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Pediatric Physical Medicine & Rehabilitation

Home 9 Service 9 Logan Health Children’s 9 Pediatric Physical Medicine & Rehabilitation

What is Pediatric PM&R?

Pediatric physical medicine and rehabilitation (PM&R), sometimes also known as rehabiliation medicine or physiatry, really aims to restore and enhance functional ability and quality of life to those with physical impairments or disabilities affecting the brain, spinal cord, nerves, joints, muscles, ligaments, and tendons.

The pediatric physiatrist’s main goals are to maximize the patients’ independence in activities of daily living and improve their quality of life. Logan Health Children’s works closely with children and teens to build strength, gross and fine motor skills, coordination, balance, and endurance to help them achieve their full potential.

Conditions We Treat

At Logan Health Children’s Specialists, we care for babies, children, teens and young adults with developmental disabilities, illnesses and traumatic injuries. Knowing that collaboration and teamwork are necessary in the delivery of excellent care, the Logan Health Pediatric Rehabilitation Medicine team works closely with other specialists such as Neurology, Neurosurgery, Orthopedic Surgery and Genetics. Our mission is to provide comprehensive, family-centered rehabilitation services for a variety of diagnoses, including:

  • Arthrogryposis
  • Brachial Plexus Injury
  • Brain and Spinal Cord Tumors
  • Brain Injury (severe traumatic, concussion, stroke, and infection)
  • Cancer-related problems
  • Cerebral Palsy
  • Chronic Pain
  • Development Delay
  • Debility or Deconditioning
  • Lim Deficiencies
  • Muscular Dystrophy
  • Neuropathy
  • Osteogenesis Imperfecta
  • Other Neuromusclar Disorders
  • Sensory Processing Dysfunction
  • Spasticity (or other types of hypertonia, ex: Dystonia)
  • Spina Bifida
  • Spinal Cord Injury (traumatic, transverse myelitis, acute flaccid myelitis)
  • Toe-walking and other Gait impairments
  • Torticollis
  • Other services: Baclofen Pump Management, Botox Injections, Bracing Evaluation, EMG/Nerve Conduction Study Testing, and Specialized Equipment Evaluation.

Spasticity

What is Spasticity?
Spasticity is abnormal muscle tightness due to an overactive spinal reflex. That same reflex that makes your leg jump when a doctor taps on your knee, is responsible for spasticity. This hyperactive reflex keeps muscles turned “on” causing muscle tightness and associated problems. This reflex becomes overactive (typically) due to a permanent injury to the brain or spinal cord and can affect any muscle in the body. The type and location of the injury to the brain or spinal cord dictates which muscles are affect. For example, it could affect only a few muscles, one whole side of the body, or both sides of the body. It can even influence the way we talk, swallow food, poop and pee!

Fact #1: Did you know the highest risk of stroke is actually when we are babies and not as adults!

What problems can Spasticity cause?
Spasticity can lead to stiff or fixed joints call contractures, interfere with the way we move or walk, cause spasms or pain that interfere with function and sleep. In young kids with developing bones, spasticity can also cause twisting bone deformity, hip joint problems (hip dysplasia) and abnormal spinal curvature (neuromuscular scoliosis).

Fact #2: The lowest portion of your spinal cord turns into a collection of nerves called the “cauda equina,” latin for “horse’s tail.” Injury to the cauda equina leads to flaccid tone rather than spasticity or spastic tone.

What can make Spasticity worse?
Spasticity can be influenced by many things including cold temperatures, pain, constipation, medications, sleep, mood and infections or illness. Despite these transient or temporary increases or reductions in spasticity, the baseline spastic tone of affected muscles does NOT change over the lifespan. This is because spasticity is (typically) the result of a permanent injury to the brain or spinal cord injury. However, during times of rapid growth, such as during puberty, the muscles can quickly become very tight as the bones lengthen rapidly pulling even moreso on these tight muscles. This can be a time for aggressive treatment!

So how do we treat Spasticity?
There is no cure for spasticity but there are MANY things that CAN greatly reduce spasticity and prevent or eliminate the problems it can cause.

