The pandemic effects of COVID-19 on children with disabilities have received little attention, possibly because the disease disproportionately affects the elderly. In this special issue of the Journal of Pediatric Rehabilitation Medicine specialists assess the impact of pandemic on pediatric patients with special needs, their caregivers and health care providers. They also focus on the growing importance of telemedicine and provide insights and recommendations for reducing the impact of the virus in the short and long term.
Pediatric rehabilitation patients often have increased access and treatment needs. As clinics were discontinued or postponed during the pandemic, some patients who may need care did not receive timely care. These children should be the focus of assessment and intervention to reduce the adverse effects of COVID-19 and the resulting restraint strategies. More ethical and informed decisions should be needed in the treatment of people with disabilities and should be included in future emergency planning. “
Guest Editors Matthew J. McLaughlin, MD, MS, Child Mercy – Kansas City, MO, USA, and Christian J. Vercler, MD, CS Mott Children ‘s Hospital, University of Michigan, Ann Arbor, MI, USA
Children make up about 2% of COVID-19 cases in the United States. In most cases the child is asymptomatic or with mild symptoms. However, children with disabilities such as cerebral palsy (CP) are more vulnerable and are at greater risk for respiratory problems. Some may present with inflammatory multisystem syndrome (MIS-C) and require supportive care.
This particular case addresses many aspects of COVID-19 in vulnerable children with special needs, including spasticity management, autism spectrum disorders, CP, neuromuscular disorders, tracheostomies, MIS-C, school, and how to deliver medications safely and effectively. It also considers the impact of the pandemic on healthcare providers in training including the need for medical education, training and disability-sensitive practice; the differential effects of pandemic on black, Latinx, and Native American populations; as well as telemedicine knowledge and the place of meaningful education.
There are concerns that the virus may affect children with disabilities differently when viewed through the lens of race and equality. In the US, early data reported from multiple jurisdictions showed that COVID-19 has a disproportionate effect when measuring mortality and infection rates in blacks, Native Americans, and Latinx compared to white populations. in several areas of the country.
The risk of children with disabilities contracting coronavirus is directly related to caregivers and / or family members sharing the live regimen, explains Maurice G. Sholas, MD, PhD, Principal and Physician -children, Sholas Medical Consulting, LLC, New Orleans, LA, USA. It sets out a number of steps to alleviate the problems, concluding “Individual providers, health systems and policy interventions need to be accountable and proactive to ensure that marginalized communities do not continue to be affected. unfair. “
Patients with pre-existing respiratory disorders such as CP are at increased risk for respiratory problems if they contract with COVID-19, notes Joline E. Brandenburg, MD, Department of Physical Medicine and Rehabilitation -conventional, and Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA, and colleagues in a study of the study of respiratory function and diaphragm muscle force generation in children with CP. They compare and link clinical work and basic science research examining phrenic motor neuron and diaphragm dysfunction in an animal model and discuss the ability of people with CP to experience real respiratory symptoms from COVID- 19.
“We need to be vigilant in encouraging and supporting the families of children with CP and individuals with CP to use physical speed, good hand hygiene, reduce trips to public places such as stores and restaurants, and cleaning any equipment used outdoors. home (i.e., pedestrians and wheelchairs) to reduce the risk of contracting with COVID-19, ”advises Dr. Brandenburg.
COVID-19 has accelerated the adoption of telehealth across many medical experts and is a particular focus on this issue. “Telemedicine offerings are expanding with many pediatric rehabilitation providers,” explained Dr. McLaughlin and Dr. Vercler. “Historically, pediatric rehabilitation patients are more difficult to carry, may come from a more challenging socioeconomic background, and have more medical co-morbidities than the general pediatric population. With more clinics offering telemedicine prescribing, this could limit COVID-19 and reduce the burden on carers if medical care is provided within the home setting. “
A study of pediatricians by Anton Dietzen, MD, DC, Marianjoy Rehabilitation Hospital, Northwestern Medicine, Lombard, IL, USA, and colleagues, showed a significant increase in telehealth use from COVID-19, from less at 15% to 97%. Over 80% of respondents said they felt comfortable using telehealth, 77% felt confident in the quality of care provided, and 91% thought that patients satisfied with telehealth visits.
“Responses indicate that telehealth is expected to play a role in pediatric psychology in the future and interest in telehealth continuing education is common. Most pediatricians are pediatricians. expects to continue or expand telehealth offerings after COVID-19, “notes Drs. Dietzen.
The guest editors add that “the benefit of telemedicine and its extended use may continue to benefit patients with rehabilitation needs, although we must be aware that procedures will be required. such as intrathecal baclofen reabsorption or botulinum toxin injection in human visits. “
“Through this issue of the Journal of Pediatric Rehabilitation Medicine we are disseminating a wealth of information about COVID-19 and its impact on our pediatric rehabilitation carers, providers and those with special needs, “said Editor-in-Chief Elaine L. Pico, MD , FAAP, FAAPM & R, UCSF Benioff Children ‘s Hospital, Oakland, CA, USA. “I believe this type of global outreach and information exchange is an essential part of the global solution. to help reduce the spread of this deadly virus.