Your comments: 12 April 2017

CSP fellow Lorraine Clapham identified the ‘Clapham sign’, a stretch-sensitive contraction in the muscles of facial expression after complete denervation.This sign has now been recognised in A J Larner’s fourth edition of A Dictionary of Neurological Signs. 

 

Lorraine, renowned for her work in facial nerve palsy, co-founded and chaired Facial Therapy Specialists UK until last December. When checking the inside of a patient’s mouth and cheek following complete facial nerve palsy, she noticed that when the cheek was stretched, there was a subsequent spasm of the muscles of facial expression – even though they had no voluntary or spontaneous movement. Lorraine shared this observation with Professor Jonathan Cole, a neurophysiologist, at the eleventh International Facial Nerve Symposium in Rome in 2009. With support from consultant neurophysiology colleagues and University Hospital Southampton NHS Trust (Dr David Allen and Dr Ramamurthy Arunachalam), the team studied the muscle response to passive stretch, using needle electromyography (EMG).  

 

They reported their findings in the Journal of Laryngology and Otology in 2011 (125(7):732-7). The Clapham sign, lasting up to 60 seconds, occurred from seven to eight weeks following injury or transection of the facial nerve, even though EMG showed complete denervation of the muscles. For the first time, this provided evidence of preservation of activity in the facial muscles’ excitation-contraction apparatus.  

 

I am a committee member on the Aquatic Therapy Association of Chartered Physiotherapists (ATACP). I also sit on the committee of the Pool Water Treatment Advisory Group (PWTAG) which is seen as the UK governing body for the management of pools. I am increasingly aware of hydrotherapy pools that are not managed according to the PWTAG standards and that could be at risk if there was a medico-legal case involving a patient having aquatic therapy treatment. 

 

A PWTAG book titled Swimming Pool Water, to be published later this year, contains a chapter on hydrotherapy pools that I co-wrote with two microbiologists.

 

The chapter sets out the role of the designated aquatic physiotherapist in the water safety group management of a hydrotherapy pool (a role which, unfortunately, can be unknown to the physiotherapists who have not attended an ATACP foundation aquatic therapy course). There is no longer adequate undergraduate training and managers are often not aware of the governance requirements when running a hydrotherapy pool. 

 

The ATACP plans to include the updated PWTAG guidelines as a topic in a forthcoming study day, which will capture members’ interest. Meanwhile, it is important all physiotherapists treating in hydrotherapy pools and their managers are aware of the implications and risks.

 

For more information visit the website here. 

 

We have been overwhelmed by the response to our call for volunteers in an article about the London Marathon (page 10, 1 March). The event is vital for our fund-raising and the physios who volunteered will be key to our runners’ experience and safety. Sands, the stillbirth and neonatal death charity, works with professionals to try and ensure parents and families receive the best possible care.