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Cerebral Palsy / Paediatric Orthopaedics

The Integrated Cerebral Palsy Service (ICPS) at SPARSH Hospital is a multi-disciplinary clinic devoted to children and adolescents with cerebral palsy and/ or spasticity.

Our philosophy is that a team of dedicated professionals having specific expertise are best placed to assess and manage children with cerebral palsy (CP).

ICPS at SPARSH is led by Dr Minal Kekatpure, Consultant Paediatric Neurologist. Physiotherapists with specific experience in cerebral palsy, speech therapists and an experienced Orthotist complete the team. We also have access to a range of other medical professionals including geneticist, paediatricians, cardiologists, neurosurgeons, spinal surgeons and other sub-specialists who can consult as needed.

Dr Minal Kekatpure is a Paediatric Neurologist with a special interest in neurodevelopmental disorders including cerebral palsy. She is well acquainted with current therapeutic options for spasticity management, management of movement disorders, epilepsy, hyperactivity, and other medical conditions that are commonly associated with neurodevelopmental disorders.

What is the benefit for children with CP and parents?

  • An integrated service reduces the need for several hospital appointments
  • Clinical decisions made by a team of experienced professionals brings together a wealth of knowledge and expertise. This results in better quality decisions
  • Any doubts and clarifications can be resolved immediately. For instance, whether to alter the dosage of medications after surgery
  • Long-term predictions about mobility and function are more accurate when a neurologist and orthopaedic surgeon discuss the neurological and musculo-skeletal aspects of the condition
  • Multi-disciplinary management of children with CP is the key to successful management of CP and the standard of care in much of the developed world. At ICPS, we aim to provide  services that are at par with the international centers of excellence world wide.

How is ICPS configured?

Parents and patients make an appointment to be reviewed in the multi-disciplinary clinic (MDC). A standardised proforma is used to obtain a full history from birth to the present day. In particular, we will concentrate on the child’s function and current parental concerns/ expectations. Validated measures of current ability and function such as the Functional Mobility Scale and Gillette FAQ are also collected.

The child will be examined jointly by Dr Sampath and Dr Kekatpure to gather information about the severity of spasticity, joint movements and bony problems. The child’s gait will be analysed and scored. If required, a video recording of the child’s gait will be made for analysis and future comparison. An experienced physiotherapist will initially carry out a detailed developmental assessment. The team will then summarise the current problems and consider all the available treatment options. The team will then have a thorough discussion about the benefits and risks of any treatment recommendations. If the child has been referred by another clinician, a detailed letter with physical examination findings will be sent. A copy of this letter will also be given to the parents for future reference.

Parents are then given adequate time to consider any treatment recommendations and contact the team as appropriate. If no further treatment is considered necessary in the MDC, an appointment for further follow-up is agreed with the parents.

How can I use the ICPS at SPARSH?

  • Parents requiring comprehensive assessment of a child with cerebral palsy
  • Second opinion for a child for whom surgery/ intervention has been advised
  • Ongoing monitoring of children with cerebral palsy (6 – 12 monthly assessments)
  • Assessment of children with CP/ spasticity for consideration of Botulinum toxin injection (Botox ®) and multi-level orthopaedic surgery (SEMLS or Single Event Multi-level Surgery)
  • Advice regarding anti-spasticity surgery such as selective dorsal rhizotomy (SDR) and intrathecal Baclofen pump insertion (ITB)
  • Paediatricians, Physiotherapists and Orthopaedic surgeons requiring help with managing a complex or difficult problem in a child with cerebral palsy
  • Orthotic assessment and advice regarding braces, seating and postural management
  • Gait analysis and treatment recommendations
  • Child operated in an outside institution where post-operative goals are not being achieved
  • Assessment of adults with CP

I am a physiotherapist. Why should I use the ICPS?

  • There are numerous advantages to the child by being reviewed in the MDC
  • Parents and families of children with CP frequently visit a number of different professionals including developmental paediatrician, neurologist, physiotherapist, and orthopaedic surgeon. This involves frequent visits to hospital and sometimes conflicting advice resulting in confusion and anxiety amongst families. A one-stop clinic reduces the need for multiple hospital visits. All the doubts of the family can be resolved in 1 consultation. Clear guidance can be provided to the treating physiotherapist.
  • Families can see a variety of specialists in one clinic visit. Testing, such as X-rays or lab work, can be undertaken simultaneously. Families will also be linked with medical, educational, social and financial resources in the community as needed.
  • The vision of the Cerebral Palsy Program is that every child with cerebral palsy will reach his/her full potential physically, cognitively, socially and in education.
  • Surgical treatment plans can be carefully co-ordinated and timed so that there is minimal disruption to the child’s education
  • Detailed post-op rehabilitation, individualised to the patient, will be provided ahead of the surgery date. Community physiotherapists are also encouraged to attend out patient appointments and during the post-op period to ensure smooth transition from the hospital to a home/ community-based therapy programme.
  • The ICPS is the ideal environment for interested therapists to learn more about the current trends in the management of children with CP. We will be conducting regular continuing professional development activities such as seminars and workshops with invited national and international faculty.
  • The aim of the integrated programme is to deliver world class health care in an academic setting using the latest evidence and techniques.