50 Years of Paediatric Rehabilitation

Submitted by: Dr. Golda Milo-Manson, Vice-President Medicine & Academic Affairs at Holland Bloorview Kids Rehabilitation Hospital

The progress in the field of paediatric rehabilitation and developmental paediatrics has been astronomical, and the number of discoveries, advancements, and milestones have been plentiful over the past five decades. To showcase the exciting evolution of care, this post will highlight a few of these changes and contributions from organizations and researchers in the paediatric rehabilitation field.
In 1974, the treatment and management of neuromuscular conditions has dramatically improved. The first study evaluating corticosteroids in the treatment of Duchenne muscular dystrophy was published. Now, corticosteroid treatment is the gold standard, effectively slowing disease progression resulting in life spans into the late 20’s and early 30’s. More recently, gene targeting treatment in spinal muscular atrophy has substantially improved clinical outcomes.  
For children with cerebral palsy the field was forever changed in 1997 with the publication of groundbreaking work by Drs. Peter Rosenbaum and Robert Palisano. They pioneered the Gross Motor Function Classification System for Cerebral Palsy, enabling all health professionals working with children with CP to have a common language focusing on a child’s function rather than their limitations. At around the same time the World Health Organization updated their international classification of function that helped to reframe our language to be more positive with a focus on activity and participation rather than disease and disability.
In 2001, the Royal College of Physicians and Surgeons of Canada, together with leaders in the field, worked to create a formal recognized subspecialty of developmental pediatrics in Canada. This ushered in national standardized training standards for developmental pediatricians. In 2012, the subspecialty became accredited and the first national examination for developmental pediatrics was held.
The management of spasticity in Cerebral Palsy has also grown significantly with new choices and evidence- informed treatments that enable children and their families to improve quality of life and participation. Options such as botulinum toxin, intrathecal baclofen and selective dorsal rhizotomy have all become viable options in the last two decades.
While the international community seeks to understand increased prevalence among young people, our understanding of autism spectrum disorder has been greatly enhanced resulting in faster diagnosis and treatment. Social acceptance for those living on the spectrum has been a boon to the social fabric of society. Conditions like pervasive developmental disorder not otherwise specified (PDD-NOS) and Asperger’s are now under the umbrella of ASD leading to new avenues of scientific discovery.
Our understanding of genetics has significantly advanced.  In recent years, we have uncovered connections between global developmental delay and specific genes that have opened up new pathways of research and possible treatment strategies.
Finally, and perhaps most importantly, the growth and integration of family-centred care has elevated our children and families as true partners in care.  This partnership has transformed healthcare for the better, leading to brighter futures and lives of possibility. 

While we still have a long journey ahead, the last 50 years have represented great hope and progress. With continued Fresh Thinking and Brave Ideas, the paediatric rehabilitation population will continue to receive innovative, high quality care across the country and around the world.