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Referral Tips for Therapists PDF Print E-mail
Written by Administrator   
Tuesday, 17 January 2012 02:53

If a child does not meet the age-appropriate motor development milestones, it may be a sign of a serious neurological or neuromuscular disorder. Signs of weakness should be followed up with an evaluation by a specialist.  Early diagnosis of neuromuscular disorders is important because it helps target interventions, improve outcomes, reduce family distress related to the diagnostic process, and provide the opportunity for accurate genetic counseling.

Therapists are perfectly placed to facilitate this conversation between referring providers and parents. They have the professional background and medical knowledge to raise concerns with referring physicians and have the rapport and training to help guide families through further evaluations and diagnosis.

When you identify significant concerns about motor development that suggest motor weakness (as opposed to coordination issues) consult with the parents and (when relevant, after receiving the guardian’s permission) the referring provider

Strategies for communicating your concerns to the referring provider:

1.     Give specific reasons for your concerns.

Describe red flags for muscle weakness that should prompt a referral to a specialist for evaluation:

  • Unable to support head when pulled to sit by 5 months
  • Unable to sit independently by 7 months
  • Unable to rise to stand without support by 18 months
  • Unable to walk with normal posture or gait by 18 months
  • Unable to run (both feet off the floor) by 2 years
  • Unable to jump (both feet off the floor) by 2.5 years or hop (on one foot) by 4 years
  • Unable to climb steps with alternating feet by 3.5 years

Also communicate with the family and provider any yellow flags that increase your concern about muscle weakness.

2.     Use results of standardized testing to support your concerns.

  • Using a standardized tool to make an overall assessment will give you a percentile function of age; this gives you and the referring provider a context in which to understand the child’s development.
  • Note: Because some concerns focus on the quality of movement (how they do it, not whether they can), not all children with red flags will score below age norms on standardized testing. If you obtain a score within normal limits but the child has a red flag, the child generally still needs to be evaluated.
  • Always evaluate function compared to peers and in context of environmental factors, and track development over time.

Following are some key phrases suggested by experienced therapists to facilitate these discussions with the referring physician. 

  • I’m concerned that this looks like weakness, and not a problem with coordination. I see these signs of muscle weakness: __________.
  • Have you already ruled out___________?
  • Have you already done a CK? 
  • Can we rule out________ (a neuromuscular disorder, muscular dystrophy, etc)? It may be unlikely, but I am worried because I see these things: (list). 
  • I could target my therapies more appropriately if we rule out __________. I want to make sure this is not a problem with muscle weakness so I can provide the appropriate intervention.   Strength building could cause muscle damage if a child has muscular dystrophy.

Other suggestions of how to communicate concern to the referring physician are provided under each red flag category.

Strategies for communicating your concerns to parents:

Families often work with the same therapist over an extended period of time, and many families report that they are very comfortable speaking with the therapist. When possible, build upon your history with the family as you bring up your concerns.

  • Ask families what concerns they have, and what problems they have noticed; for example,“Have you noticed that [name] moves or plays in different ways than his siblings or peers?”
  • Validate family concerns by saying, “I’ve noticed that too.”  Rephrase concerns to make them more specific when needed, for example, “I know, he looks strong but he is overusing some other muscles to make up for weakness in his legs and chest.”
  • Explain (in non-technical language) and/or show parents the findings (test results and clinical observations) that support your concerns.
  • Encourage families to ask questions and give them multiple opportunities for questions throughout your conversation.  Invite them to contact you with any further questions.  Often, in the wake of a new concern, families are too distressed or confused to listen carefully and remember what you say.
  • Help families understand your observations/assessment results and assist them in planning for the next steps (such as contacting their physician, making an appointment with a specialist).
  • Guide families as they consider how to speak with other healthcare professionals about their concerns.  For example, you might say. “When [name] goes in for his check-up visit next week, it would be a good time to tell his doctor about the concerns we have for his muscle weakness.”  Support families as they process new information you share, as well as any recommendations that involve further testing.  Let them know that you are willing to contact their doctor to share your observations.  Ask the family to keep you up to date on decisions so you can work together on finding the most effective therapy for the child.

Remember:Families are referred to you for a reason; they are aware that there is some concern with their child’s development. You are helping to clarify a reason for their child’s delay.

For more information and examples of how to communicate with the family, visit the “Supporting Parents” page.


Last Updated on Monday, 20 August 2012 18:47

Did you know?

Red flags for prompt referral to a specialist (consider pediatric neurology) include: Tongue fasciculation; loss of motor milestones; CK>3 times normal