CPF LIVE! with Peter Rosenbaum Transcript

Transcript

Rachel:

Hello everybody and welcome to CPF Live. We have a very special guest with us today, Dr. Peter Rosenbaum. Peter is a developmental pediatrician and actually a wonderful mentor and has been...Played a huge role actually at the foundation for many years. He also started CanChild in 1989, I think I believe, Peter? Which is getting to the stage where it's almost 20 years that it was started. So I'd love to actually hear your thoughts on the future and beyond. Actually more than that, hang on. 30 years. But Peter has held more than 80 peer reviewed research grants and is a contributing author to over 300 peer review journal articles, so we are absolutely very excited for you to be joining us today. And I would just like to welcome, Peter.

Dr. Peter Rosenbaum:

Thank you.

Rachel:

And so today, Peter, I think we have our wonderful Facebook community who's going to be joining us for this discussion. So anyone watching, please let us know where you are from, and if you've got any questions, as we're having this discussion today. We want every, really wanted to hear your thoughts as well. But Peter sort of to start off, I'd love to sort of hear your thoughts on a little bit about where we've come from. In the world of research and in the world of clinical care, particularly as it's come to cerebral palsy, we've come so far in the last 30 years since you started CanChild. Can you just sort of give us a little bit of an overview of where you think we've come from?

Dr. Peter Rosenbaum:

Well, the short answer is that we basically expanded our thinking and I would say that our thinking and our ideas and our understandings about health are probably more important than any medical invention or intervention. And essentially we used to think that we had to put lots of effort into therapy to deal with the problems that are associated with the functional problems that are associated with cerebral palsy, such as problems with spasticity, range of motion and so on.

Dr. Peter Rosenbaum:

And while those ideas are still important, what we've come to recognize is that we're not aiming to fix cerebral palsy, because we can't do that. We are not aiming for normal function because we don't know how to make that happen. What we are aiming for is to help people become as functional and capable as they can, however they do it. And that has, I think, expanded the spotlight to include enabling and encouraging children to do things how they want, enabling and encouraging parents to enable their children to do those things and recognizing that what is particularly most important is children's engagement in life. What the world health organization calls "participation" and that's changed the whole game for me.

Rachel:

And I think, because globally we've got a lot of people who are watching this from all around the world. We've got Claire, who's already joined us from Scotland. Do you see this trend happening globally as well? Is this just isn't a North American idea?

Dr. Peter Rosenbaum:

No. Thank you for that. It's a good question. It's not a North American idea at all. In fact, much of our thinking has been strongly influenced by the World Health Organization's framework for health called the International Classification of Functioning Health and Disability and Health. And the idea is that in addition to problems in the body with any health condition, whether its cerebral palsy or diabetes or Alzheimer's disease, in addition to thinking about what's going on medically, we also have to think about how any condition is affecting and influencing people's ability to function in day to day life and their ability to engage in ways in life in ways that are meaningful for them.

Dr. Peter Rosenbaum:

And we're now also expected, actively and formally, to pay attention to things that have always been there, but we kind of ignored. One of those is environments, plural, and the other is personal factors. And if we can engage with kids and families in ways that are important to them and build our ideas about therapy around those things. And if we are prepared to take, to have an awareness of the environment, then we see things happening that are beyond just trying to fix the body.

Rachel:

And I think when you say "we," can you sort of expand... We're really sort of talking about what the medical profession here has learned. Because I think individuals and adults out there with cerebral palsy who are watching and families have known this for a really long time and have been advocating for how to make it happen. But this is sort of the trend that we're hoping to see and to sort of carry forward within all aspects of their care. And so there's a lot of this actually is information that medical professionals need to take on board.

