Cate’s incredible career of caring for children

 

New guidelines for stroke rehabilitation for children define best practice for the long-term care of children who have a stroke, estimated to number about 100 each year in Australia. APA member Cate Clancy was a part of the multi- professional team which helped to develop the guideline.

Parents love to show family and friends videos of their child’s milestones, such as beginning to crawl or taking their very first steps, but a select group of parents also love sharing those videos with Cate Clancy specifically. That’s because Cate has been instrumental in helping their babies learn how to walk, crawl or better manage their functional challenges.

As a senior physiotherapist at Monash Children’s Hospital, Cate helps many children experiencing a range of issues including stroke, acquired brain injury and cerebral palsy. Her clinical caseload focuses on improving children’s function and participation through a collaborative approach that includes allied health professionals, medical staff and most importantly, the parents and child themselves.

Proudly displayed around Cate’s office are photos of children she has treated, photographs sent to her by grateful and proud parents who acknowledge her important contribution to their child’s progress. Her email inbox often contains videos from parents of children she has helped throughout her career in paediatrics; just this week she delighted in a video sent to her of a little girl crawling for the first time.

‘She’d had a stroke when she was a baby and had a lot of trouble organising her body on the right side to do what it should do,’ Cate says. ‘We’d worked and worked on her crawling and motor planning. To be included in that email, sent by the family, is a real privilege. Seeing that progress and receiving comments such as “We know she wouldn’t be there unless you’d helped us to learn how to help her” is pretty special.’

What underlines Cate’s work in paediatrics is her desire to help children achieve their maximum potential. Her vast experience has taught her that one of the best things she can do is teach the family of her young patients how to help their child. Empowering the family network through education has become an important tool in her clinical toolbox. She might treat the child for an hour a week over six weeks but teaching their parents and carers how to get the best function and participation from that child on a daily basis is what makes the real difference.

‘A family knows their child best. And nothing you can offer, academically and intellectually, is as valuable as what they know about their child individually,’ Cate says. ‘When you acknowledge that, that’s really powerful. You say to parents “What can you tell me about your child? You know them the best. I’m going to assess with some tools that I have, and let’s bring that information together”.

‘It’s wonderful when you can help them, and you see the lightbulb moments where the parents say “Oh, I saw them [child] do this”. I suggest the next challenge, and then they meet that challenge. I say to them “You’re there, you’ve got your instinct, trust yourself”. That’s fabulous, when we know that the family can identify and set up the next level of progression for their child.’

As a young woman, Cate had a sense that her life would involve working with children; her mother Helen was a nurse and in Year 10 Cate had the good fortune of undertaking work experience with a paediatrician in the neonatal unit at Mercy Hospital for Women, East Melbourne. She learnt that the journey to medical paediatric specialty would take years and the brief time she spent in the hospital’s physiotherapy department, as part of the experience, left a lasting impression on the teen. ‘Seeing the paediatric physiotherapists working was a wonderful opportunity for me. I saw their positive approach to helping children improve,’ Cate says.

Cate graduated with a Bachelor of Applied Science (Physiotherapy) from La Trobe University in 1998 and immediately joined South West Healthcare in Warrnambool, along the picturesque Great Ocean Road in Victoria. The role exposed Cate to the vast opportunities within the profession as she completed rotations in inpatients, outpatients, hydrotherapy, adult rehabilitation and more. She was on the road seeing patients in rural community centres, working with people of all ages and building the skills and knowledge that propelled her career forward.

‘By then, I’d had a wonderful four years of physio at La Trobe. I enjoyed working in neurology, respiratory and women’s health, so I was open- minded about what I did,’ Cate says. ‘In paediatrics, I have found that my adult-based experience in cardio, respiratory, neurology and musculoskeletal has been really helpful for my skills and knowledge— you bring all of those things into paediatrics in the next layer of speciality. It is important to acknowledge that the child is not simply a little adult though. Their bodies are growing and work differently.’

After 18 months with South West Healthcare, Cate joined the staff at Monash Medical Centre as a Grade 1 in the rotations program,

again exploring the scope of the profession in its entirety. Her role was incredibly diverse; she worked in the neurosurgery/neurology wards, intensive care, general medicine, and as the ‘annual leave reliever’. ‘The annual leave reliever role offered a different clinical area most weeks and built your flexibility and adaptability,’ she says.

It was during this period that Cate’s interest in both paediatrics and stroke rehabilitation began to build. Like most people, Cate had little realisation that children, not just adults, suffered strokes. She continued to work rotations at Monash Medical Centre, all the while building up a solid knowledge base covering the broad scope of physiotherapy.