Proven Interventions:

  • Conservative interventions -> Examples include movement and stretching, bracing, serial casting and positioning.
  • Oral medications -> #1 option is oral baclofen.
  • Injections -> Botox, Dysport and other types of botulinum toxin can be effective for a select number of muscles.
  • Baclofen pump -> Is a very effective therapy that requires surgical pump placement and ongoing physician management, programming and pump refills. It is a reversible intervention meaning the pump can be removed if we no longer wish to use it.
  • Selective dorsal rhizotomy -> A permanent neurosurgical procedure performed at select specialty pediatric medical centers that can greatly reduce spasticity. It can lead to significant sensory and movement issues and requires intensive, prolonged rehabilitation.
  • Orthopedic surgery -> There are various bone and soft tissue procedures that our Orthopedic surgeons can perform to improve walking, movement, joint contracture, hip or spine problems.

*Other conservative options can include acupuncture, acupressure, chiropractic manipulation, E-stim, heat therapies, other soft tissue therapies (ex: Reiki, Airrosti, simple massage), vestibular therapy, vibration plates.

So what is the best option for my child?
There is no “one size fits all” approach. Talk to your physician about the options and which ones may be helpful for your child now and in the future

Patient Resources

Cerebral Palsy (CP)

How and when is Cerebral Palsy (CP) diagnosed?
CP is the most common movement disorder in childhood. Despite this, it often goes undiagnosed – especially when symptoms are mild. Diagnostic workup is typically done within the first year of life and may be prompted by an infant with delays in motor development, muscle weakness or tightness, or a history of a complicated pregnancy or birth. Diagnosis is made after a thorough neurological examination and brain imaging such as a cranial ultrasound or brain MRI.

Does CP get worse over time?
CP is the result of injury or stroke to a young brain. This means that the brain injury does not get worse over time. However, the movement-related issues can cause problems that worsen – especially during times of rapid growth. This can lead to functional problems, bone and joint deformities, and pain.

What are some of the treatments for CP?
So far there is no cure for CP, however, there are many treatments to help a child with CP thrive. Children with CP share common signs and symptoms related to muscle weakness, muscle over-activity and tightness. Treatment may include occupational, physical and speech therapies, bracing, specialized equipment, medications, muscle injections, intrathecal baclofen pumps and orthopedic surgeries.

What is the Physiatrist’s role in treatment?
The PM&R physician’s (we are called “physiatrists”) role is to screen for medical issues associated with CP as well as to screen and prescribe treatments targeting functional and musculoskeletal issues. Specifically, physiatrists prescribe therapies, bracing, specialized equipment, oral medications and perform “Botox* injections,” manage baclofen pumps and collaborate closely with Pediatricians, Orthopedists, Neurosurgeons, Geneticists and other subspecialists to navigate the right treatment plan for each child.

What else to know?
If your child has been diagnosed with cerebral palsy, know that they are a special gift, a true survivor and have great value to society and anyone they encounter. There are many amazing stories and great people living with “CP.” You and your family can help write the next chapter in this legacy. Ask how to connect with your community, state, national or even international CP organizations.

What next?
Start by visiting the Cerebral Palsy Foundation: http://yourcpf.org
Consider other specific resources or needs your child may have and review the below list. If help is wanted to navigate these resources and to understand more about social services for your child, please request a social worker consultation.

Resources

Resource List:
Adaptive Sports & Recreation:  Ask these organizations if they are the right fit for you or your child.

Meet Our team

Nicholas Fleming

Nicholas Fleming, DO

Contact Us

Logan Health Children’s Specialists – Pediatric PM&R
202 Conway Drive, Suite 200
Kalispell, MT 59901

Phone and Fax
Phone: (406) 758-7490
Fax: (406) 758-7080

Office Hours
Monday through Friday 8 a.m. to 5 p.m.

Regional Clinics:
Bozeman Clinic
1610 Ellis Street, Suite 1B
Bozeman, MT 59715
(406) 602-4995

Great Falls Clinic
2012 14th Street SW
Great Falls, MT 59404
(406) 604-4960

Helena Clinic
121 N. Last Chance Gulch, Suite C
Helena, MT 59601
(406) 603-4900

Missoula Clinic
1821 South Avenue West, Suite 202
Missoula, MT 59801
(406) 493-0844

For Referring Providers

Our team of registered nurses is available 24/7 to facilitate timely communication for acute telemedicine consults, provider-to-provider consults, direct admissions, and transfers. The One Call team partners with A.L.E.R.T. and specialty transport teams to coordinate flight and ground transports as needed.

(833) LOGAN4U or (833) 564-2648 

For our full list of services, click here.

What to bring to an appointment

  • Shorts for your child to wear during the exam so we can see their knees
  • Braces/Orthotics that are currently worn, too small or poor fitting
  • Gait aides like arm crutches, canes and walkers
  • Wheelchairs