Physiotherapists managing abnormal muscle tone in adults with cerebral palsy should discuss treatments for spasticity or dystonia with their patients, says the National Institute for Health and Care Excellence (NICE).
In guidance published on 15 January, NICE recommends that all health professionals should document treatment goals. The benefits and risks of treatments, including the risk of deterioration in function, should be discussed with the patients as part of a multidisciplinary treatment strategy.
Recommendations on the initial management of spasticity and dystonia say that physios should be award that adults with cerebral palsy may have both spasticity and dystonia.
The severity of symptoms for both conditions may fluctuate in response to health, social and emotional wellbeing and environmental factors.
NICE says that at every review, physios should discuss with patients factors that may exacerbate their spasticity or dystonia. These include
- bladder problems (for example, urinary tract infection or bladder stones)
- emotional distress
- pressure sores
- changes in home or work environments, including seating
- medication changes and side effects
The guidance aims to improve health and wellbeing, promote access to services and support participation and independent living.
It has been written for a wide readership. This includes healthcare professionals in primary and secondary care and people responsible for planning services, commissioners and providers.
Guidance welcomed by physios in professional network
The Association of Chartered Physiotherapists for People with a Learning Disability (ACPPLD) said the guidance will help physios to support adults with cerebral palsy to access timely health care.
‘The acknowledgement that adults with cerebral palsy will require ongoing access to services that will include multidisciplinary team reassessments, and that these will be at different stages in the person’s life to ensure that changing clinical and functional needs are met is welcome,’ said ACPPLD chair Jenny Tinkler.
The professional network also welcomed the requirement of primary and secondary care to address through reasonable adjustments, any physical or organisational barriers for adults with cerebral palsy in accessing their services.
It was pleased at the importance given to physical activity for adults with cerebral palsy in maintaining their level of physical fitness, physical and mental wellbeing, and the role that physiotherapy has in this.
‘It is also good to note the acknowledgement of the role of the physiotherapist in prophylactic chest care with the recommendation to refer to specialist respiratory services for ongoing monitoring,’ said Dr Tinkler.
‘However, the ACPPLD would like to have seen more recognition to promoting the use of 24-hour postural management strategies to manage muscle tone, posture and musculoskeletal changes.’
Charity welcomes guidance
Adult CP Hub, a charity co-founded by neurophysiotherapist Miriam Creeger, welcomed the guidance.
The charity pointed to research by the Royal College of Surgeons in Ireland and the University of Surrey which found that adults with cerebral palsy are 28 per cent more at risk of depression and 40 per cent more at risk of anxiety than adults without cerebral palsy.
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