The Disability Physio

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Carlingford, NSW
The Disability Physio

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NDIS Registered Mobile Physiotherapy Service in the Hills District and Western Sydney.

Experienced working with children and adults with Cerebral Palsy, Intellectual Disability and Neurological Disorders.

16/10/2026

Is an extra 3° worth it? 🤔

I shared this paper a year ago, and revisited it in much greater detail while developing my serial casting course.

This systematic review raises questions about how much adding Botox actually contributes to serial casting outcomes for children with cerebral palsy.

The additional gain in passive ankle dorsiflexion? Around 3°. The authors questioned how clinically meaningful that difference was and when one study was removed in a sensitivity analysis, the difference was no longer statistically significant.

The review also shared that in one study, spasticity returned and increased faster in the botox and casting group than the casting group only.

So, is that potential extra range worth the trade-off, particularly when questions remain about long-term effects?

Three degrees might matter for an individual child. But we need to ask what it changes for their movement, function and goals and weigh that against the potential risks.

I’ve shared other posts about Botox’s potential adverse effects on my page.

Follow along if you’re keen to question familiar practices and look more closely at the evidence behind them.

💬 Comment CASTING and I’ll send you the article to read for yourself.

📚 Milne, N., Miao, M., & Beattie, E. (2020). The effects of serial casting on lower limb function for children with Cerebral Palsy: A systematic review with meta-analysis. BMC Pediatrics, 20, 324.

28/08/2026

We don’t stop being their physio just because they turn 18.

In my recent posts, I’ve been talking about the uncomfortable reality that cerebral palsy is a lifelong condition but our systems and clinical attention don’t always treat it that way.

We’ve discussed how muscle in cerebral palsy may show signs of accelerated ageing.

But that isn’t the only challenge.

Many adults with CP also face a “quiet cliff” as they leave paediatric services:

📉 Specialist care becomes harder to access
📉 Rehabilitation and therapy reduce or disappear
📉 Pain, fatigue and functional changes begin to accumulate
📉 Preventable complications can go unnoticed

This matters because adults with CP commonly experience:
🧠 Chronic pain and fatigue
🧠 Earlier functional decline
🧠 Reduced mobility and participation
🧠 Increasing isolation and anxiety
🧠 Difficulty finding clinicians who understand cerebral palsy across the lifespan

We cannot discuss accelerated ageing in CP without also asking:

Who is helping adults respond to these changes?

As physiotherapists, we may know their history.

We may have watched them grow.

We may understand what is at stake.

But our role cannot simply end when paediatric services do.

We need to shift our thinking from:
“paediatric physiotherapist”
to
👉 “lifespan physiotherapist”

Because cerebral palsy doesn’t disappear at 18 and neither does the need for knowledgeable, proactive physiotherapy.

💬 COMMENT “AGEING” and I’ll send you the research paper behind this post.

💾 SAVE this as a reminder to consider the person in front of you not only today but 10, 20 and 30 years from now.

📲 SHARE this with another physio who works in paediatrics and disability. Adults with CP deserve more of our attention!

26/08/2026

I thought I had a pretty good list of things that were “kinda sus” about cerebral palsy care.

Then I read the comments. 😳

And honestly, some of you came up with much better ones than I did.

But underneath the funny, controversial and sometimes uncomfortable comments was something much more important.

Adults with CP told us what it was like to grow up through the very systems and interventions we work in today.

Parents shared where they feel the system is letting their children down.

And clinicians questioned whether some of the things we routinely do actually deserve to be routine.

I don't necessarily agree with every comment.

That's not the point.

The point is that we NEED these conversations.

We need to be able to question our practice without immediately becoming defensive.

We need to listen to families.

And we REALLY need to listen to adults with CP who can tell us what happened after childhood therapy ended.

Because the goal isn't to prove that our current practice is right.

The goal is to keep making it better for the next kid in front of us.

So I'm handing the comments section back to you.

👇 Finish the sentence:

“Kinda sus that…”

Apparently we're making Part 3. 😂

23/08/2026

When I was a new grad physio, I never really questioned Botox.

Child with cerebral palsy + spasticity = Botox.

It was just part of the management pathway.

But over the years, I started becoming less comfortable with that assumption.

I felt like I was seeing diminishing returns.

And more importantly, I started asking a different question:

Are we trying to reduce spasticity… or improve function?

Because they're not necessarily the same thing.

This 5-year study is another reason I think we need to keep questioning our assumptions.

The children who received Botox during the study period showed less improvement in grip strength and greater decline in bimanual hand function compared with those who didn't.

Does this prove Botox CAUSED those outcomes?

No.

It's a small observational study, and there are important limitations.

But I don't think we should dismiss it either.

Especially when so much of what we've historically looked at with Botox has been relatively short-term.

The longer we follow children, the more we can start asking the question that matters to me:

What happens to their muscle, strength and FUNCTION years later?

My position on Botox has become increasingly cautious.

And research like this makes me more comfortable questioning something I once simply accepted as standard practice.

I think we should all be willing to do that.

Want to read the study and make up your own mind?

DM me “BOTOX1” and I'll send you the link to the open access paper.

Tabard-Fougère A, Bonnefoy-Mazure A, Louis S, Armand S, De Coulon G, Vazquez O. Long-term functional decline following upper limb botulinum toxin injections in children with unilateral cerebral palsy: A preliminary retrospective 5-year follow-up case-control study. J Child Orthop. 2026 Aug 13:18632521261475145. doi: 10.1177/18632521261475145. Epub ahead of print. PMID: 42602096; PMCID: PMC13473363.

