1. In the long run, Elias should be able to return to playing many sports. Do you think this is something that should be addressed now, or do you think he should be discouraged from exploring sports until he has adjusted to the return to school? Why? 2. If you do an image search for “pediatric prostheses,” you will see many types of artificial limbs. Some cosmetically look like the limb they are replacing, and some look like high-tech hardware. Which is better? Why do you think this?
Elias was an active athletic 9-year-old. He had played team soccer every autumn, and softball spring
since he was 6. Early last summer, Janet noticed her son Elias was limping. “The ache in his leg would
come and go. We thought it was probably just growing pains.” It turned out to be a tumor in his knee. Elias
was diagnosed with Ewing’s sarcoma, a rare and aggressive cancer. He started a 36-week regimen of
chemotherapy right away. Janet says, “It was so overwhelming, but we felt confident in the care he was
getting. Everyone was so positive. We never questioned it and never doubted the doctors.”
Elias was in the hospital three weeks of each of the next nine months for chemo treatment, and sometimes
with complications. His tumor responded well to the treatment, though, and he eventually had surgery to
amputate his leg below the knee. Elias missed school and his friends. Because of the chemotherapy, his immune
system was suppressed and he could have few outside visitors. He did have a teacher who came to visit him so
that he could keep up with classes, but otherwise he felt left out and angry at the world.
Because of his chronic pain and difficulties with mobility and other daily tasks, Elias began to receive
OT and PT in his home. The physical therapist was fun and made up games and silly obstacle courses that
challenged Elias while making him laugh. His parents were ecstatic, because prior to these games, they in-
sisted that it had been months since he had laughed.
The OT started working with Elias on dressing and self-care tasks, but found that he was poorly
motivated and easily frustrated, lashing out at her in anger. He said that he did not see the point, that there
was no reason to get dressed because there was nothing to do and nowhere to go. On impulse, the OT
asked Elias where he would go if he could go anywhere he wanted. Elias chose Mars! On her next visit,
Elias presented the OT of a drawing of himself on Mars, bald with one leg and a scowl on his face.
Using Elias’s interest in art, Elias and his OT began a long journey toward a healthier self-concept,
improved motivation, and cooperation. His ADL and IADL skills improved, and his academic grades did too.
Because the medical team had indicated that Elias would need bone-lengthening surgery every four to six
months during his growth years, building resilience and coping strategies when he was in chronic pain were
very important.
Through the use of humor and artistic expression, Elias was able to maintain and eventually improve
his participation in everyday activities. He returned to school for fifth grade, at age 10, and was ready to go
forward with his life.
Elias will return to school after a year of surgeries and cancer treatments. With the prosthetic limb, Elias will
have some difficulty participating in sports at school. In addition, he is likely to be self-conscious because
of the appearance of the prosthesis, and being able to blend in with his peer groups rather than engage in
activities that make it more apparent.
Some questions to consider:
1. In the long run, Elias should be able to return to playing many sports. Do you think this is something that should be addressed now, or do you think he should be discouraged from exploring sports until he has adjusted to the return to school? Why?
2. If you do an image search for “pediatric prostheses,” you will see many types of artificial limbs. Some cosmetically look like the limb they are replacing, and some look like high-tech hardware. Which is better? Why do you think this?
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