Dr. Peter Rosenbaum:

I couldn't agree more. The thinking, the limitation in medical thinking is based in part at least on 20th century ideas that science and biomedical science were going to sort things out. And there's no doubt that there have been phenomenal advances in our understanding of medicine and of biology. And the polio vaccine is one of a hundred examples, and I mentioned that only because we're in the middle of the COVID situation and a vaccine for COVID would have a huge impact. At the same time, we have tended to feel that we had to attack the medical problems, in the case of cerebral palsy spasticity and so on, and try to improve them. And we can do that. The sad thing that we've come to recognize, or the frustrating thing...It's not sad, it's frustrating is that changing spasticity does not automatically change people's function.

Rachel:

Absolutely. And I think we've got even more people that have joined us now from Turkey. We've got some more from Scotland. We've got someone from Atlanta. It's really quite amazing. We really want to hear where you're all from. So please keep adding in and any questions that you have for Peter as well on these ideas. Because I think, this is sort of my question to you now though, is now that we're thinking about function, we're trying to think about participation and what this means. How do we start defining goals? So for example, if I am a young family, my child just has now got a diagnosis and all I'm getting told about is the medical things that are, need help or need changing or need, God forbid someone uses the word fixing. How can we start having these conversations with professionals and getting them to understand where, how important these other goals are?

Dr. Peter Rosenbaum:

Well, one of the things that we recognize is that when we set goals, we should always, whether we are the parents or we are the professionals setting the goal, the other party should say, why is that important?

Rachel:

Mm-hmm (affirmative).

Dr. Peter Rosenbaum:

So for example, when a parent, if a parent says to me, "well, I want my child to walk and I want therapy to help them to walk." My discussion with them will include, "what do you hope they'll do when they can walk? And are there some things that we can help them do while they're learning to walk?" So for example, using a walker. And I've had many conversations with parents and with professionals, "I don't want my child to use a Walker because they'll become dependent on it."

Dr. Peter Rosenbaum:

And my comments back are "first of all, if they become dependent on it and it helps them improve their function, I don't care. I am dependent on my glasses, and hooray for my glasses." But the other thing is because children at a young age are constantly changing, using the Walker may help them to learn balance and the discipline involved in mobility, and eventually they may not need the walker. So if they need it forever, that's fine with me. If they use it as a way of developing, like we use training wheels on a two wheel bicycle, then good for...Let's go for it.

Rachel:

And I think this brings up a really good point because you use the word developing. And so the idea of childhood development versus rehabilitation, and I just want to touch on this because I think it really makes a difference in how goals are defined, but it really makes a difference in how care is delivered. Thinking about the difference between what those two things are. Do you just want to give your sort of ideas around those two different things? Because it's really important to distinguish between them.

Dr. Peter Rosenbaum:

Yes. Thank you for that. After I've had a stroke, I hope that I will have lots of help from lots of professionals to help me return to function. Rehabilitate, excuse me, getting back to where I used to be with my goals identified. And one of my goals obviously would be to talk. That's much more important than being able to play tennis.

Dr. Peter Rosenbaum:

But when we're talking about children, we're not really rehabilitating at all. We have taken ideas, good ideas from adult rehabilitation and brought them into childhood without thinking about the fact that children are fundamentally different. We're not returning them to function because they haven't had it. We're helping them develop and become as capable and as able as they can with whatever abilities they have and with whatever we can offer so that they become whole people even if they use a wheelchair, even if they use a communication system, even if they do things differently.

Rachel:

Yeah. And I think that is just so...It's fundamentally down to that whole idea of, 30 years ago the treatments that probably would've happened, and I know we've got plenty of adults who are watching this right now as well, 30 years ago, what you had to go through as a child hopefully is very different to what is happening now.

Dr. Peter Rosenbaum:

That's what we hope. Yes.

Rachel:

Now the only difference is though, I suppose the word rehabilitation, for adults who are watching though. Potentially if they've had a decline in function, if they're finding something where they are struggling now doing a task that they could do previously, the ideas and the principles around rehabilitation then could actually be more relevant. Is that correct?

