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Planting seeds: thoughts on pediatric rehabilitation.

Planting Seeds: Thoughts on Pediatric Rehabilitation

The old saying "as the twig is bent, so grows the tree" is never so true as in pediatric rehabilitation. The initial experiences children have related to their disability casts the future for adjustment to their residual impairment, development of self-esteem, relationship potential and future vocational choices. Children look to grown ups to help them figure out what's going on in the present and what might happen in the future. Doctors, therapists, nurses, prosthetists, teachers, social workers and even the people who empty the trash play a key role in helping children maximize their rehabilitation experiences. All of the rehabilitation and allied health personnel that come in contact with children with disabilities and their families share an important role in shaping the child's future. There are four things we all can do: provide age-appropriate information, and clear expectations, provide role models, and assist with the transition from the rehabilitation/medical setting to the home, school and real world environment.

Children look to grown-ups for information and expectations. They seek knowledgeable adults to define the environment and establish boundaries. Little minds have millions of questions. What happened (is happening) to me? Will it hurt? Will I get better? Did I cause this to happen because I was bad? Why did my mom and dad leave me here? Unfortunately they are often too scared to ask the questions. Fear and fertile imagination are a breeding ground for misinformation. It doesn't take children very long to figure out that the adults who have always had all the answers-- their parents-- don't know much about disability, medicine and rehabilitation things.

During the early rehabilitation experience the seeds of empowerment of a fully functioning, integrated citizen with a disability are planted. Expansive rather than restrictive ideas about lifestyles, recreation, education, vocational and family options increase independence and decrease dependence. Children are adaptable to change but often the medical model creates unreasonable limitations in what a child or parent believes is possible. Appropriate assistive technology is very enabling. The difference in a six-year-old, orthopedically disabled child in a stroller and that same child in the appropriately fitted manual or electric wheelchair is a miracle. Devices that foster independence are critical.

Kids like to meet their peers who have "been around" more. They don't mind asking other kids dumb questions. Children with disabilities also need role models. Grown-ups with a similar disability are a boost to morale and creative imaginings about what might be in the future. There are excellent movies available for children about successful adults with all sorts of disabilities. Parents need education. Disabled kids are, foremost, kids-- sometimes they fail, fall down or get their feelings hurt. Children with disabilities learn quickly how to use their disability to get their way. Learning to say "no" is a great skill to teach parents. How these issues are dealt with in the early years creates the potential for adjustment to work settings in later years.

Probably the greatest crime of pediatric rehabilitation is to provide the perfect medical rehabilitation and then fail to assist the child and their family to make the needed transition into the real world. The outside world is not as friendly or accessible as the rehabilitation world. In home or school evaluations, communication or architectural barrier removal can ease the transition. Teaching kids to deal with the millions of questions from others can help. Disabled children are never too young for assertiveness skills. Support groups can be a great community resource.

All who meet or work with disabled children have an opportunity to plant those seeds of empowerment, seeds that mature into a productive citizen with a disability.
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Article Details
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Author:Bibb, Tamara
Publication:The Journal of Rehabilitation
Article Type:editorial
Date:Jul 1, 1990
Previous Article:Guest editor's perspective: Children and rehabilitation: a new frontier.
Next Article:Pediatric rehabilitation: special patients, special needs.

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