Department of Physical Medicine and Rehabilitation University of Colorado Denver, School of Medicine Aurora, Colorado. University of Colorado Denver Department of Physical Medicine and Rehabilitation and Health Sciences Center.
SETTING THE TONE
HISTORY
Even if one has access to records, the parents should be asked to tell the child's history in their own words. The child may have special interests and strengths that need further development or difficulties in certain subjects, which may require additional help and adaptation of the IEP.
EXAMINATION
In children with ataxia, telangiectasias are usually present on the flexor surface of the knees and elbows. If the baby is anxious, upset, restless or crying, this part of the examination should be postponed.
INFORMING INTERVIEW
The pediatric rehabilitation examination is meaningless if the physiatrist does not build from it a coherent picture of the child's functional achievements. This assessment complements and integrates the variety of information derived from all phases of the examination.
Children with special health care needs (CSHCN) are those children who have had or are at risk for a chronic physical, developmental, behavioral or emotional condition and who also require health and related services of a type or amount beyond that which children generally required. (1). Finally, this chapter will discuss the issue of palliative care for children with special health needs.
MEDICAL HOME
This chapter will focus on a discussion of providing medical care to CSHCN using a medical home model, the routine health maintenance issues for children with disabilities, and the common acute medical problems that a PCP may be asked to address in this evaluate group of children. The medical home was also described as an effective model for implementing a successful transition to adult medical care as children with special health care needs age.
ROUTINE HEALTH MAINTENANCE
Use of antiviral medications should be considered for children with disabilities because of their high risk of significant morbidity. Children with congenital cytomegalovirus (CMV), both symptomatic and asymptomatic at birth, are at risk of progressive and late-onset hearing loss (42).
ACUTE ILLNESS IN THE PRIMARY CARE OFFICE
Treatment of fractures in children with disabilities varies depending on the diagnosis, type and location of the fracture. Prediction of height from knee height in children with cerebral palsy and non-palliated children.
PALLIATIVE CARE
American Academy of Pediatrics Ad Hoc Task Force on Definition of the Medical Home: The medical home. Dental health status of mentally and physically disabled children and adults in the Galway Community Care Area of the Western Health Board.
CONCLUSION
Developmental enamel defects in primary teeth in children with cerebral palsy, mental retardation or hearing impairment: a review. Gastroesophageal reflux in children with cerebral palsy and its relation to erosion of primary and permanent teeth.
ADJUSTMENT VERSUS PSYCHIATRIC DIAGNOSIS
In line with the centrality of development, the assessment objects constitute a "moving target". Environmental demands change, as do the child's or teenager's ability to meet them. The effects can be bidirectional (4), where the deficit from the medical condition interacts with the parent's traits or the child's status resulting in disturbed parenting.
NATURE OF MEASUREMENT
One is test-retest, meaning the ability of the test to give a similar result if given a second time to a child. Another is alternate form reliability, where the child is tested with an alternate form of the test, measuring the same trait and in the same way as the original test.
USES OF ASSESSMENT
It is clear that assessing a child or teenager's learning is essential for both the school and medical environment. Differential diagnosis may be important, as in the case of post-traumatic stress disorder, where cognitive symptoms of that disorder may be mistaken for the effects of mild brain injury or concussion.
TYPES OF ASSESSMENTS
Some include consistency scales that add information about the nature of the responses given. For example, many of the "culture fair" tests are only normed for children in the United States.
SPECIFIC INSTRUMENTS
The Wechsler scales include the Wechsler Intelligence Scale for Children, 4th Edition (WISC-IV) (75), the Wechsler Adult Intelligence Scale, 3rd Edition (WAIS-III) (76), and the Wechsler Preschool and Primary Scale of Intelligence, 3rd Edition ( WPPSI-III) (77). The factor structure of the WISC-IV was significantly changed compared to the previous edition. Scores are plotted on a profile with two forms available - the actual state of the family as perceived by individual members and the ideal state.
