BOOK REVIEW Treatment Short and Sweet Frequency intensive is a program designed to enable children...

herapy intensive is a program designed to

enable children with neuromotor im-

pairments to go beyond their current level of

function. The model used at Pediatric Therapy

Associates is for the child to receive a program

of three to four hours per day of therapy. De-

pending upon the child’s age and other con-

siderations, this program may last anywhere

from three days for babies to three weeks for

children from out of the country. If more than

one therapy is included, then communication

and highly integrated coordination are a must.

Motor-learning theo-

ry considers practice the

most important variable

when learning a new

motor skill (Schmidt &

Lee, 1999). Thus motor-

learning theory and re-

search support the in-

tensive therapy model,

in which new elements

of functional tasks are

introduced and practiced and repeated with a

critical eye for efficiency and coordination that

is unique to NDT. In addition, the families are

given extensive information on how to take this

program home to their regular therapists, as

well as how to include it within the family and

community context.

Michael, an engaging five-year old with quad-

riplegic cerebral palsy, was brought to Pediatric

TreatmentFrequencyIS IT MERELY TRADITION?

By Barry Chapman, PT

A review of “Intermittent intensive phys-iotherapy in children with cerebral palsy:a pilot study” by Johanne Trahan andFrancine Malouin in DevelopmentalMedicine and Child Neurology. 2002,44(4), 233-239.

friend of mine, a fellow pediatrictherapist, is a rather iconoclastic

sort who likes to circulate during breaksat conferences asking other therapistsabout treatment frequency. “How oftendo you see your kids?” he’ll ask mildly.Regardless of the answer he’ll ask sim-ply, “Why?” A representative sample ofmost responses would include:

“That’s the way we’ve always done it.”“That’s what our schedule will allow.”“They seem to make satisfactory

progress with that frequency.”My friend’s queries and the usual re-

sponses highlight, of course, that muchof what we do is based on tradition andopinion rather than systematic evidence.

Trahan and Malouin’s pilot study con-tributes to a slowly growing body of sys-tematic evidence comparing various phys-ical therapy (PT) treatment frequenciesin children with cerebral palsy, and is oneof a very few that compares “burst” or“intermittent” with “routine” treatment.Five children, age

Short and SweetA CASE STUDY OF THE INTENSIVE THERAPY MODEL

By Suzanne M. Davis, PT

3

Therapy Associates for an intensive in physical

and occupational therapies with consultation

in speech. Physical therapy was provided by

Suzanne Davis, occupational therapy by Lezlie

Adler, and speech consultation by Monica Wo-

jcik. (Unfortunately Michael missed some ses-

sions due to illness during the week.) The fol-

lowing is a synopsis of our findings, intervention,

and outcomes.

CURRENT PARTICIPATION:Michael has

a twin.His typically developing brother,Nicholas,

is delightful and loves

being with Michael.

Michael is very imagina-

tive in his play with oth-

ers. He attends a devel-

opmental preschool in

Fort Lauderdale, which

will soon be training him

in the use of a power

wheelchair. Michael is in-

cluded and participates

in all family functions, although he requires as-

sistance due to his significant motoric challenges,

as described below.

CURRENT FUNCTION:Although Michael

loves toys, it is difficult for him to readily play

with them due to his impairments. He is un-

able to explore his environment. He sits with

support and is sometimes (continued on page 12)(continued on page 18)

T H E N E U R O - D E V E L O P M E N T A L T R E A T M E N T A S S O C I A T I O N • M A R C H / A P R I L 2 0 0 4 • VO L U M E 1 1 , I S S U E 2

I N T E N S I V E T R E A T M E N T

3 President’s Message 4 NDTA News 4 Family Corner 9 Disaster Planning10 Caregiver Perspective 15 Therapy Talk 16 Early Intervention 17 Question from the Field

I N S I D E T H E N E T W O R K :

A

T

BOOK REVIEW

Motor learning

theory and research

support the intensive

therapy model.

REGION 1WA, OR, ID, MT,West CanadaNancy Garcia, PTShriners Hospital, 911 W. 5thSpokane, Washington 99210(509) [email protected]

REGION 2NB, NF, NS, ON, PE, PQEast CanadaChair position available Please call Director Pam Moore(918) 747-6947

REGION 3Southern CA, Northern CA, NVMichelle G. Prettyman, PT5460 White Oak Avenue #K301Encino, CA 91316(818) [email protected]

Carrie H.Taguma-Nakamura, OT1235 South Ogden DriveLos Angeles CA 90019(310) [email protected]

REGION 4WY, CO, UT, NM,AZTori J. Rosenthal, PT, MS3718 Pioneer Ave.Cheyenne,WY 82001(307) 635-2900Fax: (307) [email protected]

REGION 5TX, LACarol S. Nuñez-Parker, OTR andTeresa De La Isla, MS, OTRNTS, Inc.4423 ShadowdaleHouston,TX 77041Work: (713) 466-6872 Ext 221Fax: (713) [email protected]

REGION 6KS, MO, OK,ARMs.Myles Claire U.Quiben,PT,CSCI550 Files Rd., P200Hot Springs, AR 71913-5464 (501) 525-3917or (501) [email protected]

REGION 7ND, SD, MN,WI, NE, IA, IL,Middle CanadaStacy Reichmuth, OTR/L7819 South 97th CircleLa Vista, NE 68128(402) 339-2533

REGION 8MI, IN, OHKristine Waffle, PT827 Upland Ridge Dr.Ft.Wayne, IN 46825(219) 446-0100, #[email protected]

Kristie Swoverland, PT10911 Old Oak CourtFort Wayne, IN 46845(219) 484-6636 ext. [email protected]

REGION 9KY,VA,TN, NC,Al, MS,GA, SC, FL, PRJeannette A. Beach, PT220 Hemphill Ave.Chattanooga,TN 37411(423) [email protected]

REGION 10ME, NH,VT, NY, MA.CT, RI, PA, DE, NJ,MD,WV, DCLaura Z. Gras PT, DSc ,GCSThe Sage Colleges45 Ferry StreetTroy, NY 12180(518) 244-2066fax (518) 244-4524

Debra Berube PT1270 Belmont AveSchenectady, NY 12308(518) [email protected]

REGION 11AKDee A. Berline-Nauman, OT6705 Lunar DriveAnchorage, AK 99504-4575(907) 550-3004Fax: (907) [email protected]

Cara Ann Leckwold4325 Laurel, St. #100Anchorage, AK 99508(907) 561-8775Fax: (907) [email protected]

REGION 12HISandra Kong, OT99-033 Kaupili PlaceAiea, HI 96701(808) [email protected]

Jan A. Miyashiro1251 Ulupuni StreetKailua, HI 96734(808) 483-4980

PRESIDENT Wendy Drake-Kline, OTNeurodevelopmental Therapy Associates1314 Timber Ridge Ct.Waynesville, OH 45068(937) [email protected]

PAST PRESIDENT Brenda Pratt, LPT416 Yale AvenueAlma, MI 48801(517) 463-4324 (517) 466-9037 [email protected]

SECRETARY/TREASURER Linda Markstein, PTMiami Valley Hospital1 Wyoming St., Dayton OH 45409(937) [email protected]

IG EXECUTIVE COMMITTEE CHAIRCathy Hazzard, PT916 31 Avenue, NW Calgary, AlbertaCanada T2K 0A5 (403) 289-8249 [email protected]

IG REPRESENTATIVEIG REPRESENTATIVETherese McDermott1416 W.Thome Ave.Chicago, IL 60660(847) [email protected]

DIRECTOR OF REGIONS Pam Moore, MOT, OTR3509 South Richmond Ave.Tulsa, OK 74135(918) [email protected]

DIRECTOR OF MEMBERSHIP Gina Best, PT, MS203 Woodrow StreetMarietta, OH 45750(740) 376-1422 (740) 376-9739 [email protected]

NETWORK LIAISONPamela Mullens, Ph. D., PT5623 57th Ave. NESeattle,WA 98105206/[email protected]

MEMBER-AT-LARGEWendi McKenna, DPTPathway Center2591 Compass Rd.Glenview, IL 60025847/[email protected]

MEMBER-AT-LARGEKim Westhoff, OTR/LKim’s Kids Pediatric Occupational Therapy15900 S. Hawkins RoadAshland, MO 65201 USA(573) 657-0171 [email protected]

PAST CHAIR OF IGEXECUTIVE COMMITTEEKay Folmar, PT73423 Foxtail LanePalm Desert, CA 92260(760) 346-9965(760) 346-9965 [email protected]

R E G I O N A L C H A I R P E R S O N S

N D T A B O A R D O F D I R E C T O R S

2 • N D T A N E T W O R K • M A R C H / A P R I L 2 0 0 4 • I N T E N S I V E T R E A T M E N T

Views expressed in the NDTA Network are those of the authors and are not attributed to the NDTA, the Director of Publications or the Editor, unless expressly stated.The NDTA does not endorse any instructors, courses, educational opportunities, employment classifieds, products or services mentioned in the NDTA Network.Copyright 2001 by the Neuro-Developmental Treatment Association.Materials may not be reproduced without written permission from the Editor.

IG EXECUTIVE COMMITTEEChair: Cathy Hazzard Vice Chair:Teddy ParkinsonTreasurer: Sherry W.Arndt Secretary:Teresa GutierrezPeds Subcommittee Chair: Kacy HertzAH Subcommittee Chair: Cathy RunyanCI Working Group Chair: Karen BruntonOT Working Group Chair: Lezlie AdlerPT Working Group Chair:

Susan Breznak-HoneychurchSLP Working Group Chair: Gay Lloyd PinderCI Representative: Judi BiermanOT Representative: Mechthild RastPT Representative: Monica DiamondSLP Representative: Rona AlexanderNominating Committee Chair: Mona Miley, OT

IG STANDING COMMITTEESBonnie Boenig, Grievance Committee ChairTom Diamond, Peer Review Committee ChairJudith C. Bierman and Lois L. Bly,Theoretical

Base Committee Co-ChairsLinda Kliebhan, Curriculum Committee Chair

L E A D E R S H I P D I R E C T O R Y

INSTRUCTORS GROUP

NDTA OFFICE1540 S.Coast Hwy, Ste. 203Laguna Beach, CA 92651 800/869-9295 • 949/376-3456 Fax [email protected] • www.ndta.org

A subscription to the Network, which is publishedsix times annually to more than 3,000 members,is included in every NDTA membership.Additionalsubscriptions and copies of archived articles areavailable for a small fee.

