A DOCTOR AND CLOWN KNOW MORE THAN A DOCTOR ALONE

Shaare Zedek Medical Center, Jerusalem

HILLA BEN-PAZI, MD AVRAHAM COHEN

AVRAHAM COHEN

Case presentation: 8 year old girl referred for Botulinum toxin injections (BTX)

Underlying anxiety Emotional therapy -> still had anxiety Mother- anxious as well

Decided to perform injections with general anesthesia

PICU was canceled-> clown care 5th injection-> she did

not cry

She Laughed

Is there a need for clown care for injections in CP?

Methods- Visual analogue scale Valid Usually child rated Parent assessment

<5 years Cognitive impairment

1 2 3 4 5

Population:32 children age 6.7±4.5 years23 boys

Time line…

Before During After

VAS pain ratingclown care Vs control

ControlClown

before after1

2

3

4

5

3.56

4.56

3.41

2.84

p=.80

p=.003 VAS

VAS pain ratingclown care Vs control

ControlClown

before after1

2

3

4

5

3.56

4.56

3.41

2.84

p=.80

p=.003

Effect size 1.78

VAS

no correlation between pain before & after

0.5 1 1.5 2 2.5 3 3.5 4 4.5 50

1

2

3

4

5

VAS before

VA

S a

fter

Severe pain VAS>4/5vs non-severe pain VAS<4/5

Control (n=13) Clown (n=19)

non se-

vere68%

se-vere32%

Parameter Type III Sum of Squares df F Sig.

Corrected Model 29.965 9 2.700 .043

Intercept .009 1 .008 .932

Age 3.906 1 3.168 .095

Gender .234 1 .189 .670School attendance .182 1 .148 .706Communication skills .019 1 .015 .904

# Muscles .000 1 .000 .996

Upper Limb 1.757 1 1.425 .251

Sensitive sites 4.135 1 3.353 .087Report (parent/child) 7.355 1 5.965 .027

Clown care* 8.247 1 6.688 .021

Tests of Between-Subjects Effects

Take home message

Assess child tolerance to painEvaluate pain using validated toolsManage pain with effective tools

available

Traumatic manipulation Empowered

THANKS SUPPORT Tradis Gat Inc Magi Foundation

PHOTOSPublic Relations –SZMCChildren and Parents

RESEARCHERSNaama Kroyzer- Shapira, MA Yehuda Pollak, PhDRenana Lotem- Ophir, BA

DAY CARE STAFF Yael Greenberg