Shail Maharaj, Physiotherapist

Shail Maharaj is a paediatric physiotherapist who works with children with limb difference at Lady Cilento Children’s Hospital in Brisbane, within the Queensland Paediatric Rehabilitation Service. In this article Shail shares his professional story, his role in the lives of children and family, emphasises the importance of early intervention and ‘whole-of-team’ healthcare support, and reflects on advances in prosthetic technology.

What are you qualifications?

I completed a Bachelor of Physiotherapy with Honours in 2001. Since completing my tertiary studies I have also undertaken additional training in physiotherapy to ensure that I remain abreast of changes in the field, and in particular the paediatric physiotherapy arena.

I have also undertaken post-graduate studies in Paralympic Classification, which means I am accredited to assess and classify Paralympic athletes. Currently I classify athletes in Boccia (a wheelchair based sport) and Wheelchair 7-a-Side Football (soccer). I really enjoy being a classifier as it allows me to guide children into sports from a participation level all the way through to representing their country. I also get to meet professionals and athletes from all over the world.

Why did you choose to study physiotherapy?

To be quite honest when I finished my secondary studies I really wasn’t sure what I wanted to do. I had never undertaken work experience in physiotherapy whilst I was at school, so it wasn’t on my immediate post-school studies radar.

However, towards the end of my secondary schooling I looked into physiotherapy and, after learning more about it, I though it did sound like something I might be suited to. I wasn’t interested in a ‘desk job’ and I really enjoy talking to and helping people; so I decided I would enrol in a Bachelor of Physiotherapy. When I started the course I still wasn’t completely sure if physiotherapy was for me; that was, until I completed a subject called ‘Physiotherapist - Teacher of Movement’. This subject made me aware that physiotherapy is about more than just ‘sports physio’ but also about mentoring patients to achieve goals in many areas. After completing that subject I was hooked and knew I had chosen to enter into a profession that would be my career for life. Indeed the notion of ‘Teacher of Movement’ is my own professional and personal ethos now.

Why did you choose to then focus on paediatric physiotherapy?

In my final year of physiotherapy studies I was required to undertake eight placements in a variety of settings ranging from hospitals to rehabilitation facilities. I completed placements across a number of disciplines, ranging from geriatric to paediatric physiotherapy. To be honest, until I completed a placement in paediatrics I had never really considered it as an area I was interested in.

I was very fortunate to complete a placement at the Royal Children’s Hospital in Brisbane (which has now merged with the other major children’s hospital in Brisbane and is called The Lady Cilento Children’s Hospital) and found that working with children brought me a lot of personal and professional joy. It was a joy to assist children to get better physically and help them achieve their goals (and have fun at the same time!). It was then that I decided paediatric physiotherapy was the field I wanted to pursue and I was lucky to be offered employment at the Children’s Hospital once I received my degree.

What is your role in working with children and families with limb differences?

I wear a couple of hats at work. I am Clinic Coordinator and the Senior Physiotherapist in the Limb Deficiency Clinic within the Queensland Paediatric Rehabilitation Service at the hospital. I also work with children with brain injury, spinal cord injury and cerebral palsy.

As a physiotherapist I work with children and young people with limb differences, as well as their families. This happens as early as when the family first find out that they will soon be welcoming a baby with limb difference into their lives. As a team we provide education and anticipatory guidance and then see the family soon after their child is born. We then follow these families all the way through their growing years until they leave high school.

I also work with children and families pre and post a limb amputation by preparing them for upcoming surgery and initiating training soon after a child’s amputation. I work with children who have a congenital or acquired limb difference to determine whether a prosthesis is suitable and, if so, assist them to learn how to use it. Overall, what we work on is shaped by what the child and family are hoping to achieve. This may be achieved through prosthetic training, aids and adaptations or simply advice.

As the Coordinator of our Clinic I also undertake managerial and advocacy tasks. I coordinate the incredible team of professionals who form part of the Clinic. I also sit on some Advisory Boards, sit on the Committee of the Queensland Artificial Limbs Service and try to advocate on behalf of patients and colleagues when I can.

