How physiotherapy insight strengthens case management for complex lives

By Katy Duncanson, ILS Case Management

The transition from paediatric to adult services marks an important stage in life, but for young people with complex needs, it can bring uncertainty.

Support structures shift – multidisciplinary teams, coordinated care, and proactive planning, often change – and families may face fragmented and often under-resourced adult systems.

Closing these gaps requires collaboration and a commitment to consistent, joined-up support at every stage.

This lack of continuity is what first sparked my move into case management.

After years of working as a children’s and orthopaedic physiotherapist, both within the NHS and privately, I wanted to do more to help individuals and families find their voice, often after years of feeling unheard or overlooked.

While physiotherapy allowed me to support physical recovery, case management offered a broader platform to address the systemic barriers that so often stand in the way of progress.

It was a move that felt both natural and necessary, borne out of a deep frustration and a growing desire to be part of the solution.

From Paediatrics to Advocacy – Physiotherapy Principles in a Broader Role

My clinical background has always centred on supporting children and young people, particularly those with complex physical needs.

In my private practice, I continue to offer community-based physiotherapy for individuals who find it difficult to access clinic-based services, a model that allows for flexibility, familiarity, and a more holistic understanding of each client’s environment.

Understanding the nuances of rehabilitation helps me set realistic goals, and advocate for resources that truly make a difference.

It’s about joining the dots between therapy, equipment, housing, education and emotional wellbeing – because these elements don’t exist in isolation for the clients we support.

Inspired by Case Managers – Why Integration Matters

Working alongside case managers during my time within the NHS, I was struck by the depth of their relationships with clients and families, the trust they built, the consistency they offered, and the fierce advocacy they provided.

They weren’t just coordinating care, they were restoring dignity, fighting for access, and helping people rebuild lives after catastrophic injuries or birth-related trauma.

This level of advocacy resonated deeply with me.

Katy Duncanson

Now as a case manager myself, I see the power of integration every day.

My clinical experience continues to inform everything I do, from understanding the nuances of rehabilitation to recognising the emotional toll of long-term disability.

At its heart, this transition is about continuity. It’s about ensuring that the support we offer children doesn’t disappear the moment they reach adulthood.

It’s about recognising that needs don’t stop at 18, and neither should our commitment.

Case Example – Navigating a Complex Transition with Physiotherapy-Led Insight

One young person I supported, whom I’ll call A, had level IV cerebral palsy with significant dystonia.

Throughout childhood, he benefitted from a highly coordinated paediatric network: daily physiotherapy input at school, regular six-weekly reviews from myself, and strong multidisciplinary involvement from neurology, orthopaedics, and community therapy teams.

Over the years, he built deep, trusting relationships with clinicians who understood the nuances of his presentation, the fluctuations in tone, the impact of fatigue, the subtle signs of pain, and the way his environment shaped his function.

This continuity meant that even small changes in his posture, mobility, or comfort were recognised early and responded to quickly.

At 15, A underwent deep brain stimulation to help manage his dystonia.

It was a complex intervention requiring careful monitoring and close collaboration between his surgical team and the community paediatric therapists who knew him so well.

Together, we supported him through the adjustments, ensuring that shifts in tone, motor control, or functional ability were understood. For A and his family, this joined-up approach provided reassurance during an already challenging period.

However, when A turned 16, everything changed.

As he attended mainstream school and did not have a cognitive impairment, he no longer met the criteria for paediatric services.

Overnight, the coordinated support he had relied on for years disappeared.

Adult services — despite their best intentions — did not have the specialist skills, capacity, or MDT structure to replicate the level of input he had previously received.

The family suddenly found themselves navigating a fragmented system that felt unfamiliar, inconsistent, and ill-equipped to meet his needs.

This is where my physiotherapy background became essential to my role as his case manager.

Drawing on years of clinical experience, I was able to understand the complexity of his condition and the demands of the support he required.

That insight helped me recognise the risks associated with the sudden reduction in therapy input, including the potential for increased pain, loss of function, and deterioration in posture and mobility.

My clinical understanding has allowed me to help coordinate communication between the various services involved in my clients’ care, ensuring that vital knowledge is not lost during periods of transition.

It also enables me to support families through the emotional impact of sudden changes in provision, helping them understand what can realistically be replicated in adult services and where creative, alternative solutions may be needed.

By joining the dots between surgical needs, therapy requirements, equipment provision, educational environments, and wider wellbeing, I can help rebuild more stable support structures that recognise the complexity of each individual’s condition and the importance of proactive, skilled intervention.

Experiences like this continue to reinforce why physiotherapy insight is so valuable within case management: it allows us to see the whole picture, anticipate risks, and advocate for the continuity that young people so urgently need as they move into adulthood.

Looking Ahead

Looking ahead, those experiences have strengthened my commitment – what’s changed is the scope.

I’m now able to support clients not just in their recovery, but in their right to live full, independent, and meaningful lives.

Case management aligns with my values of compassion, collaboration, and a belief in the potential of every individual.

It’s a profession that gives me a platform to champion those values, and to work alongside others who are just as passionate about making sure no one falls through the cracks.

Experiences like the one with client A continue to shape my approach as a case manager and reinforce why physiotherapy insight is so valuable in this role.

They remind me that continuity isn’t just a principle—it’s a lifeline for families navigating complex transitions.

Because everyone deserves to be heard.

Everyone deserves to be supported. And everyone deserves the chance to thrive, not just as a child, but throughout their entire life.

Find out more about ILS Case Management at indliv.co.uk