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LEARNING OBJECTIVES
Upon completion of this chapter, the reader will be able to:
Describe the epidemiology and advances in recovery specific to the management of pediatric patients with spinal cord injury (SCI).
Identify appropriate tests and measures specific to the management of pediatric patients with SCI.
Explore interventions specific to the management of pediatric patients with SCI.
Utilize a model for identifying and classifying a movement systems diagnosis in the pediatric SCI population.
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Working with a child with a spinal cord injury (SCI), whether traumatic or atraumatic requires that physical therapists embrace the dynamic systems theory as a framework to drive therapeutic practice that supports a child’s functional abilities and level of participation. Physical therapists must consider the individual intrinsic and extrinsic factors that influence the child with an SCI developmental journey. Constraints in subsystems that result in impairments that limit function must be continuously addressed and managed. Opportunities for the child to exploit affordances in the environment, practice meaningful functional tasks, explore diverse movement strategies, and engage in extensive practice that manipulates control parameters in order to drive developmental learning are foundational to providing a rich learning environment for children with SCI.1 This introduction provides background regarding the prevalence and impact of SCI on health care, society, family, and the child and offers insights regarding advances in management and promotion of knowledge translation practices.
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EPIDEMIOLOGY AND ADVANCES IN RECOVERY
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The management of pediatric SCIs has unique challenges to address the physical, cognitive, and social development of the child who has neuromuscular skeletal damage to the developing spinal column. Pediatric physical therapy must not only focus on the immediate needs of the child and family but also plan for and address the far-reaching implications across the patient’s life span. SCI in infants, children, and adolescents is a rare occurrence, representing less than 5% of the total population of individuals injured per year according to The National Spinal Cord Injury Statistical Center (NSCISC). However, SCI impacts children and their families across the patient’s life span, impacting psychological, social, and motor development.2 In addition, health care costs and resources extend beyond the initial injury and include prevention of secondary complications (eg, scoliosis, hip dysplasia, pressure ulcers) and environmental modifications to ensure transition into adulthood. The application of the evidence supporting plasticity in the spinal cord has the potential to improve long-term outcomes and goals of childhood SCIs.
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Efforts to coordinate the care and rehabilitation of individuals with SCI in the United States resulted in the development of SCI model systems across the country in the 1970s, with initially 7 institutions, which has now increased to 18 to advance the care and research for adults with SCI. The SCI Model System is run by the US Department of Health and Human Services, National Institute on ...