title: The continuum of care for individuals with lifelong disabilities: role of the physical therapist.
abstract: Many individuals with lifelong disabilities (LLDs) of childhood onset are living longer, participating in adult roles, and seeking comprehensive health care services, including physical therapy, with greater frequency than in the past. Individuals with LLDs have the same goals of health and wellness as those without disabilities. Aging with a chronic LLD is not yet well understood; however, impairments such as pain, fatigue, and osteoporosis often present earlier than in adults who are aging typically. People with LLDs, especially those living with developmental disabilities such as cerebral palsy, myelomeningocele, Down syndrome, and intellectual disabilities, frequently have complex and multiple body system impairments and functional limitations that can: (1) be the cause of numerous and varied secondary conditions, (2) limit overall earning power, (3) diminish insurance coverage, and (4) create unique challenges for accessing health care. Collaboration between adult and pediatric practitioners is encouraged to facilitate smooth transitions to health practitioners, including physical therapists. A collaborative client-centered emphasis to support the transition to adult-oriented facilities and promote strategies to increase accessibility should become standard parts of examination, goal setting, and intervention. This perspective article identifies barriers individuals with selected LLDs experience in accessing health care, including physical therapy. Strategies are suggested, including establishment of niche practices, physical accessibility improvement, and inclusion of more specific curriculum content in professional (entry-level) doctorate physical therapy schools.
authors.affiliation: M.N. Orlin, PT, PhD, Department of Physical Therapy & Rehabilitation Sciences, Drexel University, 7th Floor, Room 729, 1601 Cherry St, MS 7502, Philadelphia, PA 19102 (USA). margo.n.orlin@drexel.edu.
authors.forename: Margo N
authors.initials: MN
authors.lastname: Orlin
authors.affiliation: N.A. Cicirello, PT, MPH, EdD, College of Health Professions, School of Physical Therapy, Pacific University, Hillsboro, Oregon.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Cicirello
authors.affiliation: A.E. O'Donnell, PT, PhD, School of Physical Therapy, Texas Woman's University, Houston, Texas.
authors.forename: Anne E
authors.initials: AE
authors.lastname: O'Donnell
authors.affiliation: A.K. Doty, PT, PhD, PCS, Division of Physical Therapy, Walsh University, North Canton, Ohio, and Portage County Educational Service Center, Ravenna, Ohio.
authors.forename: Antonette K
authors.initials: AK
authors.lastname: Doty
mesh_terms: D000293:Adolescent; D000375:Aging / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services; D003299:Cooperative Behavior; D002658:Developmental Disabilities / Q000191:economics / Q000503:physiopathology / Q000534:rehabilitation*; D020446:Fitness Centers; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage; D007348:Insurance, Health; D008607:Intellectual Disability / Q000150:complications / Q000503:physiopathology; D059825:Physical Therapists; D024382:Professional Role; D060305:Transition to Adult Care; D055815:Young Adult