FiFth EDition Pediatric Michael A. Alexander Rehabilitation Dennis J. Matthews Principles and Practice Fifth Edition Editors: Michael A. Alexander, MD • Dennis J. Matthews, MD Widely acknowledged as the cornerstone reference in the feld, Pediatric Rehabilitation brings together renowned specialists from all sectors of the pediatric rehabilitation community to provide the most current and comprehensive information available. The ffth edition has been substantially updated and expanded with evidence-based discussions of new theories, therapies, interventions, research fndings, and controversies. Five completely new chapters focus on such emerging areas as the use of ultrasound to guide motor point and nerve injections, rehabilitation of chronic pain and conversion disorders, management of concussions, sports injuries, and neurodegenerative and demyelinating diseases in children. This edition also addresses important new directions in genetic markers and tests, cognitive, developmental, and neuropsychological assessment, and rehabilitation for common genetic conditions. Additionally, several new contributors provide fresh perspectives to the voices of established leaders in the feld. The text covers all aspects of pediatric rehabilitation medicine from basic examination and testing to electrodiagnosis, therapeutic exercise, orthotics and assistive devices, gait labs, aging with pediatric onset disability, and in-depth clinical management of the full range of childhood disabilities and injuries. “Pearls and Perils” featured throughout the book underscore crucial information, and illustrations, summary tables, information boxes, and lists contribute to the text’s abundant clinical utility. New to the Fifth Edition: n E very chapter has been thoroughly revised and expanded to refect current thinking and practice n E vidence-based discussions of new theories, therapies, interventions, research fndings, and areas of controversy Pediatric n F ive entirely new chapters illuminating emerging areas: rehabilitation of chronic pain and conversion disorders, ultrasound-guided injections, concussion management, sports injuries, and neurodegenerative and demyelinating diseases in children Rehabilitation About the Editors: Principles and Practice Michael A. Alexander, MD, Professor, Pediatrics, Physical Medicine and Rehabilitation, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Emeritus Medical Staff, Alfred I. duPont Hospital for Children, Wilmington, DE Fifth Edition Dennis J. Matthews, MD, Fischahs Chair, Pediatric Rehabilitation Medicine; Professor and Chair, Department of Physical Medicine and Rehabilitation, University of Colorado Denver, School of Medicine, Children’s Hospital Colorado, Aurora, CO 11 West 42nd Street New York, NY 10036 www.demosmedical.com 9 781620 700617 Pediatric Rehabilitation Principles and Practice Alexander • Matthews Pediatric Rehabilitation Principles and Practice Fifth Edition EDITORS Michael A. Alexander, MD Professor, Pediatrics, Physical Medicine and Rehabilitation Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia, Pennsylvania; Emeritus Medical Staff Alfred I. duPont Hospital for Children Wilmington, Delaware Dennis J. Matthews, MD Fischahs Chair Pediatric Rehabilitation Medicine; Professor and Chair Department of Physical Medicine and Rehabilitation University of Colorado Denver, School of Medicine Children’s Hospital Colorado Aurora, Colorado ASSOCIATE EDITOR Kevin P. Murphy, MD Medical Director Sanford Health Systems Pediatric Rehabilitation Bismarck, North Dakota; Medical Director Northern Minnesota Clinics Gillette Children’s Specialty Healthcare Duluth, Minnesota NEW YORK Visit our website at www.demosmedical.com ISBN: 9781620700617 e-book ISBN: 9781617052255 Acquisitions Editor: Beth Barry Compositor: Exeter Premedia Services Private Ltd. © 2015 Demos Medical Publishing, LLC. