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Making the right moves

Physios treat many conditions in many ways but movement is always key. Martin Whittaker reports

A common public perception of a physiotherapist is of someone who works in an NHS hospital or treats sports injuries. But physiotherapy is much broader than that - it is used to treat a wide range of conditions, from asthma to tinnitus.

The Chartered Society of Physiotherapy, its professional and trade union body, defines it as "a health care profession concerned with human function and movement and maximising potential".

The society speaks out on health issues. In recent months it has warned about the risks of mobile phone text messaging in causing repetitive strain injury; the dangers of broken paving slabs; and the health risks to children caused by lugging heavy school bags.

Specialist roles

Physiotherapists have traditionally worked in hospitals and health centres, but increasingly work in a range of settings in the community, in workplaces and in schools. The profession embraces a wide wealth of specialisms, each with its own association.

It has 38 special interest groups, which include those working with cystic fibrosis, in paediatrics and with people with learning disabilities, all of which have an overlapping interest in treating children with special needs.

The Association of Chartered Physiotherapists for People with Learning Disabilities, for example, has 250 members who use a range of interventions in their work. These include rebound therapy (using a trampoline to improve motor skills and balance), hydrotherapy (exercising in water), horse riding, and advice on seating.

Paediatric physiotherapists in the health service commonly work as part of child health multi-disciplinary teams, which also include occupational therapists, speech and language therapists, and health visitors.

They play a part in assessment of special educational needs; they advise parents and carers (and children, if they are old enough), on their condition, and work with them to develop strategies so the child can achieve his or her potential.

In Bedfordshire, for example, physiotherapy is one of a range of services offered by a child development centre that provides services to children with disabilities. The paediatric physiotherapy team assess and treat children in a variety of places, including special and mainstream schools, nurseries and at home.

For children with cerebral palsy, a physiotherapist can teach a child how to control their head movements or how to sit, as part of a tailored treatment plan, as well as teaching parents how to help their child at home.

Physios also treat developmental co-ordination disorder (dyspraxia), a syndrome where a person's motor skills are impaired, bringing difficulties with movement and co-ordination. They assess the child's difficulties and plan a treatment programme, which may include games to improve motor skills.

Physiotherapy has one of the highest growth rates of any of the NHS professions, but those entering have faced a job crisis. While there is a shortage of physios at senior level, there has also been a chronic shortage of posts for new recruits. By last November, six months after completing their degrees, more than half of new graduates were still seeking their first NHS junior job, according to the Chartered Society of Physiotherapy.

Working in tesco

The society blames poor local workforce planning after the Government expanded the number of training places. "We know of first-class graduates who are working in Tesco, Topshop and TSB just to make ends meet," says Phil Gray, the society's chief executive.

Ironically, physiotherapy is one of the most popular degrees in the country. School leavers are expected to have three A-levels at a minimum of grade C and above, and one should be biology. The typical A-level profile of a school leaver accepted for all physiotherapy programmes in 2002 had the equivalent of three Bs.

Qualities looked for include communication and caring skills, sensitivity and tolerance, and the ability to use initiative.

It takes three or four years of full-time study to become a chartered and state-registered physiotherapist, though there are a number of fast-track Masters programmes open to those with a relevant degree, such as biological science, psychology or sports science.

Physiotherapy is open to older students - currently more than a third of all entrants are over 21 when they begin training. Newly qualified physios do a series of four-month rotations covering a range of skills, such as paediatrics or stroke rehabilitation, and, within two or three years, begin applying for more specialised roles.

The starting salary for a new graduate physiotherapist is pound;19,166.

The highest point on the physiotherapy career band is to become a consultant, who can earn more than pound;88,000.

Sally Braithwaite works with special needs children in mainstream schools in Birmingham and is on the national committee of the Association of Paediatric Chartered Physiotherapists.

I work across a spectrum of needs, with a wide range of special needs children; some with minimal problems, some with very significant problems, and some who need very specialist help.

But we try to integrate the therapy: if you put in individual exercise programmes that take a child out of class for half an hour a day, it starts to make them seem really different - their peers see them as different, they see themselves as different. So you look to integrate all your physio goals into what's happening in the classroom.

For example, in PE, if particular children have specific stretching they need to do for certain muscle groups, the whole class does that as part of their warm up. You don't want to make them feel singled out.

My specific interest and expertise is working with children with developmental co-ordination disorder, looking at developing co-ordination and balance by all sorts of everyday activities.

I don't have an average day. You're looking all the time at dealing with priorities. Sometimes you have two or three children in the same school, in which case you'd almost certainly spend a morning there. While you were in school you'd be looking at reassessing the child's condition and what they were able to do, and what they needed to do matched in with the curriculum for that particular age group and stage.

You might be looking at a specific access problem and how to get round it.

It may just be that a child can't get her walker into the dining room because the tables are too close together.

In my working day, I might do specific teaching sessions for small groups of school staff. It may even be dinner time staff, because it's just as important for them to understand about children and their needs.

Often, at the end of the school day I do in-service training for school staff. If they have a child with cerebral palsy, or Duchenne muscular dystrophy, we would talk about all the implications that go with that, how that impacts on the school and how it might affect a child's ability to learn.

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