Movement Disorder Service

The Movement Disorder Service offers an additional opinion regarding assessment, diagnosis, prognosis and management of children with locomotor or movement disorders of neurological origin.

This service is designed to benefit children with movement disorders where there are specific questions regarding diagnosis, prognosis and motor management. There is a particular emphasis on the management of spasticity and dystonia.

Referrals may be initiated by any member of the local team, but must be endorsed in writing by the child’s consultant paediatrician or orthopaedic surgeon.

Referrals should be directed to , Dr Lucinda Carr, Consultant Paediatric Neurologist or Stephanie Cawker, Clinical Specialist Physiotherapist via secure email: gos-tr.Neurodisabilityreferrals@nhs.net

Please use our referral criteria for further information required when referring to the Movement Disorder Service.

• Any child aged 15 years or younger (over 16 years only with agreement from GOSH medical director)
• Has a central motor disorder affecting movement, tone or posture (such as Cerebral Palsy, acquired Brain Injury, Neurometabolic or Neurogenetic conditions)
• Requires MDT assessment at tertiary level for management advice of movement, tone or posture (including orthotic, pharmacological or surgical intervention)
• Is receiving ongoing care from local child community service

• Please note we will unable to accept referrals without the below information
• Medical history and details of relevant investigations such as MRI and x-rays MUST be included
• Details of previous tone management and/orthopaedic surgery they have had in the past 
• Details of all local professionals involved in the child’s care including specialist teams including contact details for liaison before the child is seen i.e. Therapists, Orthopaedic surgeons, community nursing
• Copies of relevant medical summaries and reports from the local team
• Details of special family considerations such as interpreters, transport or disabled access
• Details of social work involvement and any care orders

• Referral is primarily for diagnosis (will be cross referred on to neurology)
• Referral information is incomplete (see below)
• If there is no copy of relevant x-rays and MRI scans and/or insufficient medical history
• Referral is NOT from a Consultant Paediatrician or Orthopaedic surgeon or Clinical Specialist Physiotherapist (based within a specialist tone management or orthopaedic service)
• ALL internal referrals unless prior approval is received from the local Paediatric team
• GOSH is not the child’s regional centre (unless it is for 2nd opinion)

We accept referrals via secure NHS email: gos-tr.Neurodisabiltyreferrals@nhs.net marked ‘MDC new referral’ and child’s name

The child’s physiotherapist/occupational therapist is welcome to attend the clinic appointment with the family’s permission. Parents are asked where possible to bring to the clinic their child’s usual walking aids and current orthotics.

During the assessment the child’s medical history is reviewed, including past and current medical issues and developmental concerns. Any questions parents and child have for the clinic team is also discussed.

Emphasis is placed on current mobility, equipment, orthotics, therapy provision and physical management programmes and previous interventions and surgery.

Following this discussion, the team will assess the child. This includes looking at joint ranges, selective muscle control, spasticity, functional movements and mobility (transfers and walking). Where gait is being assessed, the child will be asked to walk with and without their usual aids and orthoses.

The parents are present throughout the assessment.

Following assessment and discussion, the team meets briefly to consider the findings and co-ordinate feedback. The team then discusses the findings and conclusions with the parents and child.

Following the appointment, the team physiotherapist will contact the local physiotherapist (if not present at the appointment) to discuss findings and recommendations. A written report is sent to the parents, referrer and an agreed circulation list within five

The Movment Disorder team is made up of a consultant paediatric neurologist, a consultant developmental paediatrician, clinical specialist physiotherapists, and a specialist registrar.

You can contact the Movement Disorder Service on 020 7405 9200 ext 4543.