Referral and assessment
The earliest referrals, usually to physiotherapy and occupational therapy, should be made as soon as the paediatrician identifies a locomotor disorder or delay potentially affecting functional skills.
In milder cases, professionals such as health visitors visiting babies at home may be the first to observe delayed development and it is important for them to be aware of the need to refer to appropriate therapists, if necessary via the GP.
Referral to speech and language therapy should take place as soon as potential communication difficulties are identified.
Therapy services should include senior staff with specialist knowledge of child development and CP and should ensure that experienced supervision is available. Therapists should be core members of the multidisciplinary team, preferably based on one site with close links to specialist orthopaedic, orthotic and general equipment facilities as well as to community services.
The therapist should know what the parents have already been told about their child, establish how much of this they have understood, what their main concerns are, particular problems in day-to-day management and how much time the family has, or is expecting, to provide to help their child. This latter point can be the main variable when planning treatment.
Wherever possible the therapist should have visited the child's home, partly to see the circumstances in which any management programme will take place, but also because the family will be more at ease and likely to discuss issues more openly.
The infant's movement and postural abilities are noted, particularly any persistent posture or movement as these are likely causes for gradually developing deformity.
A management programme should be planned based on clearly defined short and long-term aims. The programme should be fully and openly discussed with the parents so that they understand and agree both the aims of management and their role.