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LEARNING OBJECTIVES
Upon completion of this chapter, the reader will be able to:
Identify the role of physical therapy in the pediatric acute care setting.
Identify and understand the unique challenges, both medical and physical, presented in the acute care setting.
Identify elements required for a complete functional history or prior level of function (PLOF).
Identify important objective information required to determine appropriate discharge environment.
Identify common precautions and how they may affect the physical therapist’s plan of care.
Identify the clinical presentation of the most common diagnoses encountered in the inpatient pediatric setting.
Identify appropriate evaluative tests and measures for the most common diagnoses found in the inpatient setting.
Identify and support with clinical reasoning a variety of therapeutic interventions appropriate for the inpatient setting.
Identify appropriate measurable goals for the inpatient setting.
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In the year 2019, there were 5.2 million pediatric hospital admissions reported, with the majority (76.2%) being newborns and infants under the age of one year.1
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This number includes medical as well as surgical admissions. Respiratory conditions were the primary reason for admissions in children younger than 10 years while mental disorders were the leading reason for admissions for children older than 10 years.1 These children present with a wide variety of acuity levels—some stable and others having experienced severe trauma or are at high risk of experiencing rapid decompensation.2 Acuity refers to the level of complexity of health problems that a patient poses and the level of care that the patient requires to address these complexities. Each hospital uses a system they have developed to determine acuity. The number of patients in the hospital and their acuity levels are used to determine medical staffing patterns for each shift.
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Given the variety of diagnoses encountered in the acute care setting, the practice of physical therapy can be challenging, but it remains of great importance to the recovery and improved function of a patient. Physical therapy must take place within the confines of the comprehensive care a child in the hospital is receiving. This requires scheduling around competing medical tests and interventions, medication administration, and caregivers are availability for training. The physical therapist (PT) has a responsibility to be familiar with a wide variety of medical diagnoses and interventions. Patients can have changing clinical presentations related to emerging deficits from disease progression or physiologic instability. The acute care PT must be attuned to changes in patient status that may be indicative of a medical emergency or a significant event that affects overall function.
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It is in the acute care hospital that many families and patients may first encounter the profession of physical therapy. PTs are an integral part of the inpatient medical team, and their contributions are an important component of a child’s medical care. The data collected during an acute care PT evaluation may be ...