pGALSplus

pGALSplus is a ‘toolkit’ based on pGALS, and includes questions and assessments to help identify children with more serious pathology. 

pGALSplus aims to help clinicians determine if a child with a musculoskeletal problem will need specialist referral or not and if so whether to rheumatology,  orthopaedics or neurology/neurodisability. A Model of Care involving triage is called RightPath and further information is available: 

https://www.rightpath.solutions

• Children with musculoskeletal problems access healthcare in many different ways. For many children, particularly young children, presentations can be vague;  an example is the clumsy child where it is often not clear if the problem is related to musculoskeletal, neurological or developmental difficulties.
• pGALS as a musculoskeletal assessment is useful to identify areas that may be abnormal (such as a restricted wrist, or a swollen ankle). However as a 'stand alone' assessment it does not give information as to the likely cause of the abnormality and which may be needed to guide ongoing referrals.
• pGALSplus was developed as a tool for clinicians who may be asked to assess children with problems such as limp, clumsiness and or joint pain.
• The addition of specific manoeuvres to pGALS support the clinician to differentiate between certain conditions and is focussed on exemplar presentations; 

• Common conditions (such as hypermobility and developmental co-ordination disorder),
• Less common but eminently treatable conditions (such as juvenile idiopathic arthritis) and,
• Very rare but life-changing conditions (such as muscular dystrophy and the mucopolysaccharidoses).

Resources to demonstrate pGALSplus can be found below:

• Basic Instructions for assessment using pGALSplus
• pGALSplus Animation
• pGALSplus checklist 
• pGALSplus proforma (5-10 years)
• pGALSplus preschool proforma (2-4 years) 
• pGALSplus red flags 
• pGALSplus DCD example form
• pGALSplus DMD example form
• pGALSplus Hypermobility example form