therapy prior to surgery, although I do not have assess to the notes as it was at another facility, so I am not sure of what interventions the previous therapist performed. The patient had dislocated her hip x2 prior to admission. The patient underwent a total hip replacement. Secondary to the age of the patient and the surgical intervention, the patient is currently TDWB, strict posterior hip precautions, and a Hip Spica Brace that is to be worn at all times. The patient is to be seen BID for a stay of 1 week to 1.5 weeks. Along with the significant orthopedic history, the patient has a past medical history of autism. With regards to the autism spectrum, this patient is nearly non-verbal, somewhat resistant to touch, and displays a lack of interest in general. I have had one treatment session with this patient which was very difficult for the patient to focus and she was very agitated throughout the treatment session with an obvious lack of interest in the treatment session. She had a extreme difficulty with maintaining WB status and ambulation with use of assistive device. As far a “play” therapy or activities to engage the patient, do any experienced therapist have suggestions/strategies for interventions allowing for minimal agitation and overall compliance with WB and hip precautions in order for a successful session? Thank you for your help.