Infection, Cancer and Immunity (ICI)

Infection, Cancer and Immunity (ICI) 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 ICI 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.

We see children who require physiotherapy with the following conditions:

acute lymphoblastic leukaemia (ALL)

acute myeloid leukaemia (AML)

non-Hodgkins lymphoma

haemophagocytic lymphohistiocytosis (HLH)

brain and spinal cord tumours

Ewing's sarcoma

osteosarcoma

neuroblastoma

hepatoblastoma

Wilms' tumour

retinoblastoma

rhabdomyosarcoma

other rare tumour types

Langerhans cell histiocytosis

Hodgkins 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 Hurlers

autoimmune and rheumatological conditions

immunological conditions

severe combined immune deficiency (SCID)

combined immune deficiency (CID)

Wiscott Aldridge 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 whilst the child is playing.

The physiotherapists will then 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 aged five 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.

“Physiotherapy was something really positive that we could focus on when Jake had a stroke following his leukaemia diagnosis. Jake loved getting off the ward and really looked forward to his physiotherapy sessions over in the gym ‑ most of them anyway!”
Parents of Jake, 7

“Grace seemed to get stuck with her development when she was admitted to hospital and underwent months of chemotherapy and then a bone marrow transplant. The physiotherapists were great at giving us ideas and a programme to help improve her development and help her achieve new skills.”
Parents of Grace, 9 months

“Physio is quite hard sometimes, but I know I need to be pushed a bit to make me as good as possible, get me home as soon as possible and try to get me back doing all the things I was doing before I started chemo.”
George, 10