ABSTRACT
In this special communication, an overview of the research on trauma, resilience, and action items for the pediatric physical therapist (PT) is addressed. The experiences of early childhood, positive and negative, impact overall development and well-being throughout the lifespan. Childhood trauma can include exposure to abuse, neglect, violence, racism, or medical procedures. These adverse childhood experiences are associated with poor physical and mental health outcomes that can extend into adulthood and can appear in the pediatric rehabilitative realm as caregivers who become labeled noncompliant. Trauma is common and impacts all children; however, some populations, such as children with disabilities, have greater risk for experiencing adversity. An individual's trauma history is not always visible, necessitating a standard approach. Pediatric PTs must take an intentional approach to address the detrimental effects of trauma on those we serve. Many organizations recommend adopting trauma-informed care as the standard of care for all populations.
Subject(s)
Physical Therapy Modalities , Wounds and Injuries , Child , Child, Preschool , Humans , Physical Therapists , PediatricsABSTRACT
This perspective article advocates for pediatric physical therapists to increase their role and visibility in the primary and secondary prevention of chronic pain during 2 critical developmental periods: infancy and early adolescence. The opioid epidemic and the disabling aspects of chronic pain are adversely affecting children and their families. Health care disciplines are adopting measures that address risk factors for the development of chronic pain in children, including strategies to minimize acute procedural pain and parental education to reinforce healthy pain-coping behaviors. Pediatric physical therapists are uniquely positioned to develop and adopt strategies to aid in this effort. They routinely screen and evaluate children for developmental delays and work with children who are at increased risk for developing chronic pain as a sequela of their health condition or as a consequence of painful medical procedures.
Subject(s)
Adaptation, Psychological/physiology , Chronic Pain/prevention & control , Parents/education , Physical Therapy Modalities , Adolescent , Health Status , Humans , Infant , Risk FactorsABSTRACT
BACKGROUND: Neuro-Developmental Treatment (NDT) currently embraces evidence-based concepts of motor control, motor learning and neuroplasticity. However, most research has been performed on outdated models of NDT. OBJECTIVE: This case series examines the short- and long-term outcomes of a three-week intensive using contemporary NDT interventions. METHODS: Six children, 2-10 years old with neurologic disorders and Gross Motor Function Classification System (GMFCS) levels I-III participated in the intervention. The three-week intensive included 60 minutes of physical, occupational and speech therapy 3-5 times weekly. RESULTS: All children demonstrated Gross Motor Function Measure-66 gains of medium to large effect sizes. These gains were maintained or improved upon 3 months' post conclusion of the intensive intervention. CONCLUSIONS: This study supports emerging research regarding the effectiveness of intensive intervention and further study of current NDT interventions.
Subject(s)
Exercise Therapy/methods , Motor Skills/physiology , Nervous System Diseases/physiopathology , Nervous System Diseases/therapy , Occupational Therapy/methods , Speech Therapy/methods , Child , Child, Preschool , Exercise Therapy/trends , Female , Humans , Male , Nervous System Diseases/diagnosis , Occupational Therapy/trends , Physical Therapy Modalities/trends , Pilot Projects , Speech Therapy/trends , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND AND PURPOSE: Whole body vibration training is a viable option for children with Rett syndrome; however, the positioning requirements and intense vibration may be interpreted as pain. CASE: A 13-year-old girl with a diagnosis of Rett syndrome, Stage IV, participated. The Individualized Numeric Rating Scale was developed in collaboration with the caregiver and scored by a physical therapist and student physical therapists during 16 sessions of whole body vibration training. OUTCOMES: The therapist and students reached 100% agreement on the Individualized Numeric Rating Scale ratings and successfully provided distractions to prevent pain and distress from reaching a level 5 out of 10 for 139 of 144 sessions. CONCLUSION: This is the first case in the literature to demonstrate use of the Individualized Numeric Rating Scale with a child who is nonverbal during a potentially painful physical therapy procedure.
Subject(s)
Monitoring, Physiologic/methods , Nonverbal Communication , Pain Measurement/methods , Pain, Procedural/etiology , Physical Therapy Modalities , Rett Syndrome/rehabilitation , Vibration/adverse effects , Adolescent , Female , Humans , Treatment OutcomeSubject(s)
Chronic Pain , Pediatrics , Child , Humans , Lower Extremity , Outcome Assessment, Health Care , Physical Therapy ModalitiesABSTRACT
PURPOSE: This study explored pain assessment measures and interventions used by physical therapists in the treatment of children with neurologic impairment. METHODS: Following extensive literature review on pain assessment and intervention, a survey was developed, pilot tested, and posted on the listserv of the Pediatric Section of the American Physical Therapy Association. RESULTS: Eighty percent of the respondents used subjective measures to assess pain, 70% used self-report scales, and 41% used behavioral and physiological measures. Behaviors frequently used included vocalizations, facial expression, and irritability. Rarely used cues included decreased attention, withdrawal, and changes in sleeping and eating behaviors. Therapists used research-supported pain interventions such as distraction and praise as well as potentially harmful distress producing measures such as procedural talk and reassurance. CONCLUSION: Further research is needed to determine the feasibility of using behavioral pain assessment measures during physical therapy sessions. Physical therapist continuing education regarding nonpharmaceutical pain interventions is indicated.
Subject(s)
Cerebral Palsy/rehabilitation , Pain Measurement/methods , Pain , Physical Therapy Modalities , Surveys and Questionnaires , Cerebral Palsy/complications , Child , Humans , Pain/diagnosis , Pain/etiology , Pain Management , Physical Therapy Specialty/education , Treatment OutcomeABSTRACT
PURPOSE: This literature review explores pain assessment tools and psychosocial pain management methods that are pertinent to physical therapy (PT) for children with cerebral palsy (CP). SUMMARY OF KEY POINTS: Children with CP experience considerable pain that affects quality of life and cooperation during healthcare procedures. Physical therapist-led research on interventions to address pain in this population is limited, despite evidence for the prevalence of pain during PT interventions, and the preponderance of research supporting the use of psychosocial pain management during other healthcare-related pain-inducing procedures. STATEMENT OF CONCLUSIONS AND RECOMMENDATIONS FOR PHYSICAL THERAPY PRACTICE: Research completed primarily by non-physical therapist healthcare professionals delineate assessment tools and psychosocial pain management techniques that hold promise for evaluating and reducing pain that occurs during PT procedures for children with CP.
