Alexander M.A., Matthews D.J.. Pediatric Rehabilitation: Principles and Practice. 4 th. åd. — New York: Demos Medical Publishing,2010. — 540 ð.. 2010

Medicine and rehabilitation are changing. Many of us see very few arthritis patients. Our rheumatology colleagues are doing a fantastic job with these children and so the need for rehabilitations has decreased. Leg lengthening, limb salvage procedures, limb reattachment, and improved safety of farm machinery have decreased the number of children who need prosthesis. Genetic testing has altered the referral patterns for children who need electromyography. Bladder continence and bowel irrigation surgeries have changed how we manage patients with spinal cord injuries. More of us are seeing children with concussions as the literature proves the value of screening and following the children serially. Our options for spasticity management are different and more widely used than in the last edition of this book.

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Dedicatio

Contents

Prefac

Contributor

Pediatric Rehabilitation

Michael A. Alexander and Gabriella E. Molna

History and Examination

The physiatric history and examination of a child require a blend of medical diagnostic skills to establish or confirm the diagnosis as well as a knowledge of child development and behavior to evaluate functional assets and difficulties for the intervention phase of rehabilitation.

SETTING THE TONE

HISTORY

Prenatal and Perinatal History

Developmental History

General Health History

History of Behavior

Educational and Social History

School-aged and Adolescent Patients

Musculoskeletal System

Sensory Examination

Functional Evaluation

INFORMING INTERVIEW

Susan D. Apkon and Deirdre Arnhol

Medical Care of Children with Disabilities

Children with special health care needs (CSHCN) are those children who have been or are at risk for a chronic physical, developmental, behavioral, or emotional condition

MEDICAL HOME

ROUTINE health maintenance

ACUTE ILLNESS IN THE PRIMARY CARE OFFICE

Children with disabilities present to primary care providers with the same childhood illnesses of their typical peers, but the presenting signs and symptoms may be quite different.

Respiratory Complications

Neurological Complications

Orthopedic Complications

PALLIATIVE CARE

Primary care for children with special health care needs may include consideration for palliative care services

CONCLUSION

Psychological Assessment in Pediatric Rehabilitation

Jane A. Crowley and Kayla White-Water

The goal in pediatric rehabilitation is not an end point as in the adult world. Rather, it is a process toward the continued development of ever-changing abilities and emotional, behavioral, and cognitive structures.

ADJUSTMENT VERSUS PSYCHIATRIC DIAGNOSIS

NATURE OF MEASUREMENT

USES OF ASSESSMENT

TYPES OF ASSESSMENTS

SPECIFIC INSTRUMENTS

Neuropsychological Evaluation

Language Functioning Tests

Memory and Learning Tests

Sensory-Perceptual and Motor Tests

Cognitive and Intellectual Measures

Instruments for Use With Young Children

Alternative Tests of Cognitive Function

Achievement Tests

Adaptive Behavior

Psychosocial Evaluation

Population-Specific Assessments

CONCLUSION

Language Deveionment In Disorders of Communication and Orai Motor Function

Lynn Driver, Rita Ayyangar, and Marie Van Tubberge

Communication, as defined by the National Joint Committee for the Communicative Needs of Persons

SPEECH AND LANGUAGE DEVELOPMENT AND DISORDERS

Within the field of communication sciences and disorders, we think of communication as broadly comprised of speech and language.

Speech Components

Contribution of Respiratory Dysfunction to Speech Disorders

Contribution of Phonatory Dysfunction to Speech Disorders

Contribution of Articulatory/Resonatory Dysfunction to Speech Disorders

Motor Speech Disorders

Language Components

Speech and Language Acquisition

Speech and Language Disorders

Assessment and Treatment of SpeechZLanguage Disorders

FEEDING AND SWALLOWING PROCESSES AND DISORDERS

PEARLS OR PERILS

Ellen S. Kaitz and Michelle Mille

Adaptive Sports and Recreation

Adapted sports for the disabled (DA) were born in the mid-twentieth century as a tool for the rehabilitation of injured war veterans.

HISTORY

EXERCISE IN PEDIATRICS: PHYSIOLOGIC IMPACT

EXERCISE IN PEDIATRICS: PSYCHOSOCIAL IMPACT

ADAPTED SPORTS AND RECREATION PROFESSIONALS

PARTICIPATION IN PHYSICAL ACTIVITY

INJURY IN THE DISABLED ATHLETE

Adapting Recreation Opportunities

Sports for Fun and Competition

PEARLS OR PERILS

Orthotic and Asslstive Devices

Elizabeth L. Koczur, Carrie E. Strine, Denise Peischl, Richard Lytton, Tariq Rahman, and Michael A. Alexande

Knowledge of orthotic and assistive devices is an important component of rehabilitation practice.

UPPER AND LOWER LIMB ORTHOSES

When choosing an orthosis, there are a few key principles to keep in mind.

Shoe Inserts

Orthoses for Positioning, Range of Motion, and Healing

Mobility Aids

Wheelchairs and Seating

Car Seats

Adaptive Interfaces

Recreational Equipment

AUGMENTATIVE AND ALTERNATIVE COMMUNICATION (AAC) AND COMPUTER ACCESS FOR LEARNING, WRITING, AND LIVING

All children, whether disabled or not, utilize a complex communication system that integrates spoken, written, and pragmatic social language skills.

