Ethical issues in paediatric rehabilitation

Flett, Peter; Stoffell, Brian

doi:10.1046/j.1440-1754.2003.00114.x

Cited by 11 publications

(10 citation statements)

References 10 publications

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“…Major ethical issues with respect to prematurity have arisen as medical care has advanced, but ethical dilemmas in pediatric rehabilitation management are rarely discussed yet are nevertheless imperative to consider. For example, it is unethical for therapists not to base practice on the best medical evidence 37. The tremendous variability in physical therapy practice across therapists, settings, and geographical regions indicates there is either a lack of evidence in the field or a failure to incorporate evidence.…”

Section: Translating Evidence Into Clinical Practicementioning

confidence: 99%

Rehabilitative Therapies in Cerebral Palsy: The Good, the Not As Good, and the Possible

Damiano

2009

J Child Neurol

106

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In the past decade, growing recognition of the importance of motor activity for the development and maintenance of central nervous system pathways and for recovery of function post injury has provided new avenues for rehabilitation. Physical therapy is likely to have a prominent role in stimulating neuroplastic changes in damaged developing nervous systems that may finally alter the natural history of these disorders, which has not yet been possible. In this article, we discuss the scientific evidence for various physical therapy treatment options for children with cerebral palsy. Newer, more intense, and task-related exercise programs show the strongest level of evidence. Traditional approaches and newer "packaged" approaches have failed to provide evidence of superiority. Their continued prevalence among clinicians is puzzling and disconcerting, as evidence supporting other approaches continues to accumulate. Keywords physical therapy; outcomes; motor activity; plasticity; exercise Cerebral palsy encompasses a "group of disorders of movement and posture causing activity limitation attributed to a static disturbance in the developing brain, often accompanied by associated impairments and secondary health conditions." 1 Nearly all individuals with cerebral palsy receive physical therapy services in childhood, often regularly for many years. The main question is whether the scientific evidence for the efficacy or effectiveness of physical therapy justifies its frequent use in this population. We will also discuss the recently emerging therapy approaches with significant potential for altering the current neurological prognosis for those with this disorder.The amount of evidence supporting or failing to support the effectiveness of physical therapy for children with cerebral palsy has increased exponentially in each of the past 2 decades. Reasons for this include (1) academic progress within the physical therapy profession, including a greater number of PhD-trained therapists and elevation of the basic education level for therapists from a bachelor's to a doctoral degree and (2) factors outside of the profession, such as a greater focus on evidence-based practice in all medical and allied health fields and increased pressure from third-party payers to demonstrate efficacy of therapies.

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Section: Translating Evidence Into Clinical Practicementioning

confidence: 99%

Rehabilitative Therapies in Cerebral Palsy: The Good, the Not As Good, and the Possible

Damiano

2009

J Child Neurol

106

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“…Patients and other health care professionals may hold different definitions of end goals in rehabilitation. 17,18 Thus, decisions to commence or cease physical therapy treatment might be made by the physical therapist or by an alternative health care professional, or the decision might be made on the basis of funding constraints and opportunities. 19,20 Purtilo et al 12(p41) defined these types of ethical issues as "locus of authority" problems.…”

Section: • Audio Abstracts Podcastmentioning

confidence: 99%

“…They include scenarios where a physical therapist, working within a multidisciplinary health care team, may not have the designated authority or moral agency to be able to achieve their discipline-specific professional therapeutic goals and outcomes for the patient. 17 Poulis' 16 second ethical dimension of clinical practice concerns the often intimate and one-on-one interaction of physical therapy treatment, relying on touch, communication, advice, and at times, patient dependency. For example, patients with chronic illnesses, 21,22 athletes who depend on being injury free for competition, 23 and families who rely on ongoing management of their children with chronic conditions 24 form close and personal relationships with their treating physical therapist.…”

Section: • Audio Abstracts Podcastmentioning

confidence: 99%

Closing the Gap Between Ethics Knowledge and Practice Through Active Engagement: An Applied Model of Physical Therapy Ethics

et al. 2010

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Physical therapist practice has a distinct focus that is holistic (ie, patient centered) and at the same time connected to a range of other providers within health care systems. Although there is a growing body of literature in physical therapy ethics knowledge, including clinical obligations and underlying philosophical principles, less is known about the unique ethical issues that physical therapists encounter, and how and why they make ethical decisions. As moral agents, physical therapists are required to make autonomous clinical and ethical decisions based on connections and relationships with their patients, other health care team members, and health institutions and policies. This article identifies specific ethical dimensions of physical therapist practice and highlights the development and focus of ethics knowledge in physical therapy over the last several decades. An applied ethics model, called the "active engagement model," is proposed to integrate clinical and ethical dimensions of practice with the theoretical knowledge and literature about ethics. The active engagement model has 3 practical steps: to listen actively, to think reflexively, and to reason critically. The model focuses on the underlying skills, attitudes, and actions that are required to build a sense of moral agency and purpose within physical therapist practice and to decrease gaps between the ethical dimensions of physical therapist practice and physical therapy ethics knowledge and scholarship. A clinical case study is provided to illustrate how the ethics engagement model might be used to analyze and provide insight into the ethical dimensions of physical therapist practice.

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“…Evidence on the status of intervention services following early hearing detection is scanty because such services are offered predominantly by private providers who often are reluctant to provide information on their services for research purposes (Madriz, 2000;Russo, 2000). The target of intervention services is not necessarily to provide the entire range of options currently offered in developed countries (Gabbard & Schryer, 2003;Gravel & O'Gara, 2003) but to focus on functionality, affordability and what is culturally appropriate within an ethical framework (Flett & Stoffell, 2003). For instance, in Brazil, improved interactions between children with hearing loss and their families were reported following a specialized speech and hearing intervention program comprising speech therapy, sign language and oral language workshops for the children; sign language workshops for hearing parents; and a parent support group (Grandori & Hayes, 2006).…”

Section: Scope and Status Of Interventionmentioning

confidence: 99%

Bilateral Cochlear Implantation in Children: Experiences and Considerations

Bohnert¹,

Spitzlei²,

Lippert³

et al. 2006

TVR

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Permission to Copy: The Alexander Graham Bell Association for the Deaf and Hard of Hearing, as copyright owner of this journal, allows single copies of an article to be made for personal use. This consent does not extend to posting on Web sites or other kinds of copying, such as copying for general distribution, for advertising or promotional purposes, for creating new collective works of any type, or for resale without the express written permission of the publisher. For more information, contact AG Bell at

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Ethical issues in paediatric rehabilitation

Cited by 11 publications

References 10 publications

Rehabilitative Therapies in Cerebral Palsy: The Good, the Not As Good, and the Possible

Rehabilitative Therapies in Cerebral Palsy: The Good, the Not As Good, and the Possible

Closing the Gap Between Ethics Knowledge and Practice Through Active Engagement: An Applied Model of Physical Therapy Ethics

Bilateral Cochlear Implantation in Children: Experiences and Considerations

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