🧠 Rehabilitation Medicine · Rapid Recall

Screening tests, diagnostic tools & most accurate treatments + easy mnemonics (Nelson Pediatrics 22nd Ed.)

🌐 paeds.online — Pediatric Learning Platform
🧩 750 · TBI Rehabilitation
🔍 SCREENING / ASSESSMENT
• Pediatric GCS (3-8 severe, 9-12 moderate, 13-15 mild)
• Rancho Los Amigos Scale (RLAS) – levels I to VIII
• Children’s Orientation & Amnesia Test (COAT) – defines end of PTA
• PSH-AM scale (Pediatric paroxysmal sympathetic hyperactivity assessment measure)
🩺 DIAGNOSTIC TESTS
• Serial neurologic exam + biomarkers (investigational)
• CT/MRI (exclude structural lesions)
• Sleep diary (circadian disruption)
• EEG if suspicion of subclinical seizures
💊 MOST ACCURATE TREATMENT
• Agitation: environmental modification first, restraints last
• Neurostimulation: amantadine, methylphenidate, L-dopa
• PSH: propranolol + gabapentin ± morphine; avoid oral baclofen
• Posttraumatic seizures: AED prophylaxis for 7 days ONLY (levetiracetam/phenytoin)
📌 MNEMONIC “TBI-4S”
Stimulate (environmental) → Sedate? No → Stimulants (amantadine) → Seizure prophylaxis (7d).
PSH Propranolol + Gabapentin + Opioids (PRN).
🩻 751 · Spinal Cord Injury & AD
🔍 SCREENING / ASSESSMENT
• ASIA Impairment Scale (AIS) – complete/incomplete + sacral sparing
• SCIWORA suspicion in child with normal X-ray + deficits → MRI
• Autonomic dysreflexia (AD): BP monitoring; AD emergency card
• Renal ultrasound + urodynamics (neurogenic bladder)
🩺 DIAGNOSTIC TESTS
• MRI spine (SCIWORA, cord edema/contusion)
• Urodynamics + cystourethrogram
• D-dimer + venous duplex (DVT screen post-SCI)
• Hypercalcemia: serum calcium, PTH, urine calcium/creatinine
💊 MOST ACCURATE TREATMENT
• AD emergency: sit upright, relieve bladder/bowel, nifedipine 0.25-0.5 mg/kg or nitropaste
• DVT prophylaxis: mechanical for all; adolescents + LMWH
• Bladder: CIC 4-6x/day, anticholinergics (oxybutynin)
• Bowel: UMN: digital stim + enemas; LMN: manual evacuation
📌 MNEMONIC “AD-UP”
Assess, Disimpact bladder/catheter, Upright position, Prophylaxis (nifedipine/nitropaste).
SCIWORA “MRI before mobility”
💪 752 · Spasticity Management
🔍 SCREENING / ASSESSMENT
• Modified Ashworth scale / Tardieu scale
• GMFCS (Gross Motor Function Classification)
• Range of motion + contracture assessment
• Assess impact on care, pain, function
🩺 DIAGNOSTIC TESTS
• Clinical history + video gait analysis
• Dynamic EMG (for surgical planning - SDR)
• Liver enzymes before & during dantrolene (hepatotoxicity risk)
• Imaging: spine MRI if suspect structural cause
💊 MOST ACCURATE TREATMENT
• Focal: botulinum toxin A (Botox/Dysport) q3-6mo
• Generalized: oral baclofen (GABAB agonist)
• Severe generalized: intrathecal baclofen (ITB) pump
• Spastic diplegia (ideal candidate): selective dorsal rhizotomy (SDR)
📌 MNEMONIC “SPASTIC”
Stretching + Phenol (large muscles) + AFO orthosis + Systemic baclofen + Toxin (botulinum) + ITB + Child selection → SDR.
🤱 753 · Birth Brachial Plexus Palsy
🔍 SCREENING / ASSESSMENT
• Active Movement Scale (AMS) – infant strength
• Narakas classification (I–IV, includes Horner = poor prognosis)
• Cookie test at 9 months (indicates need for surgery)
• Evaluate for associated DDH, torticollis, phrenic nerve palsy
🩺 DIAGNOSTIC TESTS
• MRI brachial plexus (preferred for root avulsion)
• EMG/NCS: normal sensory response + no motor = preganglionic avulsion
• CT myelogram (if MRI not available)
• Shoulder ultrasound for glenohumeral dysplasia
💊 MOST ACCURATE TREATMENT
• Early PT/ROM (start 2 weeks of age)
• Surgical indicators: no antigravity elbow flexion by 6 months (Narakas I/II) or 3 months (III/IV)
• Primary nerve transfer: spinal accessory → suprascapular; radial → axillary