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photo- copying, recording, or otherwise, without the prior written permission of the publisher. Medicine is an ever-changing science. Research and clinical experience are continually expanding our knowledge, in particular our understanding of proper treatment and drug therapy. The authors, editors, and publisher have made every effort to ensure that all information in this book is in accordance with the state of knowledge at the time of pro- duction of the book. Nevertheless, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the contents of the publication. Every reader should examine carefully the package inserts accompanying each drug and should carefully check whether the dosage schedules mentioned therein or the contraindications stated by the manufacturer differ from the statements made in this book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Library of Congress Cataloging-in-Publication Data Pediatric rehabilitation (Molnar) Pediatric rehabilitation : principles and practice / [edited by] Michael A. Alexander, Dennis J. Matthews ; associate editor, Kevin P. Murphy.—Fifth edition. p. ; cm. Includes bibliographical references and index. ISBN 978-1-62070-061-7 (alk. paper)—ISBN 978-1-61705-225-5 (e-book) I. Alexander, Michael A. (Michael Allen), 1947- , editor. II. Matthews, Dennis J., editor. III. Murphy, Kevin P., 1956- , editor. IV. Title. [DNLM: 1. Disabled Children—rehabilitation. WS 368] RJ138 617'.03—dc23 2014048188 Special discounts on bulk quantities of Demos Medical Publishing books are available to corporations, professional associations, pharmaceutical companies, health care organizations, and other qualifying groups. For details, please contact: Special Sales Department Demos Medical Publishing, LLC 11 West 42nd Street, 15th Floor New York, NY 10036 Phone: 800-532-8663 or 212-683-0072 Fax: 212-941-7842 E-mail: D EDICATION To Dr Gabriella Molnar, who passed away since the last California, where she created a new Department of edition. She has left a void that will not be fi lled. She is Pediatric Rehabilitation Medicine, she fi nished training a recognized founder of our fi eld of pediatric rehabili- her last of over 50 domestic and international fellows. tation medicine. Dr Molnar created our fi rst textbook, Her speaking career has included invitations from all edited the subsequent two editions, and wrote numer- over the world, including Australia, Europe, Asia, and ous state-of-the-art reviews for the Child with Physical England. She has served on the editorial boards for the Disability. After escaping from Hungary in 1956 from the Archives of Physical Medicine and Rehabilitation from 1976 Russian occupation and communist regime, Dr Molnar to 1994 and Developmental Medicine and Child N eurology displayed much foresight and courage throughout her from 1992 to 1997. She is a recipient of the Krusen Award professional career. Her guiding principle has always from the American Academy of Physical Medicine and been that children are not miniature adults, but individ- Rehabilitation (AAPMR), the highest honor obtainable uals with changing physical, intellectual, and emotional for proven performance in clinical expertise, contribu- abilities and needs. At every age, therefore, the principles tions to the literature, and administration in the fi eld of rehabilitation medicine have to be adapted to these of rehabilitation medicine. Simply stated, Dr Molnar changing aptitudes. Beginning as a resident at Albert defi nes the standard for the rest of us to follow. Her hus- Einstein College of Medicine, Dr Molnar quickly rose band’s generous contribution to the PMR Foundation through the ranks from faculty instructor to full tenured created an award for lifetime achievement in pediatric professor, while developing and running the Pediatric rehabilitation and funds research stipends to increase the Rehabilitation Medicine Service. Concluding her career body of knowledge in pediatric rehabilitation. Her life is at Children’s Hospital and Research Center in Oakland, an inspiration to all of us. C ONTENTS Contributors vii Preface xiii Share Pediatric Rehabilitation: Principles and Practice, Fifth Edition CHAPTER 1 History and Examination 1 Maureen R. Nelson, Michael A. Alexander, and Gabriella E. Molnar CHAPTER 2 Medical Care of Children With Disabilities 12 Susan D. Apkon and Emily Myers CHAPTER 3 Psychological Assessment in Pediatric Rehabilitation 23 Jamie L. Spohn and Jane A. Crowley CHAPTER 4 Language Development and Disorders of Communication and Oral Motor Function 53 Lynn Driver, Rita Ayyangar, and Marie Van Tubbergen CHAPTER 5 Quantitative Assessment of Gait: A Systematic Approach 78 James J. Carollo and Dennis J. Matthews CHAPTER 6 Electrodiagnosis in Pediatrics 113 Craig M. McDonald CHAPTER 7 Guidance Techniques for Botulinum Toxins and Other Injections 153 Katharine E. Alter and Kevin P. Murphy CHAPTER 8 Orthotics and Assistive Devices 170 E