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Educational Objectives
Pediatric Rehabilitation Rotation

Medical Knowledge

1. Summarize the impact of growth and development on management of children with congenital and acquired disabilities.
2. Summarize the Pathology, recovery, and rehabilitation of pediatric traumatic brain injury.
3. Summarize the pathology, recovery, and rehabilitation of pediatric spinal cord injury.
4. Summarize the pathology, recovery, and rehabilitation of stroke in children/adolescents.
5. Differentiate between normal and abnormal gait in children and adolescents.
6. Summarize the importance of adequate nutrition in children/adolescents chronic disease.
7. Summarize the pathophysiology of neuromuscular disease; short term goals of exercise, bracing, equipment, with anticipatory guidance in children/ adolescents.
8. Recognize Cerebral Palsy and the associated management issues.
   1. Prenatal, perinatal, postnatal risk factors associated with CP
   2. Classify and describe types of CP
   3. Prognosis for ambulation
   4. Management of impairments to promote and optimize functional mobility. ADLs and communication including orthotics, gait analysis, and assistive technology.
   5. Spasticity management orthotics, medications, including role of Botox
   6. Post-surgical management-orthopedic and neurosurgical (selective dorsal rhizotomy)
   7. Issues involved in transition to adulthood.
9. Summarize the indications for therapeutic exercise, electrical stimulation, spasticity management and other rehabilitation modalities with pediatric populations.
10. Summarize the different forms of spinal bifida and the associated management issues.
    1. forms of spinal dysraphism based on degree of neural tube malformation.
    2. genetics and epidemiology
    3. identify motor and sensory levels
    4. neurologic consequences including hydrocephalus, Chiari malformation
    5. identify signs of tethered cord
    6. associated lower extremity and spinal malformations and the role of orthopaedic surgery and bracing
11. Summarize critical pre-prosthetic training for lower extremity congenital amputee including postural training, attaining balance, symmetric pelvis, and muscle development.
12. Recognize when it is developmentally appropriate to provide various
    pre-prosthetic and prosthetic devices to LE congenital and acquired amputees.
13. Recognize when to provide replacement prosthesis secondary to growth.
14. Summarize how to evaluate burns based on depth, extent, type of burn, and age of patient.
15. Summarize pediatric burn wound care
    1. Summarize potential ongoing medical issues such as respiratory compromise secondary to inhalation injuries
    2. Summarize potential complications such as soft tissue contractures across growing joints and disfiguring scars
16. Recognize how a specific pediatric disability can interfere with sexual development.
17. Summarize a patients transition to adult issues of sexuality and fertility.
18. Recognize and respect family and cultural differences regarding issues of sexuality, and means of providing information.
19. Discuss the classification system for juvenile rheumatoid arthritis including incidence, model of onset, associated findings, and natural course of each.
20. Discuss the pathogenesis/evaluation of common acute and overuse musculoskeletal pain syndromes involving the back, knee anterior leg, ankle/foot and upper extremity in pediatric patients.
21. Discuss non-invasive pulmonary rehabilitation issues.
22. Discuss pediatric chronic pain syndrome.

Patient Care

1. Perform a detailed pediatric examination; general, neurologic, and musculoskeletal.
2. Interpret diagnostic studies commonly ordered in pediatric rehabilitation medicine
3. Coordinate medical care and management of spasticity in traumatic and non-traumatic brain injury and spinal cord injury including:
   1. Medications
   2. Bracing
   3. motor point injections in cerebral palsy and spasticity management, including post operative care of selective dorsal rhizotomy
4. Assess the need for psychological support especially for children/adolescents with chronic diseases and acquired injuries
5. Prescribe appropriate bracing for upper and lower extremities in children/adolescents.
6. Prescribe appropriate assistive devices for children/adolescents.
7. Describe the management of neurologic bowel and bladder in children/adolescents.
8. Develop management strategies for community re-entry after traumatic injuries
9. Recommend a plan for skin care/decubiti ulcer care in children/adolescents.
10. Evaluate and formulate treatment plan for acute pediatric trauma (consultation service).
11. Evaluate and formulate treatment plan for acute post-operative brain tumors in children/adolescents.
12. Recognize balance between the proper size and weight of the prosthetic device on one hand and motor skills, developmental abilities and expanding functional needs of the child.
13. Summarize functional needs of congenital upper extremity amputee i.e. when to introduce pre-prosthetic training, passive prosthesis
14. Recognize when it is developmentally appropriate to introduce advanced devices such as self activated terminal device, myoelectric control, cable elbow for UE
15. Formulate goals regarding proper positioning, splinting, pressure garments and exercise of pediatric burn patients.
16. Summarize treatment options for burn complications (e.g. soft tissue contractures across growing joints; disfiguring scars)
17. With family approval, provide anticipatory guidance for adolescents on issues such as contraception and STDs.
18. Summarize treatment planning for common neuromuscular disorders including pharmacological, surgical and therapeutic interventions.
19. Summarize treatment planning for juvenile rheumatoid arthritis syndromes including pharmacological, surgical and therapeutic interventions.
20. Summarize treatment planning for common acute and overuse musculoskeletal pain syndromes involving the back, knee anterior leg, ankle/foot and upper extremity in pediatric patients.
21. Demonstrate how to interact with various medico-legal aspects of child care systems (e.g., child protection, guardianship)

Interpersonal and Communication Skills

1. Serve as leader of the rehabilitation team on rounds and during interdisciplinary team conferences.
2. Present information to patients, family members, caregivers & other health care providers in an effective manner.
3. Establish trust and maintain positive rapport with patients.
4. Demonstrate effective listening skills.
5. Promote teamwork in the clinical setting.
6. Complete dictations and chart notes in a legible & timely manner.

Professionalism

1. Demonstrate sensitivity and responsiveness to age, culture, disability and gender of patients and colleagues.
2. Consider effects of personal, social and cultural factors in the disease process and patient management.
3. Demonstrate reliability, punctuality, integrity and honesty in all interactions with patients and colleagues.
4. Accept personal responsibility for own actions & decisions.
5. Apply sound ethical principles in practice (e.g., informed consent, confidentiality, veracity, provision or withholding of care).

Practice-Based Learning and Improvement

1. Demonstrate skill in supervising junior residents and medical students in information gathering, decision-making, and patient management.
2. Identify appropriate assessment & measurement tools to evaluate functional status or outcomes of interventions.
3. Evaluate and/or modify own practice based on feedback from others.
4. Use information technology to appraise & assimilate evidence from scientific studies to enhance patient care outcomes.

Systems-Based Practice

1. Summarize the physicians role in advocating for care needs
2. Summarize the physicians role in disease management across various levels of the health care system in a cost effective manner
3. Demonstrate how to access various community resources on behalf of the patient
4. Demonstrate integrity and responsibility in interactions with insurance and/or disability-oriented agencies.