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Assessment and pre-op

What happens at the initial assessment?

We first organise an appointment to see the child at one of the Complex Movement Clinics. Any information from the child's local physiotherapist and parents can be collected at this time to support the assessment. At this appointment children will undergo a joint initial assessment by the Consultant Paediatric Neurologist and Physiotherapist.

The physiotherapy assessment may include a:

  • Neurological examination
  • Musculoskeletal screen
  • Functional mobility, transfers and activities of daily living
  • Observation of posture/movements
  • Pain behaviour
  • Range of movement

The outcome of this assessment will be discussed in the Complex Movement Disorder Multidisciplinary meeting, and if DBS is felt to be an appropriate treatment option, a discussion will be had with the family. The patient will then be placed on the list for a baseline assessment.

During this clinic appointment the procedure will be described in detail to the family including the risks and possible adverse effects. Potential disadvantages to DBS therapy will also be discussed.

Realistic objectives of DBS therapy will be discussed and agreed collaboratively with the parents, including the importance of regular attendance of outpatient appointments. If DBS is not deemed to be the best treatment option, patients will be discharged from the DBS service back to their referrer with a report to detail the assessment findings.

DBS Baseline assessment

If a child fits the criteria and is a good candidate for DBS, the child will be sent for neuro-physiology tests at King's College Hospital NHS Foundation Trust in London. If the result of these tests is satisfactory the neurosurgery team will coordinate an admission to the Bristol Royal Hospital for Children for a multi-disciplinary team baseline assessment. This is normally completed over 4 days and requires an inpatient stay. As part of these assessments, some video recordings will need to be taken of the child. Written consent will be required for this to be completed.

Assessments will be made by the multi-disciplinary team, including:

  • Physiotherapy
  • Occupational Therapy
  • Speech and Language Therapy
  • Psychology

The assessment results are then discussed at a multidisciplinary team meeting.