Dr. Peter Rosenbaum:

Absolutely. Because an adult who has a functional limitation that is new, is an adult who will seek help to try to slow down the loss of function, improve their function, and if they have cerebral palsy or don't have cerebral palsy, that's the same issue. The way...What we're trying to do is help people return to the function they had before, whatever limited it. But with children, we're really trying to promote development. That's the key difference from how we have traditionally thought about things. We've, and I don't, I want to just add that I don't mean that anybody has ever been a bad person in the old methods. I've been doing this work since my training in the early 1970s. I was trained to think this way. I have applied these ideas, the original ideas, with good intentions and good faith. I think what's happened is that the spotlight has gotten bigger, as I said earlier, and we're recognizing that if we talk and think differently, we can perhaps act differently. And there's some evidence to support that this leads to better outcomes and families are more content with these ideas.

Rachel:

Absolutely. And I think it's something that we're seeing a lot of now, particularly in the research field is the idea of bringing families into research and bringing individuals into research. So not just being the byproduct or the end result, but actually from the very beginning and asking what do they want to see? What advances are actually happening? And I know you've got some exciting stuff going on actually thinking about bringing families into the conversation a lot earlier. And obviously you've always been a huge proponent to make sure that all stakeholders are at the table at all parts of the research cycle. But what have you seen, I suppose, in that change with sort of thinking about the continuum of research and what we can all do to try and be more involved?

Dr. Peter Rosenbaum:

You're absolutely right that the way in which we're thinking, certainly about health services and clinical research is very different from how it used to be where parents, patient, children, patients, if you like were the subjects of the research. We did research on you, and if you were lucky, we told you what we found at the end of it. But you were basically not a whole lot more than lab rats for our experiments.

Dr. Peter Rosenbaum:

The way in which the, and this is an international trend, the way in which we're thinking now is that if we're going to study aspects of your life as a family or children's' lives, then we have to find out first of all, what's important to you? Second of all, to get your ideas about how to study these things. Third of all, to help, to have you help us figure out the best approaches to this. And internationally, this is reflected in the United Kingdom, in the James Lind Alliance, in the United States with PCORI the Patient-Centered Outcomes Research Institute, in Canada with the SPORs, which are something for Patient Outcome Research. But all of them have the same idea that it's essentially nothing about us without us.

Rachel:

Yeah, no, and it's so important. And I think that sort of comes to another piece that we've worked on a lot together, which is CP Resource org. So when we think, when we sort of came together to think about, all right, how, what are we going to develop? How are we going to get a resource out there that has the best available evidence, but in ways that everybody can relate to it and absorb that information to become a better consumer? Because at the end of the day, all of us need to be better consumers in our life. In not just healthcare, but in education, in how we interact with our employees and all those different elements. And that was our purpose for CP Resource.Org.

Rachel:

But can you just sort of dive in a little bit, because I know we mentioned the ICF, so the International Classification of Function a little bit earlier, but can you just dive in a little bit into those five components again and what they mean?

Rachel:

For everyone else watching as well, Peter also was the co-author of a publication about the F words of disability. So I want to touch base on that as well, but do you want to just sort of expand a little bit on the ICF and the different components of it and why it's so important?

Dr. Peter Rosenbaum:

The...You asked a lot of questions in that.

Rachel:

I know, I asked too many questions just then. So the ICF and the components of it and why it's important.

Dr. Peter Rosenbaum:

The CP Resource is a, well as the name implies a resource that is constantly growing and is designed to provide anybody who is interested, whether you're a person with cerebral palsy or a parent or a student or a professional with current ideas about the things we've been talking about. The World Health Organization's Framework for Health talks about body structure and function. So obviously there are a lot of things that we can understand about how the brain may be impaired leading to cerebral palsy, how we can detect that early on in an infant's and child's life. What we can do about it with medical interventions such as botulinum, toxin and other kinds of intervention. But we're also interested, as I said earlier, in the second component of this framework, which is activity. And we talk about, and anybody who's listening will have heard the phrase "activities of daily living."

Dr. Peter Rosenbaum:

We get up in the morning. We get dressed. We eat. We brush our teeth. We go to the toilet. We go to school. We go to work. We do a thousand things that are part of our day to day routine. To what extent can we focus on helping people do that, even if they do it differently?

