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Chapter 2 Index
A. Evaluation by system:
1. General
2. HEENT
3. Cardiopulmonary
4. GI
5. GU
6. Orthopedics
7. Neurological
--Breath-Holding
Spells
--Benign Febrile Seizures
--Treating Children with Seizures
--ADHD
--Occupational Therapy |
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Pediatric Physiatry
Elizabeth Moberg-Wolff MD
Physical Medicine & Rehabilitation
Training: Separate residency in rehabilitation medicine and fellowship in
same specialty.
Goal of Physiatry:
Optimize a child’s function despite residual
disability.
Operate as a team, which includes: patient and family, physiatrist,
primary care and consulting physicians, nursing, PT, OT, Speech pathologist,
Psychologist, nutritionist, recreation therapist, learning specialist, social worker.
Problems Handled by This Team Headed By a Psychiatrist:
- Evaluation of functional deficits by team: mobility, safety,
cognition, communication, swallowing, equipment.
- Continued care related to disability: pressure sores, contractures,
seizures, and scoliosis.
- Orthotic and prosthetic assessment and prescription; wheelchair
prescription.
- Bowel and bladder management and education.
- Pulmonary rehabilitation.
- Family education and support.
Typical Types of Rehabilitation Patients:
| 1. CP, mild or severe |
7. Traumatic brain injury |
| 2. Spina Bifida/Spinal cord injury |
8. Meningitis/encephalitis |
| 3. Stroke/Brain tumor |
9. Rheumatologic diseases |
| 4. Amputees |
10. Cardiopulmonary disorders |
| 5. Metabolic/genetic disorders |
11. Developmental delay |
| 6. Muscular dystrophy |
12. Brachial plexus palsy |
Case report of case of spastic diplegia discussed. Approach we should
take with children:
1. General approach: Use ancillary services such as PT, OT.
2. Medications that can be used: Injections:
- Phenol (last 6 months) useful for treatment of spasticity
of larger muscles.
- Botulinum toxin: (last 3 months) useful for treatment of
spasticity of smaller muscles.
3. Surgery after four years of age.
4. Do not be afraid to use wheelchairs in children that need them.
5. Other meds such as Dantrium and Valium may be too sedative.
Be aware of the IEP (Individual educational program) that schools are
required to create for every child with a disability.
Be an advocate for children with disabilities.
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