EDITORIAL INFORMATIONWe invite members and non-members to submit ar-ticles, ideas and comments to the editor.Editorial as-sistance and guidelines are available for writers.Lookbelow for upcoming deadlines and themes.

ADVERTISING INFORMATIONTo reach health care professionals who practiceNDT, advertise your products, services, employ-ment classifieds, educational opportunities andNDTA-approved courses in the Network. All adsare placed on a first-come, first-served basis. Pay-ment is required prior to insertion.

DISPLAY AD RATESAdvertise your products and services in multiplethemed issues to maximize your investment. Formore information or to place your ad, contactCindy Percival Rounds at 800/869-9295 ext. 268.

Space Per issue 4 or more issuesFull page . . . . . . $800 . . . . . . $600 per issueHalf page . . . . . . $500 . . . . . . $400 per issueQuarter page . . $350 . . . . . . $250 per issue

EMPLOYMENT CLASSIFIEDSHave an open position? Find your next employee here.Members can place employment classified ads for $100for the first 50 words,plus $1 for each additional word.Non-members may place classifieds at an additional fee.Placement is for one issue of the Network and 30 dayson the NDTA Web site. Longer placement is availablefor an additional fee.For more information or to placeyour ad, contact contact Cindy Percival Rounds at800/869-9295, ext. 268.

EDUCATIONAL OPPORTUNITIESOrganizing a workshop? Your educational oppor-tunity can be placed in one issue of Network andfor 30 days on the NDTA Web site for $200.Longerplacement is available for an additional fee.For moreinformation or to place your ad,contact Cindy Per-cival Rounds at 800/869-9295, ext. 268.

NDTA-APPROVED COURSESEducational courses that are approved by NDTA canbe placed in one issue of Network for $100. Formore information or to place your ad,contact Cindy Percival Rounds at 800/869-9295, ext. 268.

ARTICLE & ADVERTISING DEADLINESCopy received after the dates specified will beconsidered for the following issue.

2004 ISSUES THEME DEADLINEJuly/August . Pain Management . . . . . . . . . . . . . May 1Sept/Oct . . . Respiration & Feeding . . . . . . . . . . July 1Nov/Dec. . . Dystonia. . . . . . . . . . . . . . . . . . . . Sept 1

K.T. Anders, Editor, NDTA NetworkP.O. Box 521, Upperville,VA 20185540/592-7002 • 540/592-7032 [email protected]

Pamela Mullens, Ph.D., PT, Network Liaison5623 57th Ave. NESeattle,WA 98105206/[email protected]

A B O U T T H E N D T A N E T W O R K M E S S A G E F R O M T H E P R E S I D E N T

N D T A N E T W O R K • M A R C H / A P R I L 2 0 0 4 • I N T E N S I V E T R E A T M E N T • 3

s we move into 2004 I feel compelled tolook at a topic close to my heart: growth

through service. What does this have to do withNDT and NDTA? For me, and I believe for manyin our organization, service is at the center ofour professional and personal identities. It is cer-tainly critical to our association.

NDTA has been one of the avenues for mygrowth through purposeful service. Serving in-volves time, energy, and commitment. It can befrustrating and irritating. It can make you won-der what in the world you were thinking whenyou volunteered.

It can also be exciting and rewarding. Throughservice we have an opportunity to follow ourcalling to give of ourselves, to use some talent,gift, or passion for the good of others. The funnything about serving is that we usually get muchmore in return!

Serving brings us close to other individualswho have a similar passion or interest. ThroughNDTA, I have met many wonderful cliniciansfrom across the country whom I now include asmy friends, not just my peers. We have servedtogether as regional chairs, as board members, asinstructors. We have laughed, planned, strug-gled, and succeeded. Together. We have frus-trated each other, respected each other’s beliefsand values, and most importantly, learned fromeach other in the process of giving. ThroughNDTA, I have acquired clinical skills, relation-ship skills, teaching techniques, and manage-ment strategies. Best of all, I am still learningand growing as a person and as a therapist!

Involvement in NDTA gives me first-handawareness of what is happening within the as-sociation and as a team member to decide howwe move forward. I am empowered to think andto voice my opinions. And I am held account-able for my part in making things happen. Asboard members, we share ideas, plan together,and work to achieve the goals we establish. I cantell you with much pride that you have a boardof directors and many committee members whowork diligently for YOU.

I continue to be amazed at the number ofpeople it takes to keep the association running.And, how important it is to have many diversebackgrounds and views for keeping us a vibrant

organization in today’shealthcare arena.

A few months ago, inthe interest of office effi-ciency, I asked our mem-bers to renew their membership online and tomake a donation toward enhancing program de-velopment. Many thanks to those who re-sponded. I am happy to report that nearly half ofrenewing members did so online. Members con-tributed over $3800.00!

NDTA is moving forward with a new Web sitedesign, which will make its debut at the NDTAAnnual Conference in Orlando this May. Thesecond printing of our theory book will soon beavailable. Research chair Janet Powell and hercommittee are working to develop a researchplan that fits within our larger strategic plan.We’re reviewing our regional structure and plan-ning for ways to better utilize our regional chair-persons on a local level. Our 2004 NITE cours-es are up and running, with locations andinformation available on our Web site. The Al-liance Committee is working on increasing ourWeb site links, our university connections, andthe development of a mentoring program.

This is an exciting time within NDTA! Ourgoal is to be a vital professional organization fo-cused on meeting your needs. But we need yourhelp. We need you to join in the process. Can wecount on you? Please contact the NDTA office,or me at [email protected], if you are inter-ested in our association’s future.

I encourage you all to take this opportunityfor personal growth through service and becomeactive in YOUR association. It is definitely a win-win situation.

Wendy Drake-Kline

President, NDTA

Wendy Drake-Kline

AGrowth Through Service

F A M I L Y C O R N E R


Web Links Connect You to InformationBy Pamela Curtiss-Smith, OTR/L

CALLING FOR AUCTION DONATIONS!NDTA Silent Auction

At the NDTA Annual Conference

May 7, 2004, 5:30pm–7:00pm

FOR COOL STUFF!

NDTA’s silent auction is a fun-filled event—and a worthwhile cause. Now is the timeto clean out and donate those no-longerneeded items:gift items, fine artwork,col-lectibles,products and services,baskets ofgoodies, etc. Proceeds go directly to theNDTA Equipment Assistance Fund to helppatients of NDTA member therapists.Bring your items to the conference orcontact the office to make a donation.

CONGRATULATIONS!Trisha Moratorio has completed theprocess to become an AH PTInstructor. She will be an-nounced as a new Instructor atthe upcoming IG meeting in Orlando. Please join me in congratulatingher, and AH CI’s, please keep her in mindfor your next course!—Sandy Kurosaki, Chair, PT Instructor CandidateReview Committee

WELCOME TO ALL YOU DEVOTED FAMILY MEMBERS!We’re thrilled to have you join us as mem-

bers of NDTA! Through this column and

other NDTA sites, we hope you will find in-

formation, support, and resources about how

Neuro-Developmental Treatment can bene-

fit you and your family.

Please visit the NDTA Web site. This valu-

able resource presents information about our

members and research opportunities and in-

cludes a trove of books, articles, and videos

to buy or borrow from our Lending Library.

The Education page lists courses available to

therapy professionals, but also highlights new

courses geared toward care providers and

family members. You’ll find answers to your

questions and plenty of guidance in your

search for more information.

On the Alliances page, under “The Client

and Family Links,” you’ll find links oriented

specifically to you, including:

United Cerebral Palsy (www.ucpa.org). This

site presents a host of information about

UCP, including your local chapter and na-

tional events.

American Academy for Cerebral Palsy and

Developmental Medicine (www.aacpdm.org.).

The resource directory is geared for adults

with CP and a library includes recommend-

ed readings for parents as well.

Exceptional Parent Magazine

(www.Eparent.com). Articles and advertise-

ments here are related to disability. The library

includes software in 50 different categories.

National Institute of Neurological Disorders

and Stroke (www.ninds.nih.gov). Informa-

tion about all types of neurological injuries,

current research articles, and a diagnostic list

of studies searching for subjects is available.

The March of Dimes (www.modimes.org).

The focus here is on pregnancy, prematuri-

ty, and health concerns for babies with and

without disabilities.

Easter Seals (www.easterseals.org). This site

has a calendar, camp applications and lists

affiliates in eight different countries.

National Disability Sports Alliance

(www.ndsaonline.org). You’ll find details

about a variety of sports events and organi-

zations for disabled athletes. Links include

the CP International Sports and Recreation

Association at www.cpirsa.org

The Cerebral Palsy Network

(thecpnetwork.tripod.com). This is a parent

support Web site based in the state of Wash-

ington and has many topics, resources, and

links to other diagnosis specific sites.

KidsHealth (www.kidshealth.org). This kid

friendly site is for siblings as well as those

with a disability. It is not limited to infor-

mation about CP.

Cerebral Palsy and Aging (www.geocities.com/

Tokyo/7970/cpage.htm). Created and main-

tained by an older adult with CP, this site has

links to other sites, personal stories, lists of ar-

ticles, and focuses on dental care and dentists.

Cerebral Palsy Resource Center

(www.twinenterprises.com/cp). This site has

a book list, parent listserve, a CP dictionary,

and a focus on hippotherapy.

The above is merely a sampling of the con-

nections you have made by taking the initia-

tive to join NDTA. Happy surfing!! ■

Pamela Curtiss-Smith is an occupational ther-

apist in Omaha, Nebraska. She can be reached

at [email protected].

FA M I LY C O R N E R

REMINDER:IG Meeting PRIOR TO NDTA 2004CONFERENCE AT THE CARIBE ROYALE, ORLANDO, FL

May 1-4, 2004: Saturday Arrivals &Executive Committee MeetingMeeting Schedule: Sunday 8:00 amthrough Tuesday 12:00 Noon

Return your Instructor Meeting Registration Form today!