Although I have a few roles, put simply, I see my job as being someone that is there to maximise functions and expand the horizons of children limb difference and their families. I want to see that all of the children that I work with receive the support and education they need to meet their goals and aspirations.

What other professionals work with you deliver best outcomes for children?

We take a multi-disciplinary approach to supporting children with limb difference in our clinic. I’m fortunate to work with experts in Rehabilitation including Rehab Medical Consultants, Nursing, Occupational Therapy, Social Work, Neuropsychology, Rehab Engineering, Prosthetics and Orthotics. By having a ‘whole of team’ approach we can provide a developmental service that addresses the individual needs of not only the children and young people but also their families.

As a child grows they might require additional support in particular areas, whether it is physical or emotional, and we can facilitate this quickly because of the array of experts that form that work within our service.

Why is early intervention important for children with a limb difference and their families?

Early intervention is critical as it means we can give children and families timely assistance, advice and support and by doing so hopefully mitigate issues down the track.

Often we see parents before their child has been born and just after they have learned their child will have a limb difference. Naturally, when parents learn their child will have a limb difference they have lots of questions, can feel quite anxious and are keen to learn what this will mean for them and their child. So, by working with parents at this early stage we can help to minimise fears, build an early rapport between the team and the parents and ensure they feel supported prior to their baby’s birth.

Once a baby is born with a limb difference or acquires one during childhood we then aim to provide support immediately. Although not all children will use a prosthesis we know that when it is suitable it is critical to encourage a child to accept and use their prosthesis as soon as possible. In my experience, early acceptance of a prosthesis generally leads to positive physical and psychological outcomes for children. We know that children both ‘learn to move’ and ‘move to learn’ and so we try and get in as early as we can to ensure that this is happening well (with or without a prosthesis).

We also know that for positivity to occur it is important that parents, siblings, extended family and friends also accept the child’s prosthesis and encourage him or her to use it. In addition to parents, siblings can play a vital role in assisting a child to accept their limb difference and we try and involve all members of the family. Because siblings play a significant amount of the time together we have found that educating siblings can often be just as important as educating and training parents. By taking a ‘whole of family’ approach we can help to ensure that all members of the family have a positive attitude towards a child’s prosthetic use.

At our Clinic we like to work with the entire family as we know that by doing so the child we are supporting will generally have positive lifelong outcomes.

How do you involve ‘the whole family’ in maintaining good physiotherapy activity in the home?

I’m the father of three young children myself, so I know just how busy households can be! In our Clinic we understand that and we try to get to know each family so that we better understand their household pressures and interpersonal dynamics.

By understanding family needs we are then better placed to develop physiotherapy activities that can be integrated into the everyday household or structural environment. We often try and involve siblings in this planning, as siblings can be incredible supports to brothers and sisters with limb difference and can even join in on physiotherapy activities – making it a fun, rather than disliked, activity!

Are there any new developments in the area of limb difference that excite and interest you?

I think one of the most interesting areas right now, and into the future, are 3-D printers. We are just now starting to see how these can benefit amputees and children with limb difference. We actually have a few producers of this technology in Australia which is very exciting.

I think the advances in recreational prosthetic limbs are also very exciting. More and more children are now able to use a suitable recreational limb that then allows them to participate in the same activities as their peers. This is not only beneficial from a physical body perspective but also from a wellbeing perspective. It means that children with limb difference are getting more opportunities to ‘try new things’ and ‘have a go’.

While the National Disability Insurance Scheme (NDIS) isn’t fully rolled-out I think this marks a new era for disability support in Australia. I think the NDIS has the potential to provide great support to children with limb differences and ensure that they have adequate support throughout their lives.

Any final comments?

I’m really proud of our Clinic and the work we are doing. However, we know we can still improve things and make our service better – we are never fully satisfied and want to ensure the needs of all of our children and families are met.

I believe that partnering with Limbs 4 Life and other community organisations allows us to provide the support we can’t offer in a hospital and rehabilitation setting. The Limbs 4 Kids program, website, Fact Sheets and peer support opportunities are resources we can’t offer. But by working collaboratively we can provide full-service support to parents and for that we are truly grateful.