lizabeth L. Koczur, Carrie E. Strine, Denise Peischl, Richard Lytton, Tariq Rahman, and Michael A. Alexander CHAPTER 9 Adaptive Sports and Recreation 196 Michelle Miller and Ellen S. Kaitz CHAPTER 10 Orthopedics and Musculoskeletal Conditions 217 K evin P. Murphy, Colleen A. Wunderlich, Elaine L. Pico, Sherilyn Whateley Driscoll, Elizabeth Moberg Wolff, Melanie Rak, and Maureen R. Nelson CHAPTER 11 Acute Management and Rehabilitation of Sport-Specifi c Musculoskeletal Injuries 284 Aaron M. Karlin and Kevin P. Murphy CHAPTER 12 Concussion Management and Rehabilitation 298 Nicole Marcantuono and Jamie L. Spohn CHAPTER 13 Pediatric Limb Defi ciencies 307 Ann Modrcin, Matthew McLaughlin, and Matthew Luetke CHAPTER 14 Cerebral Palsy 336 Mary McMahon, David Pruitt, and Jilda Vargus-Adams CHAPTER 15 Spina Bifi da 373 E laine L. Pico, Pamela E. Wilson, Kathryn Smith, Jeffrey Thomson, Jeffrey Young, Daria Ettinger, Gerald H. Clayton, and Kerstin Sobus vi CONTENTS CHAPTER 16 Spinal Cord Injuries 412 Joseph E. Hornyak IV, Michael W. Wheaton, and Virginia S. Nelson CHAPTER 17 Traumatic Brain Injury 429 Linda E. Krach, Mark E. Gormley, Jr., and Marcie Ward CHAPTER 18 Neuromuscular Diseases 461 Craig M. McDonald CHAPTER 19 Neurodegenerative and Demyelinating Diseases and Other CNS Disorders 518 Amy Houtrow CHAPTER 20 Rehabilitation of Chronic Pain and Conversion Disorders 550 Marisa A. Wiktor and Stacy J. B. Peterson (A. Chronic Pain) 550 Michelle Miller (B. Conversion Disorders) 557 CHAPTER 21 Aging With Pediatric Onset Disability and Diseases 561 Margaret A. Turk, Jan Willem Gorter, and Lynne Romeiser Logan Index 607 C ONTRIBUTORS M ichael A. Alexander, MD James J. Carollo, PhD, PE Professor Director, Center for Gait and Movement Analysis, Pediatrics, Physical Medicine and Rehabilitation M usculoskeletal Research Center Sidney Kimmel Medical College at Thomas Jefferson Children’s Hospital Colorado; University Associate Professor Philadelphia, Pennsylvania; Physical Medicine and Rehabilitation, Emeritus Medical Staff Orthopaedics, Bioengineering Alfred I. duPont Hospital for Children University of Colorado Anschutz Medical Campus Wilmington, Delaware Aurora, Colorado Gerald H. Clayton, PhD Katharine E. Alter, MD Director Senior Clinician/Medical Director Translational Medicine and Outcomes Programs Functional and Applied Biomechanics Section Department of Physical Medicine and Rehabilitation Rehabilitation Medicine/Clinical Center University of Colorado Denver, School of Medicine Eunice Shriver National Institute for Child Health Children’s Hospital Colorado and Human Development Aurora, Colorado National Institutes of Health Bethesda, Maryland; Jane A. Crowley, PsyD Staff Physiatrist Psychologist Rehabilitation Programs Behavioral Health Mount Washington Pediatric Hospital Alfred I. duPont Hospital for Children Baltimore, Maryland Wilmington, Delaware Lynn Driver, MA, MS, CCC-SLP Speech-Language Pathologist Susan D. Apkon, MD D epartment of Speech-Language Pathology Professor Un iversity of Michigan Health System Department of Rehabilitation Medicine Ann Arbor, Michigan University of Washington; Director D aria Ettinger, RN Department of Rehabilitation Medicine S enior Research Associate Seattle Children’s Hospital Institute on Development & Disability Seattle, Washington Ore gon Health & Science University Portland, Oregon Rita Ayyangar, MD Mark E. Gormley, Jr., MD Associate Professor Clinical Assistant Professor Department of Physical Medicine and Rehabilitation Department of Physical Medicine and Rehabilitation University of Michigan Medical School; University of Minnesota Attending Physician Minneapolis, Minnesota; Physical Medicine and Rehabilitation Chief Section of Pediatric Rehabilitation Division of Pediatric Rehabilitation C. S. Mott Children’s Hospital Gillette Children’s Specialty Healthcare Ann Arbor, Michigan St. Paul, Minnesota viii CONTRIBUTORS Jan Willem Gorter, MD, PhD, FRCPC Linda E. Krach, MD Professor President Physical Medicine and Rehabilitation Courage Kenny Rehabilitation Institute Department of Pediatrics and School of Rehabilitation Allina Health; Science Adjunct Professor CanChild Centre for Childhood Disability Research Department of Physical Medicine and Rehabilitation McMaster University University of Minnesota Hamilton, Ontario, Canada Minneapolis, Minnesota Joseph E. Hornyak IV, MD, PhD Matthew Luetke, CPO Professor Certifi ed Prosthetist/Orthotist