Why travelling physiotherapy matters
- Shayna Gavin, Splash Principal Physiotherapist
- 1 hour ago
- 10 min read
We are proud at Splash Physiotherapy to be able to provide flexible visiting physiotherapy services to your home, education setting, playground, sports or active leisure location .
And there are so many different reasons why!
Summary:
To get best results as quickly as possible
use of natural settings best practice in Early Childhood Intervention
using Motor Learning Principles to use your new skills in real life situations
using neuroplasticity to make practice meaningful and optimise learning
to translate new skills in to real life participation
to be in a state where you are ready and able to learn
family centred practice
routines based care to fit practise into your everyday life
To facilitate inclusion
in education settings like childcare, kinder and school
in sport and active leisure activities
in the community
Safety
safe and effective assistive technology
assessment of environment for risks (eg falls risk) and opportunities (eg to practise in everyday life)
manual handling training
Teamwork
joint sessions with allied health professionals, educators, sports coaches, dance teachers…!
Helping families access physiotherapy
transport issues
where travel takes a toll so you’re not able to learn once you arrive
allowing parents to work instead of taking half days off for appointments and travel
getting services in a therapy desert
managing access issues
supporting families under pressure.
There’s a lot!
Here’s some details!
To get best results, as quickly as possible
Early childhood intervention best practice
For early childhood intervention, sessions conducted in natural settings are accepted as best practice. This is from the NDIS early childhood intervention guidelines.
“Best practice recognises children learn and develop in natural, everyday settings. This includes their own home, and other places, such as childcare, playgroup or preschool, where they play with family or friends. This means the adults they are with need information, tools, and support to help the child’s development and participation.”
There is a huge amount of literature showing the benefits of working with children in their own settings rather than a clinical environment
These benefits are true for children of all ages! The majority of simply do better and get more out of their sessions in natural settings.
Motor learning principles best practice
In motor learning theory, tasks are sometimes practised in a sterile controlled environment, and then once the skill is in place, it is translated into an open environment where there are gradually more variables.
eg. Consider the difference of walking on a flat surface down the hallway that you’ve practised hundreds of times, compared to walking across a park where the grass and paths are uneven, there’s dappled light from trees changing your visual input, gusts of wind come up and blow you around, and where your attention gets taken by a cute dog or an interesting bird, and while you were chatting or playing with your mates. It’s a far more complex task involving all of your systems!
We love to commence working in this open environment from the get go because then we don’t have to do all the work on generalising the skill from a closed to an open environment. Children are just able to keep learning and go! They also enjoy themselves a lot more, and we don’t have to “manufacture fun”, it’s there ready and waiting in the environment!
Making practice meaningful
Two of the key components for every part of the therapy session is whether the activity is active and meaningful.
Neuroscience tells us that neuroplasticity is optimised when we are actively engaged, and when the action is meaningful and makes sense to us. The easiest way for our brains to understand the purpose of the task is to do it in the way you are going to do it when you’ve learnt it!
There’s a big difference between practising something in a clinical setting with a therapy item compared to practising it at home eg. climbing on and off a block in a therapy gym, compared to navigating getting out from underneath the doona and passed yourself toys and wriggle into the edge of the bed and sliding down safely to the floor in your own bedroom. Simulation of tasks in therapy sessions has its place but translation to real life is vital.
Translating functional skills into participation
Specificity is vital when learning new skills. You need to practice the way that you’re going to perform the skill, and you need to practice with all the variability that comes up.
This is the missing link between learning a skill and being able to participate.
We have often had children come to our service who have for example, learnt to kick a ball, but they are stuck kicking the ball up and down the driveway. Then we work with them to add in the missing steps to help them participate in a community soccer program for example.
We can visit the location, we can liaise with the coach about inclusion, and in our individual sessions we can work on the skills in an open environment and all of the different conditions and complexities with being part of outdoors with others.
Being ready to learn
Many children find clinical environments challenging to exist within, let alone to connect with an allied health professional, play and learn. Some have had negative past experiences from medical or therapy sessions. Others just find new environments really overwhelming for various reasons, which is especially more common for neurodivergent children.
In order to learn, we need to be in a calm and alert state. Paediatric physiotherapy is based on playful interactions that are active and meaningful. It’s an often quoted statistic that 20 repetitions of playful practice can achieve learning compared to hundreds of non-playful practices. If using the correct setting can facilitate quicker learning then why wouldn’t we use it!
Other examples where travel really affects learning, are where children are too exhausted or disregulated from the travel to participate. Consider some neurodivergent children who really struggle with travel, children who get carsick and have the vestibular or visual issues, children who have energy limiting conditions and are completely wiped out by travelling so that the session becomes ineffective, and the fallout after the session is just not worthwhile for families
Family centred practice
Family are key partners in helping us identify goals, challenges, potential motivations, problem-solving, and working out strategies that will be useful to them in their every day lives.
Routines based care
This is best practice in early intervention but again it’s a strategy that helps people of all ages. Being able to visit families in their own homes allows us to identify aspects of their routines and home environment where it is possible to slot in practice throughout the day. This makes the practice meaningful and part of the everyday routine rather than having the burden of trying to remember an exercise program that they inevitably miss on some days. Families are flat out, we need to make things as easy as possible.
It is infinitely easier to achieve this when visiting the home environment. Imagine instead being in a clinic and saying, do you have something a similar height to this table and this type of item and then and then…
Instead during the session we can easily see what’s available, and work with families to create a solution, practise it together, and leave them with everything beautifully set up and ready to be successful immediately without any extra mental load on their part
Facilitating inclusion
a) in education settings
Early childhood educators and teachers are highly skilled and want to do the best they can for their students. Often they just need some extra help to problem solve and also discover not yet realised opportunities to facilitate a child’s inclusion, or to give them more opportunities to practice goals they are working on.
