Let's face it: negative incidents happen all the time. These events can alter lives, and those who are affected have no choice but to make the best of their situation. In a blink of an eye, every aspect of life can be different. As it is, adults understandably have a hard time trying to get better - but what about the youth that are too young to comprehend what happened to them? Most agree that even though both sides have it tough, pediatric patients have it tougher.
Rehabilitation is the process of helping an individual achieve the highest quality of life. Many of the pediatric patients treated inside in-patient rehabilitation were born with a defect or disorder. Due to their condition, they have to go through rehabilitation to learn how to live in society. For others, different accidents and incidents damaged their bodily functions, behaviors, and overall autonomy. Rehabilitation is their way of re-learning how to do ordinary and everyday things that they knew how to do before they got hurt, such as walking, drinking, and lifting objects.
Before exploring how pediatric patients go through rehabilitation, it is important to understand that being injured as a child makes it so that he or she can be put at a disadvantage in the future. How severe that can be depends on the age and what incident the child went through. Due to children still developing, injuries early on in life can affect growth and how kids function as adults - meaning that the younger and less developed a child is the more severe their injury. Childhood anatomy and adult anatomy are different, making children vulnerable in different places and functions of their bodies.
The airways of children - specifically young ones and infants - are smaller than those of adults and adolescents. When incidents happen that affect the airway, such as asthma attacks and allergic reactions, it can be fatal for children and adults alike. However, even minor episodes that cause little swelling and damage can be a death sentence for kids and not adults due to the difference of the size of their airways. Infants primarily breathe through their nose in the first 4-6 months of life. If their nasopharynx ( nose-based airway ) closes up from some sort of contact or incident, then immediate attention and possible hospitalization are required. Even after infancy, the heightened danger of respiratory injury still lingers. Young children have smaller oral cavities and tongues that are capable of blocking their tracheas and also have cartilaginous tracheas that are prone to collapse if not positioned appropriately.
The list of possible injuries to the airways of pediatric patients is endless. Due to the care that many infants receive, it is rare for one to go through an incidental airway obstruction - unfortunately, the same cannot be said for children in general. Events such as a fire, a car crash, a stroke, an allergic reaction, or an asthma attack can quickly block or swell the airways. Injuries to the upper chest and throat of a young child can also cause trauma to the trachea and disrupt that airway in the future.
Another injury that is different in adults and children is thoracic injuries, which is also a larger cause of mortality for pediatric patients than for adult patients. Their organs and structures located in their chest are less protected due to the ribs and sternum not being completely formed. Some of these organs and structures are among the most important in our body, and they include the heart and the lungs. Due to the lack of ossification of both the rib cage and sternum for young children, what lies under is not as protected as would be inside an adult. Not to mention the chest wall of a child isn’t strong and has much more cartilage in it than it would have if it was completely developed. The most common thoracic injuries include rib fractures, blood vessel injuries, and pulmonary confusion - while falls and motor accidents cause the majority of these injuries. Long-term hospitalization is typically not required for fractured ribs and contusions. It is necessary if a child has abnormal vital signs, serious damage to thoracic structures and/or the underlying organs, and suspicion if the injury is self-inflicted or a result of abuse.
Similar to a child's thorax, a child’s abdomen is also more vulnerable due to a thin abdominal wall and a generally smaller amount of fat and muscle. The unossified rib cage combined with the thin abdomen makes it so that the liver and spleen are both at a greater risk for injury and trauma. The rib cage also is more pliable and only provides a small amount of protection from outside dangers. Internal organs and structures within the abdomen include the spleen, liver, pancreas, duodenum, kidney, and bladder - all of which aid in different bodily functions, such as urine production or digestion. Different incidents happen that cause damage to these vital parts of the body. Based on a survey carried out by the Royal Children’s Hospital in Melbourne, 24% of the pediatric patients that wind up in a hospital for abdomen injuries are there due to non-transport collisions. A staggering 49% were hospitalized because of motor collisions, and a small amount were admitted because of a variety of other reasons - such as falls or penetration.
The last kind of injury we will be visiting are head injuries, which is one of the most fatal injuries someone can have. It is a leading cause of disability and mortality for pediatric patients. As we know, the brain is one of the most important organs and plays a part in everything we do with our bodies - so damaging the brain can cause serious issues and even death. Although brain injuries can harm anybody, children - especially younger children - are more at risk for a variety of reasons. The skull itself can be molded and it's not rigid like adult skulls. If an accident were to happen that caused a child’s head to hit something, their skull could become deformed and that could affect the underlying brain. The thin bones of the skull and open sutures can also create fractures that will grow as the child grows, leading to problems in the future. Another important thing to consider is that a child’s head is very heavy and large for their small body and weak neck; hence why new mothers are told to always support their child’s head until they are strong enough to do it themselves. This head-to-body ratio can result in both neck and head injury and can even cause brain stem dysfunction. The children most affected by head injuries are those under three, but usually, the damage is minimal and the result of a minor incident - in fact, 90% are discharged after just a few days in the hospital. Although the different causes of head injuries for children vary, it is safe to say most are because of accidental trauma.
