Children ’ s services
Children ’ s services
As can often happen between acute and community services , communication and coordination of follow up was often problematic .
From 2014 , the Scottish Occupational Therapy Cerebral Palsy Network had been gathering information about upper limb assessment and treatment options for children with cerebral palsy . This included looking at the Swedish cerebral palsy surveillance programme ( CPUPS ), which included an occupational therapy assessment focused on upper limb function .
The Cerebral Palsy Integrated Pathway Scotland ( CPIPS ) – a lower limb surveillance programme – had recently started , so we began to communicate with the CPIPS steering group about the inclusion of an occupational therapy assessment on the CPIPS database .
Occupational therapy clinics began in Lanarkshire in 2015 and in Glasgow in 2016 , focused on regularly reviewing children and young people with cerebral palsy and from 2019 we began recording on the CPIPS database .
The main aims of the surveillance programme are to maximise the participation in occupations and the wellbeing of children and young people with cerebral palsy by :
• Monitoring occupational performance and providing intervention in a timely fashion .
• Supporting children , young people and families to be managers of their own care .
• Monitoring spasticity and range of motion of the upper limb .
• Ensuring that no child is lost to follow up .
• Ensuring that occupational therapists working with children have appropriate experience and knowledge to inform clinical decision making and to follow evidence-based interventions .
• Ensuring effective multidisciplinary working ; being a key referral source for interventions such as botox will ensure that it is done when there are functional goals and that therapists are ready to provide the appropriate follow up intervention .
Children aged two to five are seen every six months and then annually from age six to 16 . The clinic involves discussion with the child and family about participation in day-to-day life and any concerns that they might have – these concerns are not limited to arm and hand function .
Formal outcome measures include the PEDI- CAT and range of motion measures of the shoulder , elbow , forearm , wrist and fingers . A traffic light system helps identify when range of motion is being lost and is a visual prompt for families , however due to the complexities of the upper limb , range of motion values are always considered along with the impact on everyday activity .
Reading and resources
Alriksson-Schmidt AI , Arner M , Westbom L , Krumlinde-Sundholm L , Nordmark E , Rodby-Bousquet E , Hägglund G ( 2017 ) A combined surveillance program and quality register improves management of childhood disability . Disabil Rehabil . 39 ( 8 ): 830-836 . doi : 10.3109 / 09638288.2016.1161843 . Epub 2016 Apr 4 . PMID : 27044661 .
National Institute of Clinical Excellence ( 2012 ) Spasticity in Under 19s : Management . Available at www . nice . org . uk / guidance / cg145 .
UK and Ireland Upper Limb Rehabilitation Network ( 2019 ) Botulinum toxin : An upper limb rehabilitation clinical guidance . British Academy of Childhood Disability .
Since starting occupational therapy surveillance assessments for CPIPS , families report that they appreciate the opportunity for regular , planned contact with the occupational therapy service . Often the concerns discussed are not related to upper limb function , but are participation-based concerns , resulting in timely interventions for these concerns too .
Our staff report an improved understanding of how muscle tone impacts on movement and activity and better knowledge of the pathways for treatment and evidence base for interventions .
We have improved the communication between community occupational therapy teams and the acute services who deliver medical interventions such as focal tone management . This means that there has been an improved focus on participationbased goals and better co-ordination and timing of these interventions to match the capacity of the community teams who provide the follow up occupational therapy interventions .
There are now four health boards in Scotland carrying out occupational therapy surveillance assessments for CPIPS with interest from several others . There is also interest from occupational therapists across England , Wales and Northern Island , and a national occupational therapy CPIP steering group is being created to support these therapists .
Words TAHNEE CONN , OT Advanced Practitioner , NHS Greater Glasgow and Clyde , and HEATHER MACINTOSH , Specialist Occupational Therapist , NHS Lanarkshire . Contact tahnee . conn @ ggc . scot . nhs . uk
February 2024 OTnews 37