Blood, Cells and Cancer (BCC)

Blood, Cells and Cancer (BCC) is a division within Great Ormond Street Hospital (GOSH). The division covers the treatment of children with cancer, underlying immunology problems and congenital or acquired infectious diseases. Many of these children will undergo a bone marrow transplant as part of their treatment.

The BCC physiotherapists primarily offer physiotherapy treatment as an inpatient service, although we also offer a service to the haematology and oncology daycare unit, Safari Day Care.

We work closely with other specialist services within GOSH such as Neurosciences, Orthotics and the Botulinum Toxin service. We also have access to the latest research, specialised equipment, a large hydrotherapy pool and physiotherapy gym. The physiotherapists are familiar with treating children with a wide range of equipment such as wound drains, chest drains, tracheostomies, neck collars, Hickman® lines and internal and external ventricular shunts.

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

• acute lymphoblastic leukaemia (ALL)
• acute myeloid leukaemia (AML)
• non-Hodgkin lymphoma (T-cell and B-cell)
• haemophagocytic lymphohistiocytosis (HLH)

• brain and spinal cord tumours
• Ewing sarcoma
• osteosarcoma
• neuroblastoma
• hepatoblastoma
• Wilms' tumour
• retinoblastoma
• rhabdomyosarcoma
• other rare tumour types
• Langerhans cell histiocytosis
• Hodgkin lymphoma

Children receiving stem cell transplants for a variety of underlying conditions including:

• malignancies (ALL, AML, lymphomas)
• haemophagocytic lymphohistiocytosis (HLH)
• bone marrow failures
• red blood cell disorders
• metabolic conditions, such as Hurler syndrome
• autoimmune and rheumatological conditions
• immunological conditions.

• severe combined immune deficiency (SCID)
• combined immune deficiency (CID)
• Wiskott–Aldrich syndrome (WAS)
• other types of congenital immunology conditions

• tuberculosis (TB)
• typhoid
• malaria
• HIV
• complications of viral and bacterial infections, such as CMV, toxoplasmosis, varicella

Children are assessed by specialist physiotherapists who are specifically trained and experienced in working with children with difficulties arising from their initial diagnosis, or as a consequence of their treatment, including chemotherapy, radiotherapy, bone marrow transplant and/or surgery.

The physiotherapist may look at:

• joint range
• muscle power
• balance
• co-ordination
• muscle tone and movement quality
• posture
• breathing
• how a child moves (rolls, sits, stands, walks) and gets from one position to another.

The aim of physiotherapy is to restore and maximise function through a variety of treatment techniques. Assessment and treatment can take place on the ward, in the physiotherapy gym or in the play room on the ward. We often carry out assessments while the child is playing.

The physiotherapists will assess the child and treat at various stages throughout their hospital admission. Specialist physiotherapists may also be present or asked to attend clinics to assess children alongside the doctor.

The physiotherapists work closely with other members of the multidisciplinary team including occupational therapists, play specialists, teachers, psychologists, social workers, nurses and doctors, giving a holistic approach to patient care.

The physiotherapists will often provide individualised treatment programmes following thorough assessment. Treatment programmes can include:

• strengthening exercises
• stretching exercises
• balance and co-ordination activities
• hydrotherapy (exercises in water)
• developmental play programmes
• positioning to optimise function
• splinting
• activities and exercises to ease stiffness, encourage movement and optimise function
• walking practice and gait re-education
• training in the use of equipment that helps replace lost function or promotes independence, such as crutches, walking frames, standing frames, specialist seating
• chest physiotherapy, including breathing exercises and sputum clearance techniques
• advice and education to patients, parents, carers and family members.

The physiotherapists have recently set up a soft play group called 'Tiny Tumblers', which is open to children on Lion and Elephant Wards age five years and under. The aim of this group is to provide a normal experience, which many of the children undergoing chemotherapy treatment miss out on, and to provide an informal opportunity to assess, monitor and communicate with parents regarding the child’s multi-disciplinary needs. The group focuses on mobility, exercise activity, improving development, balance, ball skills and social interaction. If proved successful, we hope to set up an additional group for the older children on the wards.