The Role of the Physiotherapist and Occupational Therapist

1. The Role of the Physiotherapist and Occupational Therapist Karen Atkinson Senior Lecturer, University of East London October 13th 2009

2. Aims of session Find out about your experience Provide an overview of physiotherapy and occupational therapy Explain professional regulation Provide information about ways of working – MDT and key workers Give examples of the ways in which PTs and OTs work with children

3. Your experience?

4. What is Physiotherapy? Physiotherapy is a healthcare profession with a science foundation. It involves working with people to promote their own health and well being It helps restore movement and function to as near normal as possible when someone is affected by injury, illness or by developmental or other disability

6. What is Physiotherapy? • It uses physical approaches to promote, maintain and restore physical, psychological and social well-being, taking account of variations in health status

8. What is Occupational Therapy? • Occupational therapy is a health care profession that enables people to achieve health, well-being, and life satisfaction through participation in occupation • Occupation: daily activities for children such as development of physical skills, communication/social skills (roles of student, player, friend), play skills, self care

10. What is Occupational Therapy? • Treatment methods – often normal activities of self care, leisure, creative activities, educational activities or environmental modification • Selection of treatment: needs to fulfil the aims of treatment, meaningful for the client, make the best use of existing resources and fit in with the overall programme of intervention

12. Regulation • Professional Bodies: • CSP • BAOT/COT • Codes of conduct and ethical considerations/core skills/scope of practice • Regulatory body: • HPC • Competencies/fitness for practice • Protection of the public

13. Multidisciplinary team • Change in children’s services • More holistic approach • Delivery of therapy but also consultancy, educational and training roles • Multiprofessional and multiagency framework • Family centred: information exchange, supportive care for family, partnership and enablement

14. Multidisciplinary team • Joint decision making • Collaborative goal setting – improved working relationships, adherence and effectiveness • Realistic and achievable goals – child and family at centre • Working with: paediatrician, nursing staff, play therapists, teachers, SALTs, key workers, social workers................

15. Key worker • National Service Framework for Children (2004) highlighted need for a Key Worker system for children who have contacts with a wide range of professionals • Aim: holistic, joined up approach • Chosen by family to co-ordinate care: may be one of the professionals with whom they have most contact • Nationally – wide diversity of provision

16. OT – play assessment • Developmental description of a child’s play → allows selection of appropriate play activities for home and school • Modification and accessibility • Can link into learning potential, facilitate emergence of new skills and develop new competencies • Improved ability to express playfulness • Parent video of play – to encourage dialogue and feedback • Task analysis to address barriers and supports • May negotiate safe and supported play opportunities

17. OT – self care • Care of one’s own body – basic survival and wellbeing • Assessment – baseline • Hands – on treatment: e.g. biomechanical, sensory processing and/or neurodevelopmental techniques to improve postural tone and alignment in upper body to help with feeding • Teaching of others to carry out basic techniques • Advice on environment • Provision of adaptive equipment (in various environments) • Wheelchair assessments • Impact of independence: personal identity and self esteem

19. Physiotherapy - assessment • Focus on child’s abilities, activities and participation (noting limitation or restriction of these) • Muscle tone, spasticity, reflex activity, patterns of activity, muscle weakness, fatigue, inco-ordination, sensory/perceptual and cognitive functions, biomechanical assessment (position), gait analysis • Use of published validated measures e.g. Paediatric Evaluation of Disability Index or the Gross Motor Function Measure • Analysis and goal setting e.g. Walking may be limited by spatial-perceptual problems and increased spastic hypertonia associated with fear of movement in space → primary problem to target is spatial perception • Long term, short term and sessional goals can be developed

20. Examples of Goals • Long term: • Improve function and quality of life • Enable increased participation in school activities • Prevent/limit development of secondary impairments • Maintain level of function to avoid use of walking aid • Promote wellness and fitness over lifespan • Short term: • Increase distance walked in given time • Improve oxygen uptake during exercise • Minimise contractures in calf muscles • Improve strength in lower limb muscles • Improve symmetry of gait and balance • Sessional: • Stretch calf muscles to get foot flat on floor • Improve dynamic standing balance • Increase time on treadmill and walking practice

21. Examples of intervention • Exercises for mobility and strengthening • Specific handling/treatment techniques e.g. Neurodevelopmental therapy (Bobath), Conductive education, craniosacral therapy • Postural management • Night positioning • Seating • Functional tasks • Respiratory care • Prescription and use of assistive technology e.g. orthotics, standing supports • Advice and guidance to parents or other professionals • Advice on environment and access

23. Teamwork

24. Any Questions?