729

Postgraduate Training MADAM - I am replying to Zena Schofield’s letter in the July issue regarding a lady with a severely restricted glenohumeral joint. It appears that the patient was not treated adequately.

The implication is that after completing three or four years training a physiother- apist is not qualified to examine, assess and treat a patient with severe fractures involving the glenohumeral joint. Most physiotherapists will have treated many patients unsupervised before they attend any post-registration courses, therefore if this is the case it is worrying. So far as I am aware the syllabus does include assessment of musculoskeletal disorders. I would be grateful if a member who is

concerned with education would clarify the aims and objectives of the physiotherapy course with regard to treating this condition. Sarah Wickham MCSP MMACP Hong Kong

Ann Thomson MSc MCSP DipTP MMACe Head of School of Physiotherapy, The Middlesex Hospital and University College London, contributes:

The old maxim ‘you cannot put an old head on young shoulders’ holds even truer today than eve^ While Sarah Wickham

CLOSING DATES The closing dates for receipt of copy for the Journal are as follows: ‘Courses and Conferences’, ‘Noticeboard’ and ‘Personal’: 20th of the month preceding publication. ‘Board and Branch News’: 15th of the month preceding publication. ‘Appointments Vacant’: 20th of the month preceding publication. But your vacancy can still appear if it reaches this office by 4 pm on the 24th - though at a premium rate. See page i for full details. Please address all job ad- vertisements to the advertisement manager, Mr R Denham, Journal Department, CSP, 14 Bedford Row. London WClR 4ED. Course and Branch or Specific Interest Group meeting notices should be addressed to the editor, together with all other material for publication. NB. This schedule will change from the January 1995 issue onwards. Please watch the Journal for details.

Correction The Tripp Trapp adjustable chair

featured in the August ‘Product News’ page is available from Disability Care Services (telO235 523353). We regret that this number was printed incorrectly and apologise for inconvenience caused.

can be reassured that the principles of assessing and treating musculoskeletal dysfunction constitutes an important component of the undergraduate curriculum, so also are the principles relating to other aspects of our multi- faceted and exciting profession.

Graduation means, therefore, that the physiotherapist has a sound foundation on which to build and working as a physio- therapist should be seen as continuing education while providing a quality service to patients.

Provision of such a service requires that physiotherapists have a structured postgraduate education in its broadest sense.

At present it tends to be left to a few dedicated professionals who seek to push forward the frontiers of knowledge and skills, often at considerable personal and financial sacrifice. The way forward is to empower all physiotherapists to access a broad, flexible programme of education which may have the academic labels of ‘master’ and ‘doctor’ but could also include certificates, diplomas, memberships or Fellowships.

Contact Point Community Extension The purchasers of therapy services are increasingly looking for management of care in the community. It is acknowledged that there is a need for flexibility, good communication skills, professionalism, clinical audit and a pioneering spirit!

I would be very interested to hear from provider units, who have been approached to increase their acute work in the community beyond their normal practice, eg hospital at home; respiratory on call; musculoskeletal on call, and so on.

I would also like to know how it was approached, ie what criteria of patients were seen; what protocols were set; how it was monitored; whether it was successful; and if it led to further developments. Judith Aspinall MCSP (Mrs) Superintendent Physiotherapist

Firs Health Centre Firs Lane Smethwick Warley West Midlands 867 6AE

Community

Soclai Services Centre I am a senior I physiotherapist, seconded by an NHS trust to work in a resource centre run by social services. This is a day centre for elderly and frail people and I am keen to contact any other physiotherapists with a similar post to compare philosophies, aims and objectives, etc. Anne Dreyer MCSP Rosyth Resource Centre Granville Way Rosyth Fife KY11 2HP

Dyspraxia Assessment and Treatment The treatment of children with severe dyspraxia (‘clumsy’ children) currently involves a variety of professionals, using a wide range of approaches, with uncertain effectiveness. If untreated, clumsy children accumulate additional problems through- out their schooldays (Losse et al, 1991) and so services in Cambridgeshire now attempt to screen systematically for dyspraxia when children enter primary school, using the Movement ABC checklist. Clinical medical officers are making a growing number of referrals for treatment to Lifespan Healthcare’s Child Development Centre.

With funding from Anglia and Oxford Regional Health Authority, we are attempting a randomised controlled trial comparing different approaches to assessment and treatment. One approach for five- to eight-year-olds involves assessment and treatment by a physio- therapist of small groups in a specialist centre, weekly over two school terms. May I invite readers of Physiotherapy to advise us on their own experience of physiotherapy with groups of ClUmSy children, so that this element of our comparative trial can represent the best of current practice available in Britain?

We would be most grateful for any advice or comments on such first-hand experiences, so that the potential contribution of physiotherapy to the care of such children can be clearly demonstrated. Woody Caan DPhil Head of R&D Lifespan Healthcare Douglas House 18b Trumpington Road Cambridge CB2 2AH

Reference Losse. A, Henderson, S E, Elliman, D, Hall, D, Knight, E and Jongmans, M (1991). ‘Clumsiness in children - Do they grow out of it? A ten-year follow-up study’, Developmental Medicine and Child Neurology, 33, 55 - 68.

Chronic Fatigue In the near future, we hope to set up a comprehensive chronic fatigue clinic, in- corporating a psychiatrist, psychologist, physician and physiotherapist.

Our role will be in the assessment and rehabilitation of these patients. My initial thoughts are to promote improved exercise tolerance through paced exercise, and to look at neural mobilising techniques to treat these patients.

I would be very interested to hear from any other physiotherapists working with chronic fatigue patients. Lynn Heath MCSP Superintendent Physiotherapist (Riverside Mental Health Trust) Community Physiotherapy Department Chelsea and Westminster Hospital Fulham Road London SWlO 9NH (tel 081-846 6070)

Physiotherapy, October 1994, vol80, no 10