CORRECTION. In the last issue, atthe end of Mary Rose Franjoine's articleon the Pediatric Balance Scale, the nameof Joan Gunther, one of the co-authorsof the article that first appeared inPediatric PT Journal, was misspelled. Weregret the error.

HOT BIDS

N D T A N E W S


WASHINGTON, DCMarch 26-28: Utilizing Neuro-Developmental Treatment forChildren with Neuromotor Involvement—Practical ClinicalApplicationsWendy Drake-Kline, NDTA OT Instructor

DAYTON, OHIOMay 21-23: Creative Routes to OutcomesKay Folmar, PT

TULSA, OKLAHOMAJune 18-20: Applying Theoretical Concepts to Produce Functional Outcomes Lezlie Adler, NDTA OT Instructor

TROY, NEW YORKJuly 19-23: NDT Five Day Intro to Adult HemiplegiaTeddy Parkinson, PT, andCathy Hazzard, PT, NDTA Coordinator Instructors

SEATTLE, WASHINGTONAugust 19-21: NDT Introduction to PediatricsBrett Nirider, PT

SHEPARD, MIAugust 27-29: NDT Introduction to PediatricsLinda Kliebhan, PT

HOUSTON, TEXASSeptember 24-26: Beyond Weight Bearing: Developing HandFunction in Children and AdolescentsLezlie Adler, NDTA OT Instructor

MARIETTA, OHOctober 1-3: An NDT Gait CourseMonica Diamond, NDTA Coordinator Instructor

SALT LAKE CITY, UTAHOctober 8-10: Introduction to NDT in Managing AdultHemiplegiaKay Folmar, NDTA Coordinator Instructor

AUSTIN, TEXASOctober, 15-17: Pediatric NDT for Children with Different Kinds of Cerebral PalsyLauren Beeler, NDTA Coordinator Instructor

TROY, NEW YORKNovember 5-7: An NDT Key to Baby Treatment: Identifying and Using Trunk Components for Functional Movements in the Baby From 3-12 monthsSherry Arndt, NDTA Coordinator Instructor

FOR MORE INFORMATION

CONTACT NDTA AT

[email protected]

or visit www.ndta.org

1540 South Coast Hwy., Ste. 203

Laguna Beach, CA 92651

800-869-9295

949-376-3456 Fax

NDTA Institute forTraining and Education

( N I T E )

Neuro-DevelopmentalTreatment Association2004 Course Calendar

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N D T A 2 0 0 4 C O N F E R E N C E • O R L A N D O , F L O R I D A • M A Y 5 - 8 , 2 0 0 4

Don’t Miss These Informative Pre-conference WorkshopsWEDNESDAY, MAY 5, 2004 • Orlando, FloridaA separate registration fee is required for each of these special programs, whichincludes continental breakfast, refreshment breaks, and all course materials.Registration in each of the workshops is limited to 50 participants.

NDTA 2004 PRE-CONFERENCE

Pre-Conference WorkshopTHERAPEUTIC AQUATICS FOR CLIENTSWITH NEUROLOGICAL IMPAIRMENTJane Styer-Acevedo, PT

This workshop is designed for the health careprofessional and paraprofessional currentlyworking in the aquatic environment or desiringto begin work in aquatics. A problem-basedapproach is used to determine the aquatictreatment strategies best suited to the clientbased on functional goal, the task analysis ofthat goal, and the impact of water on theclient’s movement.

A variety of treatment techniques will betaught to emphasize the strengthening andsymmetry of the trunk while activating andstrengthening the extremities. Safety andswim skills will be reviewed as they can beapplied to “land” function. A videotapedtreatment will be used to assist in planningand integrating aquatic and land-basedinterventions.

Strong emphasis is placed on the pool labto practice the techniques with supervision.Therapists should wear bathing suits for theafternoon sessions.

Morning Session: 8:30 am – 12:00 pmHeld at the Caribe Royale Resort.

Afternoon Session – An in-pool lab sessionheld in the therapy pool at Florida Hospital.Transportation provided. Afternoon attendeeswill be assigned to Group A or Group B scheduled as follows:

• Group A: (1:00 pm – 2:45 pm)• Group B: (2:45 pm – 4:30 pm)

Jane Styer-Acevedo, PT has presented over100 workshops since 1983 on therapeuticaquatics and NDT. She has also authored mul-tiple chapters and articles and is the recipientof the Pennsylvania Physical TherapyAssociation 2000 Carlin-Michels AchievementAward for her contribution in patient care,education, research, and community service.

Pre-Conference WorkshopUSING TAPING AS AN ADJUNCT TO NDTJudi Bierman, PT and Monica Diamond, MS, PT

This one-day workshop will review principles of taping as applied tothe treatment of individuals who are receiving therapy in an NDTframework. A brief lecture will be followed with practice with a variety of materials and an opportunity to learn specific strategiesto use with clients with neuromotor impairments that influence postureand movement. Videos will be used to supplement lab sessions.

Morning Session: 8:30 am – 12:00 pm. Topics include:• Theory & principles of taping combined with

NDT Theory• Kinetic tapes• Tensowrap, Kinesiotape• Wrist & hand, thoracic spine, & shoulder

Afternoon Session: 1:00pm – 5:00pm. Topics include: • Knee• Foot & ankle• Hypafix & leukotape• Trunk• Paraspinals & abdominals• Video case studies

Judi Bierman, PT, is a pediatric Physical Therapist and Coordinator/Instructor for NDTA. She has a private practice in Augusta, Georgia,and teaches a wide variety of NDT courses across the country,including the popular “Taping” course.

Monica Diamond, MS, PT, is a rehabilitation services clinical specialist.During her 25 years of clinical practice, she has developed a special interest in using taping as an adjunct to NDT.

After attending this workshop and observing brief videos of clientassessment, you will be able to:• Discuss the theory and basic principles of using taping for the

treatment/management of posture and movement problemsin children and adults with neuromotor impairments

• Demonstrate at least 10 strategies to improve posture andmovement utilizing at least 3 different materials in the upperextremities, lower extremities and trunk.

• Select the type of tape, placement, timing of application andremoval suggestions.

Therapists should wear lab clothes, such as a two-piece bathingsuit, to allow taping of the arms, legs and trunk. Each participantshould also bring a pair of safety tipped scissors. Participants willreceive the various tapes to take home as part of the coursematerials included with registration.

Three full days of outstanding educational sessions presented by a distinguished faculty of NDTAInstructors & featured Guest Speakers

Conference format that includes provocative generalsessions, parallel sessions for pediatrics and adults, interactive panel discussions, & case-study presentations

High-powered interaction opportunities with your colleagues:Networking Receptions, Award of Excellence Luncheon, Silent Auction, Meet NDTA Lunch Session

Exhibitor Showcase & Poster Session

Two separate Pre-Conference Courses:

“Therapeutic Aquatics for Clients with NeurologicalImpairment”–Jane Styer-Acevedo, PT

“Taping As An Adjunct to NDT Treatment”–Judith Bierman, PT & Monica Diamond, MS, PT

REGISTER TODAY FOR NDTA 2004

OPENING KEYNOTE ADDRESS: The Vast Spectrum of the Possible—Kay Folmar, PT

From Disability to Recovery: A Top-Down Model for Task-Oriented

Intervention in Neurologic Rehabilitation—James Gordon, EdD, PT

Assessment & Treatment of the Infant with Cerebral Palsy—

Gay Girolami, PT, MS, Judy Gardner, MA, CCC, SLP

& Diane Fritts Ryan, OTR/L

Achieving Functional Outcomes Related to the UE Using Principles

of NDT (Bobath) While Integrating Specific Concepts of CIMT—

Catherine Runyan, OTR

Plasticity & Recovery— Randolph Nudo, PhD

Enriched Environments— Randolph Nudo, PhD

An Introduction to Functional Strategies for Recovery of Cognition,

Communications & Executive Functions—Mark Ylvisaker, PhD

Practical Approaches to Enriched Therapy Environments in

Pediatrics—Brett Nirider, PT & Gay-Lloyd Pinder, SLP

Skill Acquisition: The Functional Outcome of Therapy—

Janice Hulme, PT, DHSc

Skill Learning As An Essential Substrate for Functional Recovery—

Carolee Winstein, PhD, PT, FAPTA

Constraint-Induced Movement Therapy: Another Form of NDT or

Something Completely Different?—Carolee Winstein, PhD, PT, FAPTA

Functional Strategies for Recovery of Cognition, Communication

& Executive Functions After Brain Injury in Children & Young Adults

—Mark Ylvisaker, PhD

Is Constraint The Only Way? Novel Models of Task-Oriented

Exercise After Stroke—Richard Macko, MD

The Role of Constraint: Panel Discussion—

Moderators: Kay Folmar & Clare Giuffrida, PhD, OTR/L.

Panelists: Dr. Nudo, Dr. Macko, Dr. Winstein, Janice Hulme,

Catherine Runyan, Chris Cayo.

Conference Sessions

Contact NDTA for more information and to register at: www.ndta.org or call (800) 869-9295

P L A S T I C I T Y & R E C O V E R Y A C R O S S T H E L I F E S PA N

M A Y 5 - 8 , 2 0 0 4

N D T A N E W S

Colleague Close-UpsNDTA MEMBER NEWS. By Gina M. Best, PT, MS, NCS


COLLEAGUE CLOSE-UPS INFORMATION FORMNAME ____________________________________________________________________________________________________

DISCIPLINE: ■■ PT ■■ OT ■■ SLP NDT-TRAINED: ■■ ADULT HEMI ■■ PEDS

TITLE/POSITION __________________________________________________________________________________________

Place of employment ________________________________________________________________________________________

Address ___________________________________________________________________________________________________

City, State, Zip ______________________________________________________________________________________________

Event ( New job, promotion, etc.) ______________________________________________________________________________

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

Family Facts (Your engagement or your 50th anniversary, etc.) or Professional Accomplishments (Publications, Honors, Awards,

Advanced Degree, etc.) you’d like to share: ________________________________________________________________________

__________________________________________________________________________________________________________

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NDTA MEMBERS RECOGNIZED AT AMERICAN

PHYSICAL THERAPY ASSOCIATION

NDTA was well represented at the American Physical

Therapy Associations's Combined Section Meeting held

in Nashville, TN, February 4-8, 2004. The following

NDTA members were recognized at the Opening Cer-

emony as Certified Specialists by the American Board

of Physical Therapy Specialities:

Pediatrics: SHERRY ARDNT, PT, MA; ELAINE CLARK, PT, MPT; NOEL

ENRIQUEZ, PT; LORRAINE GLUMAC, PT, MED; DIANA KENNEY, PT,

MS; ANNE MARIE SANTOS, PT, MSPT; AND DEBORAH THOMAS, PT.

