Intensive therapy week information for parents and carers

Your child has been invited to attend an intensive therapy week with the metabolic bone disease team.

This resource will explain what is involved within the intensive therapy week. It will give you an idea of what to expect throughout the week and what will be expected of you and your child.

What is an intensive therapy week?

An intensive therapy week involves your child being admitted to a ward at Sheffield Children’s hospital for up to 4 nights.

Your appointment will begin on a Monday afternoon at 1pm and leave on the Friday at lunchtime.

A therapy week may be arranged to allow your child to have treatment at the same time or it may be entirely separate from your treatment visits.

Why have we been chosen?

Your child may have reached a plateau with their development, functional ability or walking.

They may have had a run of fractures or an episode of orthopaedic surgery which means their function is lower than usual.

The intensive therapy week will help provide them with the range of movement, muscle strength, functional ability, skills and confidence to move forward and progress.

What will happen when we come in for an intensive therapy week?

On the first afternoon your child will be assessed by an occupational therapist and physiotherapist. This assessment may take place on the hospital ward or in the physiotherapy department. During the assessment we will look at the movement of your child’s arms and legs and ask them to demonstrate some activities.

We will also ask you and your child some questions about how they move around their environment, at school or nursery, at home and in the community.

All this information will help us to work together to formulate agreed therapy goals.

After this an exercise plan will be provided. If your child needs an assessment for new equipment, this will also be arranged.

Who will we meet?

Physiotherapist or an occupational therapist

Your child will be seen 2 times by a physiotherapist or an occupational therapist on Tuesday, Wednesday and Thursday, and you will be given a timetable for these visits. The visits may involve both the physiotherapist and the occupational therapist, but will sometimes involve just 1. This will be dependent on your child’s needs and the initial goals which were agreed.

The therapist may also provide your child with a program of exercises to do in the evenings. These exercises are important as they will help to ensure that your child gains the most out of the week activities.

Clinical psychologist and orthotist

With your consent the therapist may also arrange an appointment for your child with other professionals who work with the team, including the clinical psychologist or orthotist.

A clinical psychologist’s aim is to help young people and their families in times of difficulty. They will offer you and your child sometime to talk around your concerns and try to understand your situation and work with you and your child to find helpful ways forward. Referral to the clinical psychologist will only be done with your consent.

The orthotist provides braces or splints, and special footwear to help children with movement difficulties and to relieve discomfort. Referral to the orthotist will only be done with your consent.

If your child is already seen by these team members or other professionals within Sheffield Children’s hospital please make the metabolic team aware before your child’s intensive therapy week as this will allow us the opportunity to try organise reviews if required during the intensive therapy week.

Where will we stay?

We find it very helpful if you stay in the hospital with your child for the week. You are then able to watch and be involved in their exercise program and improvement throughout the week, helping you and your child to continue this program on your return home.

Older children may feel happy to stay overnight on the ward without their parent or carer. This is fine, but we would ask you to attend the ward each day to observe the therapy taking place.

On Friday your child will have a final assessment. This will show all the improvements made during the week, and find which areas still need work. It will help develop on-going goals for future improvement and maintenance of the progress already made.

Delayed onset muscle soreness (DOMS)

During the intensive therapy week your child will be asked to work very hard.

Occasionally this leads to a muscle pain called ‘delayed onset muscle soreness’ (DOMS). DOMS in 1 or 2 days after someone has gone through exercise that your body is not used to, for example doing activates that you do not normally complete.

There are many theories as to why DOMS occurs. The most commonly accepted theory is from the unaccustomed loads placed upon your muscles and causes inflammation. This is does not cause permanent damage.

When training your muscles or increasing your exercise tolerance, this might be unavoidable and actually help prepare your muscles for increased levels of activity in the future.

This is not something you or your child should worry about. However if you are concerned about this, please do not hesitate to contact the team to discuss this further.

What happens after the week?

Your child will be given a program of activities to continue at home.

We will be in contact with your local physiotherapist and occupational therapist making them aware of your child’s improvement, program and current goals.

You will be given a follow-up appointment for 6 weeks after in the physiotherapy department.

We will also ask you for feedback on how you and your child felt the week went so we can continue to improve the care we provide.

Can we say no?

We are aware that the intensive therapy week is a big commitment for families, and that it can be difficult to arrange family life around a week of inpatient therapy.

If this is the case we will try to provide intensive therapy in a format which is easier for you and your family to access.

This might be daily visits to Sheffield Children’s hospital if you live a sensible commutable distance away or weekly visits for a course of 6 weeks.

However, we have found the full week to be most beneficial for most children.