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Objectives

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OBJECTIVES

After reading this chapter, the reader will be able to:

  • Describe how the epidemiology and pathophysiology of spinal cord injury (SCI) differ between children and adults

  • Describe the medical sequelae of SCI in children

  • Discuss the management of spasticity in children with SCI

  • Describe the spinal column complications of SCI in children

  • Describe the psychological effects of SCI on children and their families

  • Discuss the management of the upper extremities in children with SCI

  • Describe the available orthotic options for standing and walking for children with SCI

  • Discuss the selection of wheelchairs for children with SCI

  • Discuss the challenges of discharge planning and school reentry after SCI in children

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Introduction

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Management of children with spinal cord injury (SCI) presents unique acute and long-term medical, surgical, psychological, and rehabilitative challenges. As with other severe, chronic diseases in children, SCI affects the entire family, and as such, requires that care be directed not only to the affected child, but also to all members of the child's family. Advancements in medicine, technology, and public policy related to disabilities have combined to increase the expectation of improved outcome and quality of life. With provision of timely and appropriate interventions during acute, subacute, and long-term rehabilitation and good general pediatric, as well as SCI-focused, medical care, children with SCI can participate in a full range of social, educational, recreational, and interpersonal activities and become productive members of society as adults. In this chapter, we review the important aspects of SCI in children that will enable therapists, nurses, physicians, and other specialists to help children achieve these goals.

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Epidemiology and Pathophysiology of SCI in Children

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The Incidence of Pediatric SCI

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Pediatric SCI is a relatively uncommon disease that each year affects approximately 1500 to 2000 children younger than 18 years of age in the United States. Of the 10,000 to 11,000 cases of SCI annually, only 5%1 occur in children younger than 10 years old, the time at which the spine approaches adult size and rigidity.1,2 The incidence varies between countries, ranging from 0.5 to nearly 3 cases per 100,000 children per year.3 The U.S. incidence is estimated to be 1.99 per 100,000.4 As with other forms of childhood trauma, gender and race play important roles. Boys are almost twice as likely as girls to experience SCI, with an incidence in boys of 2.79 per 100,000 versus 1.15 per 100,000 in girls. While most cases of pediatric SCI occur in Caucasians, the incidence in African Americans and Hispanics has been rising steadily over the last two decades. The etiology of SCI in children includes motor vehicle accidents (MVA; 56%), falls (14.2%), gun violence (9.2%), and sports injuries (7.7%). As one would expect, etiology of SCI is very much age dependent, with younger children sustaining injuries due to MVAs and falls, whereas violence and ...

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