Physical Therapy – How should diagnoses affect pediatric rehabilitation?

As a pediatric therapist for almost 15 years, I can personally say that this niche in our profession is rich in complexities. We all know as practitioners that treatment strategies are different for every patient, even for those with the same diagnosis. But variables including, but not limited to, human growth, emergence or non-emergence of new motor skills, and specificity of family and home situation place the clinical decision-making process in pediatric therapy on a different platform. For the past 5 years, I have been working with children with disabilities and their families in a non-profit out-patient rehabilitation facility in New York. Every child is referred by a resident pediatric physician in the medical department to the rehabilitation department for all therapy needs including physical, occupational, and speech therapy. While direct access is not practiced in my workplace, the resident physicians work with the therapists in determining the best way a child with disabilities can attain optimum functional capacity. Sahrmann (2005) in his article asked if physicians realize the complimentary nature of our scope of practice, rather than a conflicting one, with theirs (p. 556). I am fortunate to work with physicians who value my professional input as a physical therapist as much as I value theirs and so my answer is a resounding yes. At work, heads butt every so often and conflicts arise, but all because both members of the medical and rehabilitation departments advocate for what they feel will be the best treatment approach to help the child. And the appropriate treatment plan is first and foremost guided by a diagnosis or diagnoses.

Simoneau and Allison (2010) stated that the diagnostic process is not an exact science and is one of probability than a certainty. When a child is referred to my care with a medical diagnosis of spina bifida for example, I think of that diagnosis as a business entity and the child’s body systems as the various departments of that company. A thriving business is one where all departments function optimally. When one department falters, the success of the company becomes uncertain. Other departments need to work harder to keep the business running and undue workload may cause more departments to fail. If the child’s neuromuscular system is not working, imagine the skeletal system going into malalignment due deficits in the muscular system and how the postural system will adapt to these musculoskeletal restrictions. The end-result would be an inability to move or movement patterns that are atypical and biomechanically inefficient. With trained eyes in movement analysis, I create a treatment plan not intended to address the medical diagnosis of spina bifida but to help the child attain functional skills limited by impairments in his systems. The American Physical Therapy Association (APTA) in the Guide to Physical Therapist Practice 3.0 stated that physical therapists diagnose the “impact of a condition on function at the level of the system (especially the movement system) and at the level of the whole person” (APTA, 2014, p. 31). With the same child in mind, I would for example create a treatment plan intended to address postural instability during walking that limits the child’s ability to play with peers in school. I may then refer the child back to the physician and an orthotist who would help me procure a leg brace that the child could use to improve his ambulation pattern. Since the diagnostic process revealed an intervention needed that is not within my scope of practice, it is my responsibility to refer the child to the appropriate health practitioners (APTA, 2014, pp. 31-32).

Immersing myself deeply into the role I play in the diagnostic process as a physical therapist allows the full utilization of the knowledge and skills I learned in school, ensures an appropriate plan of care for my patients, and furthers my contribution to the profession in its goal towards autonomy.

References
APTA. (2014). Guide to physical therapist practice 3.0. Alexandria, VA: APTA. Retrieved from http://guidetoptpractice.apta.org
Labilles, I. (2015, 18 January). Introductory Discussion forum. Retrieved from Utica College Engage website at https://engage.utica.edu/learn/mod/forum/discuss.php?d=51508
Sahrmann, S. (2005). Are physical therapists fulfilling their responsibilities as diagnosticians? Journal of Orthopaedic & Sports Physical Therapy, 35(9). 556-558. Retrieved from https://drive.google.com/a/utica.edu/file/d/0B6H3AGASWe0ScWM4bWM4VWgyVnM/edit
Simoneau, G. G., Allison, S. C. (2010). Physical therapists as evidence-based diagnosticians. Journal of Orthopaedic & Sports Physical Therapy, 40(10). 603-605. Retrieved from http://web.a.ebscohost.com.ezproxy.utica.edu/ehost/command/detail?sid=1dfe643d-335b-41ed-98b4-d96fb4629ef9%40sessionmgr4005&vid=11&hid=4207