The Disability Physio

Home
Australia
Carlingford, NSW
The Disability Physio

Call Directions Website

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.

13/11/2026

To all the physio students about to join our profession, I'm rooting for you! 🙌

12 years ago, I was in your shoes. Excited, nervous and wondering if I knew enough to be a good physio.

Looking back, there's so much I wish I could tell my younger self.

And I hope some of that advice helps you as you begin your own journey.

You don't need to have it all figured out. Stay curious, ask questions, embrace the challenges and enjoy the little wins along the way.

You've got so much to learn, but also so much to offer.

Welcome to the profession. I can't wait to see the difference you'll make!

Experienced physios, what advice would you give your younger self?

11/11/2026

💉 Is it time we rethink how we use Botox in cerebral palsy?

Botox has been a go-to intervention for managing spasticity in children with CP for decades.

And yes, it works! But there's more to the story.

A 2019 review by Multani and colleagues raises some important questions about its long-term use.

✅ Reduces spasticity in the short term

⚠️ Functional improvements aren't always meaningful or long-lasting

⚠️ Muscle atrophy and changes in muscle composition are real concerns

⚠️ Repeated injections may offer diminishing benefits

I'm not saying we should stop using Botox.

But I do think we need to be more thoughtful about when, why and how often we use it.

Because reducing spasticity doesn't automatically mean improving function.

And ultimately, isn't that what we're trying to achieve?

👇 Comment BOTOX and I'll send you the full paper!

📚 Reference: Multani, I., Manji, J., Hastings-Ison, T., Khot, A., & Graham, H. K. (2019). Botulinum toxin in the management of children with cerebral palsy. Pediatric Drugs, 21(4), 261–281.

https://doi.org/10.1007/s40272-019-00344-8

Are you pro botox??

05/11/2026

Three things I wish I understood earlier about AFOs as a physio working with people with cerebral palsy...

When I first started, I thought AFO prescription was relatively straightforward.

Choose the AFO. Set the ankle at 90°. Recommend how long to wear it.

But then I started seeing AFOs that weren't achieving what I'd expected.

And I began questioning whether I was actually considering the right things.

Here are three lessons that changed how I practise:

1️⃣ Hinged AFOs aren't for everyone. Just because an AFO allows ankle movement doesn't mean that movement will be beneficial. Gait pattern, range of motion and motor control all matter.

2️⃣ 90° isn't a universal target. Gastrocnemius length, stiffness and foot alignment influence how we position the ankle.

3️⃣ Wear time needs a purpose. Rather than automatically prescribing all-day wear, consider what the AFO is trying to achieve and when it will be most useful.

And perhaps the most important lesson?

An AFO prescription isn't finished when the device is delivered.

We need to keep reviewing comfort, fit, function and whether it's achieving the person's goals.

These decisions are best made together with the individual, their orthotist and supporting team.

Save this for your next AFO assessment.

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.

Address

Carlingford, NSW
2118

Telephone

+61410626878

Website

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

Alerts

Be the first to know and let us send you an email when The Disability Physio posts news and promotions. Your email address will not be used for any other purpose, and you can unsubscribe at any time.