Physiotherapy

Aquatic physiotherapy (hydrotherapy) is the use of warm water to relieve discomfort and promote physical well-being. Our heated pool is graduated to allow for different depths of treatment. Using the heat and buoyancy of water, pain can be eased and muscles relaxed to aid normal movement and function that is not possible on land.

The aquatic therapy pool is a child-friendly and fun environment that encourages our patients to reach their full potential by working on their strength, flexibility, balance, posture, mobility and functional activities, on an individual or group basis. Access to the pool is via the stairs, over the side or using a hoist.

Aquatic Physiotherapy can be appopriate for a wide variety of inpatients and outpatients with different conditions within all physiotherapy specialities. We consider each patient for their suitability, on an individual basis, after a medical screening form has been completed.

Alder Hey's aquatic therapy pool is open from 8.30am to 4.30pm, Monday to Friday.

Frequently asked questions

What if I can’t swim?

You don't need to be able to swim to use our pool, and a member of staff will be in the pool with you.

What will happen when we arrive?

You need to allow enough time for changing before your appointment time. You and your child will be shown to the changing area. At your first appointment you will be asked to complete a health screening sheet with a member of staff. You will be asked for consent to the treatment and be able to discuss any questions.

What happens in the pool?

Before entering the pool everyone should have a quick shower. The physiotherapist will assess your child during the initial session. At the end of session the physiotherapist will advise you of when to arrange further appointments.

What do we need to bring?

• Swimsuit
• Towel
• Shampoo and toiletries for afterwards
• Swim nappy for babies
• Incontinence garments if required

For more information, contact:

Susie Harrison, Clinical Lead for Aquatic Physiotherapy: susie.harrison@alderhey.nhs.ukor call 0151 252 5372

The Neurophysiotherapy team have extensive experience in a range of neurological conditions and syndromes that affect muscles, balance, posture, movement, co-ordination, growth, development and play.

Acute neurosciences service

The acute neurosciences team provides a service for inpatients with neurological conditions for example: following head injury, after neurosurgery, spinal cord injury and meningitis. We also provide a service for inpatients with oncological conditions requiring rehabilitation for mobility problems. We also assess and establish developmental and positioning programmes for babies who are inpatients, and provide advice on postural management for children who are inpatients with long term neurodisability.

We work closely with many teams and frequently carry out joint sessions with other therapists from Speech and Language Therapy and Occupational Therapy. We form a key role within the Head Injury Rehabilitation Team (HIRT) and also liaise closely with community therapists to assist discharge home.

The way we work:

• All babies and children have an individual assessment
• Standardised measures may be used to establish a baseline and measure change
• A variety of treatment approaches are utilised incorporating Bobath, Motor Re-learning and Movement Control principles
• Treatment programmes may include positioning, advice for families and carers, stretching or strengthening exercises, balance exercises and functional activities
• Children may be referred to other disciplines i.e. hydrotherapy, orthotics
• Treatment goals will be identified with the child and family

Neuromuscular service

The neuromuscular physiotherapy therapy team work within the larger multidisciplinary neuromuscular team which includes Consultants, speech and language therapist, occupational therapist, dietician, clinical psychologists, neuromuscular care advisors and pathway cocoordinator.

The team provides specialist neuromuscular assessment and management of over 500 children with neuromuscular conditions across the North West, North Wales and the Isle of Man. This service is mainly delivered in outpatient clinics however the team also provide assessment and management for acute inpatients, rehabilitation and pre/post spinal surgery patients.

Services and clinics the team contribute to and provide include:

• Consultant led New patient / diagnostic clinics
• Multidisciplinary Arthrogryposis clinic
• Joint Neuropathy clinic
• Complex spinal management, including spinal clinic and pre/post surgery
• Therapy clinic
• Joint neuromuscular / orthopaedic clinic
• Transition to Walton
• Liaison/Advice to local therapists

The team are members of the Northstar Clinical Network and contribute to the National Northstar database which aims to drive improvements and developments in services with children living with Duchenne muscular dystrophy one of the most common neuromuscular conditions. The network consists of centres across the UK with Alder Hey being one of the largest centres along with Newcastle and Great Ormond Street Hospital. The team also contribute to SMartNet, a similar national database for Spinal Muscular atrophy.

The team are also a key part of the Children’s Neuromuscular Research team and have recently received funding through partnerships with Duchenne charities for additional staff to support and increase clinical trial capacity working with the clinical research facility here at Alder Hey. Clinical trials we currently contribute to include Summit 005, Pfizer B516002, Serpin DMD, FOR-DMD and Heart Protection. We also aim to promote therapy-led in-house research.

