Edinburgh Conference 2013
Professionals Conference 2013, at the Royal College of Surgeons, Edinburgh.
Looking beyond the motor problems
Our chair was Dr Kenneth McWilliam, a paediatric neurologist at the local Royal Hospital for Sick Children, who had to begin by taking us through the presentation of his colleague Dr Paul Eunson, who had dropped out because of a family bereavement.
Dr Eunson’s talk, ‘Looking beyond the motor problems’, gave us a good start with an excellent run-down of the sometimes very disabling difficulties commonly associated with hemiplegia: epilepsy; communication; executive function (difficulties focussing, problem solving, organisation etc.); emotional and behavioural (more noticeable in less affected children).
“Set a good baseline for understanding the day”
Cerebral visual impairments
Our second speaker, visual specialist Professor Gordon Dutton, stressed that while children usually have a visual examination after diagnosis, with hemiplegia the problem is less in the eye itself than in how the brain processes what is seen.
Areas of difficulty can include clarity of vision, colour vision, contrast perception, field of vision, movement detection, visual memory, dealing with complex visual scenes, visual fatigue, recognition, orientation and mobility in the three dimensional world. And it is important to test for this type of difficulty.
Gordon Dutton then looked at ways of helping children function: a child with hemianopia (where they see only one half of the visual field) can rotate a page of text by 90° and read vertically – the brain soon adjusts to reading letters on their sides); a child who can’t recognise too many faces at once should arrive at a party early and meet the other children gradually; a child with optic ataxia (a difficulty with spatial awareness) can learn to move around confidently by pushing a trolley with toy bricks. For more useful tips, you can download Professor Dutton’s article for the charity Cerebra at http://tinyurl.com/ovmhgpd
“Really engaging motivating presentation highlighting important considerations for our practice.”
After coffee we heard Sandra McKay talk about her work as a Bobath OT. In the past Bobath clinics had a rather different approach to therapy than the NHS, and HemiHelp has always been wary of recommending one approach over another, but there is much more overlap and cooperation now, although the mostly NHS audience envied Sandra her longer sessions with children. Much of her talk was about outcome measures of therapy and the need to be aware of what is important to a child, who might learn, say, to tie shoelaces but not do it because it takes too long.
“Liked case studies –helped me put theory to practice.”
Study on play-based therapy
After lunch (and a demonstration of bimanual magic therapy by Richard McDougall from Breathe Magic, which runs an annual camp for children with hemiplegia), Dr Anna Basu from Newcastle talked about her research into play therapy.
There have been very few Randomised Control Trials (the only kind considered scientifically valid) of treatment for children with hemiplegia, so we were all keen to know the results. Anna’s work arose out of the recent discovery that the brain areas involved in performing movements are also activated by simply watching movements. Seventy children with hemiplegia, aged 3-10, spent 15 minutes with a parent every weekday for 3 months playing with a variety of toys which would encourage the use of both their hands. But half of them first watched their parent doing an action and then copied it repeatedly, while the other half just played repeatedly with the same toys without the parent doing it first.
The results show in fact that both groups improved their hand function, but there was little difference between the two – yet more proof that it is the regularity of therapy that is important, and that a relatively short play based session each day can have results.
One reason for holding our professional conference in Edinburgh this year was to take advantage of our local patron, MSP Siobhan McMahon, being based there, and Siobhan rounded the day off with a keynote speech where she talked about her own experience of the NHS and the need for greater attention to the needs of adults, like her, with hemiplegia.
The professionals who attend our conferences spend their lives treating children, and don’t always think about what happens when their patients grow up, so it was a useful reminder for them and they had lots of questions to ask.
One of our aims at HemiHelp is to get improved medical services for adults with hemiplegia, so let’s hope that they leave our conferences with more awareness of this issue.
“A very inspiring speaker who raised lots of interesting thought provoking points.”
Click on the links below to download copies of some of the speakers' presentations:
Dr Paul Eunson – The associated morbidities with hemiplegia
Sandra Mackey - Bobath Therapy and hemiplegia