Neuromedical Physiotherapy

The Neuromedical Physiotherapy Team at Great Ormond Street Hospital (GOSH) works closely with other specialist teams within GOSH in order to provide a comprehensive range of services.

The physiotherapists are familiar with treating children with a wide range of very rare conditions. They work closely with the multidisciplinary team to ensure a holistic approach to care and have an excellent relationship with other hospitals and physiotherapy teams throughout the UK. The team make referrals to rehabilitation centres, local hospitals and community centres so treatment can be continued when the child is discharged from GOSH.

They are also in contact with various patient support groups (eg DEBRA and The MPS Society) and specialist physiotherapists will often speak on their study days and at conferences. Specialist physiotherapists participate in research and regularly submit posters at conferences.

The team provides advice and support to other physiotherapy teams, particularly regarding rarer conditions where information can be scant.

A referral for a physiotherapy assessment is made by the child’s doctor or nurse. A referral is followed by a physiotherapy assessment, which can often help to make a diagnosis, or to plan further treatment or investigations. Following assessment, an individualised treatment programme can be provided.

The physiotherapists will assess and treat children presenting with a wide variety of complex conditions, many of which are incredibly rare. Some examples of conditions more commonly seen are listed below.

• vascular malformations
• epidermolysis bullosa

• kidney disease
• acute kidney injury
• post-transplant
• exercise tolerance for long-stay patients or those on haemodialysis
• developmental delay

• bladder exstrophy and cloacal exstrophy
• pre- and post-surgical procedures
• chest treatment

• mucopolysaccharidosis
• Pompe disease
• mitochondrial disorders
• disorders that effect movement, walking and balance

• hyperinsulinaemia
• developmental delay

• gastroenterology surgery
• developmental delay due to prolonged hospital stay

• vascular malformations
• post-operation mobility
• congenital deformities
• cryoablation
• sclerotherapy

• neurodevelopmental delay
• rehabilitation

Within all these varied specialties there are many reasons why a child’s function and development may be affected. They may be weak following an operation and need help coughing or have difficulty with their walking, balance, coordination and movement. They may have been in hospital a long time and need assistance with their development.

These are all areas where a physiotherapist can help.

Children are assessed by Paediatric Chartered Physiotherapists who have lots of experience within these fields. Some children with a rarer condition that will require specialist assessment and treatment by physiotherapists who are well trained and experienced in their conditions. Advice and liaison also occurs when needed with local therapists to ensure good communication.

During the assessment the physiotherapist may look at:

• developmental milestones
• breathing and coughing
• joint range of movement
• muscle strength
• posture
• functional abilities such as walking, balance and co-ordination.

Treatment programmes can include:

• developmental activities to help the very young to roll, sit, crawl
• positioning advice to maintain a good posture at all times
• giving advice and education for parents, carers and patients
• breathing exercises and coughing exercises – particularly after operations
• strengthening exercises
• stretching exercises
• balance and co-ordination exercises
• activities to generally encourage movement and help promote functional abilities
• 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
• walking practice
• making splints to hold and support limbs in a good position.

You might find the following support groups useful:

• DEBRA
• MPS Society