Published online March 1, 2005
PEDIATRICS
Vol. 115
No. 3
March 2005, pp.
792
(doi:10.1542/peds.2004-1495)
Therapy Is More Than Treatment
Alfred L. Scherzer, EdD, MD, FAAP
Clinical Professor Emeritus of Pediatrics
Department of Pediatrics of Weill Medical College
Cornell University
New York, NY 10021
The recent statement by the Committee on Children With Disabilities1 concerning therapy services for children with motor disabilities provides useful information about how therapists function as well as prescription guidelines for pediatricians to follow. The publication is timely, because the number of children with motor disabilities remains at a steady level, and there is a strong demand for such services.2 Also, pediatricians in practice continue to have limited training, experience, and perspective in this area.3 Nevertheless, it is my view that the committee statement should have had a broader outlook beyond the single concept of treatment of the involved child.
I believe that, in addition, the pediatrician should be equally aware of the need for the family to have assistance in home management.4 The infant with motor disabilities often presents special problems in home care because of abnormal tone, posture, reflex behavior, and/or sensory deficits.5 Areas of concern include:
- handling
- positioning
- daily care (bathing, dressing, and feeding)
In each of these areas there are neurodevelopmental restrictions that confront the parent in care of the child. At the same time, these restrictions can limit response to the therapy program or a more appropriate growth process.
Home management assistance by therapists can help guide parents to more effective ways of dealing with the child that makes daily care easier and more efficient and is more closely related to therapy goals. It is of interest to note that one of the early studies of physical therapy highlighted home care assistance in management of the child as the only consistently statistically significant benefit.6
Another byproduct of therapy involvement for children with motor disabilities is family support. The availability of a caring therapy professional with whom parents can communicate concerns, obtain information, receive encouragement, and develop a supportive relationship can, in itself, serve to greatly enhance the total therapeutic milieu in which families become immersed. It can serve as a buffer and point of reference from the often well-meaning suggestions and demands of family and friends. The supportive benefit of the therapy experience itself can also be a factor that positively affects family relationships.7
Provision of therapy services for children with motor disabilities needs to go beyond treatment modalities alone and should focus as well on management assistance, especially for the very young child. It is suggested that pediatricians become better aware of the therapists’ capability to focus on management where indicated and to consult with therapists on how this can best be achieved. The pediatrician’s prescription for therapy should reflect concerns not only for treatment but for management assistance and family support. Helping pediatricians to understand this broader view could well be achieved through future guidance by the Committee on Children With Disabilities.
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FOOTNOTES
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Accepted Jul 22, 2004.
Address correspondence to Alfred L. Scherzer, EdD, MD, FAAP, PO Box 1023, New York, NY 11901. E-mail: scherzer{at}optonline.net
No conflict of interest declared.
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REFERENCES
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- American Academy of Pediatrics, Committee on Children With Disabilities. Prescribing therapy services for children with motor disabilities.
Pediatrics. 2004;113
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- Parkes J, Donnelly M, Dolk H, Hill N. Use of physiotherapy and alternatives by children with cerebral palsy: a population study.
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- Scherzer A, ed.
Early Diagnosis and Interventional Therapy in Cerebral Palsy: An Interdisciplinary Age-Focused Approach. New York, NY: Marcel Dekker; 2001:101–103
- Scherzer A, Mike V, Ilson J. Physical therapy as a determinant of change in the cerebral palsied infant.
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- King S, Teplicky R, King G, Rosenbaum P. Family-centered service for children with cerebral palsy and their families: a review of the literature.
Semin Pediatr Neurol. 2004;11
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PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics
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