Peacocks Conference Presentation

1. PHYSIOTHERAPY
MANAGEMENT
Peacocks Conference
16th January 2010
Pat Clements
Extended Scope Practitioner

2. Recent
Developments in
Healthcare for
Cerebral Palsy:
Implications and
Opportunities
For Orthotics
ispo.org.uk

3. Aims
• Increasing or improving skill repertoire
• Maintaining functional level
• Management and minimisation of
contracture deformities

4. Interventions
• Reduce the effects of abnormal
muscle/postural tone
• Musculoskeletal problems (muscle
weakness and muscle length)
• Working for activity in a functional context
and providing opportunities for practice

5. “Activity based approaches aim to prevent
secondary muskuloskeletal impairments
and maximise physical functioning, foster
cognitive, social and emotional
development of the child and develop,
maintain and perhaps restore neural
structures and pathways”

6. Interventions Not Recommended
• Passive reflexive (massage) techniques
• Passive stretching
• Therapeutic Electrical Stimulation TES to
increase function
• Classical Bobath/neuro-developmental
(NDT) – emphasis on normalisation of
muscle tone – reflex inhibiting patterns

7. Interventions To be
Recommended
• Exercise activities that include active
participation of the child to attain functional
goals
• Progressive resistance strength training
• Use of assistive technology to promote
mobility such as orthoses, wheelchairs,
walkers or crutches.

8. Positioning
• How long
• Standing
• Home or school
• Team Approach
• Practicalities

9. Function and Positioning
• Positioning must allow
child to play and
participate.
• May be able to
achieve a few
objectives with one
position

10. Therapy
• Incorporate into daily
activities
• Strength
• Maintaining muscle
length and joint range
• Two joint muscles
• Casting/orthotics
• Endurance

11. Orthotics
• Team Approach
• Objectives
• Prescription
• Walking
• Spinal
• Hips
• Contracture control
devices

12. International Classification of
Functioning
Health Condition
disorder or disease
Body Function Activity Participation
& Structures
Environmental Personal
Factors factors
Contextual factors

13. PICO
• Patient
• Intereventions – therapy dependent on the
goals of the family and child in consultation
with evidence based family centered
approach
• Comparisons
• Outcomes good outcome measures. Do
outcomes match our goals