J Johnson Module C
Orthopedic Cast Removal Study
Problem: Children have great distress when they have casts removed. Most parents say their children were more upset with the cast removal that when the bone was broken!
Dr. Johnson wanted to determine if the sensation-teaching technique was relevant to children in a threatening situation, so she tested her theory in a children’s orthopedic clinic.
Eighty-four children – 6 to 11 years of age – who were to have casts removed were randomly distributed among three groups. One group heard this description of the usual sensations: They were told that they would see the doctor, hear the buzz of the saw, and feel vibrations and tingling, but they were assured they would not be cut; that they would see chalky dust flying around, feel a little warmth in the cast, but it would not burn them; and the limb exposed would feel stiff, and for a while might seem lighter than the other arm or leg. Another group heard a description of the procedure, and the third group received the routine preparation.
Data
Collection:
During cast removal, the children were observed by two researchers, each independently scoring the children’s behavior for degree of distress based on facial tension, clenched fists, feet extension, rotation or rigidness, attempts to pull away, kicking, hitting, whining, screaming, crying, and other signs.
Results:
As with the adults, the children who heard the sensory information showed the lowest degree of distress. These children did cry of course but were able to follow directions and stay sitting for the entire procedure.
Remember Johnson's Theory: "Discrepancy between expected and experienced physical sensations (what is felt seen, heard, tasted, and smelled) during a threatening experience will result in distress."
What other age appropriate relaxation technique might have been added to this study (e.g. distracting the child away from the threatening event)? If all children were given Johnson's sensation information and another relaxation technique, how would (could) the outcomes be explained? Or was an additional group correct for this study?
