Physiotherapy for Cerebral Palsy in 2024

My thoughts on the AusACPDM 2024 themes; Respect, Respond and Reimagine.

The Australasian Academy of Cerebral Palsy and Developmental Medicine Conference, is a bienniel conference providing scientific education for all health professionals working in the field of cerebral palsy and developmental conditions. Expert clinicians from around the globe and those with lived experience present their latest findings and perspectives over 4 days of presentations. So many new thoughts and ideas! Here is how I interpreted the conference themes and how I plan to re-energise my practise ove the coming months. 

Respect- the relationships between child and caregivers, and the language of these relationships, play.

Stacey Dusing gave us this theme in a nutshell; the dyadic interaction between the parent and the child must be the basis for everything we do. 

As therapist we must respect that the infant and child exist within the incredibly important relationships they form with their caregivers. Respecting and supporting these relationships must be central to our practise. Play forms the language of these relationships and Stacey also spoke about the child’s fundamental right to play. What business does a physiotherapist have in this space? Well movement is a way to access play and learning. Stacey’s presentation, Moving to Learn, Learning to Move, centred on the idea that play, movement and parental connection are entwined. 

This sentiment was echoed in the Early Intervention panel discussion where the presenters spoke about the need for babies and children to be emotionally supported and well regulated during therapy sessions. The discussion was around the balance between making the therapy challenge of “just right” intensity such that it is achievable by the child, encourages growth, and is sustainable and enjoyable. The conclusion from this discussion was that only when the motor challenge is generated by the child, and supported by the family is therapy helpful.

Respect for the cultural context within which this parent child bond exists was another key theme. An interesting discussion occurred during the Instructional Workshop from the investigators on the Participate CP Trial around what physical activity looks like in different cultural contexts. The discussion was around how different families come together in a wide range of culturally specific physical activities well beyond sport. Again I was reminded of the the need to respect the relationships within the family unit in order to support the child in a way that is truly helpful.

I look forward to exploring with the families I work with what that parent child bond looks like within the context of their culture. I plan to ask more questions around what they wish play looked like in the context of that family unit and help to tackle those barriers through physiotherapy. 

Respond- how to get past the “I don’t know” to identify the child’s goals and truly respond through therapy. 

In the words of Amy Hogan “Please for the love of everything can we deconstruct the idea that walking is the peak of the mountain!”. Sometimes the goals we would like to have for clients are not the goals they actually want to work towards themselves. 

This conference provided a granular investigation of goal-based therapy and how we as clinicians can discover, measure and respond to the needs of the clients and their families. Several presentations had me considering how we make sure these needs remain front and centre in our clinical work. 

Unni Narayayan  encouraged us to specifically set goals that put us on the path to respond to the patients wishes. He spoke about making a difference through measuring what matters and the importance of including the child and family’s perspectives and priorities in our measurement tools. I have a long list of new assessment tools to investigate for our Hub.  

He also spoke of the need to create a close relationship with the family and child first to get past the “I don’t really know” that often comes when we ask kids what they want to work on. Only through knowing them well can we understand whether change in that specific area would be meaningful for the child and family

Investigators on the Participate CP Trial spoke of their success using motivational interviewing to identify the child and family goals within the physical activity domain and I was reminded of this communication style that I have found helpful in the past.  

Stacey Dusing spoke about responding to even the tiniest client’s goals, reminding therapists of the need to pause, wait and watch to identify the infant’s goal in relation to play so that we can support them in the movements they want to make. 

Ashleigh Hines spoke about the application of task specific training principles in cerebral palsy. Again she reinforced that responding to the family’s specific goals is central to the success of this type of therapy which must be context specific and relevant 

This delve into the literature around effective goal setting has energised me to reconsider the way we set goals at the Walky Talky Hub and keep them front and centre in all our sessions. 

Reimagine- our relationship with technology 

As an early intervention physio (who has been scarred as we all have by the early days of covid healthcare zooming) I avoid screens entirely. I believe my core place of treatment will always be sitting on the mat on the floor with my client and their family. However the dazzling array of tech presented at the conference has me really wondering about where the opportunities are to bring more telehealth technology in particular into our practice. 

As a very small, very busy practice we struggle to travel to clients homes, school and communities as much as we would like. I think we could get creative and use telehealth more to offer clients situation specific advice when we aren’t able to be there in person. 

A number of presenters spoke about the importance of coaching, the importance of guiding clients and their caregivers without physically doing much. As a physio, this is really hard! Wade and Carol Shrader spoke about their experience as parents of children with CP and how they wanted to be helped to help their child. I wonder about the role telehealth could play in helping us clinicians to move out of the drivers seat and allow parents to guide.

Re-energise

And of me this was the last theme! Being in the presence of so many inspiring clinicians, people with lived experience, and their families from around the world (even digitally) is thoroughly invigorating. I think feel re-energised ready to bring all these new ideas back to my colleagues and into my practise.