Slide 1

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

Slide 2

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

Slide 3

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

Slide 4

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

Slide 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

Slide 6

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

Slide 7

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

Slide 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

Slide 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.9

Slide 10

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

Slide 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.11

Slide 12

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

Slide 13

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

Slide 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)

Slide 15

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

Slide 16

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

Slide 17

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

Slide 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

Slide 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.19

Slide 20

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

Slide 21

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

Slide 22

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