Plastics physiotherapy

The plastics physiotherapist at Great Ormond Street Hospital (GOSH) sees children with a wide range of problems. Some of these problems are present at birth (congenital) and some may have developed in childhood. Children who need plastic or reconstructive surgery are seen as outpatients, day case patients or inpatients. Children and young people need to be referred to physiotherapy by the plastics medical team before they are reviewed.

Not all children undergoing plastics investigations or treatment will need to be seen by physiotherapy at GOSH.

Physiotherapy is offered as an inpatient and outpatient assessment service following a referral from a Plastics doctor.

Children and young people are seen on the ward following plastic surgery that may have an impact on their movement or mobility. A physiotherapist is also available to provide outpatient assessments such as gait assessments and pre-operative assessments.

We see children who require physiotherapy with the following conditions:

• general plastic and reconstructive surgery
• surgery for vascular anomalies and birthmarks.
• plastic surgery as a result of other health problems, for example on intensive care.
• ear surgery – children and young people who have surgeries that involve taking a graft from the chest wall may require advice on breathing exercises post-operatively.

The physiotherapist may be asked to complete a pre-operative or out-patient assessment if a child or young person has difficulties with moving around or is expected to have challenges as a result of their surgery. This assessment records joint ranges, muscle length, muscle tone, and age-appropriate functional skills such as crawling, standing, balance, walking and running.

It also allows us to prepare you and your child for surgery, answer questions, and plan what help and further physiotherapy might be needed after you are discharged home.

As an inpatient, children and young people may be assessed following plastic surgery to give advice on exercises and mobility and help with planning for discharge home. Children and young people are also referred for assessment when they have plastic surgery as a result of another health problem, for example on intensive care. They may require specific exercises, rehabilitation or splinting while on the ward.

The physiotherapist plays an essential role within the multidisciplinary team of doctors, nurses, occupational therapists and play therapists. After surgery they will help the child start moving and reach a level where they are safe to go home. The aim of physiotherapy is to get joints and muscles moving and to gain functional skills, such as learning to walk with crutches or a frame. This can include exercises based on the ward or in the physiotherapy gym. It may also include splinting if necessary.

Children and young people who have surgery affecting their chest wall may need to practise breathing exercises after their surgery to ensure they are taking deep breaths; this will often include blowing games for younger children. Wherever possible the physiotherapist will make it child-friendly and fun. Treatment may also be exercise focused, such as encouraging mobilisation and games in the gym.