Pediatricians are commonly asked to evaluate school-aged children with motor deficits and to participate in the writing of a prescription for physical and/or occupational therapy that is deemed necessary to remediate and/or treat the disability. In the majority of states, physical therapy services are available only through a physician's prescription. Occupational therapy services, on the other hand, are generally available in nonhospital settings (such as in schools) without physician-written prescriptive orders. The problem is as follows: Many of the therapeutic programs developed for the motor-impaired child have not been subjected to careful, scientific evaluations; therefore, it is necessary for the pediatrician to be aware of those therapeutic modalities that have and have not received scientific scrutiny and, also, be cognizant of those that are generally regarded as helpful.1 Furthermore, the physician should be able to help the parents and educators understand what can and cannot be accomplished by a therapy program. 2,3
The first responsibility of the physician is to provide an accurate diagnosis, if possible, and to ensure that the child does not have a progressive disability. The spectrum of static disorders ranges from dyspraxia (clumsiness) to cerebral palsy.4 In addition to the primary neuromotor disorder, all potential associated problems such as learning disabilities, emotional difficulties, and epilepsy must be identified and treatment programs recommended. If the parents, educator, and physician agree that the child's motor difficulties are interfering with his or her educational program, then by law (Public Law 94-142)5 a physical and/or occupational therapy program might be considered to provide assistance in the student's educational endeavors.
The Role of the Pediatrician in Prescribing Therapy Services for Children with Motor Disabilities