Dr. Peter Rosenbaum:

It's third component is participation, and that is to say engagement in life in ways that are meaningful to you. You don't have to do what I do and I don't have to do what you do. But what is it that's important to you and how can we enable you, as a person with an impairment, how can we enable parents of kids with impairments to be as engaged in life as they want to be?

Dr. Peter Rosenbaum:

And that then obviously ties into the fourth component, which is personal factors. And I like to think about the importance of personal factors as a basis for how we might intervene. And I've taken to asking people when I lecture and they're actually audiences that I can see, "how many, hands up, how many people had to take piano lessons?" And there's usually some laughing and some groaning. And I say, "how many of you loved it?" And very few hands are up. We took piano lessons because our moms and dads thought it was a good thing to do. But if we didn't love it, we probably didn't practice.

Rachel:

And let us know in the comments, if this is actually true to you. We would love to know.

Dr. Peter Rosenbaum:

So you're saying what the hell has piano lessons got to do with cerebral palsy? Well let's instead of talking about piano lessons, let's talk about what's fun for your child with cerebral palsy. So your child likes the water. Okay. How can we use water, the medium of water and engagement in activities involve water to do therapy? And we can, if we promote swimming, for example, we can have a child learning to swim, which is an activity. Doing it with other people, which may be participation. Becoming stronger and more fit, which has to do with body structure and function. And now we are building our therapy ideas around something that's already important to the child. Is the child going to want to practice? Yes. Is this like the piano? No, because if it's therapy that we prescribe that isn't fun to the child, they're not going to be engaged in it. If we can build our therapies around what's important to children and families, we can see a whole different way of thinking and acting.

Rachel:

Absolutely. It really shifts from going right, therapy is in a room, a clinical room in a hospital or wherever you might be, with the therapist and just the child or you as an individual, to going all right, where are we? Why aren't we outside? Are we in the home? Or what are your goals? Let's go swimming. Let's do these things that will actually lead to enjoyment and fun.

Dr. Peter Rosenbaum:

Or bike riding or anything else. But whatever it is, if we can help the child and the family to build their lives around those things that are important to them, then they're motivated to do them. They're doing them anyway. And now we can add our flavors on how that might be done with respect to therapy.

Rachel:

Absolutely. And I think what we are not saying is that change can happen. We're not saying that strengthening and doing things for those different components, if it's going to help you achieve your end goal, isn't helpful.

Rachel:

Claire just wrote to us: "my child is three next month and helps me. I don't want her to become my carer. I'm in a lot of pain all the time." So this is the whole thing. I think when you've got as an adult with a disability, what are you thinking and how is this...This is a lifelong journey, and I think, Claire, to your point there, it's like, "okay, well now that I'm an adult, these same sort of principles apply." It's still thinking about what do you things do you enjoy in life? What do you want to do to maintain those activities? If that's what you want to do. Or what other elements are required that a health professional can help you with?

Dr. Peter Rosenbaum:

One of the ideas we haven't talked about specifically is the idea of normal. And it's an idea I really dislike. And I use this as an example, the idea of being right-handed. Now about 80 or 85% of people are naturally, biologically right-handed, but there was a time and it may be for some other, the people listening this is still the case, there was a time where if you were left-handed, you were forced to change and use your right hand. Now I think that is incredibly stupid and is very counterproductive. If we are prepared to accept that people do things in different ways and can help people to do things the best way they can for them. That should be enough. And not one way of doing things.

Rachel:

No, and I think that's such an important point to reiterate. Yeah, Claire is even just writing to us right now: "I am left-handed and my left hand side is affected by cerebral palsy."

Rachel:

So, it's one of those things that you're like imagine if we were like, "all right, now you have to be forced to be right-handed." You're just complicating factors even further with lots of different things.

Dr. Peter Rosenbaum:

Well, Claire needs to know that we have a wonderful Canadian comedian who said that only left-handed people are in their right mind.

