Download What is Physiotherapy? - School of Psychology and Human

The Role of the
Physiotherapist and
Occupational Therapist
Karen Atkinson
Senior Lecturer, University of East London
October 13th 2009
Aims of session
• Find out about your experience
• Provide an overview of physiotherapy
and occupational therapy
• Explain professional regulation
• Provide information about ways of
working – MDT and key workers
• Give examples of the ways in which
PTs and OTs work with children
Your experience?
What is Physiotherapy?
• Physiotherapy is a healthcare profession
with a science foundation. It involves
working with people to promote their own
health and well being
• It helps restore movement and function to as
near normal as possible when someone is
affected by injury, illness or by
developmental or other disability
What is Physiotherapy?
• It uses physical approaches to
promote, maintain and restore
physical, psychological and social wellbeing, taking account of variations in
health status
What is Occupational
Therapy?
• Occupational therapy is a health care
profession that enables people to achieve
health, well-being, and life satisfaction
through participation in occupation
• Occupation: daily activities for children such
as development of physical skills,
communication/social skills (roles of
student, player, friend), play skills, self care
What is Occupational
Therapy?
• Treatment methods – often normal
activities of self care, leisure, creative
activities, educational activities or
environmental modification
• Selection of treatment: needs to fulfil
the aims of treatment, meaningful for
the client, make the best use of existing
resources and fit in with the overall
programme of intervention
Regulation
• Professional Bodies:
– CSP
– BAOT/COT
– Codes of conduct and ethical
considerations/core skills/scope of
practice
• Regulatory body:
– HPC
– Competencies/fitness for practice
– Protection of the public
Multidisciplinary team
• Change in children’s services
• More holistic approach
• Delivery of therapy but also consultancy,
educational and training roles
• Multiprofessional and multiagency
framework
• Family centred: information exchange,
supportive care for family, partnership and
enablement
Multidisciplinary team
• Joint decision making
• Collaborative goal setting – improved
working relationships, adherence and
effectiveness
• Realistic and achievable goals – child and
family at centre
• Working with: paediatrician, nursing staff,
play therapists, teachers, SALTs, key
workers, social workers................
Key worker
• National Service Framework for Children
(2004) highlighted need for a Key Worker
system for children who have contacts with a
wide range of professionals
• Aim: holistic, joined up approach
• Chosen by family to co-ordinate care: may
be one of the professionals with whom they
have most contact
• Nationally – wide diversity of provision
OT – play assessment
• Developmental description of a child’s play → allows
selection of appropriate play activities for home and
school
• Modification and accessibility
• Can link into learning potential, facilitate emergence of
new skills and develop new competencies
• Improved ability to express playfulness
• Parent video of play – to encourage dialogue and
feedback
• Task analysis to address barriers and supports
• May negotiate safe and supported play opportunities
OT – self care
• Care of one’s own body – basic survival and wellbeing
• Assessment – baseline
• Hands – on treatment: e.g. biomechanical, sensory processing
and/or neurodevelopmental techniques to improve postural
tone and alignment in upper body to help with feeding
• Teaching of others to carry out basic techniques
• Advice on environment
• Provision of adaptive equipment (in various environments)
• Wheelchair assessments
• Impact of independence: personal identity and self esteem
Physiotherapy - assessment
• Focus on child’s abilities, activities and participation (noting
limitation or restriction of these)
• Muscle tone, spasticity, reflex activity, patterns of activity,
muscle weakness, fatigue, inco-ordination, sensory/perceptual
and cognitive functions, biomechanical assessment (position),
gait analysis
• Use of published validated measures e.g. Paediatric Evaluation
of Disability Index or the Gross Motor Function Measure
• Analysis and goal setting e.g. Walking may be limited by
spatial-perceptual problems and increased spastic hypertonia
associated with fear of movement in space → primary problem
to target is spatial perception
• Long term, short term and sessional goals can be developed
Examples of Goals
• Long term:
–
–
–
–
–
Improve function and quality of life
Enable increased participation in school activities
Prevent/limit development of secondary impairments
Maintain level of function to avoid use of walking aid
Promote wellness and fitness over lifespan
• Short term:
–
–
–
–
–
Increase distance walked in given time
Improve oxygen uptake during exercise
Minimise contractures in calf muscles
Improve strength in lower limb muscles
Improve symmetry of gait and balance
• Sessional:
– Stretch calf muscles to get foot flat on floor
– Improve dynamic standing balance
– Increase time on treadmill and walking practice
Examples of intervention
• Exercises for mobility and strengthening
• Specific handling/treatment techniques e.g.
Neurodevelopmental therapy (Bobath), Conductive education,
craniosacral therapy
• Postural management
• Night positioning
• Seating
• Functional tasks
• Respiratory care
• Prescription and use of assistive technology e.g. orthotics,
standing supports
• Advice and guidance to parents or other professionals
• Advice on environment and access
Teamwork
Any Questions?