SPEECH AND LANGUAGE
Communication may be intentional or unintentional, may involve conventional or unconventional signals, may take linguistic or non-linguistic forms, and may occur through speech or other means. Communication is definitely a dynamic process used to exchange ideas, connect experiences and share desires. The chapter is divided into two parts: The first part describes the development of speech and language.
DEVELOPMENT AND DISORDERS
Some anomalies, such as cleft palate, prevent adequate ventilation of the airflow, resulting in inaccurate production of speech sounds. Congenital hearing loss can have a significant impact on the development of speech and language, depending on the severity of the loss.
FEEDING AND SWALLOWING PROCESSES AND DISORDERS
A full motor examination of the mouth should also be performed to determine the presence of any structural or functional abnormalities of the oral musculature. Food can be offered by the doctor, parent or child, depending on the readiness and health stability of the child and the availability and willingness of the parent.
ACKNOWLEDGMENT
SUGGESTED READINGS
PEARLS OR PERILS
Wheelchair sports are newer still, having parallel births in Britain and the United States in the mid-1940s. The 1970s saw the development of the United States Cerebral Palsy Athletics Association (USCPAA) and the United States Association of United for Blind Athletes (USABA).
EXERCISE IN PEDIATRICS
In the 40 years since, the number and scope of sporting and recreational opportunities have blossomed. Sports for youth with disabilities are increasingly available in many communities through adapted physical education (APE) programs in schools, inclusion programs in Boy Scouts, Little League baseball, and others.
PHYSIOLOGIC IMPACT
The NWAA created a junior division in the early 1980s, which included children and youth from 6 to 18 years of age. Supervised physical exercise can safely improve aerobic capacity and muscle strength in children with osteogenesis imperfecta (24).
PSYCHOSOCIAL IMPACT
Survivors of severe pediatric burns have lower body mass and muscle strength compared to unburned peers; however, both are significantly improved after exercise training (26). Children with polyarticular juvenile idiopathic arthritis have safely participated in aerobic conditioning programs, with marked improvements in strength and conditioning.
ADAPTED SPORTS AND
RECREATION PROFESSIONALS
The Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) records the number of days per week and daily hours of participation in recreational, household, and occupational activities over the past seven days. Together, they measure six dimensions of participation (ie, diversity, intensity, where, with whom, satisfaction, and preference) in formal and informal activities and five types of activities (recreational, physically active, social, skill-based, and self- .-improvement) regardless of the level of assistance needed.
PARTICIPATION IN PHYSICAL ACTIVITY
Lower levels of moderate or vigorous physical activity are seen in those living in high-crime areas (61). The presence of seizures, intellectual impairment, impaired walking ability and communication problems predict lower levels of physical activity among children with CP (73).
INJURY IN THE DISABLED ATHLETE
There are very few changes to the game itself and the rules of the United States Soccer Federation Resources. Effects of aquatic interventions in children with neuromotor impairments: a systematic review of the literature.
UPPER AND LOWER LIMB ORTHOSES
Continued
Hand orthosis with a flexion hinge that immobilizes the thumb in the opposite position and semi-flexes the IP joints of the index and middle fingers so that the index and middle fingers can move simultaneously towards the thumb. Although the design is light and simple, the disadvantage can be the bulkiness of the actuator as well as the ugly appearance of the orthosis.
Continued
However, the passive state should not replace the child's exploration of his environment and body. Finally, determine the specific seating goals for the child and the type of moving base (22).
Continued
The Step-N-Go bike allows a rider to stand and pedal, making propulsion easier for children with extensor tone. The Hippo Car Seat is for transporting children with hip spica supports, broomsticks and Ilfeld rails.
AUGMENTATIVE AND ALTERNATIVE COMMUNICATION (AAC) AND
Natural unaided speech may be one's primary communication technique, but supplemented by a speech amplifier or a device that generates speech in noisy environments (7). Speech-generating devices (SGDs) fall into different categories (Table 6.6), as do orthoses and other assistive devices.