Rachel:

That's true. That's very true. But yeah. And Sophie, "I loved therapy." So then that's the thing as well. So some children, and this is where I think you've got to find what works for you and what works for you and your child. Some children actually absolutely respond to therapy and enjoy it, and particularly if you can do group therapy, they love it. Other children absolutely hate it and not involved or actively participating at all. So you are not going to see those functional improvements.

Dr. Peter Rosenbaum:

That's right.

Rachel:

I think that's where this sort of major point comes from is what do you enjoy? And I think that's a really nice segue into the paper that you wrote with Dr. Jan Willem Gorter which was, "The F-words for disability," which is sort of based obviously around the International Classification of Function. But for many people watching, they may not know what that is all about. They're like F-words, what you're swearing when it comes to childhood disability? So it's not that F-word. It's the other ones. Peter, can you expand?

Dr. Peter Rosenbaum:

The paper was called the "F-words in Childhood Disability: I swear this is how we should think." And the idea, and you really need to have a visual of this, but if you can imagine a number of boxes. At the top, there's a box that says cerebral palsy. And then in the middle, there are three boxes that say body structure and function, activity and participation. At the bottom are the two boxes of personal of factors and environmental factors. And what we did was to try to be cute by reminding people of particular aspects of this framework that might help them remember the framework. So when it comes to body structure and function, we talk about fitness. And we do that because people with impairments like cerebral palsy often have less opportunity to be active and to be fit.

Dr. Peter Rosenbaum:

When it comes to activity, we talked about function and I've already said that we don't care how you do it, if you can do it, then that's enough for you. And then if you want to get better at it, you can work at it, just like your tennis serve. With respect to participation, we talked about friendships, and this is particularly important for children because children learn so much about themselves and the world around them by being with other children. When it comes to personal factors, you won't be surprised that the F-word we added was fun, for the reasons I've said earlier. And finally, we talked about the most important environment for children, which starts with F is family.

Dr. Peter Rosenbaum:

And so the words fitness, function, friendship, fun and family are examples of how to think about this framework for health and at the bottom of this picture. And you can find the pictures if you go to the CanChild website, we added an arrow that says future. Now in the World Health Organization's framework, this picture does not have time built in, but we wanted to re remind people that children are constantly changing and that we are trying to launch children toward the future. And I can tell you that this way of thinking has attracted a huge amount of attention around the world. We have about 30 translations of the poster that we developed. Again, if you go to Www.CanChild.Ca-

Rachel:

We'll put it in the comments.

Dr. Peter Rosenbaum:

You can find a whole lot of material. It's all there for free to be downloaded. There are lots of ways in which parents and professionals have adopted and adapted these ideas. And it's really quite a lot of fun because it brings all of these ideas to life.

Rachel:

And that's exactly then what we did for CP Resource.Org. So the other thing is we'll absolutely put CanChild, so go explore CanChild. CanChild is a, I suppose, an absolutely phenomenal repository of research of information of the most up to date things when it comes to a lot of, not just if you have cerebral palsy, but other disabilities as well. But also on CP Resource, what we developed were these six areas and these six areas are based on the ICF and they're based on the F-words as well. And so Peter's actually done the intro to CP Resource.Org. So please go read that. It really embeds everything that we are discussing here today. And my question for you there, we've talked a lot about childhood disability and childhood development and function. What should, when we are looking at for adults, and I think this is the whole thing, do these same principles apply? We spoke the difference between development and rehabilitation, but what about just these principles of health in general? Do they apply to adults as well?

Dr. Peter Rosenbaum:

Well, that's a really rude question. And it's a rude question because it has taken the field of childhood disability generations to recognize that children with cerebral palsy grow up to become adults with cerebral palsy. And why it's rude, and I'm teasing you, is because we know know far less than we should know about the adult lives of people who've grown up with cerebral palsy. We're just starting to learn. We're getting asked questions, we professionals all over the world are being asked questions. We haven't got a good way to answer because we simply don't know enough.

