pat clements

PHYSIOTHERAPY

MANAGEMENT

Peacocks Conference

16th January 2010

Pat Clements

Extended Scope Practitioner

Recent

Developments in

Healthcare for

Cerebral Palsy:

Implications and

Opportunities

For Orthotics

ispo.org.uk

Aims

• Increasing or improving skill repertoire

• Maintaining functional level

• Management and minimisation of

contracture deformities

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

“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”

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

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.

Positioning

• How long

• Standing

• Home or school

• Team Approach

• Practicalities

Function and Positioning

• Positioning must allow

child to play and

participate.

• May be able to

achieve a few

objectives with one

position

Therapy

• Incorporate into daily

activities

• Strength

• Maintaining muscle

length and joint range

• Two joint muscles

• Casting/orthotics

• Endurance

Orthotics

• Team Approach

• Objectives

• Prescription

• Walking

• Spinal

• Hips

• Contracture control

devices

International Classification of

Functioning

Health Condition

disorder or disease

ActivityBody Function

& Structures

Participation

Environmental

Factors

Personal

factorsContextual factors

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