PEDIATRIC

REHABILITATION
 REHABILITATION
• Definition

– Process of helping a person

– Fullest potential

– Consistent with person’s impairment and desires

 PEDIATRIC REHABILITATION
• Is the sub-specialty that utilizes an interdisciplinary approach to address the prevention, diagnosis,
treatment, and management of congenital and childhood onset physical impairments.
• Rehabilitation is the process of restoring a person with a disability to the fullest physical, mental,
social, vocational, and economic usefulness of which the person is capable.
• When individuals experience neurologic, neuromuscular, or musculoskeletal injuries or dysfunction
caused by acquired disease processes (eg, stroke, tumors, severe illness) or trauma (eg, traumatic
brain and spinal cord injuries), they are generally candidates for a program of rehabilitation
• Rehabilitation management of children with physical impairments requires identifying functional
capabilities and selecting the best
 PEDIATRIC REHABILITATION
• A subspecialty

• Different from adult rehabilitation

• Everything is changing
 PEDIATRIC REHABILITATION
Utilizes interdisciplinary approach

Congenital and child-hood onset physical impairment

Rehabilitation of children requires

– Identification
– Selection
– Understanding
 CONDITIONS TREATED
• Rehabilitation intervention strategies with an understanding of the life of course of the disability and the
continuum of care
• The Pediatric Physiatrist can provide hospital consultation, and as well as outpatient practice, including
care of newborns, infants, children and adolescents with, but not limited to :
• Cerebral palsy
• Developmental delay, developmental disabilities
• Spina bifida and other neural tube defects
• Brain injury
• spinal cord injury
• Neuromuscular disease
• Chronic pain syndrome
• Peripheral neuropathy
• Myopathies
• Genetic disorders
• Metabolic Disorders
• Brachial plexus palsy
• Congenital, hereditary Lymphedema Musculoskeletal injuries
• Cerebral palsy
• Developmental delay, developmental disabilities
• Spina bifida and other neural tube defects
• Brain injury
• Spinal cord injury
• Neuromuscular disease
 REHABILITATION PLANNING
Counseling and advice to parent and patient
regarding the diagnosis, etiology, prognosis, training and educational needs, evidence based
treatment options, community resources, advice on developmental facilitation strategies and
behavioural management …….
Formulate the best rehabilitation plan
team conference with assessment team members and parents work closely with relevant
professionals and school support teams
Plan review at critical developmental stages
review rehabilitation plan
 SPECIALTY PROGRAMS
• Hearing Aids
• Diagnostic Auditory Brainstem Response
• Hand Therapy
• Lymphedema
• Wound Care
• Aquatic Therapy
• Vestibular
• Wheelchair Management
• Womens Health/Incontinence
 INTERDISCIPLINARY TEAM
REHAB
SPECIALIST

PHYSICAL
THERAPIST PATIENT

PSYCHOLOGIST OCCUPATIONAL
THERAPIST

SPEECH
THERAPIST
 PEDIATRIC REHABILITATION
 Team members include
– Pediatric physiatrist
– Occupational therapist
– Physical therapist
– Rehabilitation nurse
– Prosthetist-orthotist
– Psychologist
– Speech-language pathologist
– Case manager
– Dietician
– Therapeutic recreation specialist
– Spiritual care
 TEAM MEMBERS
Pediatric Rehab Specialist
– Oversee medical care team
– Prescribe treatments
– Coordinate with other specialists
– Educate patient
OCCUPATIONAL THERAPIST
 TEAM MEMBERS
Occupational therapist
– Provide training
• Activities of daily living
• To compensate
• Upper extremity prosthesis
– Recommend equipment
– Fabricate splint
– Suggest home modifications
– Educate patient’s family
– Manage dysphagia
 TEAM MEMBERS
 Physical therapist
– Evaluate
• Muscle length
• Muscle strength
• Muscle tone
– Therapeutic exercises
– Normalize muscle tone
– Joint handling techniques
– Improve balance
– Training adaptive devices and lower limb prosthesis
– Perform auscultation to lung fields
– Physical therapy modalities
– Assess body posture
FOR BALANCE AND STRETCHING
GAIT TRAINING
 PEDIATRIC PHYSICAL THERAPY:

