Physiotherapy - Community (Liverpool)
Our team provides a lot of other information which we hope you’ll find useful.
How Do Babies Learn to Move?
Babies who have not been born prematurely are usually born in a position of flexion (see photo below). This means that they are bent up at the hips and knees. Their arms are tucked in and their back is rounded.
This pattern of flexion becomes less obvious as the baby begins to experience different positions and movements. As your baby gets older they begin to explore positions of extension (being straight) and positions working against gravity, e.g. sitting and standing. Here we have some guidance on the stages of motor (movement) development as your child gets older:
- 3-6 months – child begins to roll
- 6-9 months – child begins sitting independently
- 9-12 months – child begins crawling, pull to stand and may cruise around furniture
- 12-18 months – child begins to stand independently, walk with support and walk independently
Not all children will follow this guidance e.g. some children may not crawl and may bottom shuffle.
***ALL CHILDREN DEVELOP AT DIFFERENT AGES, THEREFORE THE TIMESCALES SHOWN ARE ONLY A GUIDE***
The milestones for children who are born prematurely will often be delayed by approximately the number of weeks they were early. Similarily, if your child has been diagnosed with an underlying condition their milestones may also be delayed.
If you have concerns about your child’s development here are some play ideas that may help…
Lying on their back
Encourage baby to bring their head into the middle when on their back and encourage them to play with their hands in front of them and in the middle. A play gym can help encourage your baby to bring their hands together. Once your child is able to achieve head in midline and hands together start to place toys slightly out of their reach to encourage them to turn their head side to side. This will help them move their weight side to side which will help them learn to roll.
Lying on their tummy
This is an important position to play with your baby from a very early age under supervision. It helps to develop patterns of extension which means lifting their head, straightening their back and hips which are all important when learning to sit, crawl and walk.
*** WE ADVISE IN ACCORDANCE WITH CURRENT GUIDANCE THAT ALL BABIES ARE PLACED TO SLEEP ON THEIR BACKS ***
Lying on their side
This position helps babies to bring their hands in to midline to play with their toys. It also helps to relieve pressure away from the back of the head to prevent flattening.
If, after reading this section, you continue to have concerns regarding your child’s development then please complete our self referral form for a request for a Physiotherapy Assessment.
Our Orthotics Service is based at Alder Hey Children’s Hospital, however, we have staff who run clinics out in the community:
Dave Simms – Orthotist
Christine Parry – Orthotics Administrator
Contact Number: 0151 252 5318
** Please note there will be no one to answer your call on a Wednesday. At times when Christine is not available telephone messages will be taken by the staff at the Physiotherapy department**
Why might my child be referred to an orthotic clinic?
If a doctor or physiotherapist thinks that you child may benefit from wearing a splint or orthosis you will be referred to an orthotic clinic.
The orthosis/splint can be for any part of your child’s body, neck, arm, hand, leg, foot etc.
The orthosis/splint can have many functions e.g.
- To make your child more steady in standing.
- To keep your child’s foot or leg in a good position.
- To help your child walk better.
- To help your child use their arm in a better way.
- To help your child sit in a better position.
What might happen at the clinic?
If your child goes to a mainstream school or a nursery a convenient appointment time and location will be discussed with you by your child’s treating physiotherapist or physiotherapy assistant.
If your child attends one of the special schools listed below you will receive a letter inviting you to attend the next available clinic in your child’s school.
The orthotist and maybe the clinical specialist in orthotics will assess your child.
They will discuss your child’s needs with you and your child.
The purpose of using the orthosis (splint) and the times it should be worn will be explained to you and your child and you will be asked to agree to this before the order is placed,
The orthotist will then take measurements, it may be necessary to take a plaster cast mould (this will be removed after a few minutes)
The cast/ measurements are then taken back to Alder Hey where your custom made splint may need to be sent away, this can take at least 2 weeks. If not custom made the order will need to be placed which can take several weeks dependent on stock.
A further appointment may be necessary for fitting of the splint.
You will be informed when the splint or footwear is ready and arrangements will be made for supply and fitting.
Special School Clinics
Broadgreen High School
Childwall Medical Centre
Millstead Special School
Palmeston Special School
Princes Special School
Redbridge High School
Royal School for the Blind
Sandfield Park School
Springwood Heath School
Other orthotic clinics
Alder Hey Hospital
Childwall Medical Centre
Who might I meet that’s new to me?
