speech training therapy bridging activities aural rehab

12 Access to health and therapeutic services, the physical environment, and social supports all affect how well a child with disabilities functions in his or her daily life. 11 The environment includes not just the physical world, such as the town where the child lives or the topography of the community, but also includes the attitudes and values of the family, community, and society at large and the technologies, services, supports, laws, and policies where the child lives. In addition, the ICF framework highlights the importance of a child’s environment on his or her functional outcomes. 10 These concepts are important in understanding the role of habilitative and rehabilitative therapies for children with disabilities, because achievement of skill requires extensive practice and must be integrated into the child’s routine for the successful enhancement of participation in life events. Capacity is the individual’s intrinsic ability to perform a task or an action in a standardized environment, whereas performance is how well the individual is able to actually perform the task in his or her own real-life environment. The ICF also includes the concepts of capacity and performance. 7 The WHO defines impairments as “problems in body function or structure such as a significant deviation or loss,” activity limitations as “difficulties an individual may have in executing a task,” and participation restrictions as “problems an individual may experience in involvement in life situations” ( Fig 1). Disability is the umbrella term for impairments at the body part or organ system level, activity restrictions at the person level, and participation restrictions at the person-in-society level. 7 These levels correspond to body functions, activities, and participation, respectively. There are 3 identified levels of functioning: the body part or organ system, the person, and the person in social situations.

8 Houtrow and Zima 9 provided examples of the ICF and ICD together for common pediatric diagnoses in 2017. The ICF describes the relationship between health conditions diagnosed and coded in the ICD and the personal and environmental factors that act as facilitators or barriers to functioning.

Two case examples are provided to aid the pediatric health care provider in developing expertise in addressing the therapy needs of children with disabilities in their practices. 2, – 5 This clinical report will review (1) the framework of the International Classification of Functioning, Disability and Health (ICF) for understanding the interaction between health conditions and personal and environmental factors that result in disability, (2) children with disabilities and the goals of habilitation and rehabilitation services, (3) the types of therapy services available with their general indications, (4) the locations in which children may receive therapy services and potential facilitators and barriers to securing therapy services, (5) the existing literature regarding the benefits of therapy and how therapy may be dosed to optimize functional outcomes, and (6) recommendations for writing therapy prescriptions.

Many general pediatric providers describe inadequate training to appropriately prescribe therapy in the various settings in which they may be available to children with disabilities. 1 Pediatric providers are often asked (frequently by families) or recognize the need to prescribe habilitative and rehabilitative therapies (physical, occupational, and speech and language) for infants, children, and youth with disabilities in their clinical practices. Pediatricians and other pediatric health care providers have a vitally important role of linking children and youth with disabilities in their family-centered primary care medical homes with appropriate community-based services.

Speech training therapy bridging activities aural rehab