Neurology: GINA M. BEST, PT, MS.

THANKS TO THE BOOTH STAFFERS

The NDTA booth was displayed in the exhibit hall

at the American Physical Therapy Associations's

Combined Section Meeting and was staffed by

PAMELA MULLENS, PhD, PT and MARCIA STAMER,

PT of the Instructors Group and GINA BEST, PT, MS, NCS, of

the Board of Directors

BRAVO FOR POSTER PRESENTATIONS

MARY ROSE FRANJIONE, PT, MS, PCS and colleagues

authored two excellent poster presentations. The

posters were entitled, “Performance on the Standard-

ized Walking Obstacle Course for Matched Pairs of Chil-

dren with Cerebral Palsy and Typical Development” and

“The Performance of Six School-Age Children with Cerebral Palsy

on the Pediatric Balance Scale: A 3-Year Study of Changes in Func-

tional Balance”.

CONGRATS TO THE NEW MOM

Best wishes to and congratulations to RACHEL GARBER,

OTR, who gave birth to WILLIAM REED GARBER on

December 8, 2003.

If you have news for the Colleague Close-ups column, fill out theform below or contact Gina Best at [email protected]. This form can also be found on our Web site atwww.ndta.org

A

A D V O C A C Y

s with any business, the daily life of a

therapy company is filled with clients

and the issues of billing, personnel, market-

ing, and finance. It is therefore no surprise

that short shrift is given to preparing for a dis-

aster—after all, it may never happen. Yet fire,

theft, and natural disasters do happen. And in

today’s precarious world, disaster seems clos-

er to home than ever. A calamity can cause a

significant disruption in business operations.

In many cases, such interruptions can have a

negative impact on the company’s profits or

even force a business to cease operations.

This risk is especially severe for the thera-

py company because it must operate in an ef-

ficient and timely manner to properly serve its

clients. The destruction of computer hard-

ware and software and the loss of equipment

can freeze a therapy company in its tracks. A

few days or weeks being unable to serve clients

will negatively impact both the cash flow of

the company and its base of patients.

To prevent a serious disruption when dis-

aster strikes, you should have a plan in place

for recovery to normal business operations.

The plan should be in writing, stored off

premise, and address the following:

1. PHYSICAL LOCATION

The physical location of your business is the

building structure itself and the room or rooms

where business is conducted. It also includes

the systems that keep the physical plant oper-

ating, such as walls, insulation, venting, air

conditioning, heat, and carpeting. Partial or

complete destruction of your physical plant

can occur due to numerous events—fire, hur-

ricane, flooding, theft, or utility disruption.

If you lease the premises, your main source

of protection is the terms of the lease. A well-

drafted lease will require the landlord to make

repairs to partially destroyed premises with-

in a certain period. If the landlord does not

abide by the lease terms, the tenant either

should have the opportunity to make the re-

pairs himself with a set-off against future rent

or be able to terminate the lease. If you own

the physical location, your insurance policy

should cover partial or full destruction.

In addition, you’ll want to protect the con-

tents of your office with a comprehensive in-

surance policy. Regardless of whether you lease

or own, all therapy companies need to insure

against lost income during the period of recon-

struction or relocation. Consider also coverage

for debris removal, fire department service

charge, pollutant clean-up and removal, glass

and signage, fire extinguisher recharge, key

and lock replacement, inventory, and appraisal.

Don’t’ stop your recovery plan with insur-

ance. As a precaution, do a little research and

have a back-up list of locations that can serve

as a temporary home in case of destruction of

the premises. Numerous “office suite” com-

panies lease out office space on a month-to-

month basis and can provide you with a re-

ceptionist, reception area, copier, fax,

computers, and conference room.

2.HARDWARE & OTHER EQUIPMENT

Keep a careful inventory of all hardware and

equipment on a worksheet, listing items by

manufacturer, model, and serial number. The

equipment should be insured at replacement

value. Coverage should also be purchased for

labor to install the equipment. For example,

in most cases a specialist is needed to network

the computers and printers properly.

Moreover, when purchasing equipment,

consider the brand and the vendor’s ability

to deliver replacement equipment when dis-

aster strikes. Selecting reputable brand names

for equipment is one way to ensure quick and

easy replacement in dire situations.

3. COMPUTER SOFTWARE

Software is the machinery that runs the ther-

apy company. It is crucial that data on software

be preserved in case of disaster. Standardized

backup procedures should be implemented

on a daily basis. All companies should run

daily incremental backups with a full back-

up run once a week. The full backup should

be stored off-site in a secure location. All back-

ups that are stored at the office should be

placed in a fire safe box.

Replacement of software and data and any

installation fees that would be incurred should

also be covered on the insurance policy.

4. FURNITURE

All furniture needs to inventoried and val-

ued, with the replacement cost of each noted.

The insurance policy should cover the re-

placement value of all furniture to ensure that

the billing company does not have to shoul-

der the depreciation cost of the furniture lost

in the disaster.

According to Murphy’s Law, if it can go

wrong, it will. Waiting until disaster strikes is

too late. A disaster plan can save headaches, as

well as time and money. ■

Ronald Nyman is president of MediStar Billing

Center in Trumbull, Connecticut. He can be

reached at [email protected].

Are You Ready or Not?DISASTER PLANNING CAN MAKE THE DIFFERENCE BETWEEN LIFE AND DEATH OF YOUR COMPANY. By Ronald Nyman


A

A calamity can cause significant disruption

in business operations…and have

a negative impact on the company’s

profits.

Should we take a trip to Disney World? That’s

a hard question for anyone with a disabled

child. We had been asking it for five years,

and we finally took the plunge in Novem-

ber 2003. Yes! We made it to Disney World

and it was great! Here are a few tips based

upon our experience that might help you,

too, say yes to a Disney adventure.

We are a family of five with three daugh-

ters—Amanda 6, Grace 9, and Elise 12. Elise

has CP, more specifically, a white matter dis-

ease, possibly vanishing white matter. She

has low tone with all limbs affected. Although

confined to a wheelchair, she can moder-

ately assist with sit-stand transfers.

Non-verbal, Elise is able to use basic signs,

pictures, a talker, and her smile to communi-

cate. She is timed toilet trained when her mom

sticks to the schedule. She is an independent

eater with finger foods and had a g-tube put

in two years ago for minimal night feedings.

Her seizure disorder is well controlled with

Depakote. Our other daughters are typical

and were dying to experience Disney!

First, we had to pick a time to go. Florida

summers are hot, and because Elise does not

tolerate the heat, we chose a fall visit. No-

vember was ideal, with temps in the mid to

high 70’s and only an occasional sprinkle. It

was also considered off-season, so prices

were lower and crowds thinner. We stayed

for six nights.

Lodging was the next decision. We relied

on a book we highly recommend: PassPorter

Walt Disney World Resort by Jennifer Watson,

Dave Marx, and Allison Marx (available at

book stores). It covers everything you need

to know, including where to stay, information

about the parks, and even travel agent rec-

ommendations, one of which we used to

book our trip. We decided to stay at a Disney

Resort so we could access the buses to and

from the parks and take advantage of early

park hours offered to resort patrons. We

chose a spacious two-bedroom condo at Old

Key West that had a full service kitchen, so we

were able to buy groceries and eat many

meals at the condo or carry lunch and snacks

into the park.

The buses were very accessible and com-

fortable. We took along a soft cooler and blue

ice for meals, snacks, and drinks. Through a

company Disney recommended, we were

able to rent an I.V. pole, which was delivered

to us, for Elise’s feedings.

Next, we had to plan our stay. Which parks

on which days? Which rides, shows, and

restaurants? The Passporter was an invalu-

able source of information. We also talked

with friends who go every year to determine

what might be appropriate for Elise.

We wrote out our schedule for each day.

The girls chose the rides and shows they really

wanted to do. Once their favorites were done,

we could be more flexible and go for repeats

or second choices. It was also important to

plan rest periods. We tried to come home for

lunch or in early afternoons and then go to a

different park later or in the evening. Elise

and I took one whole day off and swam, rest-

ed, and shopped in Downtown Disney.

The Magic Kingdom offered the most ap-

propriate rides and shows for Elise. At the

Magic Kingdom’s City Hall, we obtained a

Disability Pass, which allows up to five mem-

bers of a party to go through the fast-pass

line without a fast pass. This decreased wait

time and was good for our entire stay at all the

parks (just don’t forget it, like I did one day).

We also asked if Elise could ride twice.

Once they saw how difficult it was to trans-

fer her to some rides, all let us do this. Some

rides—such as the train, It’s a Small World,

and Buzz Lightyear—could accommodate

the wheelchair. Elise loved the 3-D shows,

the nighttime parade, and fireworks. Epcot

offered several fun rides and had a great

character breakfast in Norway. For Elise,

MGM and Wild Kingdom offered the least,

due to the bumpy/jerky rides and long dis-

tances between attractions.

In all we were thrilled with our vacation.

The only thing we missed was having a park

photographer take our family picture in

front of Cinderella’s castle (none of ours

came out well). At the end of our visit, we

were all glad that we’d answered “Yes” to the

Magic Kingdom. ■

Stephanie Miserocchi, PT, MHS, lives in

Nashville, TN, with her family. She can be

reached at [email protected]

1 0 • N D T A N E T W O R K • M A R C H / A P R I L 2 0 0 4 • I N T E N S I V E T R E A T M E N T

C A R E G I V E R P E R S P E C T I V E

Say Yes to the Magic!PLANNING MAKES A TRIP TO DISNEY WORLD A SUCCESS

By Stephanie Miserocchi, PT, MHS

Elise visits with Alice in Wonderland atDisney World

N D T A N E T W O R K • M A R C H / A P R I L 2 0 0 4 • I N T E N S I V E T R E A T M E N T • 1 1

N D T A 2 0 0 4 C O N F E R E N C E

CALL FOR POSTER DISPLAYSThe NDTA Conference Committee invites you to participate in the Poster Display being held in the Exhibit Hall duringthe 2004 Conference in Orlando, Florida. Posters will be on display beginning on Wednesday, May 5th through Saturday,May 8th. All poster presenters will be acknowledged and abstracts will be printed in the Conference Program Book.

