Neurosciences physiotherapy

Neuroscience is the medical speciality under the care of the neurology and neurosurgical teams. The team assesses and treats children with conditions affecting the brain, spinal cord, nerves and muscles. At Great Ormond Street Hospital (GOSH), physiotherapists work as an important part of the neurosciences team.

The Neurosciences Physiotherapy Team work closely with other specialist services in the hospital, and has access to the latest research and specialised equipment, as well as a large hydrotherapy pool and a physiotherapy gym. We are familiar with treating children with a wide range of equipment such as external ventricular drains, wound drains, neck collars and halo jackets, tracheostomies and telemetry equipment.

We work very closely with the multidisciplinary team, including doctors, nurses, occupational therapists, speech and language therapists, play team and social workers, giving a holistic approach to care. The physiotherapy assessment can help make a diagnosis or help plan further treatment or investigations. Often, the physiotherapists will provide an individualised treatment programme following the assessment.

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 the child is discharged. We are also skilled in giving advice and support to other physiotherapy teams and can help identify the child’s ongoing rehabilitation needs.

• brain tumours and spinal cord tumours
• bleeds in the brain or spinal cord (stroke)
• head injuries
• hydrocephalus and shunts
• myelomeningocele and spina bifida
• spinal cord untethering
• congenital deformities of bones in the neck
• unstable spines or necks
• malformations of the brain and skull
• epilepsy surgery
• abnormal movements
• infections in the brain such as meningitis and encephalitis
• abnormal blood vessels in the brain such as Moyamoya disease and vein of Galen malformation
• developmental regression
• autoimmune and demyelinating conditions
• transverse myelitis
• medically unexplained symptoms which affect movements and walking.

Conditions of the brain and spinal cord can often affect movement, strength, walking, balance, co-ordination and the child’s ability to play and develop. This is where a physiotherapist can help.

Children are assessed by chartered physiotherapists who are specifically trained and experienced in working with children who have difficulties arising from problems with their brain, spinal cord or nerves.

The physiotherapist may look at:

• breathing
• muscle strength and length
• muscle tone and movement quality
• joint range (how much a joint can move)
• posture
• walking, sitting and standing
• balance
• co-ordination
• how a child moves (rolls, sits, stands, walks) and gets from one position to another.

A baby or child might be assessed on the ward (Koala Ward), in the gym, or in the play room on the ward. Young children and babies are often assessed while they are playing. The neurosciences physiotherapists will also assess and treat children on the intensive care units where needed, the Rapid Assessment Neurology Unit (RANU) and in outpatient clinics. A child can be assessed at various stages throughout their admission.

Treatment programmes can include:

• positioning to optimise recovery
• advice and education for parents, carers and patients
• strengthening exercises
• stretching exercises
• developmental play programmes
• balance and coordination exercises
• activities and exercises to ease stiffness, encourage movement and optimise function
• 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, specialist seating
• chest physiotherapy, including breathing exercises and sputum clearance techniques
• advice and education to patients, parents, carers and family members
• walking practice and gait re-education
• splinting
• breathing exercises. 

• Acquired brain injury
• Stroke
• Spina bifida