Dr. Robert Palisano
PT, ScD, FAPTA Distinguished Professor Drexel University, Philadelphia, PA, USA Scientist CanChild Centre for Child Disability Research McMaster University, Hamilton, Ontario, Canada

Contextualization: Optimizing the desired home, school, and community participation of children with disabilities and preparing adolescents for successful transition to adulthood are important outcomes of pediatric rehabilitation services. Overriding assumptions for rehabilitation are: 1) real-life experiences, characterized by person-environment transactions, enable children to learn skills, form friendships, achieve personal goals, and develop meaning and purpose in life, and 2) preparing children with disabilities for life as adults is a collaborative process that begins at a young age.

Development: Family-centered services are considered best practice in pediatric rehabilitation. Collaboration (partnership) between families of children with disabilities and professionals is central to family centered services. Family-professional collaborative involves mutually supportive interactions in which information is shared, goals are identified, and interventions are planned to achieve desired child and family outcomes. Research suggests that parent engagement in goal setting and the intervention process improve a) children’s goal attainment, b) parental feeling of competency, and c) parent awareness of using everyday activities as sources for natural learning opportunities.

Although families and professionals agree that collaboration is important, there are challenges to implementation in clinical practice. Parents have consistently reported that their information needs are not fully met, emphasized the importance of considering families in the broader context of their lives, and advocated for services individualized to each family’s unique needs. Needs identified by parents include a) information about services that are presently available, b) help in locating social, recreational, and leisure activities, c) information about services in the future, and d) more time for self. Professionals have expressed that their primary focus is on the child’s health and development and that they are less comfortable providing services to meet changing child and family needs.

Final considerations: A collaborative, goal-oriented approach to pediatric rehabilitation is presented in which physical therapists share information, educate, and instruct in ways that enable the child, family, and community providers to solve problems and discover solutions to participation challenges; thereby, promoting child self-determination and parent empowerment. Therapists are encouraged to pay attention to the timing of opportunities and experiences. Awareness of context (family circumstances and situations) enables families and therapists to consider readiness to achieve goals, person-environment transactions, and what needs to happen to achieve goals for participation.

Further reading: An M, Palisano RJ, Yi CH, Chiarello LA, Dunst CJ, Gracely EJ. Effects of a Collaborative Intervention Process on Parent-Therapist Interaction: A Randomized Controlled Trial. Phys Occup Ther Pediatr. 2019;39(3):259-275. doi: 10.1080/01942638.2018.1496965.

Palisano RJ, Di Rezze B, Stewart D, Rosenbaum PL, Hlyva O, Freeman M, Nguyen T, Gorter JW. Lifecourse Health Development of Individuals with Neurodevelopmental Conditions. Dev Med Child Neurol. 2017 May;59(5):470-476. doi: 10.1111/dmcn.13402.

Palisano RJ, Chiarello LA, King GA, Novak I, Stoner T, Fiss A. Participation-based Therapy for Children with Physical Disabilities. Disabil Rehabil. 2012;34(12):1041-52. doi: 10.3109/09638288.2011.628740.


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