Knowledge guides

LG13: Foundations of paediatric rehabilitation medicine

Epidemiology, pathophysiology, and clinical sciences

Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.

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Investigations, procedures, and clinical assessment tools

Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able tinterpret the reported results of each investigation or procedure.

Advanced Trainees will know how texplain the investigation or procedure tpatients, families, and carers, and be able texplain procedural risk and obtain informed consent where applicable.

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Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these intcare.

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Clinical sciences

  • Biomechanics of human movement, to assist in differentiating normal from pathological patterns, such as:
    • functional electrical stimulation and its uses in paediatric rehabilitation
    • phases of the gait cycle
    • principles of balance and mobility
    • principles of upper and lower limb orthotics to assist with function, prevention, care, and comfort, including resting and functional upper limb splints, supports, and gait orthoses
  • Bladder and bowel health, including:
    • management of bladder and bowel dysfunction, including its medical and surgical options and how this varies depending on the patient’s developmental level and function
    • methods of assessment of bladder and bowel health and function, such as urodynamics
    • neurogenic dysfunction
    • non-neurogenic dysfunction, such as:
      • constipation
      • enuresis
    • physiology and pathophysiology of bladder and bowel function and dysfunction as related to conditions encountered in paediatric rehabilitation
  • Bone and musculoskeletal health, including:
    • factors that lead to low bone mineral density and osteoporosis in the paediatric rehabilitation patient population
    • management strategies for prevention and treatment, such as:
      • orthotic prescription
      • pharmacological
      • surgical
      • therapy
    • monitoring guidelines and assessment tools for musculoskeletal complications
    • pathophysiology of musculoskeletal complications commonly encountered in the paediatric rehabilitation population
  • Cardiovascular and respiratory health, including:
    • exercise, fitness, and long-term cardiovascular health in people with a disability
    • knowledge of the principles of assessment and management of respiratory health in children (tamariki) with disability
  • Child growth and development:
    • assessment tools:
      • behavioural
      • cognitive
      • developmental
      • growth
    • education, health, and support needs and implications for home, school, and community for children (tamariki) with disability and developmental differences
    • impact of:
      • current level of development on the rehabilitation process
      • early intervention on disability trajectory and development
      • illness and injury on a child’s physical and cognitive development, and how the developmental stage of the child affects resulting disability
    • intellectual disabilities associated with paediatric rehabilitation conditions
    • management of puberty, reproductive health, and sexuality in young people with disability
    • typical stages and ranges of development and growth across childhood and adolescence
  • Feeding and nutrition:
    • assessment and management of drooling
    • assessment and methods for feeding, including supplemental feeding for children (tamariki) with disability
    • assessment of:
      • nutritional status
      • wwallow safety
    • impact of nutrition and growth on disability
    • nutritional requirements for children (tamariki) with illness, injury, and disability
  • Pain management:
    • anatomy, pathophysiology, and physiology of pain perception and pathways
    • assessment tools for pain
    • management options:
      • environmental
      • pharmacological
      • physical
      • psychological
    • multidisciplinary approach to pain management
  • Skin health and wound management:
    • factors that lead to pressure injuries and skin breakdown, and prevention strategies
    • knowledge of principles of assessment of pressure injury, including appropriate assessment tools
    • principles of:
      • management of pressure injuries, including:
        • care of the wound
        • pressure relieving equipment
      • skin surveillance and skin breakdown
  • Vision and hearing:
    • principles of assessment and management of vision and hearing impairments

Epidemiology

  • Concepts of primary, secondary, and tertiary prevention in the context of paediatric rehabilitation medicine
  • Epidemiology and natural history of diseases and injuries in childhood and adolescence that may result in disability
  • Major preventive health programs at state and national levels, with relevance to paediatric rehabilitation medicine
  • Preventative strategies regarding illness and injuries that may cause significant disability
Clinical assessment
  • Clinical surveillance tools for medical management
  • Functional measures in rehabilitation planning, management, and outcomes
  • Goal setting tools, such as:
    • Canadian Occupational Performance Measure (COPM)
    • Goal Attainment Scaling (GAS)
  • Patient measures:
    • patient reported:
      • experience measures
      • outcome measures
  • Tools for assessment of activity, impairment, participation, and quality of life
Investigations
  • Appropriate investigations required to diagnose and treat common rehabilitation conditions, as well as prevention and management of complications
  • Application of knowledge of appropriate investigations to less common conditions
  • Investigations may include, but are not limited to:
    • medical imaging, such as:
      • CT
      • MRI
      • nuclear medicine
      • ultrasound
    • other investigations, such as:
      • genetic testing
      • neurophysiological testing
    • pathology tests, such as:
      • blood
      • urine
Procedures
  • Administration of botulinum toxin A for hypertonicity and sialorrhea
  • Procedures as required for the assessment of and ongoing management of patients with intrathecal baclofen pumps, including:
    • pump refill
    • test dosing
    • troubleshooting