The team can be contacted by calling 0151 252 5660 or by email at neuromuscle.physioah@nhs.net

Obstetric Brachial Plexus Lesions (OPBL)

We provide assessment, advice and/or treatment for children within the Liverpoolcatchment area with Obstetric Brachial Plexus Lesions (OPBL)

Spastity/movement disorder service

The spasticity service is a multidisciplinary service for children with tone and movement disorders These Specialist Tertiary Clinics provide multiagency assessment, offering a range of interventions/support and provide services across the North West, North Wales, parts of the Midlands and Northern Ireland. We work jointly with colleagues from neurology, neurosurgery, upper limb service, orthopaedics and the gait laboratory to offer in-patient and out-patient assessment and treatment, in close collaboration with community colleagues. .

Alder Hey is one of four centres in England providing assessment and management for children with cerebral palsy having Selective Dorsal Rhizotomy (SDR). The team are part of a national research project in conjunction with NHS England regarding this surgical procedure

Interventions provided include:

• Pharmacological
• Botulinum Toxin for upper and lower limbs
• Intrathecal Baclofen (ITB)
• Selective Dorsal Rhizotomy (SDR)
• Deep Brain Stimulation (DBS)
• Liaison/Advice to local therapists

The team can be contacted on 0151 252 5660.

Useful links

• Gain: Guillain-Barré & Associated Inflammatory Neuropathies
• Contact - for families of disabled children
• Scope
• HemiHelp - for children and young people with Hemiplegia
• Newlife - The charity for disabled children
• Bliss - for babies born premature or sick
• Brain Tumour Trust
• Back Up - transforming lives after spinal cord injury
• Spinal Injuries Association
• Chartered Society of Physiotherapy
• Association of Paediatric Chartered Physiotherapists
• Bobath Centre - for children with Cerebral Palsy
• Association of Chartered Physiotherapists in Neurology
• Cerebra - working wonders for children with brain conditions
• Go Kids Go! Independence through mobility
• Medtronic
• Muscular Dystrophy UK

Orthopaedics

Our team includes highly specialised physiotherapists and physiotherapy assistants.

We cover a wide range of orthopaedic patients in both the ward and outpatient settings, as well as in the hydrotherapy pool. We have excellent facilities, including a gym, which we use to rehabilitate children back to normal function and fitness.

Some of the areas we cover include:

• Rheumatology (Inflammatory disorders, hypermobility, chronic pain, chronic fatigue)
• Musculoskeletal out-patients
• Haemophilia
• Limb reconstruction and Ilizarov
• Burns & Plastics
• Major trauma

Rheumatology

The Rheumatology physiotherapy team are involved in the assessment and management of patients with a diverse range of complex rheumatological conditions, and are very involved with research into rheumatology conditions.

Chronic inflammatory disorders may include:

• Juvenile idiopathic arthritis
• Juvenile – onset systemic lupus erythematosus
• Juvenile dermatomyasitis
• Childhood scleroderma
• Systemic vasculitis

Also under the rheumatology umbrella we care for patients with non-inflammatory conditions such as:

• Hypermobility
• Chronic fatigue
• Chronic pain
• Other mechanical disorders affecting the musculoskeletal system

RHEUMATOLOGY: PHYSIOTHERAPY FOR INFLAMMATORY DISORDERS

Some of the inflammatory conditions may be life long and have an enormous impact on the child and adolescent as well as their family. They require a careful balance between medical management and rehabilitation.

• Most patients are seen as outpatients
• All children have an individual assessment
• A muscular skeletal assessment is done looking at joint and muscle involvement, skin condition, mobility and functional ability
• Some specific assessment tools may be used as indicated eg CMAS (Childhood Muscle Assessment Score)
• A variety of treatment approaches are utilised such as stretching, strengthening, proprioception, functional activities and fitness
• Patients are continually reassessed throughout the course of treatment, monitoring their condition
• Children may be referred to other disciplines such as orthotics and hydrotherapy
• We work as part of a multidisciplinary team which helps communication between the different disciplines and give a more thorough treatment approach
• Inpatient facilities are available if required

RHEUMATOLOGY: HYPERMOBILITY

Hypermobility is a description of joint movement. Hyper means ‘more’ and mobility means ‘movement’. Ligaments offer stability to joints and in hypermobility, ligaments are lax and joints have more flexibility. It is not an illness or disease, just the way someone is put together. It is considered a normal finding by medical professionals.

Many children who are hypermobile experience no symptoms or difficulties and being hypermobile is beneficial in a lot of sports. It is not fully understood why some children have more symptoms than others. It is believed that these problems are related to poor muscle strength, poor muscle stamina and poor control of joint movement.

