The Pediatric Rehabilitation Program offers care to children with congenital and acquired neurological and musculoskeletal diseases. Patients may have disorders such as cerebral palsy, brain injury, neurologic disorders, and congenital or acquired amputation. Pediatric Rehabilitation is provided through ambulatory clinics directed by a specialist in Pediatric Physiatry. A major component of the Pediatric Rehab program occurs at Shriners Hospital for Children, Northern California, directly adjacent to the UC Davis Medical Center.
Cerebral Palsy is due to brain injury that may have occurred before, during or after birth and the injury to the brain may occur through a variety of causes. In the Department of Physical Medicine and Rehabilitation we are prepared to help the patient and their family in dealing with the symptoms that are associated with cerebral palsy. In addition, we have a Spasticity Clinic where we work closely with the child in dealing with spastic movements of the muscles.
Services and Treatment Available
Botulinum toxin (BOTOX) drug treatment which has proven to be effective in controlling decreasing rigidity and spasms in muscles. Baclofen pump which is a surgically implanted device which delivers Baclofen directly to the spinal cord. Selective posterior rhizotomy For further information on cerebral palsy the National Academy of Child Development offers an informative article for parents who want to learn about cerebral palsy including symptomatic diagnosis, spasticity, athetosis, and causes. If you would like information on botulinum toxin (BOTOX) the Miller-Dwan Medical Center Web site provides some information and frequently asked questions about BOTOX, baclofen pump and selective posterior rhizotomy. These three treatments may be available at the UC Davis Department of Physical Medicine and Rehabilitation and should be discussed in detail with a Physical Medicine and Rehabilitation physician if you have any further questions or inquiries.
Functional restoration is achieved by therapies geared towards:
- improving the functional capacity of affected systems and residual capacities of unaffected systems
- providing orthotics/prosthetic devices, adaptive equipment, and assistive technology to help compensate for disabilities
- teaching compensatory alternative strategies to achieve functional skills
- training family and care providers
- improving patient motivation and participation in therapeutic activities through behavioral and psychological strategies
Population served includes patients from birth to age 21 with any of the following impairments:
- Brain injury
- Multiple trauma
- Cerebral palsy
- Acquired amputations and limb deficiencies
- Spinal cord injury
- Peripheral nerve disorders (e.g. Guillian Barre)
- Other musculoskeletal and neurological disorders
- Shriners Hospital for Children, Northern California
- California Children's Services (CCS) Medical Therapy Program: providing medical direction for therapy services within eleven CCS medical therapy units (MTU's) across eight Northern California counties.
- Muscular Dystrophy Association (MDA)
The CCS paneled treatment team include the following members:
- Physical Therapist
- Occupational Therapist
- Speech Pathologist
- Social Worker
Specialized services include the following:
- Wheelchair and durable medical equipment assessments
- Aquatic therapy
- Neuropsychological testing
- Cognitive rehabilitation
- Developmental evaluations
- Consults and specialty referraIs
Physician consultants at UC, Davis Medical Center include:
- Pediatric orthopaedics
- Child neurology
- Pediatric neuro-urology
- Pediatric neurosurgery and genetics
- Other pediatric subspecialists
Referrals are also available for out-patient physicians and community pediatric support groups.
UC Davis Medical Center Department of Physical Medicine and Rehabilitation maintains active federally funded research programs in neuromuscular disease, therapeutic exercise and nutrition, pulmonary rehabilitation of restricted lung disease, swallowing disorders, body composition analysis, and energy expenditure of locomotion in children. Other active areas of research focus on spasticity management including pharmacological agents, botulinum toxin-A (BOTOX R), and intrathecal baclofen.
Contact and Referral Information
Health care professionals who wish to refer a patient to the UC Davis Physical Medicine and Rehabilitation Clinic should call 800-4-UCDAVIS or 800-482-3284. Patients who would like more information about the clinic should call 916-734-7041.