The Staffed Poster Session will be held on Friday, May 7th from 5:30–7:00 pm.You are invited to submit an ABSTRACTof your clinical research. Each submitting Author may enter a maximum of three Abstracts. Please follow the instruc-tions listed below when offering your research for consideration.

You may wish to participate in this conference event by creating a DISPLAY featuring Clinical Applications of NDT philosophyand treatment and/or areas of interest to clinicians working with individuals with neurological impairment, i.e. enriched environments, biomedical equipment, etc.

GUIDELINES FOR POSTER PRESENTATION SUBMISSION:

Complete the Submitting Author Information:Name: ____________________________________________________________________________________________

Address: ___________________________________________________________________________________________

City, State, Zip Code, Country: ________________________________________________________________________

Telephone: __________________________ Fax: ________________________ E-mail: ____________________________

Title of Research or Display ___________________________________________________________________________

COMPLETE THE ABSTRACT OR DISPLAY IDENTIFICATION INFORMATION:

TITLE: Use all CAPITAL LettersAUTHOR(S): Underline submitting authorSITE/AGENCY: Indicate where the research study was done (if applicable)

SUBMIT THE RESEARCH/CLINICAL APPLICATIONINFORMATION:

For ABSTRACT submission, please provide ALL of therequested information. For DISPLAY submission, please provide information as applicable to your presentation.

PURPOSE: Study hypothesis/questionsSUBJECTS: Number and characteristicsMETHODS: Techniques/materials usedDATA ANALYSIS: Statistical tests usedRESULTS: What did data analysis reveal?CONCLUSIONS: Do results support the research hypothesis?RELEVANCE: Significance of the study relative to healthcareACKNOWLEDGEMENTS: Site/Agency funding/supportingthe study

SUBMIT BY APRIL 5, 2004 Send via mail, fax or email to:NDTA 2004 Poster Exhibit, C/O Evangeline Yoder13057 Warwick Blvd., Newport News,VA 23602E-mail: [email protected]: (757) 249-2258 • Fax: (757) 881-9709

The Conference Committee will acknowledge acceptance of yoursubmission by sending Poster Display Instructions.

THE RELATIONSHIP OF HAMSTRING SPASTICITY & CONTRACTURE TO GAIT IMPAIRMENT IN CHILDRENWITH SPASTIC DIPLEGIA. Glock E., Yoloho E., Physical Therapy Program, Young University, Pungo VA.

PURPOSES: The purposes of this research were to determine the: 1) reliability of hamstring spas-ticity measurements; 2) reliability of popliteal angle measurements; 3) relationship of hamstringspasticity to step length, stride length & gait velocity; 4) relationship of hamstring contracture to steplength, stride length & gait velocity. SUBJECTS: Eleven children (8M/3F) with spastic diplegia (ages3-15 yrs) were studied. All walked independently with or without appliances. METHODS: Two raterstwice graded hamstring spasticity in both legs of subjects using the modified Ashworth scale whilesubjects simulated the Terminal Swing (TSw) Phase position in standing. Raters twice goniometricallymeasured subjects popliteal angles in the supine position. Each subject walked 20í with inked shoe padsto determine stride & step length distances. Gait velocity was determined using a stopwatch. DATAANALYSIS: Intraclass correlation coefficients (ICC) and percent of agreement (0-100%) were usedto determine the reliability of intrarater & interater measurements of spasticity and popliteal angles.Speanean rank correlation coefficient was used to assess the relationship between spasticity & gait,and between hamstring contracture & gait. RESULTS: Intratester reliability for hamstring spasticitymeasurement was fair (.487) to good (.941); intertester reliability was poor (.242) to fair (.613); thepercent of agreement ranged from 0% - 10%. The reliability of popliteal angle measurements wasgood (.884) to high (.962). Negative correlation between hamstring spasticity & gait measurementswas poor (.305) to fair (.431) on the right side, and moderate (.564) to good (.877) on the left side.The Pearson product moment correlation coefficients between hamstrings range (popliteal angle) &gait were moderate (.685) to good (.840). Correlation of hamstring range with Terminal Swing Phasegait was significant at the .05 level. CONCLUSIONS: The reliability of spasticity measurements wasvariable, and the relationship of spasticity to gait was equivocal with respect to the right and leftsides. Measurements of hamstring range were reliable, and there was a significant relationship be-tween hamstring range of motion and swing-phase gait. RELEVANCE: Reliable examination proce-dures are required to assess patient impairments and their impact on functional movement. Assess-ment of the efficacy of treatment on patient functional outcomes requires the heath care provider toanalyze the relationship between measured impairments and measured functional performance.ACKNOWLEDGEMENT: This research was supported by Grant No 652 awarded by Young Univer-sity, Pungo, VA.

S A M P L E A B S T R A C T

SA

MP

LE

SUBMISSION DEADLINE: APRIL 5, 2004

M E S S A G E F R O M T H E P R E S I D E N T

able to sit with minimal support on the floor

if he has been loosened up and if he is sup-

ported correctly, with no outside distraction.

During supported sit and stand, his head con-

trol is developing. Head control is best when

no other demands are placed on his body and

when he is posturally active. Use of the limbs

often results in asymmetry in the head and

neck. He can transfer to stand with assistance

and take steps with support, although he does

tend to cross his legs intermittently. At times

he startles or extends to talk and this inter-

feres with his ability to stay upright. He has

no independent form of mobility.

Michael communicates using telegraphic

speech consisting of three- and four-word

phrases. He converses with those around him

and is understood the vast majority of times.

IMPAIRMENTS: The following impair-

ments contributed to Michael’s functional

limitations.

1. Significant weakness of the postural mus-

cles, especially those about the trunk and

pelvis. He has difficulty generating active

postural flexion in his trunk and pelvis to

bring his trunk forward over his base of

support. As a result, Michael tends to com-

pensate by activating his superficial move-

ment muscles. This prevents him from being

able to bring his arms forward for contact.

2. Asymmetric extension pattern, which in-

fluences arm position and use, as well as

head and eye position. He tends to keep

his head rotated to the left with capital

and cervical hyperextension. One arm is in

extension with the other in flexion. This

overall asymmetric pattern, which includes

the arms, head, and legs, also creates the

extensor synergy in the legs.

3. Excessive stiffness generated when Michael

attempts to move and to initiate phona-

tion. He translates this into extension with

adduction of his legs, hyperextension in

the trunk around the thoraco-lumbar junc-

tion and flexion and abduction in his arms,

or a strong pull into flexion of the trunk

and arms with anterior chest muscles.

4. Dystonia especially of the limbs. This is

exhibited with voicing, efforts to reach,

and some attempts to move his body in

transfers. As Michael initiates movement

or speech he does so suddenly and with

excessive force.

5. Excessive co-activation of the muscles of

the legs and arms with effort. This causes

Michael to be “stuck” with attempts to

move his limbs forward for a toy or to

move on the floor. It also creates excessive

stiffness with the effort of speaking. For

example, when Michael wants to reach

forward for an object his arm draws back

in stiff flexion, and when he wants to bend

his legs to move forward they sometimes

become stiff with extension, thus imped-

ing the very movement he wants to do.

6. Musculoskeletal tightness of the extrin-

sic flexors of the hand overpowering the

extensors. This results in a flat palm with

little intrinsic activation. Primarily Michael

contacts objects with the index finger of

each hand, the intrinsic musculature is

overpowered by the extrinsic muscle re-

sulting in MCP extension with distal flex-

ion of the digits. Thumbs are held tightly

in abduction.

7. Decreased mobility of the spine and rib

cage. A flattening in the thoracic spine and

rounding in the lumbar spine is accompa-

nied by muscular tightness in the intercostals.

POSTUREAND MOVEMENT STRATE-GIES:Michael attempts to solve his difficulty

with generating movement by creating stiff-

ness from his head through his lower extrem-

ities in an extension pattern and pulling with his

upper extremities in bilateral flexion or a com-

bination of asymmetrical flexion and exten-

sion. He tries to cognitively figure out how to

make his body move, and with that intention

comes a strong increase in extensor stiffness

throughout his entire body.

FAMILY GOALS: At the beginning of the

intensive, four goals were identified: 1) per-

mit Michael to use his arms away from his

body without stiffness, 2) make it easy for

him to play with his toys, 3) enable him to

operate the joy stick on the his electric wheel-

chair, and 4) allow him to have some form

of floor mobility.

TREATMENT STRATEGIES: The fol-

lowing strategies were found to be successful

with Michael:

1. Focus on symmetry. This is a critical ini-

tial treatment strategy. Alignment pro-

vides the opportunity for postural mus-

cles to activate and movement muscles

to be freed. For Michael, symmetry al-

lowed his arms to be released from the

postural system and to come down at his

sides in supported sitting to take weight

or be used for expression.

2. Decrease the stiffness in his trunk—

specifically, generating increased acti-

vation of trunk flexors to balance ex-

tension, combined with active movement

of the trunk forward over a neutral

pelvis. Adding rotation of the shoulders

over the pelvis in small ranges allowed for

a final release of Michael’s arms to posi-

tions of flexion with abduction and ad-

duction, crossing the midline of the body,

and symmetrical arm posturing.

3. Activate Michael’s postural extensors and

unyoke his arms from his trunk. Michael

is able to free his arms from his body when


I N T E N S I V E C A R E S T U D Y

(Short and Sweet continued from page 1)

Michael tries to cognitively figure out how to make his bodymove, and with thatintention comes a

strong increase in extensor stiffness.

movements are faster. When he has time

to think and uses effort, the arms pull into

flexion, which pulls the whole upper body

into flexion. The more effort he uses the

stiffer he gets.When held in midline align-

ment in extension, like “Superman,” in the

therapist’s arms, with one leg bent for-

ward into flexion (LE dissociation),

Michael was able to use more isolated ex-

tension control. Next we added linear

vestibular movement. This helped acti-

vate his postural extensors. Then we put

a toy, such as a punch bag or beach ball, in

front of him so that he could reach his

arms out into forward flexion to bop it.

