Rehabilitation Medicine

• The Rehabilitation Medicine team includes doctors who are board-certified in rehabilitation medicine for children; pediatric nurse practitioners; nurses; occupational and physical therapists; speech and language pathologists; teachers; therapeutic recreation specialists; social workers; and psychologists.
• We work closely with each other and with you to evaluate your child’s needs and abilities. Then we design a treatment plan that fits your child and family.
• Based on your child’s condition, we partner with experts from many other areas of Seattle Children’s – such as Orthopedics, Neurodevelopmental, Neurology and Neurosurgery – to make sure your child receives complete, coordinated care.

• Our inpatient rehab unit is the only one in Washington, Alaska, Montana and Idaho certified as a Pediatric Family-Centered Program by the Commission on Accreditation of Rehabilitation Facilities (CARF).
• Seattle Children’s has been named a level 1 Pediatric Trauma Rehabilitation Center by the Washington State Department of Health.
• We have been named an MDA Care Center by the Muscular Dystrophy Association and a Certified Duchenne Care Center by Parent Project Muscular Dystrophy, the leading advocacy organization for people with Duchenne muscular dystrophy.

• Many rehab centers in the community will accept children but are focused on adult patients, who often have very different conditions and needs. At Seattle Children’s, we focus only on children. Our team has special training and experience with pediatric conditions and the treatments that are right for children as they grow and develop.
• Your family is at the center of care. Parents are an active part of the team, helping to set goals and taking part in rehab sessions. We provide training and support to prepare you to meet your child’s unique needs at home.
• Teachers at our on-site school help your child stay up on their classwork. As your child gets ready to return to school after injury, illness or surgery (or as they reach school age), we work with you to make the transition a success.

Neuromuscular diseases are caused by problems with the muscles or nerves. These diseases cause muscle weakness that may make it hard for children to walk, run and use their hands and arms. Some of these diseases affect the heart and lungs. Common neuromuscular diseases that we treat include: 

• Duchenne muscular dystrophy
• Becker muscular dystrophy
• Limb-girdle muscular dystrophy
• Facioscapulohumeral muscular dystrophy
• Congenital muscular dystrophy
• Myotonic muscular dystrophy
• Spinal muscular atrophy
• Charcot-Marie-Tooth disease
• Congenital myopathy
• Peripheral neuropathy 

Some neuromuscular diseases are serious and can get worse. Some cause fewer problems and may be stable over time.

Our team recommends treatments to improve your child’s muscle strength and function. The goal is to help your child do things for themselves. Treatments may include therapy, special equipment, orthotics, medicines and surgery. The team also recommends treatments that help prevent other health problems.

Children with arthrogryposis are born with several joints that have limited flexibility (contractures) and muscle weakness. This affects your child’s ability to move. It most often affects shoulders, elbows, wrists, hands, hips, knees and feet. Our team recommends treatment to improve your child’s overall function and the range of motion of their joints. Treatments may include therapy, splints, braces and surgery. Read more.

Cerebral palsy (CP) is caused by an injury to the brain. CP affects your child’s muscle tone. It may be hard for them to move their arms and legs in a coordinated way. CP can lead to other health issues, such as vision, hearing, speech and learning problems.

Our team recommends treatment to improve your child’s overall function and general health. These may include therapy, special equipment, orthotics, surgery and medicines, such as Botox (PDF) and phenol, orthopedic surgery and neurosurgery. We are the only provider in the Pacific Northwest to offer selective dorsal rhizotomy (SDR) surgery to improve mobility and quality of life for children with CP. Read more about cerebral palsy.

A stroke occurs when the blood supply to part of the brain is cut off or when a blood vessel in the brain bursts and causes bleeding in the brain. In both cases, brain cells don’t get the oxygen and nutrients they need to survive. Strokes can cause loss of muscle use on 1 side of the body (paralysis), as well as problems with speech, memory, learning and thinking.

Our team recommends treatment to improve your child’s overall function and general health. Treatments may include therapy, special equipment, orthotics, surgery and medicines to relax tight (spastic) muscles. We also work closely with stroke specialists from Neurology. Learn more about pediatric stroke.

A serious head injury can damage a child’s brain. A TBI can cause problems with walking, moving arms and legs, talking and thinking. A mild TBI may also be called a concussion.

Our team evaluates your child to check how well their brain is working. We recommend ways to help them improve their function. We also help plan for their return to school and their community.

Some children have brain injuries that are not from trauma. Infections and problems with the immune system can lead to brain injuries. Examples include meningitis, encephalitis and acute disseminated encephalomyelitis (ADEM). Our team evaluates and treats your child. Treatment plans may be similar to those for children with TBI.

