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HISTORY AND PHYSICAL EXAMINATION OF THE PEDIATRIC REHABILITATION PATIENT: INTRODUCTION

This chapter reviews the aims and methods of the physiatric history and physical examination of the pediatric patient, focusing on the history, physical examination, and functional status. In addition to providing an overview, the goal of the chapter is to help an experienced clinician make important distinctions in clinical care of this patient population.

With acknowledgment to Jhablall Balmakund, MD, for materials on pediatric gait.

INTRODUCTION

History and physical examination in physiatry aim to not only make medical diagnoses but also to assess functional status. Additional objectives are to determine the goals, hopes, and expectations of the patient and family and to begin to develop rapport and a working relationship with them. In pediatric physical medicine and rehabilitation, there are additional dimensions of child and adolescent development and often complicated emotions of parents facing special needs or long-term disability in their children. Families often have varied levels of understanding regarding the young person whose life is going to be different from their peers.

An accurate diagnosis can make a great difference in the effectiveness of management and the prognosis of many disabling conditions. Our patients may come to us with a well-defined problem and cause, or it may be up to us to pick up on an unsuspected or missed diagnosis. Although the physiatric focus is on the musculoskeletal and neurologic systems, general health and well-being are critical to review. Therefore, a thorough general physical examination is also essential. The effect of physically disabling conditions on other organ systems should be elucidated; this often requires screening procedures and additional specialty medical care to avoid complications that may limit function. Common examples include cardiac and pulmonary dysfunction; nutritional status; metabolic, hepatic, and renal conditions; and skin integrity.

The emotional impact and understanding of a pediatric disability by the family should be addressed.1 Does a parent view the child as sick, dying, or in need of a cure? Is the condition an embarrassment or a reflection of their inadequacy or failure in their eyes? Is the family overwhelmed with guilt, fear, or shame or concerned with how we view them and how they may be judged as parents? Are they comfortable with their child openly participating in their community as they are able? Do they have the practical and emotional support they will need not only to provide care but also to facilitate an optimal level of function and quality of life for themselves and their child as a whole family? What do children or adolescents understand about themselves and their condition?

In the International Classification of Functioning (ICF) framework, this approach addresses the questions of what is wrong on a pathophysiologic level (impairment or disease), what is lacking on a functional level, what are the effects on fulfillment of appropriate roles in ...

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