Neuromedical

The neuromedical physiotherapy team at Great Ormond Street Hospital (GOSH) is made up of lots of specialties, including nephrology (problems with the kidneys), urology (problems with the bladder),dermatology (problems with the skin), endocrine (problems with hormones and growth), gastroenterology (problems with the stomach and digestion) and metabolic (problems with the body processing different substances).

A referral for a physiotherapy assessment is made by the child’s doctor or nurse.

The neuromedical physiotherapy team work closely with other specialist teams within the hospital in order to provide a comprehensive range of services. We work very closely with the multidisciplinary team, which includes doctors, nurses, clinical nurse specialists, dieticians, occupational therapists, speech and language therapists, play teamand social workers, to ensure a holistic approach to care.

Following assessment, an individualised treatment programme can be provided and we can often help make a diagnosis or help plan further treatment or investigations.

Our physiotherapists have excellent relationships with other hospitals and physiotherapy teams throughout the UK and make referrals to rehabilitation centres, local hospitals and community centres, so that treatment can be continued after discharge.

Our team are also in contact with various patient support groups, such as DEBRA and the MPS Society, and our specialist physiotherapists will often speak on their study days and at conferences.

Our specialist physiotherapists also participate in research and regularly submit posters at conferences.

They are also skilled in giving advice and support to other physiotherapy teams, particularly regarding the rarer conditions where often information is not always available.

The physiotherapists will assess and treat children presenting with a wide variety of complex conditions, a lot of which are incredibly rare. Some examples of conditions more commonly seen are:

• vascular malformations

• epidermolysis bullosa

• kidney disease – pre and post transplant

• long stay patients who require help to mobilise/cough

• developmental delay

• bladder extrophy and cloacal extrophy

• pre and post surgical procedures

• chest treatment

• mucopolysaccharidosis

• Pompe Disease

• mitochondrial disorders

• disorders that effect movement, walking and balance

• complex rare disorders to assist with diagnosis

• hyperinsulinaemia

• developmental delay

• gastroenterology surgery

• post bone marrow transplant for autoimmune intestinal failure

• developmental delay due to prolonged hospital stay

Within all these varied specialties there are many reasons why a child’s abilities and development may be affected. They may be weak following an operation and need help coughing, or have difficulty with their walking, balance, co-ordination and movement. Or they may have been in hospital a long time and need assistance with their development. These are all areas where a physiotherapist can help.

Children are assessed by physiotherapists who have lots of experience within these fields. Children with some of the rarer conditions will require specialist assessment and treatment by our physiotherapists who are well trained and experienced in their conditions. Advice and liaison with local therapists also occurs when needed to ensure good continuation of care.

During the assessment the physiotherapist may look at:

• developmental milestones such as when a child will walk, sit and crawl

• breathing and coughing

• joint range of movement

• muscle strength

• posture

• functional abilities such as walking, balance and co-ordination

Treatment programmes can include:

• developmental activities to help the very young to roll, sit, crawl

• positioning advice to maintain a good posture at all times

• giving advice and education for parents, carers and patients

• breathing exercises and coughing exercises – particularly after operations

• strengthening exercises

• stretching exercises

• balance and co-ordination exercises

• activities to generally encourage movement and help promote functional abilities

• hydrotherapy (exercises in water)

• training in the use of equipment that helps replace lost function or promotes independence, such as crutches, walking frames, standing frames

• walking practice

• making splints to hold and support limbs in a good position