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## Complete Summary

#### GUIDELINE TITLE

Prescribing therapy services for children with motor disabilities.

#### BIBLIOGRAPHIC SOURCE(S)

Michaud LJ. Prescribing therapy services for children with motor
disabilities. Pediatrics 2004 Jun;113(6):1836-8. \[23 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15173521)

#### GUIDELINE STATUS

This is the current release of the guideline.

American Academy of Pediatrics (AAP) Policies are reviewed every 3 years
by the authoring body, at which time a recommendation is made that the
policy be retired, revised, or reaffirmed without change. Until the
Board of Directors approves a revision or reaffirmation, or retires a
statement, the current policy remains in effect.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Motor disabilities, including those related to:

-   Cerebral palsy

-   Traumatic brain injury

-   Myelomeningocele

-   Spinal cord injury

-   Neuromuscular disease

-   Juvenile rheumatoid arthritis

-   Arthrogryposis

-   Limb deficiencies

#### GUIDELINE CATEGORY

Management

#### CLINICAL SPECIALTY

Family Practice\
Pediatrics\
Physical Medicine and Rehabilitation\
Speech-Language Pathology

#### INTENDED USERS

Health Care Providers\
Physician Assistants\
Physicians

#### GUIDELINE OBJECTIVE(S)

To define the context in which rehabilitation therapies should be
prescribed, emphasizing the evaluation and enhancement of the child´s
function and abilities and participation in age-appropriate life roles

#### TARGET POPULATION

Children with motor disabilities

#### INTERVENTIONS AND PRACTICES CONSIDERED

1.  Accurate diagnosis /description of disability

2.  Development of appropriate prescription for therapy programs
    (physical, occupational, and speech-language)

3.  Establishment of realistic functional goals (both short- and
    long-term

4.  Regular communication among parents and other caregivers,
    therapists, educators, and prescribing physicians

5.  Parent and caregiver education

#### MAJOR OUTCOMES CONSIDERED

Effectiveness of therapy for motor disability

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

Not stated

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Not stated

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

**The Pediatrician´s Role**

The pediatrician´s responsibility in writing a prescription for therapy
includes providing an accurate diagnosis when possible. When the exact
cause of the disability is not apparent, the physician must provide an
accurate description of the medical condition and note whether the child
has a transient, static, or progressive impairment. In addition to the
primary motor disorder, all potential associated problems such as
learning disabilities, mental retardation, sensory impairment, speech
disorders, emotional difficulties, and seizure disorders must be
identified, and a care plan must be recommended. There are some children
with special needs whose medical conditions may be affected adversely by
movement or other specific therapeutic activities; therapists and
caregivers should be advised to take appropriate precautions with these
children.

The physician´s prescription for therapy should contain, in addition to
the child´s diagnosis: age; precautions; type, frequency, and duration
of therapy; and designated goals. Goals for physical, occupational, and
speech-language therapy do not depend solely on the diagnosis or age of
the child, and they are most appropriate when they address the
functional capabilities of the individual child and are relevant to the
child´s age-appropriate life roles (school, play, work). 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 (e.g., surgical
intervention, school-to-work transition warranting assistive technology
intervention) may indicate resumption of specific short-term,
goal-directed services.

**Summary**

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.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is not specifically stated for each
recommendation.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

If the child has motor problems severe enough to interfere with
mobility, self-care, or communication, therapists may provide a program
to help the child ameliorate, compensate for, or adapt to the impairment
or disability. Physical, occupational, and speech-language therapists,
working with the family, child, physician, and teacher, promote a
positive functional adaptation to impairment or disability in the
context of the child´s developmental progress.

#### POTENTIAL HARMS

There are some children with special needs whose medical conditions may
be affected adversely by movement or other specific therapeutic
activities; therapists and caregivers should be advised to take
appropriate precautions with these children.

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

The guidance in this report does not indicate an exclusive course of
treatment or serve as a standard of medical care. Variations, taking
into account individual circumstances, may be appropriate.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Living with Illness

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Michaud LJ. Prescribing therapy services for children with motor
disabilities. Pediatrics 2004 Jun;113(6):1836-8. \[23 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15173521)

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2004 Jun 6

#### GUIDELINE DEVELOPER(S)

American Academy of Pediatrics - Medical Specialty Society

#### SOURCE(S) OF FUNDING

American Academy of Pediatrics

#### GUIDELINE COMMITTEE

Committee on Children With Disabilities

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Committee on Children With Disabilities, 2003--2004*: Adrian D.
Sandler, MD, *Chairperson*; J. Daniel Cartwright, MD; John C. Duby, MD;
Chris Plauch Johnson, MD, MEd; Lawrence C. Kaplan, MD; Eric B. Levey,
MD; Nancy A. Murphy, MD; Ann Henderson Tilton, MD

*Past Committee Members*: W. Carl Cooley, MD; Theodore A. Kastner, MD;
Marian E. Kummer, MD

*Liaisons*: Bev Crider, Family Voices; Merle McPherson, MD, Maternal and
Child Health Bureau; Linda J. Michaud, MD, American Academy of Physical
Medicine and Rehabilitation; Marshalyn Yeargin-Allsopp, MD, Centers for
Disease Control and Prevention

*Staff*: Stephanie Mucha, MPH

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

American Academy of Pediatrics (AAP) Policies are reviewed every 3 years
by the authoring body, at which time a recommendation is made that the
policy be retired, revised, or reaffirmed without change. Until the
Board of Directors approves a revision or reaffirmation, or retires a
statement, the current policy remains in effect.

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [American Academy of Pediatrics
(AAP) Publications Web
site](http://aappolicy.aappublications.org/cgi/content/full/pediatrics;113/6/1836).

Print copies: Available from American Academy of Pediatrics, 141
Northwest Point Blvd., P.O. Box 927, Elk Grove Village, IL 60009-0927.

#### AVAILABILITY OF COMPANION DOCUMENTS

None available

#### PATIENT RESOURCES

None available

#### NGC STATUS

This NGC summary was completed by ECRI on August 9, 2004. The
information was verified by the guideline developer on September 27,
2004.

#### COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to
the guideline developer\'s copyright restrictions. Please contact the
Permissions Editor, American Academy of Pediatrics (AAP), 141 Northwest
Point Blvd, Elk Grove Village, IL 60007.

### DISCLAIMER

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© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008