Organ Systems

Although the primary health care of children with dis­abilities remains the responsibility of the pediatrician, the pediatric physiatrist should perform a selective general physical examination.

Vital signs, including blood pressure and heart rate, are obtained in all patients. In myopathies and collagen diseases, cardiac auscultation should be per­formed because of the possibility of associated heart disease. In a child with developmental delay, the presence of a heart murmur may suggest an undiag­nosed syndrome. Blood pressure monitoring is par­ticularly important in spinal cord injury, neurogenic bladder, Guillain-Barre syndrome, and residual polio­myelitis, as well as in children receiving stimulant medications.

In disabilities that cause ineffective ventilation and involve the risk of minor aspirations, auscultation of the lungs must be a routine procedure. Myopathies, thoracic spinal cord dysfunction due to injury or mal­formation, severe spastic quadriparetic cerebral palsy, and any disability with oral motor dysfunction are such indications.

Abdominal and rectal examinations are essential in children with neurogenic bladder and bowel dys­function to evaluate bladder distention, bowel or rectal impaction, and anal sphincter tone. Stool consistency, intermittent or continuous bladder incontinence, and gross appearance and microscopic examination of the urine should be noted. Umbilical movements in response to eliciting superficial abdominal reflexes help to delineate the spinal cord level in thoracic lesions. Absent abdominal muscles result in loose skin folds resembling a prune; hence, the name prune-belly syndrome.