Chapter 26: Hospital and Pediatric Rehabilitation Services

Question 1

What percent of children and adolescents in the U.S have chronic health conditions?

Answer 1

25%

Question 2

Examples of chronic health conditions

Answer 2

Asthma
Diabetes
Hypertension
Obesity

Question 3

Child life specialists

Answer 3

Focused on emotional and developmental needs of the child

Question 4

Three categories of hospitals

Answer 4

General hospitals- less severe issues
Trauma centers- more severe issues (burns, TBI)
Children’s hospitals- diverse population, specialized services
hospitals offer both inpatient and outpatient

Question 5

Children’s hospitals

Answer 5

Serve broad geographic region
- Many diagnoses and challenges
- Ethnicities, socioeconomic levels
Provide specialty care
Have missions of advocacy and research
Focus on family- and child-centered approaches
Must manage accrediting and regulatory agencies
- Strict re-accreditation process

Question 6

Reimbursement

Answer 6

Private- HMOs, PPOs (coverage for hospital stays and services)
Medicare- Prospective payment system (strong impact on reimbursement, OT bills services using diagnostic groups and CPT codes, aware of payment limitations)
Medicaid- MassHealth (pay for prescriptions, hospital stays, therapies) must apply and qualify

Question 7

Children moved to SNF

Answer 7

Cheaper than acute care, shorter length of stay=less money

Question 8

Hospital team

Answer 8

Physical- leader of team
Care manager- nurse, social worker, counselor, coordinates care
Team communication occurs formally and informally (family involvement)

Question 9

OT evaluation

Answer 9

Referral from MD
Record/chart review
Interview and observation
Tools- WeeFIM, PEDI
Process leads to development of functional goals

Question 10

WeeFIM

Answer 10

FIM for children
Performance based
Valid and reliable

Question 11

Intervention

Answer 11

Preventing secondary disability and restoring performance skills
Resuming and restoring occupational performance
Adaptation for ADL skills/AT (carefully consider AT, can prohibit natural development)

Question 12

Interventions (2)

Answer 12

ADL and IADL
One-handed techniques
AT
ROM
Strength and endurance
Splints

Question 13

Learned helplessness

Answer 13

Child doesn’t do something for themselves- someone else will do it for them
Important to encourage children to engage in an activity to the extent that they best can
Affects future independence

Question 14

Engagement and independence

Answer 14

• Nurse may be rushed and may not have time to encourage independence
• Assure that recommendations are being implemented
• Various modalities can be attempted to engage child (new room, moving around)

Question 15

ICU

Answer 15

OT care usually at bedside due to critical illness or injury

Question 16

Therapy focus in ICU

Answer 16

Preventing other issues that can occur with prolonged time in bed (bedsores, weakness, decreased endurance, social isolation, sleep issues, sensory deprivation)

Question 17

OT goals in ICU

Answer 17

Contracture prevention
Skin management
Pain management
Safety
Educate family on how to interact with their child

Question 18

OT interventions in ICU

Answer 18

Stretching
Soft tissue mobilization
Splinting
Bed positioning

Question 19

Acute care

Answer 19

Increased medical stability and interaction with environment
Consider if pain interferes with functional progress
May be longest phase of inpatient care

Question 20

OT goals in acute care

Answer 20

Resume available motor functions
Build tolerance to activity
Engage child
Build rapport
Provide education on condition
Skin care

Question 21

OT interventions

Answer 21

Bedside sitting
Transfers
Preferred activities to improve strength and endurance

Question 22

Specialty units

Answer 22

Oncology, bone marrow transplant units, palliative

Question 23

Oncology

Answer 23

Understand child’s cancer and treatment
Neutropenia- weak immune system

Question 24

Subacute rehab

Answer 24

SNFs, long term care
Children who cannot be cared for at home

Question 25

Acute inpatient rehab

Answer 25

Inpatient hospital units and services Physical skills

Question 26

Outpatient rehab

Answer 26

Services for children with less severe/healing issues or have been discharged home to return for services

Question 27

Inpatient rehab

Answer 27

Medical stability is established Therapy provided in structured sessions

Question 28

Focus of inpatient rehab

Answer 28

Facilitate independence and prepare for transition home

Question 29

What is generally the most intense phase of care?

Answer 29

Inpatient rehab

Question 30

OT goals in inpatient rehab

Answer 30

Prep for transition home Increase independence in self-care skills Facilitate continued progress toward prior level of functioning Communicate with other disciplines

Question 31

OT intervention in inpatient rehab

Answer 31

Begin balance between restorative and adaptive approaches

Question 32

Outpatient rehab & community reintegration

Answer 32

Care becomes primary responsibility of the family for the first time, family may experience grief Progress toward independence pivots on family priorities and values

Question 33

OT goals in outpatient rehab

Answer 33

Identify family priorities Identify differences between current and premorbid status Identification of appropriate community resources Address concerns

Question 34

OT intervention

Answer 34

Address the concerns of the family and child

Question 35

Spina bifida

Answer 35

Spina bifida is a condition that affects the spine and is usually apparent at birth. It is a type of neural tube defect (NTD)

Question 36

3 types of spina bifida

Answer 36

Myelomeningocele Meningocele Spina Bifida Occulta

Question 37

Issues with functional activities for children with spina bifida

Answer 37

Rolling over Bathroom Mobility ADLs