4. Allow for graded postural muscle con-

trol about the hips and pelvis. To build

on #3 above, Michael was positioned ei-

ther in the therapist’s lap or on the floor

so that he could move from heel sitting

toward tall kneeling. (Tall kneeling is used

as a transition position, not as a position

to hold.) Michael needed the therapist’s

hands to help control the alignment of

his trunk and pelvis. He could continue

to move into midline graded extension

as he reached up to push a toy or bop a

ball with his arms moving away from his

body. The flexion of the legs helped to

break up his asymmetric extension pat-

tern. This had to be done in a graded way

that did not use Michael’s hamstrings or

hip flexors. Next, Michael progressed to

coming down toward a slight side sitting

position (slightly off of midline), then

raising back up, and then coming down

slightly off to the other side.

5. Keep Michael’s trunk active. Michael ad-

dressed table top work in supported sit-

ting on a chair with a solid bottom and

back with a mildly dynamic surface added

to both. A mid-chest-high table was used

to support weight bearing on fully sup-

ported arms. A slippery substance applied

to the table surface reduced resistance.

6. Keep Michael posturally active by gen-

erating dynamic movement of the base

of support and active movement of the

trunk. This was accomplished by having

Michael sit on a small chair with a cush-

ion when participating in looking activ-

ities or watching TV, video’s, other kids,

etc. A fabrifoam wrap around the lower

trunk helped Michael feel stability in his

trunk. The emphasis was that Michael

was working off a support surface.

7. Bring arms to midline in patterns of

shoulder flexion, external rotation and

adduction, and elbow flexion, with fore-

arm in neutral, wrist in extension, and

hands together in exploration. The ther-

apists held Michael on her lap with his

hips flexed greater than 90 degrees. When

the therapist shifted his trunk forward,

Michael was able to play with reaching

for his feet, knees, and to bring his hands

together to hold objects and explore bi-

lateral finger play.

8. Create a pattern of hip flexion with dy-

namic spinal extension rotation. The

purpose was to help decrease Michael’s

total extension pattern and encourage his

abdominals to actively balance the spinal

extension. In sitting on a bench, Michael

reached for an object down on the floor,

bending forward at the hips and rotat-

ing slightly to one side. He also reached

with the opposite arm to the floor. The

therapist placed her hand on his ribs with

the intention of lengthening the latis-

simus dorsi and stabilizing his rib cage.

As he returned to upright sitting, he need-

ed to be reminded to keep his chin down

so that he did not compensate with head

and neck hyperextension.

9. Counteract Michael’s tendency to usethe upper body for extension. To pre-

pare Michael for his own independent

transfers, he was placed in sitting and al-

lowed to weight bear forward on his

hands on a surface in front of him that

was at about belly height. Next, he rose to

standing with graded leg control while

keeping his arms forward. .

10. Focus on the trajectory of arm move-ment in space with contact on an objectrather than with any manipulation.Choice of activities had to be engaging

and had to require sustained visual con-

tact. Activity choices included:

a. Finger painting with shaving cream,

lotion, Vaseline, powder, pudding, ap-

plesauce, marshmallow cream, etc.

b. Water play with easy-to-manipulate

objects, i.e. balloons, bubbles, etc.

c. Reaching towards a forward surface to

knock off objects (bath blocks, magnets,

suction toys, computer key board, etc.)

11. Assist in the use of tools. If Michael

needed assistance to hold a tool, a wrap

was used over splinting.

12. Gain wrist extension and contour in thehand. It was essential to use lotions,

creams, etc. in a hand-massage model-

ing program.

13. Allow Michael to use dynamic gradedpelvic girdle muscles. This involves the

hip extensors, abductors, and oblique ab-

dominals. Transitioning from sidesit to

quadruped on the floor was an excellent

way to help Michael learn to use these

muscles. He needed some assist with

alignment in the weight-bearing arm at

the shoulder (humeral head), and then

compression was added. With this input

Michael could initiate the lift of his hips

off of the floor up to quadruped.

14. Create inhibitory movement. After get-

ting Michael into quadruped, rotational



(continued on page 14)

Choice of activities had to be

engaging and had to require

sustained visual contact.



movements through his trunk or pelvis

were provided with the therapist’s hands.

As Michael felt his inhibitory movement,

he could move his legs reciprocally as in

an assisted creeping pattern. As he prac-

ticed, the inhibitory input was decreased

so that he is was doing more of the leg

movements all on his own.

15. Focus on increasing the expansion ofthe upper rib cage. This was accom-

plished through massage and deep sen-

sory tactile input to the anterior, lateral,

and posterior rib cage. It allowed Michael

to free up his upper extremities from his

trunk and to take easier breaths.

16. Decrease the diaphragmatic holdingwithin the abdominal cavity. This re-

quired specific work to the lower anteri-

or rib cage. Throughout the handling,

Michael was encouraged to phonate and

take deep breaths.

17. Increase length and mobility of the lipsand cheeks. Michael received oral-motor

treatment of the facial and oral areas and

deep sensory tactile input to the tongue to

improve its contour and shaping for ar-

ticulation. Specific attention was given to

the tongue tip through manual manipu-

lation and the use of tastes to the tip to

heighten awareness. Michael was given

exercises in tongue tip placement in grad-

ed ranges inside and outside of the mouth.

18. Graded jaw movement. This was facili-

tated through some biting and chewing

exercises with placement of the hands to

the occiput and the TMJ to obtain a bet-

ter alignment during the oral exercises.

PROGRESS MADE DURING THE INTENSIVE:1. Free movement of arms on a non-resis-

tive surface with active shoulder flexion,

abduction, and adduction

2. Hands open on the surface contacting

light touch materials

3. Sitting on a chair with arms down at his

side, hands flat on the surface, and head

movement paired with eyes to engage in

play with others.

4. Arms brought to midline, hands together

5. Active head turning from side to side to

scan the visual field

6. Arms bilaterally and reciprocally con-

tacting legs, feet, arms, and face

7. Ability to move from sidesit to

quadruped actively using pelvic girdle

muscles with input at only one arm

8. Ability to move legs reciprocally for the

creeping pattern when minimally sup-

ported in all fours

9. Ability to hold sitting posture on the

floor with minimal support at one foot

and ability to shift weight in small ranges

to both sides. Use of flexion to “catch”

himself from falling backward with his

extension

10. Improved initiation of speech with a

more relaxed body

11. Easier breaths felt and heard during

the session

12. Increased awareness of tongue tip place-

ment for specific speech sound production

The above progress was experienced over a

short period of time and the intensive pro-

gram helped Michael reach a new level of

motor function. His family was pleased with

the changes that he made and requested future

intensives. The family was given recommen-

dations for the future, such as environmental

controls, adaptive equipment, and a thorough

functional investigation of his vision. ■

REFERENCE:Schmidt, R.A., and T. D. Lee. 1999. Motor

Control and Learning: A Behavioral Empha-

sis. Human Kinetics, third ed.

Suzanne Davis, PT, is co-owner of Pediatric

Therapy Associates in Plantation, Florida. She

can be reached at [email protected].

Order Your Copy Today!Neuro-Developmental Treatment Approach:Theoretical Foundations and Principles of Clinical Practice.By Janet M. Howle, PT, MSCT, in collaboration with the NDTA Theory Committee

Member Price: $65.00 Non-Member Price: $85.00

(Short and Sweet continued from page 13)

CALL TODAY: 800/869-9295 OR VISIT www.ndta.org

Janet Howle and contributors are to be congratulated

for producing a highly readable, well-principled, well-

organized,and exquisitely synthesized book for therapists

treating neurological conditions.

—Jane Case-Smith, Ed.D., OT/L, FAOTA

“”

T H E R A P Y T A L K

It is well known that seating stability comesfrom a stable pelvis. But for individuals withmultiple impairments, a stable pelvis is not syn-onymous with a lack of obliquity or rotation.In other words, stable does not mean symmet-rical, nor does it imply a fixed, rigid pelvis. Allof us must be able to weight shift forward andlaterally in order to have both stability and func-tional reach. That is the point at which thera-peutic handling meets assistive technology.

FACTORS IN SEATING POSITIONINGUnderstanding the principles of NDT tech-niques has aided me in understanding the dy-namics of positioning, and specifically cus-tom seating, for neurologically impairedindividuals. A thorough mat assessment pro-vides more than linear and angular measure-ments for seating; it allows one to ascertainthe point at which seating technology in wheel-chair prescription substitutes for the handplacement we use in treatment to gain align-ment and control. While pelvic stability is crit-ical, it should not be the main focus of seating.Function is the focus. It is imperative to un-derstand the full range of function, includingvision, swallowing, and functional reach.

For many folks with multiple impairments,it is most logical to consider seating in a tilt-in-space wheelchair, a recline wheelchair, oreven opening the back-to-seat angle. How-ever, this may lead to an altered visual fieldand altered biomechanics of the head andneck, with potential impact on swallowingand breathing. Furthermore, it can encour-age the individual to scoot forward and as-sume a posture dominated by posterior pelvictilt, thoracic kyphosis, and cervical hyperex-

tension [particularly with individuals withfunctional vision].

A seat depth that is too long will also causethis to occur. Vision can dictate posture andalter trunk and pelvic stability. A client’s needto find visual efficiency can override trunkpostures. Therefore, one must evaluate a

client’s functional position in space to deter-mine postural needs.

Because we are dynamic creatures, a seatingsystem must allow for maximum use of weightshift throughout all planes of the pelvis. To en-hance the effectiveness of weight shift, one mustalso look at full weight bearing through the fe-murs in sitting and weight bearing on the solesof the feet. To say that the hips and knee needto be at 90 degrees does not take into consid-eration functional reach and dynamic postures.

