ABPMR Pediatric Rehab cheat sheet

TBI severity uses post-resuscitation Glasgow Coma Scale: mild 13–15, moderate 9–12, severe 8 or less; duration of post-traumatic amnesia and loss of consciousness also modify severity classification.

The pediatric Glasgow Coma Scale modifies the verbal component for preverbal children; the motor subscore is the strongest early predictor of outcome.

PECARN rules stratify children with minor blunt head trauma by age (under 2 versus 2 years and older) and identify those at very low risk of clinically important TBI in whom CT can be deferred, reducing radiation exposure.

Rancho Los Amigos Levels I–VIII describe cognitive recovery: I no response, II generalized, III localized, IV confused-agitated, V confused-inappropriate, VI confused-appropriate, VII automatic-appropriate, VIII purposeful-appropriate.

Return to learn precedes return to sport after concussion; the graduated return-to-sport progression has six stages, advances no faster than one stage per 24 hours, and is symptom-limited.

Amantadine may speed functional recovery in children and adults with disorders of consciousness after severe traumatic brain injury.

Focal spasticity is managed with botulinum toxin A injections; generalized or refractory spasticity may require intrathecal baclofen, phenol neurolysis, or orthopedic surgery.

Antiseizure prophylaxis after traumatic brain injury is not recommended beyond 7 days; early seizure risk rises with penetrating injury, intracranial hemorrhage, and depressed skull fracture.

Post-traumatic hydrocephalus, heterotopic ossification, and hypothalamic-pituitary dysfunction are complications to screen for after severe injury and prolonged immobility.

SCIWORA (spinal cord injury without radiographic abnormality) is most common in children under 8 years because of ligamentous laxity and cartilaginous vertebrae; MRI is required because plain radiographs are normal.

Cervical injuries predominate in young children owing to a large head-to-body ratio and a high spinal fulcrum; upper cervical levels (occiput through C2) are overrepresented compared with adults.

ASIA Impairment Scale: A no sacral sparing; B sensory incomplete; C motor incomplete with more than half of key muscles below the level grading under 3/5; D at least half grading 3/5 or more; E normal.

Autonomic dysreflexia occurs with lesions at or above T6 and presents with hypertension, headache, flushing, and often bradycardia in children; the first step is sitting upright and removing the trigger (bladder, bowel, skin).

Suprasacral lesions produce an upper motor neuron bladder with detrusor overactivity and detrusor-sphincter dyssynergia; conus and cauda equina lesions produce an areflexic lower motor neuron bladder.

Paralytic scoliosis develops in nearly all children injured before skeletal maturity; bracing may slow but does not prevent progression, and growing rods or fusion may be required.

Heterotopic ossification occurs in roughly 20–30% of pediatric spinal cord injury, most often at the hip and knee, presenting with swelling, warmth, and loss of joint range.

Pressure injuries are among the most common preventable complications; risk rises with insensate skin, immobility, and poorly fitting orthoses or equipment.

Transition planning for adult care should begin in early adolescence because pediatric-onset spinal cord injury requires lifelong urologic, orthopedic, and skin surveillance.

Nerve conduction velocity in infants is roughly half of adult values and reaches the adult range by about 3–5 years; amplitudes are also lower in neonates, so age-matched normative data are mandatory.

Myopathic motor unit potentials are short in duration and low in amplitude with early recruitment; neurogenic units are long, large, and polyphasic with reduced recruitment.

Duchenne muscular dystrophy is X-linked dystrophin deficiency: boys show proximal weakness, Gowers sign, calf pseudohypertrophy, and markedly elevated creatine kinase, with cardiomyopathy and restrictive lung disease later.

Corticosteroids (prednisone or deflazacort) slow loss of ambulation in Duchenne; exon-skipping agents target specific deletions such as exon 51, and ataluren targets nonsense mutations.

Spinal muscular atrophy results from homozygous SMN1 deletion; type 1 never sits independently, type 2 sits but never walks, and treatment options include nusinersen, risdiplam, and onasemnogene abeparvovec.

A decrement greater than 10% on repetitive nerve stimulation supports a neuromuscular junction disorder such as myasthenia gravis; anti-acetylcholine receptor antibodies are often positive.

Guillain-Barré syndrome causes ascending symmetric weakness with areflexia; cerebrospinal fluid shows albuminocytologic dissociation, and treatment is IVIG or plasma exchange.

Hereditary motor and sensory neuropathy (Charcot-Marie-Tooth) causes distal weakness, pes cavus, and hammertoes; ankle-foot orthoses address foot drop and gait instability.

Birth brachial plexus injury: Erb palsy (C5–C6) produces the waiter's tip posture; Klumpke palsy (C8–T1) causes hand weakness and may include Horner syndrome.

Developmental dysplasia of the hip is screened with Ortolani and Barlow maneuvers and ultrasound; the Pavlik harness is first-line treatment for infants under 6 months.

Legg-Calvé-Perthes disease affects children 4–8 years, more often boys, with antalgic gait and limited abduction; containment of the femoral head within the acetabulum is the treatment goal.

Slipped capital femoral epiphysis occurs in obese adolescents and may present with referred knee pain and limited internal rotation; treatment is in situ pinning with protected weight bearing.

Ponseti serial casting with percutaneous Achilles tenotomy followed by abduction bracing is the standard of care for idiopathic clubfoot.

Adolescent idiopathic scoliosis: bracing is considered for Cobb angles of 25–40° in skeletally immature patients, and surgery is generally offered above 45–50°.

