Pediatric Rehabilitation Medicine at Children's
by Jane Ehrhardt
by Jane Ehrhardt
"It's hard to do the elevator pitch for this specialty," says Drew Davis, MD, one of the three physicians in Children's Division of Pediatric Rehabilitation Medicine (PRM). "We're the function people," adds Cynthia Wozow, DO, another member of the PRM team. "Kids come to us with a wide array of diagnoses, and we work to help them to flourish."
Their patients face a range of conditions that will impact them for a lifetime and can strike at any age, such as cerebral palsy, musculoskeletal conditions, and limb deficiencies. "We meet everybody where they come, no matter when they come in or how," Wozow says.
Not all are from a congenital onset. Some cases come from abrupt, traumatic injuries to the brain or spine, occurring at any age. "Their life was going a certain way and then everything changed in an instant. We walk through this traumatic life change with them," Wozow says.
Wozow brings a powerful influence to many patients, having been a patient at Children's herself just a few decades ago when diagnosed with cerebral palsy at age eight. "There wasn't a medical rehabilitation division here then, but I had surgical intervention here and then subsequently acute therapy rehabilitation," she says. "And that's how I met the current therapist who's still here."
She grew up telling her mother that she would be happy to work with kids with cerebral palsy. "It was my entire world," she says. "I realized early on I wanted to use my story to influence others. Most people view a cerebral palsy diagnosis as a person who may need assistance in throughout their life and a quality of life that is not what they would want it to be. That's not always the case."
Just this week, Wozow was with a new patient's family that had just received a diagnosis of cerebral palsy, when the mother asked Wozow if she had the disease. When Wozow affirmed that she did, the father simply said, "wow." "In that moment, he knew that there were going to be good things about his child's life," Wozow says.
These days, the PRM department serves such a universal need at Children's that the three doctors--the only three physicians in Alabama who are board certified in pediatric rehabilitation medicine--are asked to participate on a multitude of hospital clinics. Wozow sits on clinics for general rehab, brachial plexus injuries, musculature dystrophy, surgical spasticity, and gastroenterology and rehabilitation.
"Ours is not a one-and-done situation. We take a comprehensive approach because we follow patients through childhood up to age 21," David says. "Some patients begin under our care while still in the neonatal intensive care unit. Premies are at high-risk for cerebral palsy so we're involved early on in the course of their life to support their development.
"Treatment plans are unique to each patient. We take an individualistic and holistic approach. We know the range of options, but it depends on if that child would benefit most from oral medications, injections, or a procedure, some are reversible and some are not. And it depends on the timing in terms of age and where they are developmentally."
If the patient has muscular tightening at age five and is still not walking, the PRM physician knows whether relaxing the muscles in that particular patient can enhance that movement or take some of the progress already made.
"Other teams may come in for the acute hospitalization, but we're the lifelong cheerleaders," Wozow says. Beyond the medical aspects of treatments and spasticity management throughout development, the department, which also includes a researcher, nurse clinicians, and office staff, connects families with resources throughout the state for anything from helping to navigate school issues to assessing driving capabilities after a brain injury to vocational services to pinpoint skillsets for moving on to college or the workforce. "We also know the justification that works for insurance for why our patients need therapy and equipment," Wozow says. "We know how to get those types of things accomplished."
The demand for the team's expertise is extensive. "In a typical week, there are 80 inpatient kids admitted in intensive rehab who are sick enough or injured enough for a prolonged hospital stay," Davis says.
Despite the need, only 308 physicians in the nation were board certified in pediatric rehabilitation medicine by 2019. "There are not many pediatric rehabilitation providers on the whole. There are some states around us who don't have any," Wozow says. "We are limited by our numbers, so there's a constant conversation about how to improve that issue."
Wozow encourages providers to refer children to the group as soon as they see any concerns. "Our group is uniquely trained not only in rehabilitation as a whole, but in how those unique diagnoses affect those kids over a lifetime," she says. "By being involved earlier, we can anticipate possible future concerns and as well as meet current needs."