Frequent symptoms may include:

• Clumsiness and frequent falls
• Flat feet
• Clicky joints
• Tiredness
• Reluctance to walk longer distances
• Pain
• Difficulty with handwriting

RHEUMATOLOGY: HYPERMOBILITY

• Patients are usually seen as outpatients
• All children have an individual musculoskeletal assessment looking specifically at joint control through their hypermobile range
• Individual graded treatment programs are given targeting specific target areas
• Graded exercises may be given to promote strength fitness and self-management
• Other members of the multidisciplinary team may be involved in the care of your child and we have direct referral to orthotics and hydrotherapy as indicated

RHEUMATOLOGY: CHRONIC PAIN

This umbrella term is used to describe pain that lasts longer than the usual anticipated recovery. Examples include CRPS and widespread musculoskeletal pain.

The symptoms are varied, often including burning, sensitivity to touch, temperature change and colour change. These symptoms often lead to reluctance to move, which increases pain and leads to secondary problems of weakness, poor function and low morale.

Treatment of chronic pain involves a multidisciplinary approach. Medicines are sometimes helpful and are used in combination with physiotherapy and hydrotherapy.

The role of the physiotherapist involves an individualised program centred around pain management tools aimed at facilitating maximal function. This is often achieved through exercising and hydrotherapy, but also through advice, support and liaison.

The aim of a physiotherapy package is to help manage pain whilst decreasing its effect on daily life and the problems it causes. Methods used to achieve this include:

• Pain education
• Problem solving
• Activities and exercises
• Pacing
• Relaxation
• Sleep
• Routine and structure

RHEUMATOLOGY: CHRONIC FATIGUE

This refers to abnormal fatigue that is not in accordance with activity. Young people with chronic fatigue often find themselves out of school and socially isolated. Debilitating tiredness has a profound effect on a young person and their family.

The role of the physiotherapist involves detailed assessment, analysing daily routines, activity levels and sleep patterns.

The aim of management is to establish a baseline of activity achievable even on a bad day in order to implement gradual increases. The goal is to improve function, reducing the impact of debilitating fatigue via an individualised program.

Methods employed by the physiotherapist include:

• Routine and structure
• Sleep hygiene
• Graded exercise therapy
• Pacing and activities eg school and social life
• Liaison and support and advice

Musculoskeletal

Musculoskeletal physiotherapy deals with anyproblem related to muscles, bones, ligaments and tendons, as well asissues related to growth and development, i.e. 'growing pains'. We help to get young people's joints moving, rebuild muscle strength and confidence after anoperation or injury, and help to restore function to get children back to doing the things they enjoy.

Haemophilia

Haemophilia is a range of genetic disorders relating to abnormalities in the bodies ability to control the clotting of its blood, and this can lead to pains in joints and muscles caused by bleeds. Alder Hey has a regional centre for patients suffering from this condition covering an expansive region of North West England and Wales. Our therapists work closely with the doctors and nurses in the team and work, not only to rehabilitate problems caused by bleeds, but also to prevent them happening in the first place. We offer advice and education on the importance of keeping fit, healthy, strong and flexible to make sure that children with Haemophilia lead as normal a life as possible.

See Factor Fitness for more advice on sport and fitness with haemophilia.

We also carry out the Haemophilia Joint Health Score, an annual assessment of patients with haemophilia. This is in line with national guidelines and helps monitor for any deterioration, and highlight any concerns that may damage the patient’s joints.

Limb reconstruction and Ilizarov

Limb reconstruction is a method of helping children with congenital and acquired problems and deformities of the bones, joints and soft tissues of their arms and legs.

Alder Hey is a regional centre for limb reconstruction and has a highly specialised team of surgeons, nurses and physiotherapists who work closely together to monitor and review these patients to rehab them through the various stages of their recovery. The aim of physiotherapy in limb reconstruction is to maintain and maximise joint motion, muscle strength and to ensure that children remain as mobile as possible. This may be done on the ward (if the child is an inpatient), in our department, the gym and even the aquatic therapy pool.

Burns Physiotherapy

Burns physiotherapy specialises in restoring or keeping movement and function after a burn injury. Input is very important during the healing stages of a burn. Burns can be very uncomfortable and children can be reluctant and scared to move, which can lead to problems.

Our physiotherapist may use exercises, splints, fun activities and aquatic therapy in the rehabilitation process. Patients are seen as inpatients, outpatients and during any dressing changes until maximum potential is realised.

We provide advice and support in returning to school and sporting activities.

