Pediatric Rehabilitation Enhance performance after Illness, trauma, sports related injury Includes medical, social, emotional, school

Faren H. Williams, M.D., M.S.2 PHYSIATRY Goals are to –MAXIMIZE FUNCTION OF PATIENTS –STAY ACTIVE THROUGHOUT LIFETIME Faren H Williams, MD, MS –Chief, PM&R, Dept of Orthopedics/ Physical Rehab –Clinical Professor, U Mass School of Medicine

Faren H. Williams, M.D., M.S.3 CONDITIONS Musculoskeletal Injuries Brain Injury Stroke Spinal cord injuries Amputations Gait Abnormalities Severe Disabilities

Impairment(s) versus Disability IMPAIRMENT –Change in medical status, developmental level –Change in emotional status –Change in degree of wellness DISABILITY –Degree to which change in function affects person Goal is to Minimize Disability Faren H. Williams, M.D., M.S.4

Clinical Interview Assessment by a trained clinician Face-to-face evaluation Medical history Physical abilities & needs Functional abilities & needs Seating & positioning abilities & needs Home and school/ work site accessibility Currently used assistive devices Environmental considerations

Medical Problems Seizures Spasticity Contractures Altered vision Vertigo/ Dizziness Abnormal posturing Dysautonomia Bladder/ Bowel Dysfunction

Bladder Dysfunction Mechanical Problems –(Time to get to bathroom, doff clothing, etc.) Sphincter Changes Social Embarrassment Isolation Depression

Physical Examination Primary Problem Secondary conditions –Cognition, fatigue, vision –Cardiopulmonary endurance –Sensation –Bladder and bowel –Balance and falls –Skin issues –Musculoskeletal, pain –Spasticity Physical Motor Abilities

MOBILITY History –Specific questions related to mobility PHYSICAL EXAMINATION Focus on sitting posture, positioning Focus on gait, and abnormalities of gait Focus on use of adaptive technology Functional mobility Faren H. Williams, M.D., M.S.9

Assistive Technology Manual chairs Power assist chairs Power operated vehicles Motorized chairs Emerging technology Augmentive communication devices

COMPREHENSIVE GOAL is to put LIFE BACK TOGETHER DIFFERENTIATE MEDICAL from PSYCHIATRIC/ EMOTIONAL from PREMORBID conditions DEVELOPMENTAL STAGE Faren H. Williams, M.D., M.S.11

GOAL –FUNCTIONAL FOCUS Realistic, attainable Sustains self esteem, hope Faren H. Williams, M.D., M.S.12

EXERCISE PROGRAM Individualized Appropriate for Medical Problems Therapy specific prescriptions Age specific Home component Faren H. Williams, M.D., M.S.13

Devising Exercise Program Bone Density Knowledge Muscle Strength Cognition Coordination Balance Cardiovascular Health –(To build bone mass – exercise intensity 60-85% VO2 Max or 70 – 85% of maximum heart rate)

Maximize Adherence to Program Slow, steady progress Improved gait/mobility and ADL’s Meaningful activities Faren H. Williams, M.D., M.S.15

COGNITIVE/ BEHAVIORAL SENSORY DEPRIVATION CONFUSION/ DISORIENTATION ANXIETY/ DEPRESSION DECREASED INTELLECTUAL CAPACITY IMPAIRED BALANCE/ COORDINATION

Psychological Issues Loss of Self-Esteem Isolation Vulnerability Embarrassment –Physical Appearance –Bladder Dysfunction

Re-entry into School/ Work Type of School/ Job Physical versus more sedentary Level of concentration Testing – Physical/ Cognitive Review school/ job expectations Videos helpful Discussion with family and others

RESOURCES COORDINATION Medical School Cognitive – including cognitive re-training Physical – adaptive equipment –Augmentive communication –Devices for ambulation- bracing, walkers, wheelchairs Faren H. Williams, M.D., M.S.19

RESOURCES COMMUNITY –Massachusetts Brain Injury Association –PERSONAL Family support Financial Insurance vs. Family Faren H. Williams, M.D., M.S.20

Faren H. Williams, M.D., M.S.21 QUALITY OF LIFE Goal of PM&R –Addressing multiple problems of patients –Minimizing those problems –Optomizing function –Providing adaptive equipment –Minimizing disability –Inter/ multidisciplinary framework

Faren H. Williams, M.D., M.S.22 PHYSIATRY OVERVIEW THANK YOU! QUESTIONS?