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PaediatricAug 31, 2021

After 40 years in practice, dyspraxia expert Michele Lee tells Ian A McMillan about her career highs

Michèle Lee has carved out an enviable career establishing a private physiotherapy service for children with dyspraxia and their families in Buckinghamshire. As well as forging links with the Dyspraxia Foundation and colleagues in the paediatric speciality, she has gained a reputation as an international trainer, editor and author. Here, in a Q&A with PhysioUpdate editor Ian A McMillan, she urges like-minded physios to develop a clear career pathway once they have recognised their ultimate goal.

'Watch this space'. Michèle Lee is taking stock after four decades in physiotherapy

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Tell us about your early career and what did you learn?

After qualifying at The Royal London Hospital (now part of Barts Health NHS Trust) in 1981, I moved to the Royal United Hospital in Bath and decided to specialise in paediatrics. Next, to further my experience, I worked at the Great Ormond Street Hospital for Sick Children, before moving into the community in the east London borough of Newham. 

I was then appointed superintendent at the Portland Hospital, a private hospital in west London. After my first son was born, I worked part time in a job share as a paediatric superintendent with The Royal London Hospital’s community services.  

My advice to recent graduates would be to embrace your experiences and, if you find a particular area of interest, work out a clear pathway for your career plan. Physiotherapy is a very rewarding career.

When and why did you set up a private practice?

I set up my private practice in 1995 when we relocated to Buckinghamshire. Having a young family, I wanted to work within school hours, something that would have been a challenge in the NHS! I therefore decided to set up a private practice to allow me to control my working week.

In my community post in Newham, I had been referred children with diagnoses of dyspraxia. At that time, there was very little information on treatment options, and I found myself researching and discussing the management and treatments with colleagues. Jenny French and I then wrote a handbook for physiotherapists, published by the Association of Paediatric Physiotherapists (APCP), with assessment and treatment suggestions. I updated Coordination Difficulties: Practical ways forward in 2004. It is available through Amazon. 

Continuing in private practice as a paediatric neurological physiotherapist, I worked from home and carried out home and school visits. Working with a team of educational psychologists and consultants I continued my real love of working with those with developmental co-ordination disorder (DCD)/dyspraxia. [DCD is the preferred medical term for dyspraxia].

I also give lectures to physiotherapists, occupational therapists (OTs) and school staff locally, around the UK and abroad. It is very fulfilling with nothing more rewarding than seeing children become confident and successful in their daily lives.

What do you offer children and families that’s different to OTs or the NHS?

The European Academy of Childhood Disabilities (EACD) guidelines outline the diagnosis, assessment and treatment for DCD. As part of the assessment, a standardised assessment (commonly the Movement Assessment Battery for Children – 2) is carried out, either by a physiotherapist or OT. This forms part of the diagnosis (a paediatrician must confirm that the difficulties are not due to another condition). In many areas, patients see either a physiotherapist or an OT and a number of services in the NHS offer combined clinics.

Both therapies play an important role in the overall management of these children. Each child is individual so services should be tailored to meet their needs. While OTs generally consider activities of daily living, fine motor skills and sensory difficulties, physiotherapists usually concentrate on physical activity, gross motor skills, stamina and coordination. This is vital as these children are more likely to be hypoactive and are four times more likely to be obese. 

The EACD guidelines state that physical fitness should be considered as part of the intervention planning(strength, endurance, flexibility, for example). Various research articles support the effectiveness of physiotherapy and, in my view, both services are imperative to provide an effective overall management of these children.

At our practice we are part of the assessment team and offer an eight-week block of treatment (incorporating a daily home programme), a review 12 weeks later and then six-monthly reviews for long term management. This is crucial. We need to support the child, parents and all those who work with them throughout their childhood. We also work closely with private OTs in the area.

Could more be done to improve collaboration between treatments for children in the private sector and the NHS?

As private practitioners we are used to liaising and working closely with NHS teams for all our patients. Communication is key and standardised channels for doing so would benefit everyone.

The Dyspraxia Foundation, a nationwide charity, offers fantastic support and advice to parents and individuals with dyspraxia/DCD and works to improve understanding of the condition by professionals. I have been involved with the charity for 26 years – as a trustee, chair and, more recently, as a patron, plus being the editor for the professional journal and an adviser on the medical and research panels.

Why was important for you to join the APCP? 

A member of the APCP professional network for many years, I have served on their national committee as secretary and public relations officer. The network, which is recognised by the Chartered Society of Physiotherapy, offers great support, education and resources – especially as a member of the private physiotherapy group (PIPPS). 

What did receiving an MBE mean to you? 

Being awarded an MBE in recognition of services to the Dyspraxia Foundation and in the assessment and treatment to work in the field was a great privilege and be able to share my experience and knowledge with others.

What are your plans for the future?

That is a tricky question as I love my work but, after more than 40 years in physiotherapy, I’m ready to reduce my working hours to spend more time with my granddaughter, family and at our home abroad. I intend to continue to support the Dyspraxia Foundation as much as I can. I think it is a matter of ‘watch this space’!

For more information about the APCP, visit: https://apcp.csp.org.uk

For more information about the Dyspraxia Foundation, visit: https://dyspraxiafoundation.org.uk

Michèle Lee, MBE, MCSP, GradDipPhys, is based at Lee Medical Paediatric Physiotherapy Services in Denham, Buckinghamshire. Visit: http://dyspraxia-dcd.co.uk

Author: Edited by Ian A McMillan
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