Rehabilitation for children--parents can't do it all.

Management of disabling conditions in children differs from that for adults, with ongoing needs related to growth and development. Parents also vary in their ability to deal with the demands placed on the family by a child with a disability. Different disabling conditions require many of the same kinds of therapies, with more emphasis on some. Functional goals include mobility, communication, independence in activities of daily living, education and eventual appropriate vocational planning. Consultation, outpatient therapy, or intensive, inpatient management may be appropriate at different times. A rehabilitation team approach with other specialists as needed can assist the child, family, and school to achieve the best outcome possible.

Pediatric rehabilitation. 1. General principles and special considerations.

This self-directed learning module addresses core concepts in the assessment of any child with disability, including physical growth and development, evolution of reflexes, and cognitive and personality development. It is a section of the chapter on pediatric rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. The rehabilitation perspective is emphasized, especially as it changes to accommodate the developing child, with a focus on specific chronic disorders such as respiratory disease, congenital heart disease, and malignancy. These types of disorders serve as a model for the management of problems that require special medical, rehabilitative, and psychosocial consideration.

Pediatric rehabilitation. 2. Brain damage causing disability.

This self-directed learning module addresses rehabilitation issues in the child with brain damage. It is a section of the chapter on pediatric rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. In addition to the motor manifestations, intellectual, social, and emotional impairment are addressed. Problems vary with developmental stage. Emphasis is on the etiology, severity, and combination of deficits in order to develop a plan of management, including physical, occupational, and speech therapy, recreational and social milieu, and family and community resources.

Pediatric rehabilitation. 3. Disorders of the spinal cord: spinal cord injury, myelodysplasia.

This self-directed learning module provides review and references for the basic concepts of, and highlights new advances in, disorders of the spinal cord in children. It is a section of the chapter on pediatric rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. For spinal cord injury, only data pertinent to the pediatric age group are discussed. Myelodysplasia is presented in detail to include genetic implications, early intervention, long-term management planning, psychosocial impact, and quality-of-life considerations.

Pediatric rehabilitation. 4. Disorders of the motor unit.

This self-directed learning module addresses diagnostic and rehabilitation issues in children with the most common disorders of the motor unit. It is a section of the chapter on pediatric rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. Conditions occurring only in infancy or childhood and differences in diagnostic and rehabilitation approaches as compared with those used in adults are highlighted.

Pediatric rehabilitation. 5. Joint and connective tissue diseases.

This self-directed learning module presents pertinent information about rehabilitation management of specific joint and connective tissue diseases affecting children. This section highlights juvenile rheumatoid arthritis, Lyme disease, rheumatic fever, hemophilia, dermatomyositis, polymyositis, systemic lupus erythematosus, and other forms of arthritis. It is a section of the chapter of pediatric rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation.

Pediatric rehabilitation. 6. Musculoskeletal and soft tissue disorders.

This self-directed learning module highlights advances in evaluation and treatment of congenital and acquired musculoskeletal disorders in the child. It is a section of the chapter on pediatric rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. This section contains information on alterations of limb structure and gait, scoliosis, torticollis, sports injuries and overuse syndromes, and unexplained pain in children.

Wrist subluxation in juvenile rheumatoid arthritis: pathophysiology and management.

Management principles in juvenile rheumatoid arthritis provide for long-term follow-up throughout all phases of disease activity, including apparent remission. Treatment is based on the stage of disease and anatomy and kinesiology of the joints. Palmar subluxation of the wrist requires proximal support by splints for prevention and correction. Small sphygmomanometer bags have been incorporated into splints for home stretching with demonstrated improvement in bony alignment.

Parental coping in raising children who have spina bifida cystica.

In this study of 40 married couples who are rising a child with spina bifida cystica, the family stress theory was used to assess family regenerative power and vulnerability to stress. The reserach tested for differences between high and low stress families in the family environment, coping strategies, and severity of the child's problem. When compared with the high stress families, the low stress families appeared to be more cohesive, be better organised, have a more active recreation orientation, be lower in family conflict, utilise more family community relationships, and have children who have less severe physical problems. The practical implications of this study include the potentiality for applied usage of family diagnostic tests, the clinical and research application of the findings on family coping strategies for improved patient outcomes, and the need for additional social-medical research to assess accurately family concerns about health care policies.

Intramuscular neurolysis for spasticity in children.

Intramuscular neutrolysis with phenol has been used for 10 years in the management of spasticity in children. Best results depend on fastidious technique and realistic use of the procedure. Sedation or anesthesia was used in all cases -- 5% phenol in water was used for all procedures. The main indications were spasticity which interfered with function, either actual or potential, or with care. Where uninhibited vestibular or tonic neck reflexes affect muscle tone, or there is dystonia or athetosis, the procedure is less effective than where spasticity alone is present. Duration of relief of spasticity ranged from 1 month to more than 2 years. About one half of the lower extremity muscle treated required tenotomy later. Generally training was required after the procedure to obtain improved function. A representative sample of muscles treated, repeat procedures, and later surgery is discussed. The procedure is recommended for use in the management of spasticity in children as a way of improving function and/or care.

The training of coordination.

The training of coordination is generally considered a volitional activity, during which, by trial and perception of results, an individual selects the muscular activity resulting in the desired performance. This concept of volitionally directed complex coordination of multiple muscles with speed, skill, and strength does not stand the test of thorough evaluation. Attention is limited to 1 activity at a time, with the ability to shift attention not more frequently than 3 times per second. Only under special conditions can activity be limited to specific muscles during an untrained contraction without cocontraction of other muscles. However, with repeated practice of the desired activity, a pattern of performance is developed which can be carried out rapidly and forcefully without activation of other muscles. At that time, the consciousness is no longer directing the components of the activity but merely starting, maintaining, and stopping the performance. The development of these patterns, or engrams, by practice develops the capacity to automatically inhibit muscles that do not contribute to the performance of the desired pattern. The capacity for inhibition results in coordinated activation of the muscles contributing to the performance desired. Investigation of the development of coordination in many types of normal activities, as well as in neuromuscularly impaired patients, shows that engrams develop progressively by slow, precise practice of simple patterns, combined as they develop into more and more complex patterns, until the final skill is attained.