With her new-found experiences under her belt, Cate and her partner Gus decided to grab their passports and head overseas on working visas. The couple moved to London in 2002 and Cate soon found herself at the Portland Hospital for Women and Children after a brief stint at the Royal Hospital for Neuro-disability in Putney. The Portland, a private hospital, offered Cate new clinical opportunities. During her almost two years there, she treated children after spinal surgery, orthopaedic surgery and with neurological disability. Her patients included embassy-sponsored families from the Middle East, arriving in the UK for surgery and rehabilitation. That she was part of a strong multidisciplinary team in a collegiate environment with consultants and clinicians left a lasting memory on Cate.

While in London, Cate’s partner Gus proposed. As their UK odyssey drew to a close, an advertisement for a job in paediatrics back at Monash Health caught Cate’s eye. She recalls getting up in the middle of the night UK time to do a phone interview with her Australian counterparts, and receiving the subsequent job offer while travelling in Tanzania the following week.

‘We wanted to come back home, mostly for family reasons,’ Cate says. ‘We had a fabulous time overseas and it was a great experience but Australia is a wonderful place to live and our healthcare system is very good, particularly in terms of the multidisciplinary management we can offer.’

 

‘I found that in paediatrics, having had that adult base in cardio, respiratory, neurology and musculoskeletal physio has been really helpful for my skills and my knowledge.’

Cate re-joined the team at Monash as a Grade 2 in paediatrics around the time the Victorian Government was overhauling children’s health services in the state, and Cate relished being involved in the stakeholder consultation process. A statewide model of care emerged, and in 2007 positions opened up with the Victorian Paediatric Rehabilitation Service (VPRS). Cate was the first physiotherapist from Monash Health appointed to the VPRS as a senior clinician, alongside Brian Hoare, occupational therapist, who remains a valued colleague. Together with an equivalent physiotherapist and occupational therapist at The Royal Children’s Hospital, the VPRS allied health group was formed.

In 2010, Cate was looking to expand her knowledge in paediatric rehabilitation and felt very privileged to be accepted into the Graduate Diploma of Neurological Rehabilitation (Paediatrics) at the University of Western Australia. The Diploma was taught by Associate Professor Sarah Love, a paediatric physiotherapist and researcher whom she highly admires. ‘Completing the diploma over two years while pregnant twice was challenging but highly rewarding!’

With many physiotherapists now working in the VPRS, Cate brought her knowledge back to share with the team. Together with her talented colleague Janet Hough, Cate continued to mentor other physiotherapists to specialise in paediatrics. Teaching and mentoring continues to be a highlight of Cate’s role.

In 2016, Cate joined the clinical advisory group which developed the Subacute Rehabilitation of Childhood Stroke clinical guideline (tinyurl.com/yyl9fmnu), working with colleagues from the VPRS, the Royal Children’s Hospital and the Murdoch Children’s Research Institute to develop the key resource for the Victorian Stroke Clinical Network. The advisory group comprised physiotherapists, senior medical consultants, occupational therapists, music therapists, speech therapists and more. Cate was the lead on the motor sub-group and a key contributor to the recreation and leisure group during her 18-month involvement with the ground-breaking project.

‘We had physiotherapists and occupational therapists working together in our motor sub-group, because we obviously both work on the physical impacts of stroke. We searched and reviewed the published evidence around paediatric stroke.

There wasn’t a lot to be found, which was quite disappointing,’ Cate says. ‘We then embarked on a Delphi survey process to determine expert consensus. The guidelines were developed as a tool for all hospital and community-based health professionals to ensure best practice care of children with stroke.’

With as many as 100 children a year suffering stroke in Australia, Cate says the challenges for clinicians are many, not least of which is countering perceptions that strokes don’t happen in children. Another misconception is that the recovery for children who have suffered a stroke is similar to adults.

‘An adult has a stroke, and the job of the physio is to help them to regain the skills they’ve lost,’ Cate says. ‘The difference— and it’s a huge difference—with a child, is that the child is yet to learn those skills. So, if they have their stroke at four weeks of age, they’ve not yet learnt to hold their head up in sitting, let alone to walk, talk or eat. We’re conducting rehabilitation, or habilitation, in the setting of a child not yet knowing those skills.

‘We need to teach them strategies to learn the essential activities of childhood, keeping in mind their individual limitations. There’s no recipe for stroke rehab in children.’

 

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