Department of Physical Medicine and Rehabilitation Hanger Clinic Division of Pediatric Rehabilitation Kansas City, Kansas University of Michigan Ann Arbor, Michigan Richard Lytton, MA, CCC-SLP Speech-Language Pathologist Amy Houtrow, MD, PhD, MPH Coordinator Associate Professor Clinical Assistive Technology Services Departments of Physical Medicine and Rehabilitation Alfred I. duPont Hospital for Children and Pediatrics Wilmington, Delaware University of Pittsburgh; Medical Director Nicole Marcantuono, MD Rehabilitation Institute Attending Physician Children’s Hospital of Pittsburgh of UPMC Division of Pediatric Rehabiliation Medicine Pittsburgh, Pennsylvania Alfred I. duPont Hospital for Children Wilmington, Delaware; † Ellen S. Kaitz, MD Associate Professor Clinical Assistant Professor Thomas Jefferson University Hospital The Ohio State University School of Medicine Philadelphia, Pennsylvania Department of Physical Medicine and Rehabilitation; Director Pediatric Rehabilitation Fellowship Program Dennis J. Matthews, MD Nationwide Children’s Hospital Fischahs Chair Columbus, Ohio Pediatric Rehabilitation Medicine; Professor and Chair Aaron M. Karlin, MD Department of Physical Medicine and Rehabilitation Chair University of Colorado Denver, School of Medicine Department of Physical Medicine and Rehabilitation Children’s Hospital Colorado Ochsner Clinic Medical Center; Aurora, Colorado Section Head Pediatric Rehabilitation Medicine Craig M. McDonald, MD Ochsner Children’s Health Center; Professor and Chair Clinical Associate Professor Physical Medicine and Rehabilitation; Department of Physical Medicine and Rehabilitation Professor of Pediatrics LSU School of Medicine Director MDA Neuromuscular Disease Clinics New Orleans, Louisiana University of California Davis Medical Center Sacramento, California Elizabeth L. Koczur, MPT, PCS, CBIS Physical Therapist Matthew McLaughlin, MD Alfred I. duPont Hospital for Children Fellow Physician Wilmington, Delaware Division of Pediatric Rehabilitation Medicine The Children’s Mercy Hospital † Deceased. Kansas City, Missouri CONTRIBUTORS ix Mary McMahon, MD Maureen R. Nelson, MD Professor Associate Professor Pediatrics, Neurology and Rehabilitation Medicine Department of Pediatrics University of Cincinnati; University of Texas at Austin Dell Medical School; Division Chief Medical Director Pediatric Physical Medicine and Rehabilitation Physical Medicine and Rehabilitation Cincinnati Childrens Hospital Medical Center Dell Children’s Medical Center Cincinnati, Ohio Austin, Texas Virginia S. Nelson, MD, MPH Professor Michelle Miller, MD Department of Physical Medicine and Rehabilitation Assistant Clinical Professor Division of Pediatric Rehabilitation The Ohio State University; University of Michigan Section Chief Ann Arbor, Michigan Pediatric Physical Medicine and Rehabilitation Nationwide Children’s Hospital Denise Peischl, BS, BME Columbus, Ohio Rehabilitation Engineer Alfred I. duPont Hospital for Children Wilmington, Delaware Elizabeth Moberg Wolff, MD Medical Director Stacy J. B. Peterson, MD Pediatric Rehabilitation Associates Assistant Professor Brookfi eld, Wisconsin Children’s Hospital of Wisconsin Medical College of Wisconsin Milwaukee, Wisconsin Ann Modrcin, MD, EMBA Associate Professor of Pediatrics Elaine L. Pico, MD, FAAP, FAAPM&R University of Missouri at Kansas City; Medical Director Director Pediatric Rehabilitation Division of Rehabilitation Santa Clara Valley Medical Center The Children’s Mercy Hospital San Jose, California Kansas City, Missouri David Pruitt, MD Associate Professor Pediatrics, Neurology and Rehabilitation Medicine Kevin P. Murphy, MD University of Cincinnati; Medical Director Pediatric Physical Medicine and Rehabilitation Sanford Health Systems Cincinnati Children’s Hospital Medical Center Pediatric Rehabilitation Cincinnati, Ohio Bismarck, North Dakota; Medical Director Tariq Rahman, PhD Northern Minnesota Clinics Principal Research Engineer Gillette Children’s Specialty Healthcare Nemours Biomedical Research Duluth, Minnesota Alfred I. duPont Hospital for Children; Research Professor Department of Mechanical Engineering Emily Myers, MD University of Delaware Assistant Professor Wilmington, Delaware; Developmental and Behavioral Pediatrics Department of Biomedical Engineering University of Washington Drexel University Seattle Children’s Hospital Philadelphia, Pennsylvania Seattle, Washington