Pediatric Rehabilitation

Introduction

Many patients that a child neurologist encounters require the care of a pediatric rehabilitation medicine practitioner in order to optimize their quality of life in the face of neurologic disease.  Multimodal therapies are also key treatments for a wide range of pediatric neurologic diseases.  Exposure to pediatric rehabilitation medicine is therefore an important experience in order to understand the treatments that these consulting providers utilize and the options that therapists have to treat disease.  This experience will allow residents to learn about the clinical, therapeutic, procedural, and device related aspects of rehabilitation medicine.

Schedule

The schedule for this primarily outpatient, 2 week rotation is provided by the pediatric rehabilitation rotation director prior to the start of the rotation as are any further goals and objective.  Residents rotate through clinics in the AFCH rehabilitation clinic including general rehabilitation, neuromuscular, CRPS, spina bifida, and neuro-oncology clinics.  Cerebral palsy clinic occurs at the Waisman center. Exposure to procedures (Botox, phenol) takes place in the AFCH sedation center.

Patient Care

1. Take a developmental history, and list tests that may be used in developmental evaluation of a child.
2. Take a functional history pertinent to the child (e.g.typical mode of mobility use in the home, school, and community.  Equipment used including bath seat, car seat, mobility equipment).
3. Include the child (when appropriate) in getting the history.
4. Perform a physical exam of the child, in a way which maximizes the ease of the child and the parent.
5. Perform physical exam of the child with developmental delay in a respectful way.  Examine the child or adult for evidence of scoliosis, hip dislocation, contractures, increased or decreased tone, weakness, presence of primitive reflexes, head and trunk control, balance, and coordination.

Medical Knowledge

1. Identify findings regarding developmental stages, and recognize when a child is developmentally delayed.
2. Identify issues in the transition to adulthood of children.
3. Describe GMFCS level for a child with cerebral palsy
4. Provide appropriate recommendations for the medical management of children with cerebral palsy including nutrition, GI and GU management, and musculoskeletal issues. 
5. Identify when treatment of spasticity is recommended, and outline an approach to spasticity evaluation and management.
6. Provide appropriate recommendations for the medical management of children with spina bifida (includes neurogenic bowel and bladder, and pressure sores).
7. Provide appropriate recommendations for the medical management of children with NMD (including constipation, osteoporosis and understand pulmonary recommendations).
8. Be familiar with specific orthotics, gait aides and other equipment for children with cerebral palsy, spina bifida, and NM diseases.
9. Describe an approach to the evaluation and treatment of toe walking in children.
10. Explain the special considerations needed to appropriately prescribe a wheelchair for a pediatric patient.

Practice-Based Learning and Improvement

1. Identify one learning topic weekly and describe how that has impacted his or her practice.
2. Demonstrate ability to identify ways that a specific patient encounter could have been enhanced.

Communication and Interpersonal Skills

1. Treat the parent/family member and child with respect.
2. Avoid use of, or explain medical jargon.
3. Communicate effectively with the other rehabilitation team members.

Professionalism

1. Follow hospital guidelines for patient privacy and confidentiality.
2. Be on time for clinic.
3. Accept feedback willingly.

Systems-Based Practice

1. Understand and explain child-specific services related to special education, the Katie Beckett / Medical assistance program and other unique benefits for children with chronic health care support needs.
2. Be familiar with the provision of school services for children with special needs
3. Make recommendations regarding health promotion (immunizations, child safety, and primary care).