• Promotes independence
• Increases participation
• Facilitates motor development & function
• Improves strength
• Enhances learning opportunities
• Eases caregiving
• Promotes health & wellness
 TEAM MEMBERS
Rehabilitation nurse
– Direct personal care
– Determine goal
– Assesses and addresses
• Hygienic factors
• Bowel and bladder programs
• Intervention related to skin integrity
• Use of equipment
• Minimize effects of inactivity
• Medication management
• Help manage time
 TEAM MEMBERS
Psychologist
– Neurophysiological testing
• Personality style
• Psychological status
• Testing of intelligence, memory
– Ways to deal with stress
– Counseling
• Adjustment to body changes
• Problem solving skills
• Death and dying
 TEAM MEMBERS
Speech-language pathologist
– Detailed assessment
– Evaluation of swallowing
– Pragmatic and cognitive based disorders
– Motor speech
– Augmentative and alternative approaches
• Talking tracheostomy tubes
• Electro larynx
 TEAM MEMBERS
Prosthetist-orthotist
– Evaluation, design and fabrication
– Instructions in care and use
– Follow up maintenance and repair
 TESTS AND PROCEDURES
• Limb deficiency, amputee

• Electromyography (EMG) & Nerve Conduction Studies (NCS) aid in the diagnosis of
conditions or diseases related to muscles, nerves, motor neuron and neuromuscular
junction e Botulinum toxin (BOTOX) injections for spasticity reduction and pain relief
PEDIATRIC REHABILITATION
 CERBRAL PALSY
Definition

– Disorder of movement and posture

– Injury to immature brain

– Ages involved
 CERBRAL PALSY
Goals of rehabilitation

– Decrease complications

– Enhance or improve new skills

 EVALUATION
Objectives

– Type and etiology of disability

– Child’s potential for rehabilitation

 EVALUATION
Screening test for development
– Bailey scale of infant development
– Denver developmental screening test

Quantitative analysis of motor performance

– Physical parameters
– Physiological parameters

Jebson Taylor Hand Function Test

 EVALUATION
Functional assessment

– Wee FIM scale

– Gross Motor Functional Measure

– The Pediatric Evaluation of Disability Inventory

 EARLY INTERVENTION
Decreases the impact of brain injury on the development of CP

For infants and toddlers ( 0 to 3 years old)

The rationale of early intervention

 NEUROMOTOR THERAPY APPROACHES
Neurodevelopmental technique (Bobaths) Sensorimotor Sensory Integration Approach ( Ayres)
Approach to
Treatment (Rood)

CNS model Hierarchical Hierarchical Hierarchical

Goals of treatment 1. To normalize tone 1. To activate 1. To improve

2. To inhibit primitive reflexes postural responses efficacy of neural processing
3. To facilitate automatic reactions and 2. To activate movement 2. To better organize adaptive responses
normal movement pattern once atability is achieved

Primary sensory systems utilized 1. Kinesthetic 1. tactile 1. Vestibular

to effect a motor response 2. Proprioceptive 2. Proprioceptive 2. Tactile
3. tactile 3. Kinesthetic 3. kinesthetic
 NEUROMOTOR THERAPY APPROACHES
Neurodevelopmental technique Sensorimotor Sensory Integration Approach ( Ayres
(Bobaths Approach to
Treatment (Rood)

Emphasis of treatment activities 1. Positioning and handling 1. Sensory 1. Therapists

2. Facilitation of active movement stimulation to activate motor guides but child controls
response sensory input to get adaptive
purposeful response

Intended clinical population CP children Children with CP Children with learning

Adult post CVA Adults post CVA disabilities autism

Emphasis on treating infants yes no No

Emphasis on family involvement yes no no

 HANDLING TECHNIQUES
• Lifting and carrying
 POSITIONING

SUPINE

PRONE

SIDE LYING
 POSITIONING

SITTING

Long sitting W Sitting Cross legged Sitting

 POSITIONING
– Standing
 MOVEMENT BETWEEN POSITIONS

¬ Sitting to standing
 MOVEMENT BETWEEN POSITIONS
• Exercises for sitting to standing
 MOVEMENT BETWEEN POSITIONS
¬ Walking
 WHAT ARE THE EXPECTATIONS FROM
PEDIATRIC REHABILITATION?
• While the increase in technical facilities and quality of care in neonatal intensive care units
increased the life chances of preterm babies and babies born with risk factors, it has also led
to an increase in many central nervous system (CNS) -based neurodevelopmental diseases
such as cerebral palsy, mental motor retardation birth traumas.
• Such patients should be intervened early in the delivery room, and a physiotherapy and
rehabilitation program should be started as early as possible when necessary.
• A significant portion of the diseases that cause physical disability and loss of movement in
childhood can be eliminated or reduced to the lowest possible levels with correct and timely
interventions. In cases requiring treatment, the process should not only be limited to physical
therapy and rehabilitation, but many other educational and social support programs should
be used.
THE END
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