Physical Medicine and Rehabilitation: Can it Help Your Child?

We spoke with Dr. Susan Apkon, Chief Pediatric Rehabilitation, Fischahs Chair in Pediatric Rehabilitation, and Vice-Chair Department of Physical Medicine and Rehabilitation to learn more about an area of medicine called “Physical Medicine and Rehabilitation or PM&R”

And since April honors siblings, at the end of this article, we speak with 3 medical residents studying in this field because of a sibling.

Dr. Susan Apkon

PM&R stands for Physical Medicine and Rehabilitation, also known as physiatry, a medical specialty promoting healing, and rehabilitation of children and adults with differences in functions, whether born with a disability or acquired through injury or illness. Some are short-term, and some are long-term, with physiatrists focusing on maximizing a person’s functional abilities, helping them to do what they want to do in everyday life.

Physiatrists address a patient’s physical, emotional, and social needs, including things we all take for granted, such as getting up in the morning, getting dressed, eating breakfast, and then going off to start our day, whether going to work, school, or having fun. It is focusing on and maximizing someone’s abilities in those areas.

PM&R “It is a person centered approach to focus on everything the child needs and wants in life and everything a parent might want for their child.”

A team of medical professionals typically works with a physiatrist to coordinate a person’s care. Depending on the need, there might be speech-language pathologists, physical therapists, athletic trainers, occupational therapists, and social workers. You can find PM&R doctors in hospitals, clinics, and rehabilitation centers.

How Does PM&R Work, and Who Can Benefit from It?

Physiatry or rehabilitation medicine is a small field relative to areas such as pediatrics, family medicine, or internal medicine. PM&R helps patients with disabilities, injuries, chronic disease, pain, or acute illness progress toward optimal functions. The rehabilitation physician is a medical doctor who focuses on improving the overall quality of life.

In cases of injury or acute illness, such as an accident or stroke, you may be first introduced to a rehabilitation team in the hospital setting. Children with congenital health issues may receive coordinated care in hospitals, outpatient settings, or other locations.

You may find yourself in a community that does not have a rehabilitation physician. You may have therapy team members like physical, occupational, and speech therapists. This can be through pain reduction, accessing and educating on the use of assistive devices, including wheelchairs, walkers, and braces, and recovery – if from an injury or impairment.

If you are a family who has a child with social healthcare needs, and you feel like there is an opportunity to optimize your child’s abilities, whether it be through therapy, equipment, bracing, or medical medication management, then asking for a consultation with a rehabilitation physician or a PM&R would be helpful. Talking to your pediatrician or family physician and requesting a referral to a rehabilitation doctor can make a difference in your child’s care.

According to Dr. Apkon, the PM&R doctor is like the conductor of a train, calling in the other train car, such as therapists and other healthcare professionals or social workers, to complete the train, to assist with the care: To make the train what the family wants it to be. Generally, children’s hospitals are very family centered in their approach, even more so with physical medicine and rehabilitation. It is a person-centered approach to focus on everything the child needs and wants in life and everything a parent might want for their child. PM&R focuses on helping set that goal and those expectations.

PM&R doctors look at the whole family, as they are also involved in the care of the individual. In the case of a child with special healthcare needs or a child with a disability, it goes back to maximizing or a child with a disability, it goes back to maximizing that child’s health, wellbeing, and functional abilities. PM&R doctors work closely with therapists, prescribing therapy as needed.

Examples of PM&R Benefits

Dr. Apkon explains that if you have a person with cerebral palsy, you might have tight muscles and difficulty walking. That might be a time to recommend seeing a physical therapist who will be the hands-on person to deliver that one-onone care to maximize the child’s walking abilities. The PM&R physician will also look at other things, including options like medications that might help relax the muscles. In addition, Dr. Apkon explains, “we sometimes do local injections with medications such as botulinum toxins that relax muscles to help with walking.”

There might be a referral to an orthotist who makes braces, because wearing braces can sometimes help children with cerebral palsy walk better. “As a PM&R physician, I have a deep knowledge of the medical condition, and the complications associated with a particular medical condition.”

The PM&R doctor understands the prognosis and brings it all together with therapy, bracing, and perhaps some equipment that can help the child.

Another example is in the home setting or school classroom, and the child is doing a beautiful job with walking. Still, they may struggle with walking in the community, possibly limiting themselves. Perhaps going from the classroom to the playground is so fatiguing and unsafe because they feel like they will fall. Providing a piece of equipment like a wheelchair can change a life. A rehabilitation physician will try to understand all aspects of that child’s care as it relates to function, the medical condition, and then prescribe things like braces, equipment, therapy, and medications that might help maximize that. Again, it is useful to think of the analogy of the conductor working alongside the family to achieve their goals and hopes for their child. Or if the child can communicate, the physician can focus on what the child would like to do differently or better. Then, the focus for the physician is how to work with the other members of the team to help to achieve that goal.

How Do You Find a PM&R Doctor?

There are several ways that you can find a rehabilitation physician. If you are in a community where there is a children’s hospital or one in your region, you can go online and search for rehabilitation or pediatric rehabilitation. At Children’s Hospital, Colorado, it is easy to find their specialty and specialists on their website.

You can then contact that department for direct help. You can also ask your pediatrician, family physician, or primary care provider for a referral. They may know who the rehabilitation physicians are in the community. You can also ask any therapists who work with your child if they have recommendations. National organizations, such as the American Academy of Physical Medicine Rehabilitation and the American Board of Physical Medicine Rehabilitation, also have websites to help you locate a rehabilitation provider in your community.

Final Thoughts

We asked Dr. Apkon if she had any memorable stories to share.

She gave us an example of how when working with children who have neuromuscular conditions such as Duchenne Muscular Dystrophy and Spinal Muscular Atrophy, the introduction of one piece of equipment can change their lives. These conditions cause a lot of weakness; in some cases, children cannot walk, or they walk and then lose their ability to walk over time. For so many families, the goal is for their child to walk.

But for Dr. Apkon, it is about mobility and helping kids get from point A to point B. She wants children to be able to learn by exploring. If a child has muscle weakness, they cannot explore because they cannot walk. If the child cannot explore, they do not learn.

So introducing a wheelchair to a child in this situation can change their world. Once they are using the wheelchair or the power scooter. They can start moving and exploring, learning – and thriving!

A simple piece of equipment may have just completely opened up their world.

And it really is life changing.

Thanks to the following people and organizations that help us bring you this article.

Children’s Hospital Colorado

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This post originally appeared on our March/April 2023 Magazine