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Written By

Bianca de Loryn


College of Healthcare Sciences

Publish Date

22 February 2024

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Diagnosing from afar

JCU PhD candidate Claire Grant is examining if children with cerebral palsy could be diagnosed via telehealth if there is no paediatric physiotherapist available locally. She says that early intervention is key to maximise quality of life for the children and their families.

When Claire Grant started studying physiotherapy, she envisioned working as a sports physiotherapist one day. “And then I really enjoyed my paediatric placements,” she says. “It's very rewarding. Kids usually get better rather than worse, so I got into children’s physiotherapy when I started work.”

During the COVID-19 pandemic, when everything suddenly had to be done remotely, Claire was working as a physio in Townsville while also looking for a new challenge. “At the time, I felt there was much we didn’t know about telehealth,” she says. “And then, as I started researching it for my Master of Philosophy and talking to other physios, I realised the potential of telehealth, especially for rural health.”

Claire says she was primarily interested in the experiences of physiotherapists who worked with children with developmental delays. “Many said they struggled with assessments via telehealth, though they found follow-up appointments easier because they had already seen the patient in person.”

As part of her PhD, Claire is looking to find a way to help physiotherapists diagnose cerebral palsy via telehealth. Claire says that it is important to diagnose any developmental challenges in children as early as possible.

“Any child, but children with cerebral palsy in particular, really benefit in their first two to five years of their life from receiving intervention,” Claire says. “In children under five, the brain is the most neuroplastic – it can respond to change really well and make new connections and strengthen them. These younger children learn to do new things easily, and we should take advantage of that.”

Claire Grant
Dad with toddler.
Left: Claire Grant (supplied); right: early diagnosis and intervention will benefit children and their families.

Early diagnosis is key

Cerebral palsy can be diagnosed in infants as young as three months. “At the moment, children with cerebral palsy, and also other neurological conditions, get diagnosed later than they have to,” she says, adding that often children are only diagnosed when they are 18 months old or older.

“This means that they don't have access to that neuroplastic window as early as they could, and so their motor potential is not made the most of,” she says.

“Children with more severe forms of cerebral palsy don't learn any new motor skills after the age of five. This is why you really need to get in early.” If children get diagnosed and treated as early as possible, this will help improve quality of life for the children and their families.

Telehealth – the answer to the skills shortage?

The biggest challenge, especially for parents living in remote areas, is access to qualified specialists. “Outside of the bigger cities, there's reduced access to physiotherapists who can deliver treatment, but also to those experienced enough to do assessments.

“I'm hoping that if telehealth can be used in those rural and remote areas, the children would receive a diagnosis earlier. With earlier intervention, we could maximise the benefits of their neuroplasticity,” she says.

"Learning more motor skills at an early age  would improve the quality of life not only for the children, but also for their families."

Working on a remote diagnosis method

So far, there is no accepted method in Australia that allows cerebral palsy diagnoses via telehealth. This is why Claire is currently trying to determine if the Hammersmith Infant Neurological Exam (HINE), which can be used for infants as young as two months, may be a suitable assessment tool.

“The HINE is already being used to diagnose cerebral palsy, along with magnetic resonance imaging (MRI),” Claire says, “but the HINE has not been used for telehealth assessments yet.”

The first phase of Claire’s research is to work with physiotherapists and occupational therapists to understand if the HINE is still accurate when used over telehealth. The second phase will be to talk to the therapists and families involved in the research to understand their experiences.

Claire hopes to find out how the use of the HINE over telehealth impacted family’s travel, costs and diagnostic experience. “If the HINE seems accurate and viable, its application to rural populations would be an exciting area for further research,” Claire says.

This process will take approximately one to two years, but Claire is confident that this learning experience will be beneficial for the patients and the treating physiotherapists alike.

The rewards of building long-term relationships

Claire says one of the reasons why being a physio is important to her is the relationships she builds with her patients. “You don't really get that ongoing relationship working with adults, who need a specific treatment, and then you discharge them,” she says.

“Working with kids with disabilities, you work with them for a long time. You see them grow and change, and they have really interesting goals to work on. For instance, adults usually don't need to learn to ride a bike or play a specific sport. Children are also very enthusiastic about learning new things. It’s really rewarding.”

Claire says that for people who would like to work in health but are not sure which specialisation is right for them, physiotherapy is a great choice. “There are lots of different streams you can choose from, with paediatrics obviously being one of them,” she says.

“Being able to help people meet their goals and help them get better is very rewarding,” she says. “It's also quite a balanced career. Most physiotherapists don't need to work on weekends or at night, which is fantastic if you're looking for a career that suits a family.”

Finally, there is also the potential to conduct research that may improve the quality of life for many people. “After I am finished with my PhD, I would love to stay in research,” Claire says. “But I wouldn't mind doing a bit of a mix of working as a physio and doing research. That would be ideal.”

"Working with kids with disabilities, you work with them for a long time. You see them grow and change... Being able to help people meet their goals and help them get better is very rewarding."

JCU PhD Candidate Claire Grant

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