• Secondary: latissimus dorsi transfer, derotational humeral osteotomy
📌 MNEMONIC “BRACHIAL”
Biceps by 6 months → Rehab; Avulsion = surgery; Cookie test +; Horner grave; Injury level (C5-6 most common); Accessory nerve transfer; Latissimus transfer for rotation.
🧬 754 · Meningomyelocele (Spina Bifida)
🔍 SCREENING / ASSESSMENT
• Prenatal: maternal serum AFP + ultrasound (lemon/banana signs)
• Postnatal: neurologic level (motor grade 3 defines most caudal intact segment)
• Renal ultrasound + urodynamics (baseline)
• Latex allergy screening (RAST for cross-reactive foods)
🩺 DIAGNOSTIC TESTS
• Spine MRI (Chiari II, tethered cord, syrinx)
• Head ultrasound/CT (hydrocephalus, shunt evaluation)
• Urodynamics + VCUG (neurogenic bladder)
• DEXA scan (osteoporosis risk)
💊 MOST ACCURATE TREATMENT
• Prenatal: folic acid 0.4 mg daily (4 mg if prior NTD); prenatal closure reduces shunt need
• Neonatal: back closure within 48h, VP shunt for hydrocephalus
• Bladder: CIC + anticholinergics (oxybutynin)
• Latex-free environment from birth (cross-reactivity: banana, avocado, kiwi)
📌 MNEMONIC “CLOSED”
Closure (back), Latex-free, Oxybutynin (bladder), Shunt (VP), Enema program (ACE), Detethering (if decline).
🦽 755 · Upper & Lower Extremity Assistive Devices
🔍 SCREENING / ASSESSMENT
• Gait analysis + functional mobility assessment
• Tone (MAS), ROM, strength, endurance, cognition
• Home/school environment evaluation
• Prosthetic readiness: developmental milestone (pull-to-stand)
🩺 DIAGNOSTIC TESTS
• 3D gait analysis (research/clinical)
• Muscle strength manual testing
• Radiographs (limb deficiency, alignment)
• Pressure mapping for wheelchair seating
💊 MOST ACCURATE TREATMENT
• Foot drop / hypertonia: solid AFO
• Hypotonia/pronation: supramalleolar orthosis (SMO)
• Crouch gait: ground reaction AFO (GRAFO)
• Trunk/head control: custom wheelchair seating orthosis + lateral supports
• Lower limb prosthesis: fit at pull-to-stand (9-12 mo)
📌 MNEMONIC “CHOOSE”
Crouch → GRAFO; Hypertonia → solid AFO; Orthosis SMO for hypotonia; Occasion: gait trainer for poor trunk; Seating (custom) + Exoskeleton (limited use).
🌿 756 · Health & Wellness for CSHCN
🔍 SCREENING / ASSESSMENT
• Physical activity: “60 min daily” screen
• Nutritional status: BMI (adjusted if contractures/amputation)
• Sleep (PROMIS sleep disturbance scale), pain (FLACC, Faces)
• Emotional health (PHQ-9, SCARED), bullying/abuse screen
🩺 DIAGNOSTIC TESTS
• Sleep study (polysomnography) for OSA (Down syndrome, CP)
• Dual-energy X-ray absorptiometry (DEXA) if immobilization osteoporosis risk
• Behavioral assessment + functional vision/hearing
• Dental examination under anesthesia if severe behavior
💊 MOST ACCURATE TREATMENT
• Obesity: healthy behaviors + adapted exercise (exergaming, aquatic)
• Sleep disturbance: sleep hygiene + melatonin 1-3mg
• Chronic pain: biopsychosocial (CBT, gabapentin, PT)
• Emotional health: psychoeducational groups, peer support (Special Olympics)
📌 MNEMONIC “WELL”
Weight (healthy habits), Exercise (60 min, exergaming), Leisure (social inclusion), Listen (screen for pain/depression), Latex? not here — but dental & sleep!

⚡ Key Screening Tests Mnemonic (one-liner)

TBI GCS, RLAS, COAT, PSH-AM
SCI ASIA, UDS, MRI (SCIWORA)
Spasticity Ashworth, GMFCS
BBPP AMS, Narakas, Cookie test
SB AFP, US lemon/banana, UDS
Devices gait analysis, seating map
🌟 Most Accurate Treatments in a Nutshell
• TBI agitation → environment first • AD → Sit UP + nifedipine • Spasticity focal → BoNT-A, generalized → baclofen • BBPP surgery → spinal accessory transfer • SB → CIC + oxybutynin + latex-free • Crouch gait → GRAFO • Wellness → 60 min play + sleep hygiene.