Physiotherapy services

This section explains the work of the Cystic Fibrosis (CF) Physiotherapy team at Great Ormond Street Hospital (GOSH), who is involved and how they can help children and families.The aims of the service are to assess and treat children with CF, to support families to carry out and assist in carrying out physiotherapy for children of all ages and to provide support and advice to network clinics.

The GOSH CF Physiotherapy team consists of three specialist physiotherapists who have in-depth knowledge, experience and understanding of children with CF. There is also a full-time CF physiotherapy assistant working in the team who is responsible for airway clearance and nebuliser equipment.

The CF physiotherapists are also part of the wider GOSH Physiotherapy department as well as members of the CF Multidisciplinary team.

Physiotherapy for CF is made up of a number of different aspects of treatment, all of which will be introduced at the appropriate times and will continually be reviewed whenever the child with CF is reviewed.

Physiotherapy is an integral part of the treatment for CF and starts as soon as the diagnosis is confirmed.

The main components of physiotherapy for CF are:

• Airway clearance treatment – including provision of equipment, education regarding cleaning and infection control, on-going assessment and modification of technique.
• Nebuliser therapy – at times nebulised mucolytics and mucoactives (solutions that help break up mucus) may be used by CF children. It is essential that the timing of these nebulisers with airway clearance treatments is correct and the equipment is appropriate. The Physiotherapy team will ensure that these are timed correctly.
• Exercise therapy – physical activity and exercise is essential for CF. An exercise test will be undertaken by all children with CF on an annual basis. The type of test undertaken by the children may change as the child grows older. It is essential that exercise is incorporated into the child’s daily routine. Specific exercise advice for each child will be provided by the Physiotherapy team and will be individualised for each child.
• Musculoskeletal assessment and posture advice and education. 
• Continence advice, education and treatment. 
• Developmental advice and education for infants and toddlers. 

The first consultation with a specialist physiotherapist takes place during the first visit to GOSH following diagnosis (education day).

The child will then be seen at home on a regular basis, during their first year of life at home, in outreach physiotherapy visits and at GOSH (and network centre clinics if appropriate). This is to continue the education process and provide support for the family to help incorporate a regular physiotherapy routine in the child’s daily life.

The child will continue to be reviewed routinely by the Physiotherapy team at clinics and as needed.

The child will be reviewed by a physiotherapist at every clinic visit, who will:

• ask about the child’s current physiotherapy regimen
• review airway clearance techniques
• take a cough swab or a sputum sample
• provide on-going exercise advice and encouragement 

The family should always be asked to bring any airway clearance equipment to clinic (aswell as nebuliser equipment to annual review) so that technique and the equipment can be assessed.

At the annual review visit a more thorough review is undertaken which will include an exercise test – the child should therefore always bring or wear appropriate footwear and clothing to undertake the exercise test.

Throughout the duration of the admission the child will be seen two to three times per day by a physiotherapist for:

• airway clearance treatment
• exercise sessions 
• on-going education and advice
• musculoskeletal assessment and treatment if required
• continence advice, education and treatment if required 

The child should be reviewed by the network clinic physiotherapist inbetween visits to the specialist centre or during joint network clinics with the GOSH Multidisciplinary team. At these clinics the child will be reviewed jointly with the local physiotherapist.

The child may be reviewed at home, at school or at nursery, when appropriate, to:

• Assess airway clearance techniques.
• Assess nebuliser therapy.
• Assess exercise regimes, provide exercise advice and exercise prescription.
• Facilitate involvement in local gyms, sporting clubs and activities.
• Provide education, support and liaise with local hospital physiotherapists, community teams, school teachers (PE teachers in particular) and school nurses where necessary. 

A member of the CF Physiotherapy team will always be present at GOSH CF clinics and during an in-patient admission at GOSH.

If you need to contact the Physiotherapy team outside of these times:

• Email: CysticFibrosisUnitQuery@gosh.nhs.uk
• Telephone: CF office GOSH switchboard 020 7405 9200 (ext 2328 or 1119) 

Exercise is a key component of the care of CF. Regular physical activity is known to improve cardio-respiratory fitness, muscle strength, joint mobility, bone health and general wellbeing. In addition to these benefits, regular physical activity in CF also helps airway clearance. Improved physical fitness has been shown to have a positive effect on maintaining or even increasing lung function and may even improve long-term outcome.

The GOSH Physiotherapy team have built a strong relationship with Nuffield Health, the UK’s largest healthcare charity which has Fitness & Wellbeing Centres (FWC) throughout the UK, staffed by Fitness teams. Nuffield are now offering all children with CF who are under the care of GOSH free off-peak access to their gyms. All referrals for use of a Nuffield facility must be made formally through the Physiotherapy team at GOSH.

More information on this scheme is available by contacting the Physiotherapy team.

The GOSH CF Physiotherapy team is involved in research and audit in a number of areas of airway clearance and exercise. Current projects include:

• Development of an incremental step test.
• Evaluation of an intensive outpatient physiotherapy programme, the INSPIRE project.