In accordance with NICE guidelines (NICE: Spasticity in under 19s: management. Clinical guideline [CG145] Published date: 25 July 2012 Last updated: 29 November 2016; NICE: Cerebral palsy in under 25s: assessment and management, NICE guideline [NG62] Published date: 25 January 2017d), the paediatric physiotherapy service advises a 24-hour postural management strategy to prevent or delay the development of contractures or skeletal deformities in children with neurological, neurodevelopmental and neuromuscular conditions.
This approach also enables the child or young person to take part in activities appropriate to their stage of development and aids gross motor development. This approach is endorsed by the APCP (Association of Paediatric Children’s Physiotherapists) and the CSP (Chartered Society of Physiotherapists) and has been adopted nationwide including by our neighbouring service, Birmingham community paediatric physiotherapy service.
As per aforementioned NICE guidelines, the paediatric physiotherapy service offers training to parents and carers involved in delivering postural management strategies. Where appropriate, anyone who spends time with the child should be trained in the delivery of physiotherapy interventions in order to achieve a 24/7 approach. This may include families, teachers and carers who will be given training and support in order to work with the child throughout the day and outside of the sessions that the Physio staff provide.
(Paediatric Physiotherapy 2020 Service spec)
Some children require specialist equipment to support their posture and promote movement and independence. These children/young people may have difficulties in sitting or standing unaided, or they may require assistance to walk.
Specialist equipment includes:
- Standing frames
- Walking Aids
- Specialist seating to improve posture
- Sleep systems
- Postural support equipment
The paediatric physiotherapy service is responsible for assessing home equipment need and referring to Equipment stores. Once stores have funded and delivered the equipment to home, the paediatric physiotherapy service arranges with the appropriate company representative for the equipment to be set up and for a physiotherapist to be present, if required by the company. Advice is given to parents on how to make minor adjustments to the equipment and the service reviews the equipment once a year, or at parents’ request. Equipment stores are responsible for the on-going upkeep and service of home equipment.
Education is responsible for school equipment. The paediatric physiotherapy service will send a copy of the equipment assessment quote to school. School are responsible for ordering and funding the equipment. School can arrange with the appropriate rep for the equipment to be set up and we will provide a physiotherapist to be present, if requested and required by the company. School staff are responsible for making minor adjustments to the equipment and Education for any on-going upkeep and service. The physiotherapy service and the equipment companies can provide advice and the equipment companies all offer training for staff.
The physiotherapist will assess and identify appropriate equipment and then liaise with the appropriate agencies for supply and funding of the equipment. Most home-based equipment will be funded by Solihull Equipment Loans Service and school-based equipment funded by the school or local education authority.
Please note some home seating maybe assessed for by the occupational therapy team who work for Solihull Metropolitan Council rather than the paediatric physiotherapy service.
Support and education
The physiotherapist will if appropriate attend relevant meetings around the child/young person’s care. This can include the Team Around the Family meeting and Common Assessment Framework meeting as an example. When required the Paediatric Physiotherapy Service will provide information for reports (for example to inform the Education and Healthcare Plan).
Joint working and onward referrals
Paediatric Physiotherapists work very closely with various agencies, these include:
- Acute Hospital Paediatric Physiotherapy Services at Heartlands and Solihull Hospitals
- Community Services (Paediatricians, nursing, therapies)
- The Specialist Assessment Service for Complex Medical Needs
- Orthotics Service at Solihull Hospital
- Specialist Inclusion Support Service
- Equipment Loans
This work may include joint assessments and interventions or may include onward referrals and liaison.