A well-developed plan of care is the vehicle to greater functional independence and participation for children with neurological disorders. The processes of examination and evaluation outlined by the Guide to Physical Therapist Practice (American Physical Therapy Association [APTA], 2001: hereafter referred to as the Guide) lead to the plan of care. In developing such a plan, therapists integrate fundamental principles of pediatric physical therapy, such as family-centered care, a focus on individualized functional outcomes, and a commitment to the interdisciplinary process. Therapists rely on a working knowledge of (1) limitations in body structures and functions and restrictions in activities and participation associated with each child's specific diagnosis, (2) principles of motor development, motor control, and motor learning, and (3) the extant evidence for pediatric neurological interventions.
Chapter 7 addresses limitations in body structures and functions and restrictions in activities and participation associated with neurological conditions. This chapter will apply principles of motor development, learning, and control to a framework for activity-focused interventions and will review the evidence for pediatric neurological interventions addressed in the framework. This content will follow these guidelines based on principles of pediatric physical practice:
The intervention plan should ultimately focus on the child's participation in life's roles through the preservation and enhancement of function as well as prevention of secondary impairments. The intervention plan follows a top-down approach (P.H. Campbell, 1991) in which desired functional outcomes are determined first, and then components that limit these outcomes are assessed.
While the plan of care focuses on functional abilities that enhance independence in daily routines, the physical therapist should be aware that the relationship between function and quality of life is complex. In addition to functional abilities, other factors such as social networks, the child's understanding of the disability, and reciprocal relationships may determine quality of life (Shelly et al., 2008).
To increase quality of life across the life span, intervention should foster the family's development as advocates and decision makers who can be proactive about their child's needs. It is also important to foster independence in the children with whom therapists work, so that they can learn to take responsibility and advocate for their own needs as they approach adulthood.
The plan of care should focus on individualized, meaningful goals that the child or family have identified as important. Furthermore, the child's collaboration should be encouraged in developing the plan of care and setting goals, when developmentally appropriate. Child-centered, functional goals may be associated with greater gains when parents identify them as meaningful and relevant to their situation (Randall & McEwen, 2000).
The goals and objectives that structure the plan of care should be well written and measurable. Efforts by physical therapists to refine their goal writing will be rewarded time and again in practice. Goals and objectives are necessary for fulfilling administrative requirements for the Individualized Education Program (IEP) and the Individualized Family Service ...
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