Five ways to choose a good paediatric physiotherapist

Five ways to choose a good paediatric physiotherapist

Your superheroes are brave, unique and amazing! Each and every differently abled child has distinct abilities and diverse skills, requiring complex knowledge and experience from a physiotherapist. Choosing the right physiotherapist for your superhero can be a daunting task. So we have come up with a short checklist – five things to look for when choosing yours!

1. Goal setting
You need to know what difference physiotherapy is making in your superhero’s life! And these goals need to be buzzing with fun! Children need motivation to work, and every skill they learn in physiotherapy sessions should be functional, exciting and transferable to a play skill. For example, half kneeling may be teaching your child to rise from the floor into standing, to reach their favourite toy (or to explore something mischievous…like opening a kitchen cupboard!). Whatever your superhero’s abilities and interests are, their physiotherapy goals should be: tailored to your child’s favourite activities, time specific, achievable, realistic, measurable and discussed and agreed with your child (if able) and their family. One example of a superhero client’s goal is:

“To extend his head in a prone position on his wedge, to look at his sensory fish, for the duration of one song, by August 2020.” This skill is improving head control for sitting balance, so our superhero can use his Eye Gaze to say hello to his friends! But the steps leading up to this have to be buzzing with fun as well!

Your physiotherapist should be discussing family goals and aspirations at the first session. However, it may take a few sessions for the goals to be formally set, especially if your child has complex needs, so that the physiotherapist can get to know your child’s abilities.

2. Gaps in knowledge
The world of children’s neurological physiotherapy is HUGE. From standing frames to wheelchairs, work chairs to orthotics, spinal braces to walking frames, the list is never ending. All NHS trusts are different, some trusts have OTs running wheelchair clinics, others have physios. Some trusts use external orthotics services, some use in-house NHS services. All good (and not-so-good) physiotherapists will have gaps in their knowledge, but a good physiotherapist will admit this and will know how to work towards a solution. For example, I have extensive knowledge with CAPS II wheelchairs and postural alignment and know exactly how a child needs to be positioned. But out of the five special schools I have worked in, physios were never in charge of posturally supportive work or feeding chairs, and I have no idea how to adjust one. Therefore when adjusting a Leckey chair, I consult with a good OT colleague of mine, either in person or over the phone. She deals with the adjusting side and the screwdrivers, while I deal with the posture side of things! Together we make a great team and the child has the best outcome.

Unfortunately, not all physiotherapists are like this, and will say they have a knowledge of everything. This leads to poor outcomes for the child, and under-utilised skills and equipment, as well as your child not reaching their full physical potential.

3. Minimal use of technical language
Your child and you, as a parent or carer, are the most important people in your child’s physiotherapy care. That means you need to know exactly what your child is doing, why, and how this will improve their skills, strength and overall quality of life. You should understand all of your child’s medical documents, reports and programmes. It is a special skill for a physiotherapist to have clinical and specialist knowledge, but to communicate this in a way for parents to understand. Overuse of technical ‘jargon’ is not helpful for anyone. Your child’s reports should be clear and concise, and you should have a definite picture of your child’s goals. If you ask what an exercise is doing, and you need a translator for the answer, they are not the right physiotherapist for your child. One example of wording that can be found in a Bumble Bee Physio client’s report is this:

Superhero prefers to sit with her knees in full extension and her hips adducted (together) in a ‘long sitting’ position. She sits with a slight posterior (backwards) pelvic tilt, leading to some rounding of her spine.

4. Team working
Physiotherapists need your child to be motivated, to communicate and most importantly, to have fun during physiotherapy sessions! Lots of therapies cross over and overlap, so it is crucial that your physiotherapist works very closely with everyone involved, including your NHS physiotherapist. The right physiotherapist will write reports and updates for paediatrician and orthopaedic appointments, and request to attend or speak on the phone at these appointments if needed. They should be setting joint goals and writing joint programmes where appropriate. One of our clients has a joint occupational therapist and physio programme, and when working together it was realised that many of the exercises were the same, such as leaning through shoulders to weight bear through arms. A good physiotherapist will think outside the box and contact other professionals to optimise physiotherapy sessions. Another one of our clients has joint physiotherapy and music therapy sessions, and walks in his Rifton Pacer walker towards a guitar to strum it! This increases both his motivation to walk, and his ability to communicate through music.

5. A specialist in neurology
If you had back pain, you would not seek advice from an amputee rehab physiotherapist. If your elderly parent had a stroke, you would not take them to a sports injury physiotherapist for treatment. For adult conditions, you would see an adult specialist physiotherapist.

Children are more complex than adults, so need even more specialist treatment. A ‘general paediatric’ physiotherapist is not sufficient nor experienced enough for a differently abled superhero. Paediatric physio companies that treat conditions ranging from joint pain and neurological conditions to respiratory conditions and sports injuries are a red flag to look out for. Companies which try to be all things to all men may be more financially motivated, and not have your child’s best interest at heart. At Bumble Bee Physio, we are neurological specialists for differently abled children and babies with neurodevelopmental conditions.

Such a specialist may be difficult to find, as paediatric neurological physiotherapists are rare. To my mind, it is best to be patient and find the right one than to compromise with a ‘general paediatric’ physiotherapist, and struggle with your child not making progress. If there really are none in your area, it is better to go to an adult neurological physiotherapist than a children’s general one. This is because the adult physiotherapist will have extensive knowledge, experience and expertise in neurological rehabilitation. You may have to get your creative juices flowing and think of ways to make the exercises more fun yourself, but the exercises will be more beneficial than a general paediatric physiotherapist.

Here are some further guidelines:

  • If the website lists many different ‘conditions’ treated, involving a range of many specialties, such as sports injuries, joint pain, cerebral palsy, respiratory conditions and baby development, they are likely to be a ‘general’ physiotherapist with limited neurological knowledge;
  • Ask for your physiotherapist’s CV. If they have worked in hospitals, the chances are they have completed lots of ‘general’ work without specialising. However, if they have worked in special schools, the community, or specialist clinics for neurological children then this is a good sign; and
  • remember, if a physiotherapist has had adult neurological experience, for example with stroke clients, this is positive and they may be a good match for your superhero!

Bumble Bee Physio covers London zones 1 to 6. We have recently expanded to some areas surrounding London. We are a new company and although we would love to see children all over the globe, we can’t cover every area. Children’s physiotherapy is a small world though, and Hannah and Jasmine have many reliable and experienced contacts who deliver physiotherapy further afield. So please don’t hesitate to ask us if we don’t cover your area.