TRUNK STABILITY AND FUNCTIONTo enhance trunk stability for a multiply im-paired client, consider the entire lower bodyas the basis of support and not the pelvis alone.With the child I mentioned above, we found it

necessary to allow the legs to wind sweep tothe right to compensate for left lateral trunkflexion. To effectively allow this posture, thefront angle of the seat had to reflect thewindswept angle. It is often mistaken that thiscorrection should occur at the posterior por-tion of the seat. But logic dictates correctingthe seating system where the anatomical siteis mal-aligned, not necessarily where the ab-normality originates. When we did this, it al-lowed us to provide high thoracic support onthe left while stabilizing the pelvis to correcther non-structural rotational scoliosis.

Throughout the assessment process we weremindful of her efficiency for visual fields andthe biomechanics of head and neck align-ment. After each adjustment of her trunk andpelvic alignment, we asked her to scan her en-vironment and reach bilaterally so we coulddetermine when proximal stability met dis-tal mobility with function as key. Abnormaltone, functional postural tone, and primitivereflex patterns are also part of the equation.Their influence on posture, movement, andfunction must be carefully considered.

When evaluating multiply impaired indi-viduals it is paramount to include all membersof the treatment team, caregivers, and rele-vant family members. Understanding a client’schanging needs throughout the day, a week,and a year leads to a comprehensive view oftheir needs. A seating specialist alone cannotdetermine a client’s needs.

Regardless of your role in the seating team,it is important to remember that althoughthe pelvis is the base of stability, it is also thebase of mobility and should be afforded ap-propriate weight transference. Stability doesnot mean symmetry but functional align-ment. Function is complex and includes allactivities that are involved from a seated pos-ture. While challenging, careful and thought-ful positioning analysis enables optimal func-tional life pursuits for the client. ■

Teresa Plummer OTR/L, ATP is a clinical in-structor at Belmont University School of Oc-cupational Therapy in Nashville, TN, and theowner of “Community Mobility Resources”. Shecan be reached at [email protected].


Seating and StabilityAN NDT APPROACH TO EVALUATING WHEELCHAIR NEEDS

By Teresa Plummer, OTR/L,ATP

roximal stability is critical for distal mobility. But for individuals with multiple ortho-

pedic and neurological deficits, trunk stability can be an elusive pursuit.

Recently I was asked to evaluate a young girl with multiple orthopedic and neurological

problems in order to determine the best way to meet her wheelchair needs.Though I was

drawn to her captivating smile and engaging eyes, I immediately noticed her obvious need and

desire to stabilize herself by weight bearing on her lap tray.This made it very difficult for her

to play with her favorite toys without falling with her elbows onto her lap tray as a revised

weight bearing surface. Once we removed the lap tray, her chest support was her safeguard.

To enhance trunk stability,

consider the entirelower body as the

basis of support and not the pelvis alone.

P

E A R L Y I N T E R V E N T I O N


How incredibly rewarding it is to treat an infantwith a CNS involvement within the firstfew weeks of its life! During 25 years ofpractice, I’ve had the good fortune to treatmany infants. A large percentage of thesechildren do exceptionally well; they gaingross and fine motor skills as well as speechand language.

One child I began treating at three monthsof age is an excellent example. She was bornwith a Grade III bleed, left hemisphere, andGrade IV bleed, right hemisphere. She wasdiagnosed with moderate to severe involve-ment and given a very poor prognosis—shewould never walk or talk.When I began treat-ment, she weighed five lbs. Today, at 12 years,she ambulates independently with a rightAFO, uses her right hand as an assist, and hasnormal cognition, speech, and language. Sheis a cheerleader for Disabled Leisure Sports.

We have all encountered various medicaland educational professionals who negatethe value of therapy and the importance ofearly treatment. They believe that childrenwho make remarkable recoveries were ei-ther misdiagnosed or not very involved. For-tunately, MRIs have recently been able toprovide documentation of the original in-sult that has helped demonstrate the value ofearly treatment.1

CASE STUDYIn January 2003, a five-week-old male infantwith right medial cerebral artery infarct andseizures was referred to me for treatment. Hisdiagnosis was documented by MRI. He re-quired intensive medical treatment in the firstfew weeks of his life, as well as physical thera-py in the NICU. At five weeks, he was releasedfrom the hospital and referred for outpatientphysical therapy. Initial outpatient physicaltherapy evaluation documented low posturaltone and high tone in the left extremities.Ash-worth Scale for left extremities was 1+. Therewas severe sensory disorganization with re-sulting irritability.

The doctor monitored the child over hisfirst year. At three months of age, the babywas developing head and trunk control, al-though he remained highly irritable. Thedoctor remained concerned but slightly op-timistic. By six months of age, the child de-veloped skills for crawling and coming tostand. The doctor was more than enthusi-astic about his recovery. By nine months, thechild was crawling, and at 10 months, hestood alone and began taking steps, pre-senting motorically without any clinical signsof CNS involvement. At 11 months, he am-bulated independently, climbed, babbled,and was beginning to jargon. The neurolo-gist reported that “he no longer had any signsof cerebral palsy, he was normal.”

This child was my patient early in infan-cy. He is one of many children that I havebeen able to treat early with end results muchlike his. I believe several contributing fac-tors produced these results:

1. The baby received excellent care in theNICU.

2. Physical therapy was instituted immedi-ately in the hospital and then as an out-patient, with both therapists trained inneuropediatrics and Neuro-Develop-mental Treatment.

3. The parents were intensely involved inhis care.

4. My years of experience treating older andoften severely involved children provid-ed the knowledge and expertise to assistin the development of appropriate com-ponents for motor (gross and fine) andcognitive skills as they emerged.

Research is beginning to demonstrate howearly, appropriate, and intensive treatmentpositively alters the outcome for infants withCNS damage and resulting motor and cog-nitive impairments.2 The physicians withwhom I work can see the results of their in-

tensive treatment, as well those of early, in-tensive therapeutic intervention. They arebecoming the therapist’s advocate.

LEARNING FROM EXPERIENCEIn working with infants, the importance ofexperience and the skills learned in work-ing with the older, more severely involvedCNS child must be emphasized. From thesechildren therapists learn what is neededwhen treating the infant, what to facilitateand enhance, and what to inhibit and pre-vent. Every child I have ever treated hastaught me valuable information and skills,and every child has made some positive gainsrelated to his or her impairments. The im-provements may appear small to the practi-tioner, but to the child and the family theyare very important.

Therapists are extremely important in thelives of these children and their families. AsNDT therapists, we recognize that treatmentaffects every system of the body—car-diopulmonary, musculoskeletal, neuromus-cular, integumentery, cognitive, and emo-tional. Treatment must be approachedholistically, as taught and demonstrated bythe NDT approach.

Being able to use our skills to treat an infantand to change the course of that individual’slife is a moving experience. We are fortunateto be part of a wonderful profession. ■

REFERENCES:1. Faerber, E. 1995. CNS Magnetic ResonanceImaging in Infants and Children, CambridgeUniversity Press.

2. Nass, R. and D. Tauner. 2003. CognitiveDevelopment after Congenital Stroke andRecovery after Stoke in Childhood Review,December 2003.

Kristine Corn, DPT, is owner of Sierra Pedi-atric Therapy Clinic, Granite Bay, California.She can be reached at [email protected].

Early Treatment Can Mean a Brighter FutureOUTCOMES SUPPORT INFANT INTERVENTION

By Kris Corn, DPT

Q U E S T I O N F R O M T H E F I E L D


tivities to establish coordination of visionwith appropriate head/neck alignment.

• Work with the child in positions thatminimize the impact of gravity and thatrequire some degree of activation forhead lift, but not within a full range. Par-tial support of weight can also be used toreduce the impact of the weight of thehead in elevation.

• Full external support and control maybe necessary with feeding. In this situa-tion, maintaining appropriate head/neckalignment is essential, with greater sup-port provided through oral control(Helen Mueller). While you are provid-ing a greater level of assistance or controlto maintain alignment, it is importantto maintain dynamic handling (allow-ing the child to move his head/neck ashe feels is needed). The same principlesof observing and managing alignmentof the entire body apply when you arealso giving external oral control. Con-tinue to think about alignment from thebase of support upward even thoughyour direct input is provided at thehead/face and neck.

• Because vision may be a critical piece inmotivating the child to achieve andmaintain neutral head/neck alignment,it is essential to place stimulus materialsand/or yourself in the appropriate visu-al range to facilitate this alignment.

Although the presenting symptom or prob-lem may be viewed as poor head control, inorder to impact upon this component, treat-ment must address aspects of alignmentthrough the base of support to head/neck.This perspective must be maintained in theselection of equipment, supports to theequipment (head rest, harness, etc.), as wellas during direct treatment. ■

Therese McDermott, MHS, CCC-SLP, is aspeech/language pathologist and NDT speechinstructor working at Pathways Center in Glen-view, IL, and is in private practice in Chicago,IL. She can be reached at [email protected].

• Address improving balance of neck flex-ors and extensors for improved head/neckalignment relative to the trunk and sup-port surface. Initially, assist the child byplacing him or her in correct head/neckalignment, and then ask the child to sus-tain this appropriate alignment duringvisual or oral activities presented. Grad-ually, begin to provide facilitation formore dynamic head/neck control andalignment. With the child who exhibitsexcessive flexion, focus on activities forincreased graded extension. Attempt tostrengthen flexion in a child for whomextension dominates.

• Address weaknesses within specific musclegroups to allow the child to achieve andmaintain neutral head/neck alignment

• Facilitate postures and/or movement pat-terns that encourage alignment through-out the body. For example, you may at-tempt to facilitate scapular adduction withthoracic extension for more appropriatealignment through the trunk and then as-sess the balance of head/neck flexion/ex-tension upon this new base of alignment.

• Utilize postures and positions that allowactivation of specific muscle groups tosupport improved balance of head/neckflexion/extension. Upper extremityweight bearing (even in an upright po-sition) may allow for greater activationof the paraspinals for improved align-ment through the trunk, again as a basefrom which to build increased head/neck alignment.

