pediatric rehabilitation

Pediatric Rehabilitation

Enhance performance after

Illness, trauma, sports related injury

Includes medical, social, emotional, school

Faren H. Williams, M.D., M.S. 2

PHYSIATRY

• Goals are to– MAXIMIZE FUNCTION OF PATIENTS– STAY ACTIVE THROUGHOUT LIFETIME

• Faren H Williams, MD, MS– Chief, PM&R, Dept of Orthopedics/ Physical Rehab– Clinical Professor, U Mass School of Medicine


CONDITIONS

• Musculoskeletal Injuries

• Brain Injury

• Stroke

• Spinal cord injuries

• Amputations

• Gait Abnormalities

• Severe Disabilities

Impairment(s) versus Disability

IMPAIRMENT– Change in medical status, developmental level– Change in emotional status– Change in degree of wellness

DISABILITY– Degree to which change in function affects person

Goal is to Minimize Disability


Clinical Interview

• Assessment by a trained clinician • Face-to-face evaluation• Medical history • Physical abilities & needs• Functional abilities & needs • Seating & positioning abilities & needs • Home and school/ work site accessibility• Currently used assistive devices• Environmental considerations

Medical Problems

• Seizures

• Spasticity

• Contractures

• Altered vision

• Vertigo/ Dizziness

• Abnormal posturing

• Dysautonomia

• Bladder/ Bowel Dysfunction

Bladder Dysfunction

• Mechanical Problems– (Time to get to bathroom, doff clothing, etc.)

• Sphincter Changes• Social Embarrassment• Isolation• Depression

Physical Examination• Primary Problem• Secondary conditions

– Cognition, fatigue, vision– Cardiopulmonary endurance– Sensation– Bladder and bowel– Balance and falls– Skin issues– Musculoskeletal, pain– Spasticity

• Physical Motor Abilities

MOBILITY

History– Specific questions related to mobility

PHYSICAL EXAMINATION

Focus on sitting posture, positioning

Focus on gait, and abnormalities of gait• Focus on use of adaptive technology

• Functional mobility


Assistive Technology

• Manual chairs

• Power assist chairs

• Power operated vehicles

• Motorized chairs

• Emerging technology

• Augmentive communication devices

COMPREHENSIVE

• GOAL is to put LIFE BACK TOGETHER

• DIFFERENTIATE

• MEDICAL from

• PSYCHIATRIC/ EMOTIONAL from

• PREMORBID conditions

• DEVELOPMENTAL STAGE


GOAL –FUNCTIONAL FOCUS

• Realistic, attainable

• Sustains self esteem, hope


EXERCISE PROGRAM

• Individualized

• Appropriate for Medical Problems

• Therapy specific prescriptions

• Age specific

• Home component


Devising Exercise Program

• Bone Density Knowledge• Muscle Strength• Cognition• Coordination• Balance• Cardiovascular Health

– (To build bone mass – exercise intensity 60-85% VO2 Max or 70 – 85% of maximum heart rate)

Maximize Adherence to Program

Slow, steady progress

Improved gait/mobility and ADL’s

Meaningful activities


COGNITIVE/ BEHAVIORAL

• SENSORY DEPRIVATION

• CONFUSION/ DISORIENTATION

• ANXIETY/ DEPRESSION

• DECREASED INTELLECTUAL CAPACITY

• IMPAIRED BALANCE/ COORDINATION

Psychological Issues

• Loss of Self-Esteem• Isolation• Vulnerability• Embarrassment

– Physical Appearance– Bladder Dysfunction

Re-entry into School/ Work

• Type of School/ Job

• Physical versus more sedentary

• Level of concentration

• Testing – Physical/ Cognitive

• Review school/ job expectations

• Videos helpful

• Discussion with family and others

RESOURCES

• COORDINATION

• Medical

• School

• Cognitive – including cognitive re-training

• Physical – adaptive equipment– Augmentive communication – Devices for ambulation- bracing, walkers, wheelchairs


RESOURCES

• COMMUNITY – Massachusetts Brain Injury Association– PERSONAL

• Family support

• Financial

• Insurance vs. Family



QUALITY OF LIFE

• Goal of PM&R– Addressing multiple problems of patients– Minimizing those problems– Optomizing function– Providing adaptive equipment– Minimizing disability– Inter/ multidisciplinary framework


PHYSIATRY OVERVIEW

• THANK YOU!

• QUESTIONS?

pediatric rehabilitation

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