Biomedical Engineering Reference
In-Depth Information
development and growth for the practitioner because intrateam communication promotes
continued acquisition of knowledge across different areas. Furthermore, it enables more
coherent communication between the team of practitioners and the family, thereby
improving compliance with the treatment program.
In a child's infancy, families often consult a pediatrician before any other doctor.
In a rehabilitation team, the pediatrician plays a broader role, such as establishing the
diagnosis and prognosis, discussing and defining the treatment program with the rest
of the team, and accompanying the child's development over time. In this first contact
with the family, it is essential that the pediatrician be attentive to the various aspects of
childhood development and aim toward an integrated approach with other pediatric
specialists to guarantee a treatment plan targeting not only the child's clinical needs, but
also his/her developmental necessities.
To this end, it is essential that the pediatrician's approach encompass, in addition to general
pediatric knowledge and experience, broad knowledge including childhood development,
psychology, neurology, orthopedics, genetics, and psychiatry. The aim is to trace, and, if
possible, diagnose, any existent disorder in these areas. It is often necessary, in the process
of defining a diagnosis, to integrate the various members of the neurorehabilitation team,
which also includes other medical fields, to discuss the varied and complex developmental
disorders in a way that fosters cooperation, mutual understanding, and consensus.
A comprehensive approach that addresses both the definition of the diagnosis and the
treatment plans requires that the pediatrician and the rest of the team work in cooperation to
develop increasingly effective rehabilitation programs. Pediatricians should acknowledge
and understand that their role in the process of development and rehabilitation goes far
beyond that of the clinical alone.
Another reason that the process of rehabilitating children with disabilities often involves
a large number of practitioners is that many areas of development may be impacted (Campos
da Paz Jr et al. 1996; Ylvisaker 1998). This can generate obstacles to an integrated approach
between the family and the team in planning adequate, contextualized interventions.
Effective teamwork does not mean that all of the practitioners must be present at every step
of the treatment process. This process is dynamic. Some children may have predominantly
motor disorders whereas others have more language or neuropsychological impairments.
Depending on the significance of the main problems, the child may need closer follow-up
from one or more practitioners, who end up becoming case managers, i.e., the team
members closest to the family throughout treatment.
Case managers play the role of organizing and directing the rehabilitation process,
integrating information and decisions among the team, child, and family (Braga 2006). Over
the course of development, the case managers can be substituted by other practitioners
working with the child depending on the treatment needs at that particular moment. For
example, a child with cerebral palsy and acute involuntary movements (e.g., dystonia)
who has significant pain and difficulties sitting will benefit from a joint collaboration
between the pediatrician and the physical or occupational therapist. Together they can
determine the best way to position the child by using assistive technology (AT) resources
(e.g., adaptations to sit) and the need for pharmacological intervention. With adequate,
comfortable positioning, alternative communication systems can be better implemented,
with closer support and follow-up from other members of the team, such as speech
therapists or special-needs educators.
On the other hand, in the case of children with predominantly neuropsychological or
behavioral disorders [for example, caused by traumatic brain injury (TBI)], the pediatrician
would work more closely with the psychologist and educator, who would be the case
