B Y N E R I T A C H A N, S P T, T M H O L I V I A F A N, P T I, U C H

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1 B Y N E R I T A C H A N, S P T, T M H O L I V I A F A N, P T I, U C H

2 Model of Physiotherapy Service in CHW Service model of Kids Rehab Specialize clinics Family centre service Training

3 Physiotherapy Service in CHW Physiotherapy Department Rehabilitation Department In Patient Team Out Patient Team Physio for Brain Injury Team Physio for Cerebral Palsy Team

4 Physiotherapy Department Physiotherapy Department In Patient Out Patient NICU PICU Cerebral Palsy Neuro Orthopedic Orthopedic Talipes Respiratory Hydro

5 Physiotherapy Service Cover 24 hours service with 50 PTs Cover Acute and Rehab service Comprehensive rehab plan thro specialised clinic Specialized PT led clinic such as Talipes clinic Good communication with community physio for continuation of care Role of acute management of orthopedic problem with casting Run regular training course for local physio

6 Does Rehabilitation Happened in Acute Hospital?

7 Vancouver Sydney Toronto & Acute & Rehab

8 Rehab bed in acute hospital 6-10 beds Have their own team of staff (Rehab Dr., Nurse, PT OT, ST, SW, Child Life Therapist) 2/3 patients are childeren CP and Brain injury Maximum length of stay 3-12 months Rehab start from acute stage (PICU stage)

9 4 Paediatric consultants 4 PT (senior grade) 2 part-time OT Social workers Clinical psychologist Nurse Child life therapy

10 Kids Rehab Cerebral Palsy Brain Injury Spinal Cord Injury Spinal Bifida Limbs and MS Rehab

11 Spasticity Management Program for CP Botox injection Program Selective Dorsal Rhizotomy Program Intrathecal Baclofen Bump Program

12 Botox CP / Movt Dis Orthopaedics Gait Lab Neuromuscular Connective Tissue Limb Deficiency Talipes Cystic fibrosis

13 CP and Movement disorder clinic Brain injury clinic Talipes clinic CF Clinic Burn unit service Enuresis clinic

14 See patient in multidisciplinary team Pre-clinic meeting on pt s problem in all aspect Refer for Spasticity Management in Botox Clinic, Selective Dorsal Rhizotomy Clinic or ITB Clinic Refer for Orthopedic Management in ROC Clinic Gait analysis before and after management

15 Brain Injury Clinic & Rehab Start from ICU stage PT perform casting for spasticity management PT in Physio department and PT in Kids Rehab work together Out patient phase PT in Kids Rehab take major role Liaison with community facilities for equipment arrangement Brain Injury Clinic Run by Rehab doctor of Kids rehab Generate comprehensive rehab plan and discharge plan

16 PT s Role Early intervention Casting Spasticity management Gait and movement analysis Educate parent Arrange equipment Liaison with community PT Emphasis participation

17 Ponseti Clinic Dr. Ponseti, orthopedic doctor Other clinic, Ortho doctor do casting CHW - PT carry out casting CHW - Doctor perform tenotomy at 5-6 weeks post casting Patient around NSW come here for management of club foot

18 Talipes Clinic PT s Role: Carry out Ponseti Method of Management Casting: once/week for 5 cast DB boots measurement Educate parent FU and decide further management

19 Doctor Physio Laboratory Technician Nurse Dietician

20 250 patients 2 PTs Fu 3 monthly Annual admission for 2 weeks for management Annual CXR Blood test Lung function test Exercise training

21 PT s role: Maximal Exercise Testing Adherence of Airway Clearance Program ( PEP mask skills ) Inhalation Therapy (Hypertonic saline) Carer education on postural drainage, exercise regime and consolidation of sputum clearance regime Research

22 Blanket referral Daily cardiopulmonary exercise training and sputum clearance regime Weight-bearing exercise to combat osteoporosis

23 Doctors Physio Patients Nurse Specialist Child Life Therapist

24 2 PTs Responsible for inpatient and out-patient care PT s role: Maintain joint range Casting / Splintage Scar management Massage with Sorbeline cream Prescribe pressure garment Home exercise

25

26 Nephronogist Physio Urologist Nurse Neurologist

27 PT s Role Bladder Scan Assessment Uroflow Assessment Carer and patient education on bowel and bladder habbit at home and school, fluid intake advice, medication advice Relaxation exercise training for hyperactive bladder

28 Doctor conversation with parent is different Emphasis on activity and participation Respect the right and responsibility of young adult and kids Make all appointment within short period of time for long distance travelers Soft skill for parents education and communication (notices, pamphlet, fact sheet) Parent education resource centre Transitional to adult

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30 Soft skill for parents education and communication (wards signages, pamphlet, fact sheet,posters) These lights are going to be turned off at 7:00pm to assist your Doctor to discuss your child care Please keep curtains open at all times as we need to see your child

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34 Learning Point The service model of Physiotherapy in a tertiary hospital is not just direct patient care, have heavy role in the rehab planning Skill of communication with paediatric, involve Child life therapy with play Relationship of Kids Rehab and Physiotherapy Outstanding role in the Burn Unit and casting service in CHW Consultative role of Physio in different specialise clinics Service connection with the community therapist Longitudinal service in different specialty

35 Present situation Not every hospital have specialized program like: Spasticity management Burn Oncology Limited exposure in special skill and management Lack of organized professional training Service Development Survey on different specialized program in different local hospitals Census on work profile of staff on specialization of paediatric PT Develop training plan for paediatric PT

36 Local training emphasized on work based training Try on-the-job training with rotational post Local training with attachment to different hospitals for specialized services Attachment to children hospital in other countries Better communication between clusters in service development trend

37 Casting Workshop

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