One of the benefits of a big medical institution like UCSF is it brings together the talents of many different specialties, some of which are instantly recognizable, and some of which invite the question, "What is that?"

Dr. Amy Houtrow is one of the latter. A pediatrician who is also a physical medicine and rehabilitation specialist, or "rehab doctor" for short, Houtrow helps kids with disabilities of all kinds function better in getting around, at school or play — in whatever it is they'd like to do. "As a field we call ourselves the quality of life doctors," she says. Because her patients are children, she has the additional task of making sure her patients' medical problems impact their development as little as possible.

In some cases, the disability is a result of a traumatic injury or illness, such as a car accident or brain tumor; in others, it's a condition the child was born with. As medical director of both the UCSF Pediatric Rehabilitation program and the UCSF Spina Bifida Program, Houtrow sees patients with all forms of disabilities and injuries.

Houtrow decided at the ripe old age of four that she wanted to be a pediatrician, but it wasn't until she did a rotation in physical medicine and rehabilitation in medical school that she narrowed in on her specialty. A relatively new field, physical medicine and rehabilitation didn't really begin to take root until after World War II, when veterans returned home with major disabilities that, in past wars and standards of medicine, would have killed them. It's still a relatively small field, with approximately 8,500 board-certified rehab doctors practicing nationwide.

These days rehab doctors may treat everything from a war injury to a sports injury, but still, many of Houtrow's patients are survivors of accidents and conditions that just a few generations ago, would have cut short their lives dramatically.

"Fifty years ago the life expectancy for kids with spina bifida was extremely limited, but we've come leaps and bounds in our surgical and medical management of it," she says. "These days they live full adult lives — and eventually die of heart disease, like everyone else."

Often, Houtrow and other rehab doctors don't just provide treatment themselves, they act as something like a medical conductor, helping guide patients through the medical maze to the treatments that will help them, from neurosurgery to speech therapy. "By collaborating with other doctors and with physical, occupational and speech therapists, we formulate a plan to help people function better," she says. "It's kind of a whole-person approach to medicine."

It's an approach that's especially suited to treating a condition like spina bifida, which as Houtrow explains, can affect a host of body systems. The Spina Bifida Program staff includes urologists who treat bowel and bladder problems and orthopedic surgeons who correct deformities such as club feet or underdeveloped hips. Because spina bifida is a condition of the central nervous system, neurosurgeons come to the clinic and begin treating the child, often, the first day of life. Some children have learning or weight difficulties, and developmental pediatricians and nutritionists also serve at the clinic.

The Spina Bifida Association recognizes UCSF as a regional center for spina bifida, meaning they provide comprehensive care for the condition. Because the clinic covers so many of the patients' needs in one place, some children and their families regularly make a five-hour drive into San Francisco to see Houtrow and her staff.

It's those regular visits, and the chance they afford to watch a child grow that Houtrow likes best about her job. Some patients were born at UCSF, and she's literally known them since birth. "One of the great things about being a pediatrician is watching the kids grow and want to do things and engage and interact, despite some significant limitations," she says. "And it's exceptionally rewarding to be part of the recovery process."

Story written by Sierra Tzoore, a freelance writer in San Francisco.