COMPUTER ACCESS FOR LEARNING, WRITING, AND LIVING
On-screen keyboards can be programmed with different numbers and sizes of keys on a device's touch screen for people who have different visual-motor skills and abilities. In addition, many devices can be programmed with different sized keys on different parts of the screen for people who have more controlled fine motor skills in some areas.
ASSISTIVE ORTHOSES AND ROBOTS Automated Feeders
For example, if the user is weak, the robot can do most of the work. The effect of positioning for children with cerebral palsy on upper-extremity function: a review of the evidence.
MATURATIONAL FACTORS
Electromyography (EMG), nerve conduction studies (NCS), and evoked potentials, including somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs), provide useful information to assist the clinician in locating pathology in the abdomen. motor neuron and selected areas of the central nervous system. The physical examination and the child's developmental level determine the examination.
IN PEDIATRIC ELECTRODIAGNOSIS
The diameter of the fibers at the time of birth has been shown to be half that of adults. In infants and young children, two distinct peaks in the sensory nerve action potential (SNAP) are often observed upon proximal stimulation.
TECHNICAL FACTORS WITH INFANTILE NERVE CONDUCTION STUDIES
Stimulation of the posterior tibial nerve (recording abductor hallucis brevis) produces a discrete CMAP more commonly than stimulation of the peroneal nerve (recording over extensor digitorum brevis). The ground electrode is a 6-millimeter silver disk electrode placed on the back of the hand.
TECHNICAL FACTORS OF NEEDLE ELECTROMYOGRAPHY
In addition, extensor muscles such as the vastus lateralis and gastrocnemius in the legs and the triceps in the upper limbs are useful sites for evaluating insertional and spontaneous activity. In general, flexor muscles such as the tibialis anterior and the iliopsoas are useful for evaluating MUAPs and recruitment in the lower limb.
SPECIFIC CLINICAL PROBLEMS IN PEDIATRIC ELECTRODIAGNOSIS
Often patients undergo simultaneous biopsy of the deltoid (for EM) and motor tip biopsy of the anconeus or intercostal muscle (for in vitro electrophysiological studies). The role of electromyography in the management of brachial plexus palsy of the newborn.
EPIDEMIOLOGY AND RISK FACTORS
Fetal surveillance in the United States has likely increased the rate of cesarean delivery but has not been associated with any decrease in the CP rate (28). It is the best predictor of CP in full-term infants, regardless of the cause of the encephalopathy.
CLASSIFICATION
Less than 10% of children with this condition had asphyxia, in contrast to prematurity, which is associated with up to half of all cases of CP. Currently, quantitative tools are being developed and improved to describe the clinical and radiographic features of cerebral palsy, which will improve the consistency of CP classification.
PATHOLOGY
For example, an early hand preference or asymmetric use of the limbs may be the first indication of hemiparesis. However, in general, longer periods of hypotonia and severe hypotonia are associated with more severe motor impairment, regardless of the type of CP.
INITIAL EVALUATION AND CLINICAL FINDINGS
Neuroimaging can be useful in determining the etiology of CP and the timing of the insult. A practice parameter in the diagnostic evaluation of a child with CP showed that most children with CP were found to have an abnormal MRI (mean 89%) and that MRI was more likely to show an abnormality compared to CT (mean 77%) (37). .
DIFFERENTIAL DIAGNOSIS
A definitive diagnosis of CP should be made with caution, especially in the first six months of life. The practice parameter therefore recommends neuroimaging in the evaluation of a child with CP if the etiology has not been established and MRI is preferred over CT (Fig. 8.8).
ASSOCIATED DISORDERS Sensory Impairments
Equinovalgus foot deformity results from spasticity of the gastrocsoleus complex and peroneal muscles, as well as weakness of the posterior tibial muscle. Frequency and urgency are often associated with spasticity of the detrusor muscle, causing small, frequent voiding.
TREATMENT
Malrotation of the leg can interfere with stability during stance phase and effective push-off. The results of two small case series found an increased active and passive range of motion at the ankle after stimulation of the anterior tibialis (99) and improved sitting balance after stimulation of the abdominal and posterior back muscles (100).
