Prescribing Therapy Services for Children with Motor Disabilities

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DISABILITIES: PHYSICAL DISABILITIES:
Pscribing Therapy Services for Children with Motor Disabilities

Prescribing Therapy Services for Children with Motor Disabilities
* Michaud LJ. Prescribing therapy services for children with motor
disabilities. Pediatrics 2004 Jun;113(6):1836-8. [23 references] PubMed
National Guideline Clearinghouse
<http://www.guideline.gov/summary/
summary.aspx?ss=15&doc_id=5325&nbr=3638>
A shorter URL for the above link:
<http://tinyurl.com/cspqf8>

COMPLETE SUMMARY CONTENT

SCOPE
METHODOLOGY - including Rating Scheme and Cost Analysis
RECOMMENDATIONS
EVIDENCE SUPPORTING THE RECOMMENDATIONS
BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS
QUALIFYING STATEMENTS
IMPLEMENTATION OF THE GUIDELINE
INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES
IDENTIFYING INFORMATION AND AVAILABILITY
DISCLAIMER

SCOPE
DISEASE/CONDITION(S)

Motor disabilities, including those related to:

* Cerebral palsy
* Traumatic brain injury
* Myelomeningocele
* Spinal cord injury
* Neuromuscular disease
* Juvenile rheumatoid arthritis
* Arthrogryposis
* Limb deficiencies

GUIDELINE CATEGORY

Management
CLINICAL SPECIALTY

Family Practice
Pediatrics
Physical Medicine and Rehabilitation
Speech-Language Pathology
INTENDED USERS

Health Care Providers
Physician Assistants
Physicians
GUIDELINE OBJECTIVE(S)

To define the context in which rehabilitation therapies should be
prescribed, emphasizing the evaluation and enhancement of the childs
function and abilities and participation in age-appropriate life roles
TARGET POPULATION

Children with motor disabilities
INTERVENTIONS AND PRACTICES CONSIDERED

1. Accurate diagnosis /description of disability
2. Development of appropriate prescription for therapy programs
(physical, occupational, and speech-language)
3. Establishment of realistic functional goals (both short- and
long-term
4. Regular communication among parents and other caregivers,
therapists, educators, and prescribing physicians
5. Parent and caregiver education

MAJOR OUTCOMES CONSIDERED

Effectiveness of therapy for motor disability

RECOMMENDATIONS

MAJOR RECOMMENDATIONS

The Pediatricians Role

The pediatricians responsibility in writing a prescription for therapy
includes providing an accurate diagnosis when possible. When the exact
cause of the disability is not apparent, the physician must provide an
accurate description of the medical condition and note whether the child
has a transient, static, or progressive impairment. In addition to the
primary motor disorder, all potential associated problems such as learning
disabilities, mental retardation, sensory impairment, speech disorders,
emotional difficulties, and seizure disorders must be identified, and a
care plan must be recommended. There are some children with special needs
whose medical conditions may be affected adversely by movement or other
specific therapeutic activities; therapists and caregivers should be
advised to take appropriate precautions with these children.

The physicians prescription for therapy should contain, in addition to the
childs diagnosis: age; precautions; type, frequency, and duration of
therapy; and designated goals. Goals for physical, occupational, and
speech-language therapy do not depend solely on the diagnosis or age of
the child, and they are most appropriate when they address the functional
capabilities of the individual child and are relevant to the childs
age-appropriate life roles (school, play, work). The pediatrician should
work with the family, child, therapists, school personnel, developmental
diagnostic or rehabilitation team, and other physicians to establish
realistic functional goals. The pediatrician can assist families in
identifying the short- and long-term goals of treatment, establishing
realistic expectations of therapy outcomes, and understanding that therapy
will usually help the child adapt to the condition but not change the
underlying neuromuscular problem. Pediatricians should be encouraged to
seek and use expert consultation as in any other area of medicine. Helpful
resources may include local and regional diagnostic and intervention
teams, early intervention and developmental evaluation programs,
developmental pediatricians, pediatric physiatrists, pediatric
neurologists, pediatric orthopedists, and orthotists.

Regular communication among parents and other caregivers, therapists,
educators, and prescribing physicians should be ongoing, with periodic
reevaluations to assess the achievement of identified goals, to direct
therapy toward new objectives, and to determine when therapy is no longer
warranted. Changes in the childs status (e.g., surgical intervention,
school-to-work transition warranting assistive technology intervention)
may indicate resumption of specific short-term, goal-directed services.

Summary

Successful therapy programs are individually tailored to meet the childs
functional needs and should be comprehensive, coordinated, and integrated
with educational and medical treatment plans, with consideration of the
needs of parents and siblings. This can be facilitated by primary care
pediatricians and tertiary care centers working cooperatively to provide
care coordination in the context of a medical home.