Plastic surgery

Plastic surgery involves specialist hand surgery including reconstruction and repair of tendons, arteries and nerves. Physiotherapy aims to resolve maximum movement and function following surgery and can involve splinting, exercises and functional activities.

Major Trauma

Alder Hey is a designated Major Trauma Centre for children and is part of the North West Children’s Major Trauma Network. One of our physiotherapists Sharon Charlton has a duel role and works as the Trauma Rehabilitation Co-ordinator. This role ensures that the children involved in a major trauma receive co-ordinated care throughout their rehabilitation both in hospital and the community. A team of therapists support this role at the weekend on a rota basis to ensure 7 day coverage.

Chest physiotherapy helps children to breathe more easily and helps to remove excess secretions from their lungs. We treat children with a diverse range of respiratory conditions and have extensive knowledge and skills to achieve this.

Medicals

We see babies, children and young people on the wards, in accident and emergency and as outpatients. We develop individual chest management plans with the patient and families to help promote full recovery and reduce readmission into hospital. We work closely with the respiratory team.

We have many different skills to help us, for example:

• Breathing exercises
• Respiratory adjuncts
• Postural drainage
• Manual techniques
• Exercise
• Cough assist machine
• Advice and education
• Relaxation

Chest physiotherapy may be needed by babies, children or young people with:

• Recent abdominal or thoracic surgery and find it difficult to breathe and move
• A chest infection
• A long term respiratory condition such as asthma or bronchiectasis
• Complex needs who are prone to chest infections

Your physiotherapist will provide you with an information sheet.

We also help to physically rehabilitate children and young people who have had an acute admission or who have longer inpatient stays. This can be done on the ward or in our physiotherapy department where we have access to hydrotherapy and the gym. We work closely with the patients and families to develop shared goals aimed at restoring function and improving quality of life.

You can download user manuals for

• Clearway Cough Assist machine
• E70 Cough Assist machine

FREQUENTLY ASKED QUESTIONS

What do I need to bring to my outpatient appointment?

Please bring your inhalers and Volumatic spacer to every physiotherapy appointment.

If my child has come into hospital should I bring their Airvo/ Cough assist machine/ Ventilator/ Respiratory adjunct in with them?

Yes. The equipment is specific for your child. If it has not been brought in during the hospital stay, you will be asked to go home and collect it.

If my child is admitted, do they also receive their usual stretches that they have at home?

No. For an acute hospital stay unfortunately we do not have the provision for that service. Stretches would be expected to be completed by the family/guardian/carer as required. However if your child is in hospital for a longer period of time, the neurological physiotherapy team would assess and give advice accordingly.

Should my child continue to exercise after leaving the hospital?

Yes. Exercise has many benefits and we promote active lifestyles.

Liverpool City Council's Lifestyles gyms offer one month's free membership for under 17 year-olds, and £1 for each visit afterwards.

Asthma/breathing pattern dysfunction service

We offer an excellent service for children and young people with asthma, breathing pattern disorder, vocal cord dysfunction and panic attacks. The service is offered through our outpatient clinics with access to the gym for indoor exercises and Springfield Park for outdoor exercises, in addition to a variety of community settings in Liverpool. We also work in collaboration with community services like Liverpool FC Foundation, Firefit, Merseyside Dance Initiative and many more. Treatments include breathing retraining, buteyko techniques, chest physiotherapy and adjuncts, exercise, saline nasal irrigation, postural work, core stability exercises, education, inhaler technique and relaxation.

This service is run by Claire Hepworth.

Critical care

Our Paediatric Intensive Care Unit (PICU) is a 24 bed unit and a designated Lead Centre. We care for children from all specialties including cardiac surgery, neurology and neurosurgery, burns, trauma infections, shock and oncology.

Our unit provides all forms of therapy including High Frequency Oscillation, cardiac and respiratory ECMO, haemofiltration and Nitric Oxide, providing care for level 4 intensive care children. The Physiotherapy team provides a pivotal role in the treatment of these patients.

In addition to PICU we have a 18 bedded High Dependency Unit (HDU), a 16 bedded Cardiac ward and also cover respiratory Physiotherapy on the Burns Unit and Neonatal Ward. Our Physiotherapy team are instrumental in the set up and use of acute non- invasive ventilation and education throughout the hospital and further afield.

Our critical care physiotherapy team assesses all patients that come to PICU and HDU. We aim to help maintain clear airways whether patients are breathing independently, requiring some support or ventilated and ensure they have the means of clearing their own airways once the ventilation tube is out. Early rehabilitation is commenced whilst on PICU / HDU and will involve working with the nursing staff, parents and carers to provide passive movements, an active exercise programme and splints if required. If the child moves from Critical Care we will follow up their care on the ward, and will be involved with further rehabilitation as indicated.

