Paediatric rheumatology physiotherapy

Paediatric rheumatology physiotherapy at Addenbrooke’s Hospital
Staff profile block: 

Rachel Holmes

Paediatric rheumatology and musculoskeletal physiotherapy
Rachel Holmes

Introduction

The paediatric rheumatology physiotherapy and occupational therapy team at Addenbrooke’s Hospital treats patients with inflammatory musculoskeletal conditions. Inflammatory and non-inflammatory conditions can affect muscles and joints that impacts upon a young person’s participation in activities of daily living.

Inflammatory conditions may include some of the following:

  • Juvenile Idiopathic Arthritis (JIA)
  • Vasculitis
  • Juvenile Dermatomyositis  (JDM)
  • Systemic Lupus Erythematosus  (SLE)
  • Chronic Recurrent Multifocal Osteomyelitis (CRMO)  

Non-inflammatory conditions may include some of the following conditions:  

  • Hypermobility
  • Chronic Pain syndromes
  • Growing pains
  • Musculoskeletal pain, for example wrist or knee pain  

Assessments may be completed alongside the multi-disciplinary team. This team could include doctors, nurse specialist, psychologists and art therapists. Multi-disciplinary team working ensures all important aspects of the individual’s well-being are considered in the management plan.  

The main goal of therapy is to provide young people with the tools to help them to be as independent as possible and to be able to keep up with their peers emotionally, socially and physically.

What rheumatology physiotherapy services are provided?  

Patients can be referred to the lower limb exercise group run at the hospital by a physiotherapist. Exercises are provided to improve fitness, balance and muscle strength.  

Children can also be referred to hydrotherapy if appropriate which can have positive effects in improving joint movement, muscle strength and stamina.  

The physiotherapists work in a number of specialist clinics including the following:

  • Annual Rheumatology Review  Clinic
  • Non-inflammatory Pain Clinic
  • Chronic Pain Clinic
  • Clinics for inflammatory conditions

How will physiotherapy help?

In the assessment of inflammatory and non-inflammatory conditions, the physiotherapist will examine posture, walking, muscle strength, flexibility and balance. The findings from the assessment will determine the input provided. The young person will be provided with a home exercise programme to improve muscle strength and endurance to improve their level of function. Goal setting is an important aspect as it will allow young people to increase their involvement in social activities.

In inflammatory conditions, the physiotherapist will review the young person after a steroid injection and will check all joints for swelling and signs of inflammation. In some cases for muscle contractures splinting or serial casting may be considered.

In non-inflammatory conditions, young people may benefit from a block of intensive physiotherapy. Children can access the gym and can complete 1:1 gym sessions with the paediatric physiotherapy technician to target specific weakness.   

What Rheumatology Occupational Therapy services are provided?  

The role of the OT in treating young people with inflammatory and non-inflammatory conditions is very diverse, ranging from:

  • Assessing the child’s ability to perform day-to-day tasks and routines and suggesting alternative ways to carry out tasks
  • Offering practical support and advice on assistive gadgets/aids for example pencil grips, writing slopes,  bath boards
  • Offering advice on pain management and techniques to improve sleep and energy levels
  • Acting as a liaison between the family, health and social care teams and school about current needs
  • Setting patient centred goals to maintain their engagement in therapy and to motivate them to return to full function.  

How will Occupational therapy help?  

The OT can help by suggesting:

  • Hand/wrist exercises to strengthen or stretch specific muscles
  • Activity modification by suggesting different ways to do an activity for example, adopting a more supported seating posture, taking regular rest breaks and  getting the correct pen grip with or without the help of a pencil/pen  grip aid
  • Splinting - splints are sometimes used:
    • When joints are very painful and the pain and stiffness are having an effect on their ability to carry out certain tasks
    • To stabilise a joint if there is deviation or subluxation (i.e. misalignment/dislocation)
    • To stretch out soft tissues which have tightened and caused loss of movement to e.g. a finger joint
  • Teaching relaxation techniques and techniques to increase sleep and energy levels
  • Pain management advice techniques to help to reduce pain and stiffness in their hands and wrists
  • Providing information to school to support a child attending and participating in lessons and extracurricular activities during their school day
  • Pacing/energy conservation: when a child is working towards a specific goal or trying to increase their muscle strength and endurance it’s important they pace themselves