The Pediatrician’s Role
The pediatrician’s responsibility in writing a prescription for therapy includes providing an accurate diagnosis when possible. When the exact cause of the disability is not apparent, the physician must provide an accurate description of the medical condition and note whether the child has a transient, static, or progressive impairment. In addition to the primary motor disorder, all potential associated problems such as learning disabilities, mental retardation, sensory impairment, speech disorders, emotional difficulties, and seizure disorders must be identified, and a care plan must be recommended. There are some children with special needs whose medical conditions may be affected adversely by movement or other specific therapeutic activities; therapists and caregivers should be advised to take appropriate precautions with these children.
The physician’s prescription for therapy should contain, in addition to the child’s diagnosis: age; precautions; type, frequency, and duration of therapy; and designated goals. Goals for physical, occupational, and speech-language therapy do not depend solely on the diagnosis or age of the child, and they are most appropriate when they address the functional capabilities of the individual child and are relevant to the child’s age-appropriate life roles (school, play, work). The pediatrician should work with the family, child, therapists, school personnel, developmental diagnostic or rehabilitation team, and other physicians to establish realistic functional goals. The pediatrician can assist families in identifying the short- and long-term goals of treatment, establishing realistic expectations of therapy outcomes, and understanding that therapy will usually help the child adapt to the condition but not change the underlying neuromuscular problem. Pediatricians should be encouraged to seek and use expert consultation as in any other area of medicine. Helpful resources may include local and regional diagnostic and intervention teams, early intervention and developmental evaluation programs, developmental pediatricians, pediatric physiatrists, pediatric neurologists, pediatric orthopedists, and orthotists.
Regular communication among parents and other caregivers, therapists, educators, and prescribing physicians should be ongoing, with periodic reevaluations to assess the achievement of identified goals, to direct therapy toward new objectives, and to determine when therapy is no longer warranted. Changes in the child’s status (e.g., surgical intervention, school-to-work transition warranting assistive technology intervention) may indicate resumption of specific short-term, goal-directed services.
Summary
Successful therapy programs are individually tailored to meet the child’s functional needs and should be comprehensive, coordinated, and integrated with educational and medical treatment plans, with consideration of the needs of parents and siblings. This can be facilitated by primary care pediatricians and tertiary care centers working cooperatively to provide care coordination in the context of a medical home.
