September is the month to get moving and better understand the importance movement makes to our health. It's physiotherapy month and this year the Island's physiotherapists are highlighting the impact the profession makes on those with learning disabilities.

Body & Soul spoke with Rachel MacLoughlin, the physiotherapist at the Dame Marjorie Bean Hope Academy. Ms MacLoughlin is part of the three-person Department of Health team that helps the children develop and improve their everyday function. A speech therapist and occupational therapist form the other part of the team.

"We are part of a wider school team that includes teachers, para-educators, an adaptive physical education teacher, social workers and nurses," said Ms MacLoughlin.

Children at the school suffer varying degrees of brain damage and their abilities and needs vary widely.

"The degree of disability can vary greatly depending on area, structure and size of the neurological damage," said Ms MacLoughlin. "Their information processing can be affected at one, some or all of the different stages, that is at the input, integration, storage and/or output stage of brain processing."

She said children at the school have either a mild, moderate or severe neurological deficit, but held that physiotherapy is beneficial in most cases.

"Obviously, if there is more severe neurological deficit, children are more likely to have both learning and physical difficulties," she said.

And she explained that the difficulties could be complex. She said a child with a sensory processing disorder may also lack good muscle tone resulting in a tendency to slouch and may also have difficulty speaking. In such a case she said the team approach the physiotherapist, occupational therapist and speech therapist is vital for real success.

"We work together to organise the child's sensory system and posture, to improve learning functions like speaking and writing.

"Although my role as a physiotherapist is to focus on the child's motor development and control, all aspects need to be considered so to improve skill in their everyday function," she said. "The team approach we carry out at Dame Marjorie Bean Hope Academy is imperative to meet each child's individual needs."

Twenty-four children attend the school and Ms MacLoughlin said she works directly with 85 percent of them.

She said physiotherapy intervention is made a priority for those students with motor skill deficits and those who will benefit most from the therapy. Ms MacLoughlin said many times the treatment best suited for the child requires what she called a "co-treat" that is, treating with another member of the team or with the adaptive physical education teacher.

"Recently, the occupational therapist and I commenced ROM [range of movement] groups and co-ordination classes," she said.

"The speech therapist, occupational therapist and myself are also continuing block therapy again very successfully this year. This means we see a child for an hour each day, four days a week over a six-week period. We have seen excellent outcomes from working with this intense team approach towards a common goal."

All staff at the Devonshire school share the common goal she mentioned.

"I, and all the therapists, collaborate well with all other staff so that each child's therapy is continued throughout the day," she explained. "Teaching staff are aware of any children being monitored and highlight to me if they feel a child may need further physiotherapy intervention.

"Additionally, the nurse consults me with regards to any respiratory or musculoskeletal problems. Obviously all children's motor co-ordination, endurance and physical education skills are also met by the adaptive physical education teacher."

But just what types of exercises and movements does Ms MacLoughlin do with the children?

She stressed that it depends on their individual needs.

"Within the school, I have a therapy room with equipment including gym balls, bolsters, benches and wedges," she said. "This allows me to facilitate movement postures, patterns and transitions. A child may be working towards controlling their head movements or sitting independently or standing with support or walking with or without an aid."

To encourage good positioning and promote mobility, Ms MacLoughlin and the occupational therapist also use wheelchairs, gait trainers, standing frames, chairs and orthotics.

Specific stretching and strengthening programmes are created for each of the children and Ms MacLoughlin said parents are encouraged to have their children continue their programmes at home.

"A severely impaired child for example, will need a programme that looks at frequent positional change 24 hours a day, seven days a week," she said.

In fact, helping teachers and para-professionals with these positional changes is another part of the work Ms MacLoughlin does at the school.

A hydrotherapy room and new Hopsa-dress equipment are also used to help the children develop their motor skills. (See article on this page).

In her fourth year at the school Ms MacLoughlin said she finds her work rewarding.

"There have been very noticeable gains with some of the children," she said. "I've seen a child progress from walking with aids to walking independently. I've seen children develop their co-ordination skills progressing from ball throwing to jumping to riding a bike.

"In some cases it's been seeing a child just be able to sit independently for longer periods or have better head control in a lying prone and/or sitting position."

She continued: "The importance, as well, of such progression, is the maintenance of the children's skill, posture and/or musculoskeletal condition. Physiotherapy prevents muscle shortening for example, and secondary complications developing like a scoliosis.

"Each child at the beginning of the year has specific goals set that are worked towards throughout the school year. These are constantly re-evaluated to see what progress and/or changes need to be made for each individual child."