With dedicated physiotherapists such as Lisa Bleus in Perth and Victoria Linton APAM in Adelaide at the forefront, Little Big Steps is reshaping the recovery experience for children with cancer and their families and caregivers, demonstrating the power of movement and exercise in transforming young lives.

‘Cancer care is often thought of as being about medicine but the ability to move and stay active is just as critical,’ says Lisa, a senior physiotherapist at Perth Children’s Hospital. 

Supported by Little Big Steps, Lisa’s role bridges the charity’s mission and the hospital’s resources to help children remain physically active during their cancer treatment. 

Lisa has worked with children with cancer since 2010 and highlights the profound impact that physiotherapy has on these patients.

‘Our goal is to keep kids doing the things they love, ensuring they’re in the best possible condition once treatment ends. 

'This is about giving them hope and joy, even during the darkest times,’ Lisa says. 

Lisa Bleus.

‘And as a physio it is actually a very interesting space to work in because cancer can affect any part of the body. 

'We get to use all of our clinical knowledge in musculoskeletal, orthopaedics, neurological, medical, continence, chronic pain—you’re really pulling everything together.’

Victoria, who has been working as a senior physiotherapist at the Women’s and Children’s Hospital in Adelaide since June, shares a similar perspective. 

‘Cancer disrupts a child’s typically active and happy life,’ Victoria says. 

‘Our role is to address deconditioning, fatigue and mobility challenges while ensuring that children and their families feel supported throughout their journey.’

Like Lisa, Victoria values the importance of integrating tailored exercise programs into each child’s treatment plan. 

‘Whether it’s using activity trackers, virtual reality headsets or creative play-based therapy, our interventions are designed to motivate children and help them regain confidence in their bodies,’ she says.

Little Big Steps was created by two mothers, Cass Howcroft and Cindy Bakos, who recognised the gap in movement and exercise programs for children undergoing cancer treatment, each having experienced it with their own child. 

With a mission to provide physiotherapy support to children with cancer across Australia, the charity now funds dedicated physiotherapy positions in tertiary hospitals in Perth, Adelaide and Sydney and a PhD student in Melbourne and plans to expand to Tasmania and Queensland.

‘The charity was started up by two mums whose kids both had cancer and they felt that there should have been more
opportunities for their kids to move. 

'They identified a real gap in paediatric cancer care so they started this charity,’ Lisa says. 

‘They have been approaching the different tertiary sites across Australia, offering to fund positions for physios to support their agenda of helping kids to move more.’

Little Big Steps chief executive officer Dr Shane Huntington says the charity’s ultimate goal is to ensure that every child with cancer in Australia has access to a physiotherapist. 

‘We’ve gone from supporting just a few children five years ago to reaching about a third of paediatric cancer patients today. But there’s still so much to do,’ Shane says.

Physiotherapy in the paediatric oncology space involves more than traditional rehabilitation. 

As Lisa says, ‘Cancer can affect any part of the body so we draw on all areas of our clinical expertise. 

'From musculoskeletal and neurological issues to chronic pain and orthopaedics, our approach is holistic and tailored to the individual child’s needs.’

One of the key focuses of their work is educating families and caregivers about the benefits of their child staying active, even during the treatment phase. 

Lisa recalls one patient, a young boy with leukaemia, who was initially too afraid to move due to his parents’ concerns about safety. 

‘Through education and small interventions, we helped him regain his confidence. Within months, he was participating in school sports and feeling optimistic about his future,’ Lisa says.

Victoria’s approach is similarly centred on collaboration with families. 

‘It’s about empowering caregivers with the knowledge and tools they need to support their child,’ Victoria says. 

‘We provide clear and adaptable guidance, ensuring that parents feel confident in encouraging movement at home and within their community.’ 

The use of innovative tools such as virtual reality games and step trackers has proven particularly effective in engaging children who might otherwise be reluctant to participate. 

‘These tools help to make physiotherapy and activity more fun and achievable,’ Victoria says, recalling a young patient’s excitement at meeting daily step goals.

Beyond the immediate physical benefits, physiotherapy has a profound impact on the emotional and psychological wellbeing of young patients. 

‘Movement gives children a sense of control and hope,’ Lisa says. 

‘During treatment, so much is happening to them. Physio allows them to do something for themselves and that’s incredibly empowering.’ 

Victoria echoes the sentiment, highlighting how tailored exercise programs can alleviate treatment-related fatigue and improve overall quality of life. 

Victoria Linton.

‘When children see that they can still achieve milestones—whether it’s running, playing with friends or simply walking to school—it restores their confidence and brings joy to their journey,’ she says.

However, the work is not without its challenges. 

Both Lisa and Victoria note the delicate balance required to match therapy with the fluctuating health and energy levels of their young patients. 

‘It’s a roller-coaster,’ Lisa says. ‘We’re constantly adapting to where the child is in their treatment. 

'Sometimes it’s about pushing them gently; other times, it’s about sitting back and supporting them through rest and recovery.’

Victoria says that working in a multidisciplinary team is essential. 

‘We collaborate with doctors, nurses, occupational therapists and music and play therapists to ensure that our approach is comprehensive and aligned with each child’s overall care plan,’ she says.

Despite the hurdles, the rewards of working in this space are immense. 

Lisa recalls the transformative impact of children returning to see her years later, thriving and full of life. 

‘They come back to thank us and often we barely recognise them because they’ve come so far,’ she says. 

For Victoria, the most fulfilling moments are seeing families reclaim a sense of normalcy. 

‘One family, initially unsure if their child would ever leave the hospital, was eventually able to take a trip interstate,’ Victoria says. ‘Together, that’s the power of what we do.’

Little Big Steps’ plans for expansion highlight the growing recognition of physiotherapy’s role in paediatric oncology. 

Shane says partnerships and funding, through donations, are vitally important to the charity’s vision. 

‘We rely on generous donors and grants to support our work,’ he says. 

‘Every contribution helps us reach more children and families, providing them with the support they need to navigate the challenges of cancer treatment.’

The message from Lisa, Victoria and Shane, a physicist by background, is clear: movement matters. 

Through physiotherapy and exercise, Little Big Steps is not only helping children to survive cancer but also enabling them to thrive. 

‘This is about giving kids the best chance at a full and happy life. And that’s worth every step of the journey,’ Lisa says.

Getting the ball moving

Little Big Steps is all about physiotherapy and its movement towards holistic care for children with cancer. Here are a few insights into the charity.
•    The charity works with hospitals and local communities to reintegrate children into normal life, ensuring that they thrive physically, socially and emotionally post-treatment.
•    Currently supporting children in three states, Little Big Steps plans to expand its services nationwide, with Queensland and Tasmania next on the list.
•    Partnering with institutions like the University of Melbourne, the charity integrates cutting-edge research into its programs, enhancing outcomes for young patients.

Click here to find out more about Little Big Steps and its team of physiotherapists.

COURSE OF INTEREST: Cardiotoxicity and the role of exercise in cancer