Guest editor's perspective: Children and rehabilitation: a new frontier.

Guest Editor's Perspective

This special feature focuses on Child and Adolescent Concerns in Rehabilitation. Rehabilitation is currently one of the faster growing areas in the health care industry. However, for many educators, practitioners, and investigators who assist children and families, this is not a new enterprise. Interestingly, increases in knowledge, technology, and mandated services have seemingly resulted in many newer specialties (Elliott & Gramling, 1990) offering assistance, claiming expertise, and designating--if not demanding--a portion of their professional turf. Such specification of training and licensing of expertise has been confusing to educators, students, and clients. Advances in medical technology have resulted in a significant decrease in mortality of those with severely disabling conditions (Trunkey, 1980), and a consequent increase in the life span of many populations of children with chronic illness and handicapping conditions. These aforementioned trends have likely had a specific impact on the field of child and adolescent rehabilitation. Presumably, the knowledge base is broader, has more fidelity and depth, hopefully leading to better practices. Can we say that we know more about assisting children and families then we did twenty years ago? These trends for a "child" focus in rehabilitation imply that we have (1) more knowledge, (2) better technology, (3) more/newer specialties, and (4) more young people and families require assistance. Consensus on these issues is open to debate on the first three issues, but not on the last; more children and youth presently are and will be in need of comprehensive rehabilitation services in this next decade. Child rehabilitation practice requires a developmental perspective, a life span orientation, and a broad interdisciplinary partnership with many disciplines to insure maximum rehabilitative benefit for the child and the family.

Why is a developmental perspective crucial in rehabilitation of children and adolescents? A developmental or life span focus implies an awareness of the fluid and evolving nature of child/adolescent growth and the particular age or stage of the individual child's current physical cognitive and sociopsychological status. Trauma or illness cannot be viewed as a static phenomena and will change both physically and psychologically as a child grows and matures. A life span focus will permit a treatment program tailored individually to a child's evolving needs and continuing growth into adulthood. Numerous professionals in the field have endorsed the importance of such a developmental and life span focus in understanding the rehabilitative needs of children and adolescents.

Each of the articles presented in this Special Issue offers something of value in the field of child and adolescent rehabilitation. The authors represent a broad range of professional orientations all with specific interests in children and families. Dr. DiCowden, in her paper, "Pediatric Rehabilitation: Special Patients, Special Needs," presents a practical and theoretical overview of applying a "developmental focus" to child and adolescent rehabilitation. A treatment program is described and several special populations are highlighted, providing valuable practical guidance from this well-known clinician and investigator. Turner and Szymanski, both educators, offer a unique life span analysis in their manuscript, "Work Adjustment of People with Congenital Disabilities: A Longitudinal Perspective from Birth to Adulthood." The authors use Hershenson's theory of work adjustment to explore factors that affect career development of those with disabilities from birth through adolescence. Work adjustment is related to early independence opportunities and is presented as a key issue for those with congenital disabilities. Derhaag and Schoorl, of Leiden University, The Netherlands, in their investigation, "Personality Development in One-Handed Children Treated with a Myoelectrically Controlled Prosthesis," present a review of the adjustment status of children who are using this "high tech" assistive device. Their qualitative statistical analyses (inner-site analysis) of the data provides an interesting evaluation of children's personality with congenital disabilities. This study sample represents the largest known group currently reported in the literature with congenital disabilities and the use of myoelectric prostheses. Finally, Tackett, Kerr, and Helmstader, in their study, "Stresses as Perceived by Children with Physical Disabilities and Their Mothers," present useful clinical data emphasizing the importance of obtaining the child's personal view of daily stresses and their congruence with maternal views. Parental awareness of a child's views of daily stress is an important first step in any rehabilitation plan.

A special note of thanks is directed to Paul Leung, the Editor of the Journal, for encouraging the development of this special issue. Recognition is also due those individuals who served as editorial reviewers of the numerous manuscripts submitted. We hope that you enjoy the material and that it is assistive to children and adolescents with special rehabilitative needs.

References

Elliott, T.R., & Gramling, S.E. (1990). Psychologists and rehabilitation: New rules and old training models. American Psychologist, 45(6), 762-5.

Trunkey, D.D. (1983). Trauma. Scientific American, 249, 28-35.

Dennis C. Harper, Ph.D. Professor Department of Pediatrics University of Iowa College of Medicine