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June 21, 2016

Carte Blanche Broadcast on ABR Method

This is for all our parents that have asked questions regarding this past Sunday’s Carte Blanche segment on the ABR method for children with CP.

Dear all Paeds Members,

Concerning tonight’s Carte Blanche segment on the ABR method for children with Cerebral Palsy, the Paeds SIG GEC will be contacting CB to correct the statements made and provide clarity on our treatments and the approach mentioned. We will push for a public corrective broadcast. Please read the draft letter blow, add comments or email input to paediatrics@saphysio.co.za.

Dear Carte Blanche

We are the Paediatric Physiotherapy Group of the South African Society of Physiotherapy. As a member organization and NPO, we represent Physiotherapists in South Africa working with infants and children in both the private and public sector. Our aim is to protect, enhance and promote our profession, whilst ensuring the education and empowerment of the public.

Unfortunately your broadcasted segment on the ABR approach on Sunday 12 June 2016, contained some very incorrect facts on Paediatric Physiotherapy (amongst one of the mentioned conventional or recommended treatment approaches for infants or children with Cerebral Palsy) including uninformed statements without any objective input, expert opinion or research on the conventional therapy approaches and the ABR method being reported on.

As the segment stated, ABR – Advanced Biomechanical Rehabilitation, is a physical rehabilitative approach concerning working on the body’s connective tissue system. It was however incorrectly reported that Physiotherapy (and the other conventional therapies) is only focussed on the brain and have no regard for and does not treat the biomechanical or connective tissue system of infants and children with Cerebral Palsy. This could not be further from the truth as Physiotherapy sees and aims to treat the body as a whole, that is our focus. We always have to start with the foundation to movement and function, on a tissue level. There is no rehabilitation without first attending to and correcting the soft tissue and connective tissue imbalances that exist underlying to a condition. For Cerebral Palsy, this includes muscle tone imbalances (e.g. spasticity), muscle length problems (e.g shortened muscles and contractures), connective tissue laxity or stiffness (refers to structural problems leading to excessive tightness or looseness of fascia, ligaments, tendons), neural tension (refers to shortened nerves and stiffness as they move through the connective tissue system) and joint malalignment or stiffness (refers to poorly positioned joints, stiffness of the joint capsules and fluid dynamic problems inside the joints).

Physiotherapists all focus on biomechanical function, which involves the soft tissue, neural and the connective tissue systems as the body’s framework and the foundation to movement and rehabilitation. Therefore Physiotherapists spend a lot of time doing hands-on physical treatments on the body, addressing and improving the biomechanics including using various positions and other manual techniques to create a good foundation for movement. When the biomechanical foundation is created we start working on movement and ultimately function using neurodevelopmental therapies or motor learning approaches for neurological conditions.

To summarise, Physiotherapists do work on the biomechanics in addition to neurorehabilitation, we just do not label it as ABR, we call it manual joint mobilisastion (spinal and peripheral), dynamic stretching, selective muscle control and stabilising muscle work (core and stabilisers), muscle tone correction and facilitation strategies (manual techniques, electrostimulation and kinesiotaping techniques), proprioceptive and sensory work, soft tissue mobilisation, myofascial release and neural tissue mobilisation (neurodyamics). Furthermore as ABR states they uniquely work with families as an at-home therapy, we also train and educate parents and caregivers on positioning, handling, correcting muscle tone, stretching and joint mobilisation, myofascial release techniques, including therapy activities and play.

It should also be noted that the objective scientific evidence by means of research on ABR is severely lacking. Thus, this is not an evidence based approach, which means it is not an accepted scientific therapeutic or rehabilitative approach that has been tried and tested. They only mentioned one study in the segment, and that is the only research on this. When we look at evidence to support a treatment approach we want multiple high quality research studies and review publications summarising the evidence over a period of time to draw a conclusion whether its an effective approach alone or in combination with other approaches. Without research it is just an alternative approach with lay opinions. Thus there is currently no need for the ABR approach to be taught to Paediatric Physiotherapists in South Africa.

This segment on Carte Blanche did not get the opinion from the SASP or SA Paediatric Physiotherapists nor did it truthfully inform the public what our therapy approaches are about. It also did not research the subject and components mentioned or other therapies objectively.

We urge you to consider a corrective broadcast as the information you provide the public must be true and correct whilst having some sort of research and objective journalistic value. It is important that the public and more so, the highly influential parents your programme reaches are provided with the whole story, without dismissing evidence based recommended effective approaches and sugar coating an approach like ABR. This can cause undue stress and anxiety to parents doubting their current therapist/s approach and look into going to extremes to get these alternative practices and therapies for their children.

We trust you will do what is right.
Kindly contact us if you would like any more information or to discuss the contents of this letter

Sincerely

Chantelle van den Berg
Chairman – Paediatrics SIG GEC

On behalf of The Paediatrics Physiotherapy Group
A Special Interest Group of The South African Society of Physiotherapy