Speech-Generating Devices

ASSISTIVE ORTHOSES AND ROBOTS

Electrodiagnosis in Pediatrics

Craig M. McDonal

Electromyography (EMG), nerve conduction studies (NCS), and evoked potentials, including somatosensory- evoked potentials (SSEPs)

Maturational factors

IN PEDIATRIC ELECTRODIAGNOSIS

The normative neurophysiologic data relating to the maturation of peripheral nerves and muscle in children have been greatly expanded in the recent past (1-10).

Nerve Conduction Studies

Electromyography

TECHNICAL FACTORS WITH INFANTILE NERVE CONDUCTION STUDIES

Temperature

Volume Conduction

Shock Artifact

Measurement of Distances/ Measurement Error

Stimulating Electrodes

Recording Electrodes

Special Considerations for Nerve Conduction Studies

Repetitive Nerve Stimulation Studies

TECHNICAL FACTORS OF NEEDLE ELECTROMYOGRAPHY

Electrodes

Optimal Muscles to Study for Rest Activity

Optimal Muscles for Evaluation of Recruitment, Motor Unit Configuration, and Interference Pattern

Sedation

Limitations of Single-Fiber EMG

SPECIFIC CLINICAL PROBLEMS IN PEDIATRIC ELECTRODIAGNOSIS

Electrodiagnostic Evaluation of the Floppy Infant

Differential Diagnosis for Early Respiratory Distress in Infancy

Acute Onset Infantile Hypotonia

Motor Neuron Disorders

Spinal Cord Injury

Brachial Plexus and Cervical Nerve Root Lesions

Facial Paralysis in the Neonate

Neuropathies Associated With Infections

Entrapment Mononeuropathies in Children

Neuromuscular Junction Disorders

Myopathies

Somatosensory-Evoked Potentials

Conclusion

Cerebral Palsy

Mary McMahon, David Pruitt, and Jilda Vargus-Adams

Cerebral palsy (CP) is defined as “a group of disorders of the development of movement and posture, causing activity limitations that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain” (1).

EPIDEMIOLOGY AND RISK FACTORS

CLASSIFICATION

PATHOLOGY

INITIAL EVALUATION AND CLINICAL FINDINGS

Signs and Symptoms

Imaging

ASSOCIATED DISORDERS

Sensory Impairments

Visual Impairments

Hearing Impairments

Cognitive Impairments

Psychological Impairments

Epilepsy

Oromotor Impairments

Nutritional Disorders

Genitourinary Disorders

Respiratory Disorders

Bone and Mineral Density Disorders

Gait Impairments

TREATMENT

General Principles

Physical and Occupational Therapy

Speech Therapy

Hypertonia Management

COURSE AND PROGNOSIS

Outcome Measures

Quality of Life

Prognosis for Ambulation

Aging With Cerebral Palsy

PEARLS OR PERILS

Spina Blfida

Elaine L. Pico, Pamela E. Wilson, and Rochelle Haa

Spina bifida is the second most common disability in children.

EPIDEMIOLOGY

ETIOLOGY

It is important for the clinician to understand the embryogenesis of neural tube defects.

Normal Development

Pathology

Prenatal screening

CLINICAL TYPES OF NEURAL TUBE DEFECTS

Spina Bifida Occulta

Spina Bifida Cystica

Caudal Regression Syndrome

CLINICAL SIGNS AND COURSE

The spinal cord defect associated with spina bifida is often associated with other malformations.

ASSOCIATED CENTRAL NERVOUS SYSTEM MALFORMATIONS

Extensive neuropathologic studies have demonstrated that neural tube defects are associated with a high incidence of gross and microscopic malformations of the forebrain and hindbrain (34).

Spinal Cord

Cerebellum and Hindbrain

TREATMENT

Neurosurgical Treatment

NEURQGENiC BLADDER

ORTHOPEDICS

COGNITIVE FUNCTION

Neuropsychology and Learning Problems Associated With Spina Bifida

LONG TERM

Aging With a Neural Tube Defect

Vocational Counseling

CONCLUSION

Traumatic Brain Injury

Linda E. Krach, Mark E. Gormley, Jr., and Marcie War

EPIDEMIOLOGY

Traumatic brain injury (TBI) is a major cause of death and disability in children. It is the leading cause of death in those over 1 year of age.

Costs of Injury

Nonaccidental Trauma

Implications of Plasticity

Growing Skull Fracture

NEUROIMAGING

ELECTROENCEPHALOGRAPHY

INJURY SEVERITY

Glasgow Coma Scale

Posttraumatic Amnesia and Children's Orientation and Amnesia Test

Duration of Unconsciousness

COMMON MOTOR DEFICITS

A wide spectrum of motor deficits is seen after TBI. This spectrum results from the variable nature of the injury and the combination of focal and diffuse damage.

COMMON SENSORY DEFICITS

Olfactory Dysfunction (Anosmia)

Hearing Impairment

Visual Impairment

COMMON COGNITIVE DEFICITS

Although TBI can result in both motor and cognitive impairments, it is generally the cognitive impairments that most profoundly affect the individual’s ability to function.

Attention and Arousal

Memory Impairment

Behavioral Problems

Communication Deficits

Executive Function

Social Functioning

MEDICAL CONDITIONS ASSOCIATED WITH TBI

Medical conditions associated with TBI can vary greatly from individual to individual. Essentially, all organ systems can be affected when a child sustains a TBI.

Neuroendocrine Dysfunction

Cerebral Salt Wasting

Anterior Pituitary Dysfunction

Precocious Puberty

Respiratory Dysfunction

Nutritional Management

Bowel Management

Bladder Management

Central Autonomic Dysfunction

Heterotopic Ossification

Posttraumatic Epilepsy

Posttraumatic Hydrocephalus and Cerebral Atrophy