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The pediatrician should work with the family, child, therapists, school personnel, developmental diagnostic or rehabilitation team, and other physicians to establish realistic functional goals. The pediatrician can assist families in identifying the short- and long-term goals of treatment, establishing realistic expectations of therapy outcomes, and understanding that therapy will usually help the child adapt to the condition but not change the underlying neuromuscular problem. Pediatricians should be encouraged to seek and use expert consultation as in any other area of medicine. Helpful resources may include local and regional diagnostic and intervention teams, early intervention and developmental evaluation programs, developmental pediatricians, pediatric physiatrists, pediatric neurologists, pediatric orthopedists, and orthotists. Regular communication among parents and other caregivers, therapists, educators, and prescribing physicians should be ongoing, with periodic reevaluations to assess the achievement of identified goals, to direct therapy toward new objectives, and to determine when therapy is no longer warranted. Changes in the child’s status (eg, surgical intervention, school-to-work transition warranting assistive technology intervention) may indicate resumption of specific short-term, goal-directed services. Successful therapy programs are individually tailored to meet the child’s functional needs and should be comprehensive, coordinated, and integrated with educational and medical treatment plans, with consideration of the needs of parents and siblings. This can be facilitated by primary care pediatricians and tertiary care centers working cooperatively to provide care coordination in the context of a medical home.

REFERENCES

1. Sneed RC, May WL, Stencel CS. Training of pediatricians in care of physical disabilities in children with special health needs: results of a two-state survey of practicing pediatricians and national resident train-ing programs. Pediatrics. 2000;105:554 –561

2. Consensus statements. Pediatr Phys Ther. 1990;2:175–176

3. Piper MC. Efficacy of physical therapy: rate of motor development in children with cerebral palsy. Pediatr Phys Ther. 1990;2:126 –130

4. Kurtz LA. Rehabilitation: physical therapy and occupational therapy.

In: Batshaw ML, ed. Children With Disabilities. 5th ed. Baltimore, MD: Paul H. Brookes Publishing; 2002:647– 657

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