Salter-Harris physeal fractures: I through the physis; II through physis and metaphysis; III through physis and epiphysis; IV through metaphysis, physis, and epiphysis; V crush injury; higher grades carry greater growth arrest risk.

Supracondylar humerus fractures are most common at ages 5–7 and can cause cubitus varus, compartment syndrome, or neurovascular injury.

Osgood-Schlatter disease and Sever disease are traction apophysitides managed with activity modification and relative rest; symptoms resolve with skeletal maturity.

Congenital muscular torticollis is managed with repositioning and physical therapy; persistent deformational plagiocephaly may require helmet therapy.

Cerebral palsy is a nonprogressive disorder of movement and posture with prevalence near 2–3 per 1,000 live births; prematurity and low birth weight are major risk factors.

GMFCS I–V classifies gross motor function in cerebral palsy and MACS I–V classifies manual ability; both become fairly stable for prognosis after about age 2.

Spastic diplegia is the most common subtype in preterm infants; spastic quadriplegia carries the highest risk of epilepsy, intellectual disability, and feeding difficulty.

Myelomeningocele is associated with Chiari II malformation, hydrocephalus, neurogenic bladder and bowel, and latex allergy; shunt malfunction presents with headache, vomiting, or lethargy.

Ambulation potential in myelomeningocele varies with level: thoracic lesions generally use wheelchairs, while L4 lesions can ambulate with ankle-foot orthoses and crutches.

Down syndrome: screen for atlantoaxial instability before contact sports; congenital heart disease such as atrioventricular canal and hypothyroidism are common comorbidities.

Prader-Willi syndrome causes neonatal hypotonia and feeding difficulty followed by hyperphagia and obesity; growth hormone improves body composition and final height.

Fragile X syndrome is the most common inherited cause of intellectual disability; features include macroorchidism, autistic behavior, and joint hypermobility.

Rett syndrome affects girls with regression of hand use, stereotyped hand movements, and acquired microcephaly; it is caused by MECP2 mutations.

Cystic fibrosis care combines airway clearance (high-frequency chest wall oscillation, huff coughing), mucolytics, and aerobic exercise; exercise capacity predicts survival.

Anthracycline chemotherapy (doxorubicin, daunorubicin) causes dose-dependent cardiomyopathy, so childhood cancer survivors need lifelong periodic echocardiography.

Vincristine causes a symmetric peripheral neuropathy with depressed reflexes, foot drop, and constipation; severe deficits require dose reduction or discontinuation.

Intrathecal methotrexate can cause leukoencephalopathy with cognitive, attentional, and motor sequelae in survivors of childhood leukemia.

Posterior fossa tumor resection may produce cerebellar mutism syndrome with ataxia and emotional lability; speech often returns but dysarthria and cognitive deficits may persist.

Children with a Fontan circulation have reduced exercise capacity; cardiopulmonary exercise testing guides individualized activity recommendations and school participation.

Pediatric cardiac rehabilitation improves functional capacity in congenital heart disease and after transplantation; supervision intensity depends on lesion severity and residual physiology.

Osteosarcoma rehabilitation centers on limb salvage versus amputation decisions, early prosthetic fitting, and surveillance for pulmonary metastasis.

Cancer-related fatigue in children is managed with graded physical activity and energy conservation rather than prolonged bed rest.

A solid ankle-foot orthosis controls ankle position in stance, prevents plantar flexion, improves toe clearance in swing, and provides medial-lateral stability.

Ground reaction ankle-foot orthoses shift the knee toward extension in stance and are used in children with quadriceps weakness or crouch gait.

KAFOs stabilize both knee and ankle; hip-knee-ankle-foot orthoses and reciprocating gait orthoses permit standing and limited walking in higher-level paraplegia.

Tilt-in-space wheelchairs tilt the seat and back together as a unit, redistributing pressure and reducing tone without changing hip and knee angles; recline changes those angles.

Powered mobility can be introduced in toddlers and young children to support exploration, spatial learning, and participation when manual propulsion is not feasible.

Body-powered upper limb prostheses use cable and harness control, give proprioceptive feedback, and are durable; myoelectric devices require adequate residual muscle EMG signal.

Congenital transverse upper limb deficiency is typically fitted with a first prosthesis at about 6–12 months, when sitting balance and reaching emerge.

Constraint-induced movement therapy and bimanual intensive training improve upper limb function in children with hemiplegic cerebral palsy.

Standing programs and gait trainers provide weight bearing for hip development, bone mineral density, and bowel regularity in nonambulatory children.

IDEA Part C provides early intervention for children from birth to age 3 through an Individualized Family Service Plan delivered in natural environments.

IDEA Part B provides special education and related services for children aged 3 through 21 through an Individualized Education Program.

Section 504 of the Rehabilitation Act provides accommodations in general education for children who do not qualify for an IEP.

IDEA requires measurable postsecondary goals and transition services in the IEP no later than age 16; many states begin transition planning at 14.

At age 18, families should consider guardianship or supported decision-making alternatives such as power of attorney and health care proxy.

The WeeFIM measures functional independence from 6 months to 7 years (or older with developmental disability) across self-care, mobility, and cognition using 18 items scored 1–7.

The PEDI-CAT is a computer-adaptive measure covering daily activities, mobility, social-cognitive function, and responsibility in children and youth with disabilities.

Family-centered care is a core principle of pediatric rehabilitation: parents and caregivers are collaborators in goal setting, intervention design, and outcome evaluation.

Health care transition should address insurance continuity, adult provider handoff, and self-management skills, beginning in early adolescence.