Child safety

  • Emotional or behavioural presentation as a consequence of current or previous maltreatment, and the impact of neglect over time
  • Health needs of children (tamariki) and young people in the care and protection systems, including:
    • in-home care
    • out-of-home care
    • under care of the justice system
  • patterns of inflicted and accidental injury

Community disability supports

  • Funding systems to support people with disability
  • Post-discharge and community care, including:
    • community support services
    • equipment and modifications to allow maximal independence at home and in the community
    • formal and informal personal care and participation supports
    • leisure and sports activities
    • patient support organisations
    • vocational rehabilitation

Educational support

  • Alternative schooling pathways
  • Assessment and verification of disability, including intellectual disability and learning disorders
  • Modification of curriculum and assessment to allow access
  • Special educational settings
  • Supports available for children (tamariki) to access curriculum

Family

  • Alternative and complimentary therapies commonly encountered in rehabilitation care
  • Caregivers’ health, both psychological and physical, and support services
  • Impact of disablement on the child or adolescent's family, including:
    • changes to family function
    • influence of family dynamics on rehabilitation outcomes
    • need for support of the family during rehabilitation

Medicolegal

  • Knowledge of the process of guardianship in the setting of children (tamariki) and young people with a disability
  • Principles of report writing for medicolegal processes

Orthoses and equipment

  • Adaptive devices and mobility aids, and their indications and precautions for use, including, but not limited to:
    • scooters
    • standing frames
    • walking frames
    • walking sticks
    • wheelchairs
  • Australasian and Aotearoa New Zealand standards for home modifications to accommodate disabilities and access to a built environment
  • Constraints, indications, and training required for use of adaptations and devices that improve function in the home, including, but not limited to:
    • adaptive seating
    • bathing
    • hoists
    • Sleeping equipment
  • Electrical stimulation
  • Prosthetics, orthotics, and adaptive equipment in the management of impairment and disability

Psychosocial health

  • assessment tools used to identify mood, behaviour, and adjustment conditions in the setting of disability
  • development of independence across childhood and adolescence in the setting of disability, including factors that may influence independence and promotion strategies
  • management options for behaviour and mood disorders, including how to access these and their indications:
    • non-pharmacological
    • pharmacological
    • psychological therapies
  • Psychological and psychiatric issues:
    • associated with familial adjustment, grief, and loss, and living with disability
    • in the setting of disability, including:
      • adjustment disorders
      • anxiety
      • cognitive / behavioural disorders
      • depression
      • grief and loss
      • post-traumatic stress symptoms / disorder (PTSD)
      • typical psychological reactions to disablement

Rehabilitation assessment – disability and function

  • Concepts of impairment, disability, activity, and participation in reference to the International Classification of Functioning, Disability, and Health (ICF)
  • Early and effective rehabilitation / treatment to limit the disabling consequences of illness and injury
  • Early identification and treatment of disability, including secondary physical and psychological disabilities
  • Environmental factors that contribute to illness and injury, including psychological factors, and ethnic and cultural issues
  • Influence of cultural, educational, ethnic, gender, medical, physical, psychological, sexuality, and social issues on the determination of disability, and their possible effects on the outcome of rehabilitation

Rehabilitation implementation

  • Appropriate orthoses and assistive equipment for commonly encountered impairments in patients, and the limitations and training required to implement these
  • Core principles of the implementation and review of a realistic and appropriate rehabilitation program that specifies appropriate modalities of treatment
  • Impact of transitions of care in a patient's journey, and the implications for rehabilitation management and strategies to optimise these transitions
  • Principles of organisation and management of multidisciplinary rehabilitation, including the use of care plans and critical pathways
  • Role the family context plays in supporting the patient, and the influence of family dynamics on the rehabilitation plan

Rehabilitation planning

  • Roles and skills of rehabilitation team members
  • Roles of:
    • government agencies, private organisations, and volunteer groups in community care and advocacy of people with disability
    • hospital rehabilitation units, both inpatient and outpatient, and community systems
  • Standardised outcome measurement tools for the purpose of improving patient and service outcomes