A spinal cord injury can be from a trauma, an infection, an immune condition (such as transverse myelitis) or a tumor. The spinal cord controls movement of the arms and legs and the muscles that help with breathing and using the bathroom. The effects depend on what part of the spinal cord is injured.

Our team assesses your child, and we recommend ways to treat their condition and improve what they can do. We focus on: 

• Improving your child’s strength, flexibility and arm and leg movement
• Helping your child move around their home and community
• Helping them perform daily activities (such as getting dressed and eating)
• Managing their bowel and bladder
• Decreasing stiff muscles (spasticity)

A stretch injury to a child’s neck and shoulder can injure the set of nerves that control the muscles of the arm (brachial plexus). This can happen during birth if the child’s shoulder gets stuck against the mother’s pelvis. In older children and young adults, a brachial plexus injury can happen because of an accident, such as a car accident or sports injury.

We work closely with other members of the Brachial Plexus Clinic team to assess your child’s injury and recommend treatment, such as therapy, splinting and sometimes surgery, to improve your child’s use of their arm. Read more.

We work closely with Seattle Children’s Cancer and Blood Disorders Center to care for children who have cancer. Brain and spinal cord tumors and some cancer treatments can cause problems with walking, doing daily activities (such as dressing), talking and thinking.

We focus on helping your child improve their movement, strength, flexibility and communication, and on managing stiff muscles. We also consult on equipment needs and help with your child’s return to school and their community. Read more about cancers, such as brain tumors and spinal tumors.

In our general clinic, we see children with a range of problems that affect function. Some need follow-up after their inpatient rehabilitation stay, such as children with brain injury, spinal cord injury or stroke. Others were born with a condition that makes it hard for them to do what other children do, such as children with cerebral palsy, spina bifida or a missing or short limb.

Based on your child’s needs, they may see a team of providers, including these: 

• Rehabilitation doctor (physiatrist)
• Pediatric nurse practitioner
• Rehabilitation nurse
• Occupational therapist
• Physical therapist
• Neuropsychologist
• Speech and language pathologist
• Social worker
• Therapeutic recreation specialist
• Educator
• Dietitian 

The team may recommend treatments such as therapy, special equipment, splinting, orthotics, medicine and surgery. These treatments may help improve your child’s ability to walk, move and use their hands and arms.

Rehabilitation doctors and nurse practitioners work with orthopedic surgeons in the Ortho Rehab Clinic to plan and provide care for children with cerebral palsy and other neuromuscular disorders. They evaluate your child’s unique needs and offer nonsurgical and surgical treatments to improve your child’s function and comfort.

The Ortho Rehab Clinic is part of Seattle Children’s comprehensive care for children with CP. We see children who are affected in a wide range of ways – from those who move around without any help to those who use a wheelchair. Read more.

Children with a TBI may be seen at our TBI and Concussion Clinic if they have symptoms from their injury. Often children come to this clinic after their injury was evaluated somewhere else, such as at a trauma center, or by the Seattle Sports Concussion Program. They come to the TBI and Concussion Clinic because they need more support.

Based on your child’s needs, they may see a team of providers, including these: 

• Rehabilitation doctor
• Pediatric nurse practitioner
• Neuropsychologist
• Speech and language pathologist
• Education specialist 

The team evaluates your child and recommends ways to manage any problems they are having and help them to return to school.

Our Tone Management Program serves children with spasticity or dystonia that causes problems with actions such as walking, moving their arms or speaking.

Based on your child’s needs, they may see a team of providers, including these: 

• Rehabilitation doctor
• Pediatric rehabilitation nurse practitioner
• Neurodevelopmental doctor
• Neurosurgeon
• Orthopedic surgeon
• Physical therapist
• Occupational therapist 

After careful testing, our team recommends a plan of care. We work with you to create a plan that is right for your child.

The team may recommend treatments such as therapy, casting, orthotics, equipment, medicines that reduce spasticity or control dystonia and surgery.

Surgery may include: 

• Procedures that address problems with the bones, muscles or joints (orthopedic surgery)
• Intrathecal baclofen pump
• Selective dorsal rhizotomy 

These treatments may help improve your child’s ability to walk, move and use their hands and arms. The treatments may also make it easier for you to take care of your child.

Read more about the Tone Management Program.

If your child has a neuromuscular disease, such as muscular dystrophy, they will come to our Neuromuscular Clinic.

Based on your child’s needs, they may see a team of providers, including these: 

• Rehabilitation doctor
• Pediatric nurse practitioner
• Neurologist
• Cardiologist
• Pulmonologist
• Endocrinologist
• Nurse
• Occupational or physical therapist
• Dietitian
• Social worker 

The team recommends ways to improve your child’s overall health and function. Treatments may include therapy, special equipment, orthotics, surgery and medicines. The Neuromuscular Clinic has been named an MDA Care Center by the Muscular Dystrophy Association and a Certified Duchenne Care Center by Parent Project Muscular Dystrophy.

