Children’s physiotherapy offers a variety of specialist clinics within the service. Services include:
- Children and young people with Down Syndrome
- Children’s botulinum toxin (botox) service
- Foot clinic
- Health visitor clinic
- Neuro-disabilities clinic
- Orthotics clinic
- Ponseti service
- Toe-walker clinic
- Wheelchair service
Children and young people with Down’s syndrome
Children’s physiotherapists are involved in treating babies with Down’s syndrome, and depending on their individual needs, work closely with the multidisciplinary team. The physiotherapist may be involved with babies and toddlers, assessing and advising, promoting positioning and offering advice to promote development of movement skills. The physiotherapist may also be involved in working on refining movement. Treatment may be provided in a group situation.
Children’s botulinum toxin service
Botulinum toxin (botox) is a treatment which may benefit children with a movement disorder and involves injecting botulinum toxin into overactive muscles causing a temporary relaxation. The botulinum toxin service is provided for children with a neurological presentation, for example cerebral palsy, who have focal increased muscle tone that is interfering with function, personal care, positioning in equipment or causing pain. It is offered for children and young people between two and 18 years of age.
Children are initially assessed in the neuro-disability clinic and referred into the botulinum toxin clinic for a comprehensive assessment by the doctor and physiotherapist. If it is considered that botulinum toxin could be of benefit, there will be discussion with the child, parents and multi-disciplinary team to plan for this so it can be combined with a treatment or postural management programme. Botulinum toxin injections take place at the Royal Free Hospital.
Children and young people may be referred to the foot clinic if they require assessment for foot pain. Clinics are held fortnightly in clinic 1 at the Royal Free Hospital.
Health visitor clinic
There are physiotherapy screening clinics in some Camden health centres. Children under two years old are referred by health visitors if there is some concern about motor skills. In these clinics the physiotherapist has a short appointment to see if physiotherapy will be beneficial. The outcome of the assessment will be one of the following:
Advice and reassurance
Advice and a one off follow-up appointment booked
Advice and a referral made for on-going physiotherapy
Advice and referral made to other health professionals in the multidisciplinary team if appropriate
For more information about health visitor drop-ins visit: http://www.keatsgrouppractice.nhs.uk/website/F83623/files/Health_Visitor_Service_CHC_Venues_days_and_times_Revised_18_03_14master1.pdf
This is a specialist clinic which offers a consultation with a paediatrician in clinic at the Royal Free Hospital. A specialist physiotherapist is present to assess children with motor difficulties and offer advice about activities and treatment.
Children known to the children’s physiotherapy service may be referred to the joint physiotherapist and orthotist service for assessment. Children referred to this service may need splints (orthoses) which are ordered off the shelf or if required custom-made. These may include leg splints, insoles, specialist footwear and Lycra® garments. In the clinic children are assessed and measured for the appropriate item and this may involve taking a plaster cast mould. As many items are bespoke they need 2-4 weeks to be made before they can be fitted.
Ponseti is the gold standard, evidenced based, treatment for babies with talipes equinovarus, structural talipes, fixed talipes and club foot. The Ponseti method has a 95% success rate.
Babies are referred into the service and assessed around the age of two weeks by a paediatric orthopaedic consultant and a specialist paediatric physiotherapist.
If Ponseti treatment is required, it involves three phases:
- Casting: weekly casting for approximately 5 weeks
- Tenotomy: Small surgery under local anaesthetic to the achilles tendon/heel cord followed by a further three weeks of casting
- Foot abduction brace/boots and bar: These are boots attached to a bar that are worn to maintain the foot correction. These are worn for three months for 23 hours and then night and naptime until the child reaches five years of age
Referrals to the service are made by paediatricians, midwives and GPs and the service is not restricted to patients with Camden GPs. Leaflet 2 Referral to Ponseti Service at RFH
Patients referred to the rheumatology clinic will receive care in accordance to the national guidelines for patients with arthritis and other inflammatory conditions. Our clinics run monthly and are held in clinic 1 at the Royal Free Hospital. We are a multidisciplinary team of doctors, physiotherapists and administrators who work together to provide comprehensive assessment and treatment to support our patients and their families.
Children who walk on their tip-toes beyond what’s normally expected in typical development (normal variants) may be referred to the toe-walker clinic for assessment via the single point of referral (SPOR) system. Children referred to this service for ankle range and gait monitoring (monitoring the way you walk) are provided with advice and exercises to help increase or maintain their muscle length and improve function, and are sometimes treated with serial casting if required.
A specialist children’s physiotherapist works alongside the wheelchair service to support and advise children and young people on wheelchair provision.