Letters: 4 February 2015

 

As a treatment modality, CIMT is one of the most evidence based treatments for upper limb hemiplegia in both adults and children. Parents routinely report that therapists are often dismissive of CIMT as a treatment, or even actively discourage it with reasons such as ‘it doesn’t work’ or ‘it is cruel’. 

 

Such ill-informed thinking is indicative that some therapists fail to keep up to date on current research, and these misjudged comments may provide a barrier to parents seeking effective treatment for their children.

 

I would strongly urge all therapists involved with hemiplegic patients – children or adults – to read the growing evidence base and gain a thorough understanding of the treatment technique and the reasoning behind it.

 

From first-hand experience I have seen the rapid and significant results that can be gained by providing an appropriate CIMT programme. Karen Leslie, senior therapist, CIMT.co.uk

 

Since qualifying, I have searched for knowledge and understanding to improve the management of patients. I recall the advancements of electrotherapy in the 80s, excitement of McKenzie’s message after Maitland’s more passive treatments, and then the idea of neural tension proposed by David Butler et al. I attended one of Louis Gifford’s early courses, and was impressed with his message of graded exposure. I chose to be a clinician rather than a researcher or teacher, and I still find my work inspiring and learn new things from the cases I see, and my clinical skills have evolved through both experience and study. Yes, there are the ‘simple’ cases that respond to fairly basic ‘advice and exercises’, or some manual therapy. After two or three sessions they leave my clinic, happy and confident to get on with their lives.

 

My measure of success is that they come back when there is a new problem, as they know we solved it the last time. However, the more complex, chronic, challenging cases require extra skill in clinical reasoning, as well as a generous ‘toolbox’ of methods/techniques, and it is our search for solutions for these cases that can bring forth new ideas.

 

While I would not consider exploring some of the methods Paul listed, I do consider it important to keep an open and questioning mind.  

 

As I wrote (page 7, 19 November 2014), surely our profession is intelligent, as well as mature, enough to justify our autonomy of practice? Ingela Jacob

 

I frequently encounter patients who just see their GP for either a prescription or a Fit note, when these services could easily be offered during physio consultations. The recent change to legislation has addressed the issue of prescribing for physios but the Fit note issue remains. I call on the CSP to campaign for a change in legislation. Marcus Bateman

  

In the Gaza alert article published in the 21 January issue of Frontline, the name of physio Zoe Clift was changed to Zoe Clifton at the end of her profile. This has now been corrected in the online version.