Also this is an environment that is meaningful and comfortable to a child so this is an example of use of natural settings.
b) in sport and active leisure
We often support translation of skills from practise to real life situations like joining a local soccer team, and sometimes being able to do a visit or two to help with the location and liase with the coach is all that’s needed to get those amazing new kicking skills out of the backyard and into a game! And sometimes joining in or meeting with your dance teacher once or twice is enough to help them understand how to support you so you can enjoy your dance class!
c) in the community
For example families we work with often have a goal of being able to go to the playground in a way that they can all enjoy, manage the risks, and be part of the community. Other examples can be managing go to the shops, library for story time, on a family bike ride. There are specific challenges to these goals that need on the spot assessment, problem solving and support.
Safety
a) Safe and effective assistive technology
Visits are important to look at the current environment and how you are managing in it to help come up with ideas for equipment that you might like to trial.
We then organise trials and go through them with you, looking at how to set them up to your individual needs and seeing how they will work for you in your environment. This is important for how your child feels comfortable and is able to use the equipment and how well it fits their needs, but also how the parents and caregivers are able to safely effectively and comfortably use equipment. We also assess environmental compatibility such as how your walker fits through the doorways, around furniture, and onto a ramp/lift if needed.
We then work with you to problem solve through the options, and once we have agreed we write up the recommendation which you put to your funding body.
And once you have funding and your item is ready, we come out again with you to help with the setup and use of the item. Sometimes one session is enough and other times we need multiple sessions, to keep learning how to use the item and be as independent as possible.
This is not a process that could be safely replicated without assessing the environment that equipment will be used in. We are not able to write up recommendations for equipment that we have not assessed as being safe and effective because the consequences can be extremely serious. There have been cases of inappropriate equipment leading to injury or death. More commonly, inappropriate equipment is prescribed that is not useful, doesn’t improve independence, and ends up being a waste of money that you feel guilty about sitting in the garage until you find someone to pass it on to! We really want to help you find the item that suits you best.
Re-checking assistive technology is important as babies, children and young people grow and their needs change, or as the needs of their caregivers change. This is also important after for example an acute hospital stay, surgery, or change in function.
b) Assessment of environment for risks and opportunities
We look for falls prevention hazards when we visit, and we also look for opportunities to integrate learning into every day life. Sometimes there are really simple changes we can make the layout of room which means that you are doing your practice during a task that you already do each day, and you don’t have to have another exercise to remember to do separately. Falls prevention is often also very effective, and falls can have serious consequences so it’s important to look at.
c) Manual handling training
Safe transfers, positioning, and mobility supports must be demonstrated, trialled and practised in the actual setting.
Linking in with other services
Working as part of a team is a huge part of working with babies, children and young people. We can do joint sessions for example with speech pathology or OT, or an education settings with your educators, or community sports and active leisure to coordinate with staff and coaches
Helping families access physiotherapy
Sometimes travel is what provides access to physiotherapy services
Sometimes parents can’t drive, they can’t get access to support workers, or the support workers frequently cancel, and they haven’t got access to NDIS taxi travel budget. Once you factor in the support worker cost, or taxi cost, as well as cancellations and last-minute missed sessions, it often works out cheaper to have a physio visit. We put a lot of effort into trying to schedule visits nearby each other to minimise travel costs wherever we possibly can.
Sometimes visiting children in education settings what allows parents to continue working. This was a key driver of the establishment of the NDIS in response to the productivity commission report of 2011, where one of the major aim was to return caregivers to the workforce. In addition to being extremely helpful for children’s inclusion in education settings and learning, this is sometimes the only way that children who have working parents are able to access therapy services. It can also mean missing less school time!
Sometimes families live in ‘therapy deserts’ where there isn’t a local service that has the skills to meet their specific needs
Sometimes children and families have not yet received their assistive technology or vehicle modifications that they need from their funding bodies that will allow them to travel. In these instances, visiting them means they continue to have access to services in the meantime.
Sometimes children and young people have extremely complex equipment set ups which can’t be effectively replicated elsewhere. This is another example of using the environment where you are most likely to have an effective session, to minimise time on transfers and set up, and instead get to work at optimising your outcomes as quickly as possible.
Sometimes parents and primary carer are Disabled, have their own health issues, family violence, or other access issues. Visiting can make a session an effective and enjoyable part of their day rather than a stressful 4 hour affair. If we can make life easier for families who are already trying so hard to do the best for their kids, why wouldn’t we?
Sometimes visiting is just what helps families the most. There might be a new baby in the family, there might be multiple children, they might be solo parenting, there are so many different reasons why visiting might help a family to access services.
The NDIS is currently slating a 50% cut to the price of travel which will mean many allied health professionals will not be able to continue to provide this vital aspect of service for quality safety and efficacy.
If you don’t agree with this change, please contact your local MP and feel free to share any of the information in this post, or your individual experience. This is not an exhaustive list and there will be many great reasons why travel is important to you that I will have missed.
Shayna Gavin is a physiotherapist who is passionate about helping babies, children and young people learn functional skills so they can participate in life at home, school and in their community. Recognising that children do best in their own environments, she visits homes, schools, and leisure activities from football fields to ballet classes. She also has daily aquatic physiotherapy sessions available at two private swimming schools in Moonee Ponds and Greensborough, Melbourne. She combines principles of paediatric physiotherapy, Contemporary Neuro Developmental Treatment, motor learning, and swimming teaching to address the individual needs of each child and their family. She loves providing professional development to physiotherapists, allied health and education professionals, allied health assistants and swimming teachers.
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