Dr. Peter Rosenbaum:

We know that you can be a professional. You can be a parent. You can be any kind of person or almost any kind of a person and have cerebral palsy. So cerebral palsy should not in itself limit people's possibilities. But what happens to the body overtime, I'm in my mid-seventies and I can tell you, there are things I used to be able to do that I can't do as well. I think that that happens to people with cerebral palsy probably earlier in life, because of the stresses on their bodies to move against spasticity and on joints that may be stressed and so on. We simply don't know enough.

Rachel:

And I think this is a call to action for us, right? It's call to action for everybody that we now know these principles. We know what's important to people. You've told us. Our community tells us all the time what is important to them. It's now on all of us to come together to start finding some of these answers, because we hear so often that early aging or this, these things are happening, increased pain, decreased mobility. And what are we doing about it? Well, we don't know, because we don't have any answers.

Dr. Peter Rosenbaum:

But we also have to remember that everybody with cerebral palsy has a gallbladder, and I say that because of a story that was told to me some years ago by a young woman with cerebral palsy who's a wheelchair user and who had recurrent pain in her abdomen. And everybody she saw said, "well, you've got cerebral palsy" until finally somebody recognized that she had gallbladder disease. And when she had her gallbladder out, her belly pain stopped. So yes, it's true, and there's no argument with what Rachel just said about the fact that the body of somebody with cerebral palsy probably has more stresses on it, but at the same time, if you have an ache or a pain or something going on, you should be evaluated as if you didn't have cerebral palsy, because maybe what's going on has nothing to do with your cerebral palsy.

Rachel:

Absolutely. And I think this is where the continuum of care and the development of these different trajectories and understanding what's going on is going to be so important for the future as well. I think...We've had, we've got other people sort of talking in with some comments as well.

Dr. Peter Rosenbaum:

Good.

Rachel:

Dawn's just written in: "I have difficulty motivating my 30 year old adult daughter do any therapy activities to maintain what she has." And I can tell you, Dawn, for example, I am in my mid-thirties and if my mom was trying to also motivate me to maintain the things that I had, I probably also would be struggling. So I think these are the different things that as adults, what motivates us as adults are very different to what motivates us as children.

Rachel:

So I think that's just very important to remember and to understand is that when we're thinking about who we are as an adult and what motivates us and what we want to do, we have a, in a way, a lot more autonomy over our own health and the decisions that we make. And I think we have to look at it, okay, is health, is our major concern and our goal that health is something? Do we, are we concerned about our fitness? Are we concerned about our cardiovascular health? Or is it more now that we are actually concerned about, okay, I am losing function, I'm falling more, or I don't have the endurance that I used to have, but it's also got to be the purpose.

Dr. Peter Rosenbaum:

If I were talking to Dawn, if she were-

Rachel:

Well you are. She's listening.

Dr. Peter Rosenbaum:

Okay. But if she were, if we were having a conversation directly, I would ask her what she likes to do for exercise and activity and challenge her to do things that she knows her daughter might be interested in and engage her daughter in those things that are important because the idea is that if we can do things as a family, then we can potentially have more engagement. And I say this in the context of working with children and increasingly recognize that we need to help parents of young children recognize their children are going to grow up and become adults with cerebral palsy and the habits and activities and participation they engage in as children are likely to carry on into adulthood. And we need to encourage families not to tell their kids what to do, but to do things with their kids.

Rachel:

I love that. I think that's for all of us, even in our friendships or anything that we do. We usually gravitate towards people that we enjoy doing things with. So, it is finding those things that we all enjoy and have fun doing. And then there's this social aspect that makes it a lot easier. We've also got John who's here from Ireland. It's amazing. We've got such a lot of diverse group of people who are watching this today. And Tim has also joined in and he's, "my right side is affected as well. I taught myself how to use it when I was six. I wanted to play baseball and he uses it as much as I can. I've just noticed as I get older, my body is declining on the side a little bit more complicated in the back area function."

