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 participation in life activities. To be successful, 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 (Dougherty, 1991). With the more recent 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. Although 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 payers struggle to determine cost-effective plans that will yield the best outcomes, physical therapists play a crucial role in advocating for the children they serve with the support of evidence-based plans of care and measurable outcomes. In addition, the increased use of patient-reported outcome measures (PROMs) provides patient-centered data on the impact of diseases or disorders and intervention from the patient’s perspective. These data are not only used for clinical decision-making but increasingly are used by insurance companies to determine reimbursement in the outpatient setting (Davis & Bryan, 2015; Kyte et al., 2015).
Once a child is medically stable after an injury or illness, 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 rehabilitation, or outpatient rehabilitation. Some children may receive outpatient services at a facility typically geared toward adults. Although the principles of physical therapy remain the same regardless of 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 as the acute-care admission, or in a freestanding rehabilitation hospital. In a study of pediatric trauma facilities, Osberg, DiScala, and Gans (1990) explored variables that triggered discharge to inpatient rehabilitation versus the child’s home. Severity of injury and degree of impairment were major influencing factors in the decision to refer a child to inpatient ...