London Conference 2014
Here is a summary of the 2014 HemiHelp conference for professionals
The morning began with a look at the behaviour issues that can go with hemiplegia. Clinical psychologists Dr Maxine Sinclair and Dr Laura McCaig talked about two studies which showed that our children’s psychological issues are not just down to frustration at being disabled in a mainstream world: psychiatric disorders affect 10% of the general child population and 12% of children with purely physical impairments, but almost half of children with impairments, such as hemiplegia, caused by damage to the brain. Explaining why this was the case, they compared the brain to a car: if you hotwire an engine, usually something else will go wrong down the line – the radio, say, or hazard lights.
They also emphasised the importance of children being referred to Child and Adolescent Mental Health Services (CAMHS), where they would be treated using a multi-modal approach that might include Cognitive Behavioural Treatment, Mindfulness and practical problem-solving and communication training – currently only 18% of the children with psychological issues actually access CAMHS.
Later it was good to hear of developments in improving motor skills, where our guide was Dr Charlie Fairhurst, an old friend of HemiHelp and co-author of the Hemiplegia Handbook. Charlie took us on a lightning tour of assessment and treatment, with the emphasis on putting the FUN in FUNction, but for me one point stood out.
Research shows that neuroplasticity, which allows the developing brain to find new pathways to replace damaged ones, is potentially greater in the movement system than other areas such as learning. It also lasts longer than was previously thought, and involves both sides of the brain – so that in young children it’s important to exercise both sides of the body, as movement of the unaffected arm and leg will also stimulate both sides of the brain.
The Hemi Hub
HemiHelp members often complain of a lack of coordination between different clinical specialists, so it was good to hear about an example of good practice in this area – a ‘one stop shop’ called the Hemi Hub run by a team of physios and OTs and operating in three different venues across Leicestershire. Yvonne Julian (OT) and Rachel O’Sullivan again stressed the importance of assessment, coordination and a programme based on practical goals, whether for pre-school children or teenage girls worried about their hair and makeup skills.
Of course another challenge for young people with hemiplegia is transition to adult services – a phrase that unfortunately often prompts the response, ‘what adult services?’ Physiotherapist Kathy Drinan took us through the process of empowering young people to take control at this time, especially in the light of the Care Act 2014, which aims to achieve more integration between health and social aspects of care. You can find her guideline online at www.naidex.co.uk/files/kathie_drinan_multi.pdf
One of the big questions that arose as NHS cuts bit and the average length of time between physio and OT sessions became ever greater was: which is more beneficial – one session a month, say, or an intensive block of six every six months. Eventually the answer became clear – intense is better. Another big question was, which is better: CIMT or bi-manual therapy? The answer here was not as clear cut: they were equally effective – the important thing was – guess what – the intensity.
Both schools of thought were represented at the conference. Pauline Christmas updated us on a Randomised Control Trial looking at two ways of administering CIMT in preschool children. There was one group whose unaffected hand was enclosed in a splint or cast for two weeks at a time while they played for an hour each day using only their affected arm and hand, and a control group where a parent would simply hold the unaffected hand while the child used the affected one. Her study, which she hopes to repeat on a larger scale, has shown that the increase in function is similar in the two groups – the difference is that children seem happier to have their hand encased for a prolonged time than to have their parent hold it.
The bimanual side of the argument was a presentation by Amarlie Moore and Richard McDougal of the Breathe Magic Intensive Therapy Programme. The Programme runs an annual summer camp where in the course of ten days children and young people from the age of seven up have 60 hours (the magic figure) of intensive therapy disguised as fun. They began by showing a short film made at the start of last year’s camp. A small boy repeatedly tried to zip up his jacket; a girl tried to open a packet of crisps; other children demonstrated similar challenges they face in everyday life. At the end, they showed another film, shot two weeks later. Not only had they all achieved their goals, but they showed off their magic skills before the professionals at the headquarters of the Magic Circle, and the joy and sense of achievement on their faces was priceless. The Programme is looking for sponsors in other parts of the country so that they can extend its work.
All in all, it was a very interesting day, with lots of good feedback from the people who attended.
Really great conference – loads of information from an array of professionals