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Pediatric Rehabilitation

Pediatric Rehabilitation. Enhance performance after Illness, trauma, sports related injury Includes medical, social, emotional, school. PHYSIATRY. Goals are to MAXIMIZE FUNCTION OF PATIENTS STAY ACTIVE THROUGHOUT LIFETIME Faren H Williams, MD, MS

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Pediatric Rehabilitation

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

  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 Faren H. Williams, M.D., M.S.

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

  5. 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

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

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

  8. 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

  9. 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.

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

  11. 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.

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

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

  14. 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)

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

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

  17. Psychological Issues • Loss of Self-Esteem • Isolation • Vulnerability • Embarrassment • Physical Appearance • Bladder Dysfunction

  18. 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

  19. 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.

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

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