Pediatric Rehabilitation: 2022 Community Session

Pediatric Rehabilitation Medicine in the Middle East: Providing Care in Unique Global Healthcare Settings
American Board of Physical Medicine & Rehabilitation Medicine (ABPMR) defines Pediatric rehabilitation medicine (PRM) is the subspecialty that uses an interdisciplinary approach to address the prevention, diagnosis, treatment, and management of congenital and childhood-onset physical impairments including related or secondary medical, physical, functional, psychosocial, cognitive, and vocational limitations or conditions, with an understanding of the life course of disability. Subspecialty certification in PRM has been offered by the ABPMR since 2003.
In the Middle East, there are many children with special needs from genetic disorders, congenital abnormalities, birth trauma, and accidents. However, there are few formally trained pediatric rehabilitation specialists. Due to the gaps in rehabilitation and subspecialty care, many children are sent to Europe, America or Asia for further evaluation and treatment. Some middle eastern countries are now building their own healthcare and rehabilitation programs to encourage patients and families to stay in their home country to receive pediatric subspecialty and rehabilitation services. Subsequently, some U.S. trained pediatric physiatrists have worked as consultants in the Middle East. Two pediatric physiatrists will discuss their experiences in Qatar and the United Arab Emirates. The presenters will review the impact of pediatric rehabilitation specialists in a global healthcare setting, especially in Middle East.

"Therapy across the Lifespan”- Developing therapy interventions for youth and young adults with childhood onset disabilities
Recent census data reports that over three million children or 4.3% of the under-18 population in the United States has a disability. 1 The rates of cerebral palsy have held steady at 2 per 1000 live births in the United States which has led to an increase in the aging population with disabilities. 2 A tenant of treatment for childhood disability is early therapy interventions. This reinforces how early intervention is recommended to optimize neuroplasticity. 3 Recent evidence demonstrates that neuroplasticity is maximized with child-active approaches. 3 Early therapy interventions are aimed at reaching developmental milestones. These milestones can be characterized using the Gross Motor Function Measure (GMFM-66) where predicted motor scores can be made based on a patient’s functional classification level (GMFCS). It has been noted that persons with cerebral palsy may decline in gross motor function as they move into adolescence and young adulthood. 4 These changes include a decline in walking ability, early onset musculoskeletal complaints, increased spasticity, changes in muscle flexibility, strength and endurance.2,4 Increase in the number of falls and fractures2 can worsen functional decline. Pain and fatigue also contribute to patient’s decreased mobility. While the early interventions are aimed at reaching developmental milestones, therapy goals change as children with disabilities age. They often have different personal goals and shifting priorities that include socialization and community integration. They seek to gain independence and therapy that emphasizes “normalization” of movements may not interest them as much. In this presentation, we will discuss how we designed therapy interventions for youth and young adults with disabilities. The goals focused around increasing mobility in desired settings, decreasing pain and decreasing fall risk while increasing mobility confidence. We incorporated strength and resistance training principles that reinforce the research findings that neuroplasticity may go on into the teenage years.

A Pediatric Physiatrist approach to managing Postural Orthostatic Tachycardia Syndrome (POTS)
Postural Orthostatic Tachycardia Syndrome (POTS) is a disorder of the autonomic nervous system characterized by the development of symptoms, including lightheadedness, palpitations, fatigue, and headache, with upright posture. Although POTS has historically been managed by cardiologists and neurologists, seeing as an estimated 25% of POTS patients are so disabled they cannot work or attend school, it is also a natural fit for physiatry. We developed a novel multi-disciplinary clinic, combining pediatric physiatry, behavior psychology, and physical therapy services, which has proved to be an effective model for managing the various needs of this complex patient demographic.
POTS is a growing medical condition, which has benefitted from increased diagnosis and recognition over the past few years. More recently, we have seen an influx of POTS patients after Covid-19 infection. We plan to discuss several cases discussing presentation, treatment, and outcomes of patients recently evaluated in our innovative clinic.

Diagnosis and Management of Sleep Related Breathing Disorders in Patients with Spina Bifida
Persons with spina bifida are at increased risk of sleep related breathing disorders (SRBD) due to multiple anatomic and neurologic factors. This can have significant functional implications, influence cognition, and carries risk of increased morbidity and mortality if untreated. A panel consisting of a pediatric physiatrist and pediatric pulmonologist will explore the reasons behind increased risk of SRBD, implications of disorders, and treatment options. This will be followed by a question and answer period

Functional Deficits of Pediatric Patients with SARS-CoV-2 Infection
There is sparse literature surrounding the need for pediatric rehabilitation following acute SARS-CoV-2 infection but clinically our pediatric rehabilitation medicine team has seen a need. The low frequency of severe pediatric COVID19 and sequelae at any one institution necessitates broad—ideally international—collaboration across many sites to achieve adequate enrollment and generalizability.​ While the adult population's volume of patients is significant, the heterogeneity of patients requiring pediatric rehabilitation consult and/or inpatient rehabilitation hospitalization is large in comparison to adult population which was mostly pulmonary illness and critical illness. In this talk, I will review current evidence-based guidelines for rehabilitation in adult patients with COVID19 and sequelae, highlight the different patient populations we are observing in pediatric patients with 3-5 (depending on time) case presentations, and open for discussion on how we can best support pediatric patients with impairments caused from infection with SARS-CoV-2.