The team consists of Paul Ritson, Vanessa Compton, Laura Rimmer, Michael Mander and two rotational Physiotherapists.

Cystic Fibrosis

There is a Cystic Fibrosis (CF) specialist team based at Alder Hey who work in conjunction with local CF teams at 11 district general hospitals across the North West, North Wales and the Isle of Man. Our specialist physiotherapists based locally at Alder Hey are Alison Pitman, Pamela McCormack and Adam Walsh.

Our role for children, young people with cystic fibrosis and their families and carers is to educate and advise them about airway clearance and exercise. We will teach you about the different techniques and equipment that can be used, then help you to manage your day to day treatment dependant on your activity level and whether or not you have any symptoms. Please see our physiotherapy booklets for babies and children with Cystic Fibrosis (links) x2

You will see a physiotherapist regularly in clinic and in addition, we can visit you at home or at an outpatient appointment in the physiotherapy department.

Exercise

We introduce CF babies to exercise straight away and will encourage you to participate in a range of activities as you grow up depending on what you enjoy. This could be Swimming, jogging, horse riding, football, dance, trampolining and many more!

Physiotherapy and research in CF

We are a regional CF specialist centre who participate in and run many research trials, so you may be asked if you would like to be involved. This helps us to improve CF care for people with CF around the world.

Additionally, the Cystic Fibrosis Trust is a UK charity that deals with all aspects of cystic fibrosis and can be a useful information resource.

Long Term Ventilation

We have an established Long Term Ventilation (LTV) team with an expanding caseload of patients within the North West region. Our service is constantly growing and developing and we currently have approximately 160 patients on LTV. About 130 children have face mask ventilation (Non-Invasive Ventilation, also known as NIV) and 30 children have tracheostomy ventilation.

The Physiotherapy LTV team consists of team leader, Amanda Reed, Clinical Specialist Physiotherapist and Specialist Physiotherapist, Meg MacDonald. We also have two Physiotherapy assistants with extended scope roles, who train patients and their families to use the ventilators and show them how to fit the different types of masks used for NIV.

As a service we review patients on the wards and high dependency unit at Alder Hey and run regular out-patient clinics. We assess children with sleep disordered breathing or obstructive sleep apnoea who often present with daytime symptoms such as tiredness and lack of concentration. NIV may help relieve these symptoms by supporting the child’s breathing when they sleep. The ventilator is a portable device which is plugged into the mains at home and sits on a bedside table. Tubing from the ventilator is then attached to a mask fitted on the child’s face.

You can view and download user manuals for:

• A30 ventilator
• Synchrony II ventilator
• Trilogy ventilator

We have a full physiotherapy team across all specialities Monday to Friday from 8am to 4.30pm.

Out of hours services

Monday to Friday, 4.30pm to 9pm: Respiratory physiotherapist on-call at the hospital. They will assess patients on the prearranged list who would benefit from a further respiratory treatment session. They will also respond to emergency respiratory conditions. Please bleep 115 during these hours.

Monday to Friday, 9pm to 8am: Physiotherapist on-call from home. They can be contacted via switchboard from medical registrars or above, PICU nursing staff or HDU nursing staff. The on-call physiotherapist will ask a series of questions and will respond appropriately according to the on-call guidelines. It is designed for patients who would deteriorate without respiratory physiotherapy input. The physiotherapist will attend within 45 minutes of the call.

Every ward and clinical area should have a copy on the on-call guidelines.

Weekends: Two physiotherapists on-call for urgent respiratory patients within the hospital. They assess patients on a pre-arranged list decided by the respiratory physiotherapist. They will also respond to new respiratory referrals. Please bleep 115 for critical care, and 235 for the wards and A&E.

Routine referrals

Please make a referral via Meditech including the reason the referral, patient diagnosis, clinical details and which speciality of physiotherapy you require.

We do not accept referrals for suction or suction training. Please ask the nursing staff for this. If you would like a group refresher teaching session on NP suction please contact Claire Saw on bleep 235 to arrange a time and date.

Clinical placements for undergraduate physiotherapists

We are an integrated clinical teaching hospital for physiotherapists at Liverpool University. We offer clinical placements in the second and third year of training in respiratory medicals, critical care, neurology, orthopaedics, hydrotherapy, outpatients and rheumatology/chronic fatigue.

Working hours for undergraduates will be 8am/8.30am to 4pm/4.30pm. Please contact us for further information and reception staff will put you in contact with the relevant clinical educator.

We also offer elective placements during the summer period. Please contact Paul Ritson for further information via physiotherapy reception.