1. AVRAHAM COHEN
A DOCTOR AND
CLOWN KNOW MORE
THAN
A DOCTOR ALONE
HILLA BEN-
PAZI, MD Shaare Zedek Medical Center, Jerusalem
AVRAHAM COHEN

2. 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

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

4. Methods- Visual analogue scale
 Valid
 Usually child rated Population:
 Parent assessment 32 children
 <5years age 6.7±4.5 years
 Cognitive impairment 23 boys
1 2 3 4 5

5. Time line…
Before During After

6. VAS pain rating
clown care Vs control
p=. 3 VAS
Control
Clown p=. 0
3.56
before after

7. VAS pain rating
clown care Vs control
p=. 3 VAS
Control
Clown p=. 0
3.56
before after

8. no correlation between
pain before & after
VAS after
VAS before

9. Severe pain VAS>4/5
vs non-severe pain VAS<4/5
Control (n=13) Clown (n=19)
severe
non
severe

10. Tests of Between-Subjects
Effects
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 .670
School .182 1 .148 .706
attendance
Communication .019 1 .015 .904
skills
# Muscles .000 1 .000 .996
Upper Limb 1.757 1 1.425 .251
Sensitive sites 4.135 1 3.353 .087
Report 7.355 1 5.965 .027
(parent/child)
Clown care* 8.247 1 6.688 .021

11. Take home message
Assess child tolerance to pain
Evaluate pain using validated tools
Manage pain with effective tools available
Traumatic  Empowered
manipulation

12. THANKS
RESEARCHERS SUPPORT
Naama Kroyzer- Shapira, MA Tradis Gat Inc
Yehuda Pollak, PhD Magi Foundation
Renana Lotem- Ophir, BA
PHOTOS
DAY CARE STAFF Public Relations –SZMC
Yael Greenberg Children and Parents