AccessCheck

Question 1

How can a general practice improve access to patients with disability

Answer 1

building design

receptionist training and appointment booking protocols

staff training

practice equipment (including adjustable ‘hi/lo’ bed and hoist)

occupational health and safety measures

recall systems

referral pathways

use of MBS items.

Question 2

What questions about Sleep problems would you ask a patient with CP ?

Answer 2

Many people do not report sleep problems and believe they are inevitable for someone with cerebral palsy. The person may only tell you they have disturbed sleep if you ask a second time and ask systematically about:23

difficulties at bedtime

daytime sleepiness

awakening during the night

sleep pattern, including regularity and duration of sleep

snoring.

People with cerebral palsy can have any of the sleep problems seen in the general community, but they are also at higher risk of some conditions, such as restless legs syndrome and delayed response to melatonin.23

They may also experience sleep apnoea, particularly if they are overweight.

Question 3

What issue is common in patients with kyphoscoliosis

Answer 3

Reflux oesophagitis is particularly common in adults with kyphoscoliosis.

Question 4

Which specific conditions would you ask about in a middle age patient with CP

Answer 4

back pain – risk increases with age27

conditions associated with poor circulation (eg leg ulcers, painful chilblains)27

continence problems (including treatable) – these may emerge as people age27

hip – Some adults with cerebral palsy may have subluxation or dislocation of hips, especially if hip surveillance was not available or provided when they were young. 22 Hip subluxation or dislocation should be considered in any adult with cerebral palsy who does not walk or has reduced range of hip movement.22