Participation in rehabilitation activities is a vital part of the rehabilitation process. Patients are scheduled for therapy and activities every day. Patients are required to participate for a minimum of three hours per day in their rehabilitation. The following activities will help patients adjust to their disabilities, regain independence, and return to home and community: As part of therapy on Friday afternoons, adult patients may participate with the therapy staff in an organized social activity in the hospital or they may go out into the community to shop, attend a movie, go to the park, etc. On a daily basis, patients are scheduled to eat lunch and dinner in the patient dining room.
Rehabilitation patients are encouraged to provide the following personal items to assist them in regaining their independence:
Clothing: Three (3) outfits of sweat suits or loose fitting clothing and undergarments. Please note that there are no laundry facilities available for patients.
Shoes: Prefer previously worn rubber soled shoes, low in height, such as tennis shoes.
Toiletry items: Brush, comb, make-up, shaving items, etc.
These items should be labeled with the patient's name. Please have these items available for the patient by the day after admission to the Physical Medicine and Rehabilitation Unit.
During rehabilitation, the team will coordinate a family conference to discuss the patient's discharge goals, needs, and recommendations. Patient and family participation in this conference will help the patient return to a functional role within the family and community.
Community re-entry leave (CRL):
Toward the end of the rehabilitation stay, a CRL may be approved to allow the patient to leave the hospital for up to eight hours. Patient and family are encouraged to use this time to identify problems or concerns (access, mobility, safety, etc.) prior to the patient's actual discharge.
The rehabilitation doctor is trained to diagnose disabilities in all forms: physical, mental, social and vocational. The physician sees patients daily and manages their medical problems to improve and maintain optimal health while participating in intensive therapy. The physician uses a creative team-oriented approach that may include the cooperative efforts of physical therapists, occupational therapists, speech pathologists, psychologists, social workers and nurses.
Nurses on the rehabilitation unit have special training in the care of PM&R patients. The nursing staff teaches patients and their caregivers vital aspects of their physical care, including skin and wound care, bowel/ bladder care, administration of medications, proper nutrition, ostomy and stoma care, diabetic care, tracheotomy care, measurement of pulse and blood pressure, and safety precautions. In addition, nurses reinforce skills learned in therapy and help patients and their families adapt to lifestyle changes. Patients are taught to become responsible for their own care, helping to ease their return to home and community.
Physical therapists teach patients mobility skills needed to become functionally independent. An individualized program is developed and discussed with each patient and with family members as appropriate. The plan includes a list of goals tailored to the strength and movement needs of the patient. Therapists help patients achieve these goals in a variety of ways including mat exercises, wheelchair instruction, and the use of parallel bars or other devices for gait training. The family is instructed in these techniques so that they will be prepared to help the patient achieve maximal independence at home and in the community.
Occupational therapists assist patients in relearning a variety of daily activities, including eating, dressing, and personal hygiene. These activities are referred to as activities of daily living (ADL). Occupational therapists also help patients regain control and function of their arms and hands. Additionally, the occupational therapist may assess the need for a wheelchair, specialized cushions, or other equipment that will allow patients to function safely and independently in the home and community environment. Therapists instruct both the patient and family on the use of this equipment, positioning and transferring techniques, and activities of daily living.
Speech-language pathologists evaluate a patient's communication, thinking processes, and swallowing abilities. Therapy provides patients with skills to improve their attention, memory, reasoning, and understanding of language and speaking, as well as helping patients to eat and swallow safely. Therapy is individualized to meet a patient's needs. Family education is an integral part of treatment. The goal of therapy is to help patients communicate effectively at home, in the community, and in the work or school setting.
Psychologists / Neuropsychologists:
A patient's state of mind affects the extent to which he or she will benefit from rehabilitation and make a satisfactory long-term adjustment to any residual disability. Psychologists evaluate patients' psychological and neuropsychological status and facilitate their adjustment to the rehabilitation process and their adaptation to disability. Services include individual and group therapy, family support and education, neuropsychological evaluation and cognitive rehabilitation.
For children, consultation with school psychologists and other personnel is provided to facilitate the school re-entry process.
Social worker and discharge planner:
These professionals provide services to ensure that patients and family members know about relevant community resources and to help provide a smooth transition back into the home, community, and work or school setting. Our social workers run stroke and spinal cord injury support groups that are available to our rehabilitation patients and their families as well as to members of the community.