Rachel:

So I think, Tim, I think it's great that obviously as a six year old...This is the perfect example. If parents are looking at this, take Tim's advice, going all right he found something that he loved to do in playing baseball. And so of course, it may not have been perfect by the sounds of it, but you still enjoyed it and you still love playing. So, you are going to teach yourself to do those new skills and you can learn them.

Dr. Peter Rosenbaum:

I like to ask people again, when I'm lecturing, how many people play to tennis and lots of hands go. And then I ask how many people play professionally. And usually there's a bit of a laugh. And I then say, why do you bother? And the point of course, is that we don't have to be world class at things to do them. We play tennis because we like to run around and sweat, or because we like to see our friends, or we like to have an excuse to have a beer or whatever. It doesn't matter why. Those of us who want to get better, take lessons. Those of us who don't care, just go out and bash a ball around on a Saturday. So we don't have to be really good at things. But the comment I would make about what Tim just said is that if you are asymmetrical and one side of your body doesn't work as well as the other, you might benefit from some therapy or Pilates or massage therapy or something that will help to counter balance the differences on the two sides of the body.

Rachel:

And I think that's where this sort of holistic approach, if you want to call it that, comes into play. It's not that we are saying that you don't want to focus necessarily on body structure and function, if we go back to the classification within the ICF and just think about activity and participation. You really need to look at everything. And that's where I suppose the team approach and having a really good team of professionals around you and family members and friends, and whoever else, colleagues, whoever's part of your team is so important because you'll be able to actually meet those different needs.

Dr. Peter Rosenbaum:

And you asked me earlier whether the F-words apply to adults and we actually have a poster that shows the same F-words with adult cartoons, because yes, of course they do. These are F-words for life.

Rachel:

And I think that's such am important concept, that these are F-words for life. So if you're a parent of a young child, you want to start developing these through somebody's life. So as adults we have the abilities and we have, I suppose, can have that autonomy in our own decision making in what we want to do.

Dr. Peter Rosenbaum:

And you can use them for yourself too, as a parent.

Rachel:

Absolutely. So I just want to see, is there any other questions that anyone has for Peter? We would love to hear them. I have sort of, I suppose I don't know whether it's a question or, well, I suppose it is a question. All right, so we've come almost 30 years since you started CanChild, what do you want the next five to 10 years to look like?

Dr. Peter Rosenbaum:

I'd like to see the application of these ideas worldwide. I'd like to see policies and programs that are built around, not specifically around the F-words but built around this wider, broader way of thinking about disability. I have the opportunity, have had the opportunity for many years to work with really good policy makers and civil servants, and these are smart, dedicated, hardworking people. They don't spend end all day listening to these kinds of conversations. And so our responsibility is to bring them up to speed with new thinking, so that the policies and the programs and the funding that are available reflect modern thinking, and that we don't just scream and yell for more therapy, but we scream and yell about what the therapy is meant to accommodate, meant to accomplish. We scream and yell about integrated schools and recreational programs in the community and opportunities for people to have employment even if they use a wheelchair and so on and so on and so on. So I want to see us working to apply what we know already.

Rachel:

I love that because that is the thing. We do know a lot. There's a lot to learn, but we already know a lot. So let's actually, as again, another call to action, let's make sure that it's happening.

Dr. Peter Rosenbaum:

Yeah.

Rachel:

And it's definitely a focus of what we are doing here at the foundation. And we love hearing everyone who follows us, hearing your thoughts of what you would like us to do next, because we are here for you. We're, that is why the foundation exists. So on that note, Peter, I just want to say, thank you so much for joining us today.

Dr. Peter Rosenbaum:

Thank you.

Rachel:

And we will obviously, we can chat again soon. So if anyone has any other questions as well, and you would love to sort of have any follow up discussions, we are going to be doing more of these sorts of Facebook Lives. So would love to hear from all of you.

Dr. Peter Rosenbaum:

Thanks for being here.

Rachel:

All right. Thanks, Peter.

Dr. Peter Rosenbaum:

Thank you.