When you ring or visit the orthotics department in Alder Hey hospital you will most likely speak to Christine Parry, Christine is the administrator in the orthotics department.
Christine organises the scheduling of clinic appointments in the hospital and the community. She deals with all requests for orthoses in the hospital and community. She processes the orders and takes delivery of them. She then distributes them to the right person or arranges for them to be collected from Alder Hey.
Dave is the head orthotist based in Alder Hey Hospital. He works in hospital clinics, on the wards and in the operating theatres; he also comes out to community clinics mainly in special schools.
When you see Dave he will assess your child and discuss with you what he thinks may help them. He might see you with your child’s physiotherapist or he may speak to her before you attend his clinic.
He measures for some splints and takes plaster casts for others. He has a workshop in the hospital where he is able to make some orthoses himself. Others need to be sent away to be manufactured.
Dave carries out alterations and repairs to some orthoses or footwear. Dave fits footwear and orthoses and checks them to make sure they fit properly and are doing their job.
Janet is a community physiotherapist with specialist skills and training in the use of orthotics in children. She works with the community physiotherapists and Dave. Your physiotherapist will speak to Janet if she is unsure which is the best type of orthosis is for your child.
She may ask Janet to see your child in a clinic in one of the community locations.
24-hour Postural Care
Postural Management is the term used to describe the 24-hour physical management of a child who has a physical disability and limited independent movement.
Under normal circumstances, babies begin life unable to independently achieve a balanced and straight posture. Th e child’s body grows and remains straight if it is able to move in a varied and even way. It is generally agreed that, because children with neurological or motor impairment, e.g. Cerebral Palsy, lack this ability, they are at high risk of developing postural problems if not properly managed.
If these children are routinely placed in or adopt positions that do not keep their spine in line or that they are unable to move out of, they become uncomfortable and stiff and the body eventually becomes fixed in that position or other destructive postures. This is likely to cause pain, lead to damaged skin, reduce function and limit access to “normal” activities.
Postural Care is carried out on a day to day basis by all people involved in the child’s care. Postural management should start as soon as a movement problem has been identified.
Who should be involved in postural management?
Postural Management should involve everyone who has contact with the child including:
Teachers & Support staff
Allied Health Professionals (e.g. Physiotherapists, OT’s)
Doctors (Paediatricians MUST be onboard)
Other hospital staff (esp. during inpatient episodes)
Equipment companies and their representatives.
The Postural Management Plans
A postural Management Plan will include assessment, the setting of postural management goals and a package of interventions (including the provision of often highly specialised equipment).
We are currently creating A5 laminated Posture Management plans for our clients with movement disorders. These are made in conjunction with Parents, Liverpool Children’s Occupational therapists, Liverpool Wheelchair Service and Liverpool Manual Handling Team. If you would like to know more about this project then please contact your Physiotherapist.
What are we aiming for?
Give comfortable, symmetrical support for children who are unable to move well
Protect a child’s body shape during the day and night, encouraging them to grow as straight as possible
Give advice and training in positioning your child, including the use of specialist equipment.
Disabled children and young people with postural needs are usually provided with specialist equipment to help them sit and stand. With help from Aiming High for Disabled Children there has been additional equipment in Liverpool to support their posture around the clock.
Looking after posture is not just about getting a good sitting position in a wheelchair or a school chair. Out of nearly 9000 hours in a year around 4000 are spent in bed! Night time positioning equipment can have a therapeutic benefit even whilst a child is asleep. Sleep pattern, position and posture can all be improved as well as reduced pain and better mood. Stress levels may also improve because the less a child needs their position changed in the night and the longer and better they sleep, so do their parents.
In consultation with children and parents we are in the process of developing a Night-time Positioning Pathway and 24 Hour Postural Care Plans for all children with a postural need. These care plans can go wherever the child goes so their requirements are met in a consistent way by everyone involved with their support. In addition to equipment for home, night-time positioning equipment is also available in short breaks settings including Claire House, Prescot Drive, Woolton High and Zoe’s Place. There is also be new postural care equipment in use at Alder Hey Hospital to use on the wards. Parents are key to identifying their child’s needs and, working together with therapists, to working out what’s required to protect their child’s body shape. Our project group actively encourages parents to participate and still needs more parents to get involved. If you are interested then please contact us by email or telephone contact us
If you have any concerns or questions please contact your therapist.