One kind of rehabilitation that helps people who went through any of these injuries and now has trouble breathing is called pulmonary rehabilitation. Pulmonary rehabilitation’s purpose is to help people breathe normally in daily life and in activities like sports, where exercise is required. During the program, patients will learn different breathing techniques, how to breathe when under stress or during physical activity, and how to be in control of their breathing. Pulmonary rehabilitation takes place in weekly sessions and lasts up to several weeks or months.
Pulmonary rehabilitation is essential for living life - after all, humans have to breathe to live. But what about re-learning how to do everyday movement? Walking, running, jumping, etc. are all necessary to live normally, which is where physical therapy comes in. Physical therapists help to decrease patients’ pain, improve mobility, and just help them do normal activities. This kind of therapy is needed when someone’s quality of life is limited because of movement and can take place for children suffering from conditions, diseases, disorders, and all the injuries listed above. Physical therapists guide pediatric patients through developmental, coordination, and balance activities that can be in the form of games and fun exercises.
Occupational therapy is another main kind of rehabilitation that occurs after an injury or because of some type of condition, disease, or disorder. It aims to help those who have cognitive, sensory, or mild physical problems. Unlike physical therapists, occupational therapists try to break down the barriers that affect someone’s emotional and social needs. Occupational therapy helps kids to do daily activities like playing and doing schoolwork, and also teaches them about behavior and social skills. Children can learn and master simple life and fine motor skills, and hand-eye coordination, and can even help the patients get special equipment if they need it with occupational therapy. Although occupational and physical therapy have the same motive of helping someone live a normal life, they do so in many different ways. Occupational therapy helps more with cognitive-related daily routines and activities to do with the brain - while physical therapy has to do with strength, endurance, movement, and gross motor skills. Both kinds of therapy - if the injury is severe enough to require hospitalization - take place in a hospital for the first few weeks or however long the patient is admitted. If more rehabilitation therapy is needed after the patient is discharged, then it will typically happen in 2-3 weekly sessions and last until the patient is healed enough that their movement and brain don't limit their lifestyle.
In rehabilitation, there are four stages to healing and making sure that pediatric patients can leave the hospital in good condition. These are the four stages of rehabilitation :
The first stage of rehabilitation is the recovery stage. This stage is the first one and also the longest because the patient has to allow their injury to start getting better. All that is needed is to rest, let the injury start to heal, and not make the injury worse. The injury should also be protected if severe enough and the patient shouldn’t put any weight on it. Medication is also involved as the period after an injury can be extremely painful.
The second stage of rehabilitation is the repair stage. After healing, the patient starts gaining back movement and mobility - which is where physical therapy comes in. Gentle range-of-motion and flexibility exercises are used to start getting the patient back to their pre-injury conditions, but no intensive exercise occurs in order not to overwork the injury.
The third stage of rehabilitation is the strength stage. After a patient's range of motion has improved, then it's time to get their strength back. Due to the gentle exercise of the repair stage and the excessive rest of the recovery stage, the strength of a patient is sometimes almost nonexistent. This stage aims to gain back the pre-injury levels of cardiovascular and muscular strength and endurance. Weight machines are usually used in the strength stage as a safe way of getting strength back into the patient.
The fourth and final stage of rehabilitation is the function stage. Occupational therapy is at an all-time high in this stage, as higher abilities such as coordination, agility, and balance are addressed. Educating the patient on avoiding the same injury again in the future also occurs. Soon after this stage, the patient will be finished with rehabilitation and can live a normal life.
There is no doubt that rehabilitation is a lengthy and demanding process, but it can save the quality of the lives of pediatric patients and all patients in general. With rehabilitation and the kinds of therapy it provides, patients can make the most of an awful situation and live their lives to the fullest. Pediatric patients are more at risk and they take more effort to gain back the strength and skills they lost because of an injury, but in the end, it means they can have a normal life once they are finished with rehabilitation.
Sources:
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“The Royal Children’s Hospital Melbourne.” The Royal Children’s Hospital Melbourne. Accessed August 1, 2023. https://www.rch.org.au/trauma-service/manual/head-injury/.
“Pulmonary Rehabilitation.” National Heart Lung and Blood Institute. Accessed August 1, 2023. https://www.nhlbi.nih.gov/health/pulmonary-rehabilitation.
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