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Peacocks Conference Presentation
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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