A complex scenario

Following the recent death of Ivan Cameron, Frontline looks at the role of physiotherapists who work with children with complex needs

Children with complex needs such as Ivan Cameron, son of the Conservative party leader David, often have a mix of physical disabilities, sensory impairment and learning difficulties. These in turn may be affected by social or environmental factors, and each child varies in the way that their impairment impacts on development. The improved survival rate of premature babies has seen an increase in children with complex needs, and many families need the support of multiple agencies. The physiotherapist’s involvement may begin on the neonatal unit, giving families advice about how to handle and position their young baby to ensure comfort and sensory modulation. Chris Sneade, of the Association of Paediatric Chartered Physiotherapists, works with pre-school children with complex needs in her role as clinical specialist in neurodisability at Alder Hey Children’s hospital in Liverpool. She says: ‘Not all children will have a formal diagnosis when they are first referred to a physiotherapist. The physiotherapist can help investigate the child’s condition by identifying their skills, as well studying their development and the way they move and interact.’ Giving the family advice about positioning and activity will allow them to play an active role in promoting their child’s development. Support for the family is, of course, crucial. Many different services need to be involved during the early years and these services must communicate well with each other in order to deliver consistent and coordinated care, built around the needs of the child and the family. Assessment and therapy, then, is carried out in collaboration with professionals from health, education and social services. Laura Wiggins, APCP chair and lead paediatric physiotherapist for children and young persons’ specialist services, North Glasgow, also has extensive experience of working with children with complex needs. She says physiotherapists have a key role here in determining a child’s current and potential physical development, contributing to statutory education assessments and integrated assessment profiles. ‘No matter how severe a child’s impairment, it is increasingly recognised that they should be encouraged to interact with other people and with the environment around them,’ Ms Wiggins adds. Physiotherapists provide equipment, devise new movement strategies and enable families and teachers to create a supportive environment. They work both to improve impairment and to prevent or limit secondary problems. In the case of children with a life-limiting or life-threatening condition, physiotherapists may be working alongside the care and support teams at a local hospice, providing therapy for the child during their stay for respite or emergency care, Ms Wiggins adds. ‘At each transitional stage in the child’s life, it is vital that all the agencies work together and come to joint decisions,’ she explains. ‘As more and more children with severe complex disabilities survive into adulthood, planning for the challenges of that adult life is essential. Participation and inclusion remain significant issues for all who care for this client group.’

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