An emerging subspecialty of physical medicine and rehabilitation, pediatric rehabilitation medicine (PRM) addresses the unique functional needs of children with physical and developmental challenges. It applies evidence-based rehabilitation strategies to support motor development, optimize physical function, and enhance quality of life across a range of congenital and acquired conditions including cerebral palsy, spina bifida, muscular dystrophy, and brain or spinal cord injuries.

The United States has fewer than 400 certified PRM physicians, with fewer than 10 in North Carolina. “We spend years in specialized training to provide in holistic care for children with disabilities, functional needs, and deficits,” says Duke Health PRM physician Megan Kennelly, MD. “We coordinate a multidisciplinary team with orthopaedic surgeons, neurology, neurosurgeons, and more.”

For congenital conditions, early intervention is important. “Making a diagnosis early, educating a family, and connecting them with services early can help these children and their families,” says Kennelly. “With the neuroplasticity of a young brain, therapies have a greater opportunity to improve outcomes.”

Pediatric rehabilitation offers support and coordination of care for children with

• Spasticity
• High or low muscle tone
• Gait impairments
• Functional deficits
• Physically limiting disabilities
• Developmental deficits or delays
• Deficits acquired from illness or injury
• Sequelae of surgery or recovery

PRM physicians can help coordinate care across multiple specialties. “We’re like the quarterbacks of the team,” Kennelly says. “We’re trained broadly to offer therapeutic modalities, equipment, bracing, medication, and more. We also specialize in the supportive procedures for these needs, so we recognize when surgery would help and can make that referral.”

In addition to the over 70 pediatric physical, occupational, and speech therapists at Duke, a PRM physician builds another level of support and care for this population. “We are the lead to help families manage these conditions,” Kennelly says. “As patients grow and change, we are here to help them navigate the next step of their progression, for example, preparing to transition from preschool to school and beyond.”

A PRM physician can offer referring providers and families extra support. “Navigating the health system for a child or a patient with complex conditions can be overwhelming,” Kennelly says. “We see the big picture and help families tailor therapies and treatments to meet their goals. My goal is to be a liaison for these families to connect them with the right specialists and resources so caregivers can focus on getting back to their usual lives.”

Kennelly encourages pediatricians to consult and refer early. “I’m always happy to discuss cases or answer questions,” she says. While PRM physicians coordinate specialized care, pediatricians continue to provide primary care to patients. “I appreciate pediatricians and all that they do, and I’m happy to be a resource to them,” Kennelly adds.