Pediatric rehabilitation is a unique and important facet of the health-care system, and physical therapy plays a significant role. As a member of the interdisciplinary team, the physical therapist provides comprehensive care to both children and families with the ultimate goal of maximal recovery and function in life. To be successful with this extraordinary opportunity, physical therapists must possess not only the skill to deliver family-centered, culturally competent, and age-appropriate care, but also the fundamental knowledge and ability to make evidence-based clinical decisions that drive best practice and advance the field of pediatric health care and rehabilitation.
Core values central to rehabilitation have historically included the promotion of overall happiness with the ultimate goal of increased patient freedom or maximized independence. In more recent years, with the propensity of managed health care, fairness and equitable access to treatment has also become a central core value, sparking many ongoing ethical debates about frequency and duration of treatment (Dougherty, 1991; Reder, 2009). These ethical considerations arise as the philosophy in the rehabilitation field is shifting from compensation to recovery of function. While teaching compensatory techniques to a child with a new neurological injury may expedite the discharge process, taking the necessary time to focus on recovery of function could result in neuroplastic changes, with consequential improved long-term outcomes (Taub, 2002). As rehabilitation teams and payors struggle to determine the most cost-effective plans that will yield the best outcomes, physical therapists play a crucial role in advocating for their patients with the support of evidence-based plans of care and measurable outcomes.
Once a child has become medically stabilized, he or she will begin the journey of recovery. These journeys can take many forms, and may include admission to an acute rehabilitation setting, day hospital, or outpatient rehabilitation. Some children may receive outpatient services at a facility typically geared toward adults. While the principles of physical therapy remain the same despite age, specific and important nuances exist in the pediatric population that are important for all clinicians to consider when working with a pediatric client.
Pediatric Rehabilitation Settings
Pediatric rehabilitation may occur within the same hospital where the acute care was provided, but may also occur in a freestanding rehabilitation hospital. In a study of pediatric trauma facilities, Osberg and colleagues explored variables that triggered discharge to inpatient rehabilitation versus home (Osberg, DiScala, & Gans, 1990). Severity of injury and degree of impairment were major influencing factors in the decision to refer a child to inpatient rehabilitation; however, these authors also found that children were more likely to be admitted to inpatient rehabilitation if an onsite rehabilitation facility existed at the acute trauma center. While this is not always available, the authors suggest that the presence of an onsite rehabilitation facility should be external to the decision as to whether a child is appropriate for rehabilitation, ...