Read more about the Neuromuscular Program.

If your child has arthrogryposis, they may see a team of providers, including these: 

• Rehabilitation doctor
• Orthopedic surgeon
• Geneticist
• Dietitian
• Social worker
• Occupational or physical therapist 

This is based on your child’s needs. The team recommends ways to improve your child’s overall function. Treatments may include therapy, special equipment, splinting, orthotics and surgery.

Our multidisciplinary clinic for brachial plexus injuries is the only one of its kind for children in the Northwest and one of only a few in the country.

Based on your child’s needs, they may see a team of providers, including these: 

• Doctors who specialize in rehabilitation medicine, orthopedics, plastic surgery and radiology
• Nurse
• Occupational therapist
• Physical therapist
• Social worker 

The team creates a treatment plan designed to get the best results for your child. Treatments may include physical or occupational therapy, splinting, botulinum toxin injections and surgery. Read more.

Inpatient care is common for children with conditions such as moderate-to-severe brain injury, spinal cord injury (SCI), encephalitis or Guillain-Barré syndrome, or after surgery or other treatment that affects function.

In the hospital, your child is cared for by our team of specialists. We work with other healthcare providers in the hospital from pharmacy, laboratory, radiology and other specialty services to meet your child’s medical needs.

The inpatient rehabilitation program is a part of the larger hospital, so all the supportive services can provide your child the safest and highest quality care. A rehabilitation doctor is also always available to quickly address your child’s medical concerns.

We accept referrals from any provider, payor, inpatient or outpatient program as well as self-referrals.

• Learn more about our inpatient rehabilitation unit. Also read Welcome to the Rehabilitation Unit (PDF) (Spanish).
• To learn more about inpatient rehabilitation unit outcomes, see Patient Outcomes.
• For information about your stay at Seattle Children’s, please see our Hospital Campus Visitor and Family Guide.

Selective dorsal rhizotomy is a surgery done on the lower spinal cord to permanently reduce tight, stiff muscles (spasticity) in the legs. Certain nerve fibers that lead to spasticity are cut.

The goal is to improve your child’s ability to move and the quality of their movement. After surgery, your child will likely need 2 to 3 weeks of inpatient rehabilitation (physical and occupational therapy). The purpose is to increase your child’s strength and muscle control with a special focus on walking.

After going home from the hospital, your child will need outpatient therapy at least 3 to 4 times each week. Read more about selective dorsal rhizotomy and other surgical options for cerebral palsy and spasticity.

Baclofen is a medicine that relaxes muscles. It can reduce spasticity throughout your child’s body. A pump filled with baclofen is placed under the skin in your child’s belly. The pump delivers baclofen to the fluid around your child’s spinal cord. The medicine goes directly to your child’s nervous system, so your child doesn’t need as much baclofen as they do if they take it by mouth.

Before placing a pump, we inject a test dose of baclofen around your child’s spinal cord to be sure this medicine is right for your child. Then a rehabilitation doctor and physical therapist watch for several hours to see how the medicine affects your child’s body. Once we know the medicine is right for your child, we can schedule your child to get a pump. Read more about baclofen pumps and other surgical options for cerebral palsy and spasticity.

Seattle Children’s surgeons who specialize in bones, muscles and joints provide a full range of orthopedic surgeries to improve children’s function and comfort. For example, based on your child’s needs, we might recommend surgery to release stiff joints (contractures), better align bones and joints, or treat scoliosis.

Orthopedic surgeons with special expertise work closely with rehab doctors, therapists and other experts throughout Seattle Children’s, such as in our Arthrogryposis Clinic, Ortho Rehab Clinic, Hand and Upper Extremity Program, Spine Program and Brachial Plexus Clinic.

If your child needs orthopedic surgery, your team will plan and provide inpatient or clinic-based rehabilitation to help your child recover.

Children with cerebral palsy who have several stiff joints (contractures) or deformed bones in their hips, knees, ankles, or feet might benefit from having surgery to address many or all these concerns at once. This approach is called single-event multilevel surgery (SEMLS).

SEMLS requires the advanced skills, teamwork and careful coordination you will find at Seattle Children’s.

Our Orthopedics and Rehabilitation Medicine teams work together closely to develop a detailed SEMLS plan that is right for your child. We map out every aspect of your child’s surgery, as well as the intensive therapy your child will need after surgery, to get the best results. Read more about cerebral palsy treatment and the Ortho Rehab Clinic.