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 well-being, 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?