19/08/2026

I need to own this one.

I recently created a carousel about what's kinda sus about cerebral palsy....

forgot to include a sus statement about adults with CP!

The irony is uncomfortable.

Even after years of working in disability, I still caught myself thinking about CP through a predominantly paediatric lens.

That is how deeply the idea of cerebral palsy as a “childhood condition” is embedded in our profession.

But children with CP become adults with CP.

And while our research, services and clinical attention have remained heavily focused on childhood, the clock has kept ticking.

A new hypothesis paper asks whether skeletal muscle in CP may undergo accelerated ageing.

The authors highlight similarities between CP muscle and ageing muscle, with some ageing-like features appearing during childhood.

Importantly, this hypothesis still needs to be tested. But it raises a powerful clinical question:

What if lifelong CP management needs to focus not only on managing impairments, but also on actively preserving muscle health?

That could mean greater emphasis on:
Progressive strength training
Fitness and aerobic capacity
Meaningful physical activity
Adequate nutrition and protein
Future therapies targeting muscle growth, repair and ageing pathways

Most people living with CP are adults.

It is time our research, healthcare systems and clinical conversations reflected that.

Comment TIME and I’ll send you the article.

03/08/2026

The longer I've been serial casting, the more I realise there are so many lies flying around.

Experience and learning from experts has changed my thinking.

✅ Less force, better alignment
✅ Clinical reasoning over rigid techniques.
✅ Motor learning, not just stretching
✅ Botox isn't always necessary

The best in serial casting don't just know how to apply a cast.

They know why they're making every decision.

Which one surprised you the most?

💬 Comment COURSE if you'd like to learn the clinical reasoning behind how I approach serial casting and the decisions you make that influence the casts you apply.

Otherwise follow me and join me as continue to bring insights that balance research and expert opinion.

09/05/2026

Not all “dynamic” wheelchairs behave the same.

Some systems absorb force.
Others throw that force straight back into the user.

And that subtle difference?
It can completely change whether a dynamic setup actually works for the person sitting in it.

When someone is repeatedly pushing, rocking, extending, kicking, or crashing into their chair, the goal isn’t just to “make it stronger.”

It’s to manage force intelligently.

A well designed dynamic wheelchair can:
→ protect wheelchair hardware
→ reduce repetitive impact on the body
→ improve comfort and sitting tolerance
→ help protect skin integrity
→ allow movement without constantly fighting the user

But if the system rebounds too aggressively, the user can end up getting “thrown back” by the chair every single time they move.
More force. More frustration. More fatigue.

That’s why scripting dynamic components is never just about ticking a box.
You need to understand HOW the system moves… and WHO it’s moving for.

These differences can look subtle on video.
But clinically? They matter a lot.

Comment “dynamic wheelchairs” and I’ll send you links to both dynamic wheelchairs shown in the reel.

16/02/2026

Today an adult with cerebral palsy told me it was “normal” for them to open their bowels every 5 to 7 days.

And everyone around them had accepted that as normal.

If a typical adult told you that, you would be concerned immediately.

But in cerebral palsy, we quietly lower the bar.

We focus on: Range
Tone
Orthotics
Positioning
And sometimes we forget that internal organ function is driving half of what we are seeing.

Constipation can increase tone.

Reflux can drive irritability and poor sleep.

Swallow dysfunction affects chest health and energy levels.

Cerebral palsy is not just stiff limbs.

It is a multisystem condition!

If you want to be an expert in CP, you must look beyond the musculoskeletal system.

Comment GUT and I will send you the paper that inspired this post.

10/02/2026

I asked ChatGPT to make a caricature of me based on everything it knows about... And more!

Honestly… it's scary how accurate it is 😂

But that’s exactly what this page is about.

Because if you’re a physio student or early-career physio trying to understand cerebral palsy, it can feel like a completely different profession: AFOs, casting, gait analysis, standing frames, postural care, wheelchairs, tone management… and you’re expected to magically know what matters.

This account exists to make cerebral palsy physio make sense.

On this page you’ll get:
🧠 CP clinical reasoning
🦵 Orthotics + casting explained simply
🚶‍♂️ Gait analysis breakdowns you can actually apply
🧩 GMFCS IV–V equipment + positioning tips
📚 Evidence + clinical experience combined
I’m 10+ years into this work and still learning every week but I post what I wish someone had taught me earlier.

If you want to feel more confident treating CP (and stop second guessing everything)…
follow along.

👇 Now help me out:

Comment the CP topic you want next and I’ll make a post on it.

13/01/2026

Welcome to 2026 👋

If you’re a physio or physio student who wants to treat cerebral palsy without constantly second guessing every decision, you’re exactly where you need to be.

University gives you the foundations.

But it doesn’t teach you how to actually reason through complex CP presentations in real life.
That gap isn’t your fault...cerebral palsy is complicated.

I built this page for the physios who:
• Feel unsure if they’re missing something
• Overthink tone, gait, posture, and intervention choices
• Want to move from “hoping this is right” to knowing why they’re doing what they’re doing

Here you’ll learn how to:
• Think clearly in complex CP cases
• Understand the “why” behind movement, tone, and function

If your goal for 2026 is to feel calm, capable, and confident when treating cerebral palsy…

You’re in the right place.

Follow and settle in.

This year is about clarity, not chaos.

Comment "Start" and I'll send you my top posts to get you give you a head start in conquering CP physio

Address

Carlingford, NSW
2118

Telephone

+61410626878

Website

http://Www.thedisabilityphysio.com.au/

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