• Encourage the child to activate the pos-tural system from the base of stability up-ward, balancing spinal extension with ec-centric activation of the abdominalmusculature. Incorporate vision into ac-

Factors that may contribute to reducedhead/neck control:• Poor postural stability – reduced balance

of flexion/extension through the trunk• Range of motion limitations that inter-

fere with alignment• Skeletal restrictions (spinal, rib cage)• Decreased strength/endurance through

specific muscle groups• Vision impairment/weakness• Dynamic postural compensations that

the child makes to keep the airway open,avoid reflux, etc.

Poor head control manifests in several dif-ferent ways depending upon the child’sunique strengths and weaknesses. For some,it may be a reduced ability to maintain thehead upright (strength/endurance), with thehead falling forward when positioned up-right against gravity. In other children, thehead/neck may be similarly flexed forwardand downward, or upright and hyperextendedback due to poor eccentric/concentric controlof head/neck flexion/extension. Therefore,the first step should be to assess all compo-nents and impairments that may contributeto the child’s poor head control. A thoroughassessment of all systems (neuromotor andmusculoskeletal, as well as, sensory and gas-trointestinal) will guide treatment.

TREATMENT STRATEGIES:• Address limitations in range of motion

that may impact upon alignment. For ex-ample, the child who more habituallypostures with head/neck hyperextensionmay require lengthening of cervical ex-tensors. Another child may require elon-gation through anterior chest muscula-ture to achieve greater thoracic extensionfor improved alignment to support ap-propriate head/neck alignment.

Question from the Field

A

Q

Therese McDermott, MHS, CC-SLP

When working with a child with severe neuromotor impairment, what can be done toimprove head/neck control for functions of feeding and/or visual exploration?

Alignment is a critical component for both tasks. In preparing a child for feedingand/or visual activities, it is essential to continually assess the alignment of the wholebody, not only the portion related to head/neck control.

R E V I E W

range 10 to 37 months (mean 22.6; S.D 9.9),all with quadriplegia (two were diagnosedwith “double hemiplegia”) were studied. Allwere previously enrolled in a rehabilitationprogram at the same institution throughwhich they received outpatient PT services.On the Gross Motor Function ClassificationSystem (GMFCS) (Palisano et al. 1997), fourwere classified at Level IV and one at Level V.Children who were candidates for surgery orwho had other conditions which might in-terfere with an intensive treatment programwere excluded from the study.

The GMFM (Russell et al. 1989) was usedas an outcome measure and was adminis-tered at the beginning of each child’s baselineperiod and every four weeks subsequentlythroughout the study period. GMFM ad-ministration was by a single trained thera-pist who did not know the children, was un-aware of the study aims, and who was notprovided with results of previous assessments.Mean baseline GMFM scores ranged from9.4 to 39.2. At the outset of the study, all chil-dren except one could roll prone to/fromsupine, three could crawl 1.8 meters, andnone could stand, even with support.

A multiple-baseline design was used, withthe duration of the baseline phase rangingfrom eight to 20 weeks. Children receivedtheir routine treatment of twice per week PT(45 minute sessions) during the baseline. Twoexperimental phases followed immediately,each consisting of four treatments per weekfor four weeks, followed by an eight-weekrest period with no treatment. For example,child 1 had an eight-week baseline duringwhich she had 16 treatments. During the firsttreatment phase she then had 16 treatmentsover four weeks (4x/wk for 4 wks), followedby eight weeks with no treatment.

The second experimental phase repeated thefirst, with16 treatments during four weeks, fol-lowed by eight weeks with no treatment. Dur-ing rest periods, parents were asked to refrainfrom initiating replacement therapy and weregiven general advice without a specific homeprogram.All treatment was performed by thechild’s usual therapist at the rehabilitation cen-ter and was “based on the neurodevelopmen-tal approach described by Mayston (1992).”

OUTCOMESAll children showed improvements in totalGMFM scores following the experimentalphase, with increases ranging from 3% to

15.6%. However, performance improvementwas significant (p<0.05) for only three ofthe five. Notably, performance did not im-prove or decline significantly following theeight-week rest periods. It is also noteworthythat attendance at therapy sessions increasedfrom a mean of 83% during the baseline to93% during the experimental phases.

The aim of a pilot study was to providepreliminary results and focus research ques-tions; sample size was obviously a limitation,and the relatively homogeneous sample ofchildren with quadriplegia limits the abilityto generalize to the larger population of chil-dren with CP. The authors also acknowledgethat lack of a control group means thatchanges cannot be definitively attributed tothe treatment regime under study. The mul-tiple-baseline design, however, provides away to monitor stability of performance dur-ing the baseline period and the trends in thedata strongly indicate that changes may in-deed be due to the treatment regime.

In terms of delivering therapy services,this type of intermittent treatment has sev-eral advantages:

• Children with severe involvement makesignificant improvements in relativelyshort periods with intensive treatment.

• Those improvements do not deterio-rate during relatively long (2 month)rest periods.

• Compliance (attendance) may be betterwith this sort of “burst” therapy thanwith a more routine weekly regime.

Therapists reported that seeing a child al-most daily helped establish a stronger ther-apist-child interaction, optimized actual ther-apy time, and allowed for frequent updatingof goals. Once parents learned that there wasno deterioration in their child’s functionafter the first eight-week rest period, theyreported enjoying a “more normal” familylife during those rest periods.

Finally, there are possible economic ad-vantages to this type of intermittent thera-py. In this study, the actual mean number ofweekly treatments was 25% less during theexperimental phase than during the base-line phase. If this treatment regime were car-ried out over a year’s time, that 25% differ-ence would translate into 20 fewer actualtreatments—clearly a significant number tothose concerned with providing high-qual-

ity care with increasingly limited resources.The authors are appropriately careful in

drawing conclusions from their data. Theyprovide an overview of other studies thathave investigated treatment frequency, andpoint out the disadvantages as well as the ad-vantages of intermittent therapy—includingpossible interference with other types of ther-apy and increased scheduling difficulties. Thechildren in their study were provided trans-portation by the rehabilitation center; theauthors do not mention how a lack of cen-ter-provided transportation or non-center-based treatment might affect the practicali-ty of this sort of treatment regime.

This study shares with many others an in-adequate description of the actual therapyprovided. The Mayston article they reference,while giving a good overview of the historyand evolution of the “Bobath concept” (andwell worth reading in its own right), is muchtoo general to allow replication of their study.Until therapists who use the Neuro-Develop-mental Treatment approach begin accuratelydescribing what they’re doing, whether byusing microanalytic or other techniques, ourresearch and our methodology will continueto be questioned. This problem is certainlynot limited to the NDT approach; it is truefor most studies of pediatric therapy. In spiteof these limitations, Trahan and Malouin’spilot study provides a sound methodologyand raises intriguing questions about “the waywe’ve always done…” what we do. ■

REFERENCESMayston, M.J. 1992. The Bobath concept–evolution and application. In Forssberg H,Hirschfield H, editors. Movement Disorders inChildren. Basel, Switzerland: Karger. p 1-6.

Palisano R, P. Rosenbaum, S. Walter, D. Rus-sell, E. Wood, and B. Galuppi. 1997. Devel-opment and reliability of a system to classi-fy gross motor function in children withcerebral palsy. Developmental Medicine &Child Neurology 39: 214-23.

Russell D.J., P.L. Rosenbaum, D. T. Cadman, C.Gowland, S. Hardy, and S. Jarvis. 1989. Grossmotor function measure: a means to evaluatethe effect of physical therapy. DevelopmentalMedicine & Child Neurology 31: 341-52.

Barry Chapman, PT, is a pediatric therapist atCarle Foundation Hospital in Urbana, IL.He can be reached at [email protected].


(How Often... continued from page 1)

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You don’t have to be a writer to contribute to Network. Network editorK.T.Anders will be happy to work with you to refine your informationinto an article.

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For more information, contact Cindy Rounds at [email protected] or Publication Committee Chair Marcia Stamer at [email protected]’re waiting to hear from you!

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3/11/2005–3/14/2005Location: Glenview, ILInstructors: Gay Girolami, PT, MS,

Diane Fritts Ryan, OTR/L,

Therese McDermott Winter, MHS, CCC-SLP,

Judy Gardner, MA CCC-SLPContact: Julie Lugiai

Pathways Center

2591 Compass Road

Glenview, IL 60025

847-729-6220 x242

847-729-1116

[email protected]_______________________________________

Course #: 05B101

Dates: 3/19/2005–3/23/2005

3/26/2005–3/30/2005

6/1/2005–6/4/2005

6/8/2005–6/11/2005

6/15/2005–6/18/2005

7/27/2005–7/30/2005

8/3/2005–8/6/2005

8/10/2005–8/13/2005Location: Houston,TXInstructors: Sherry Lynn Wilson Arndt, PT,MA, PCS , Lezlie Adler, OT/R, MS,

Marybeth Trapani-Hanasewych, MS,

SLP/CCCContact: Mitzi Wiggin

Upcoming NDTA-Approved Courses

E D U C A T I O N A L O P P O R T U N I T I E S


Course #: 04N104Course Title: NDTConcepts Applied to OrthoticFabrication (RequiresSuccessful Completion of anNDT Basic Course)

Dates: 10/15–10/18/2004Location: Columbus, OHInstructors: Nicky Schmidt, PT,Debbie Merritt Plescia, CPOContact: David Rupp614-566-0562

Course #: 04N106 & 04N107Course Title: Pt 1: Develop-mental & Closed-Chain Bio-mechanics: Orthotic Selection,Rehab, Using Tape & TheraTogs.Pt 2: Practicum Sessions inBelow-Knee Serial Casting &Splint Fabrication Techniques

Dates: 9/4–9/10/2004 Pt 1

9/11–9/12/2004 Pt 2Location: Fresno, CAInstructor: Beverly CusickContact: Steve Davison

[email protected] at 559-449-0320__________________________

Course #: 04N105Course Title: Assistive Tech-nology Strategies: A New Per-spective in Enhancing Function

Dates: 11/4–11/6/2004Location: Lisle, ILInstructors: Gail Ritchie,OTR/L, Anne Heavey, SLPContact: Dania Polly 630-898-2200

Texas Children’s Hospital

832-826-6107

832-825-5242 Fax

[email protected]

NDT/BOBATH APPROVED ADVANCED COURSES REQUIRING THE SUCCESSFUL COMPLETION OFAN NDT BASIC COURSE

Course #: 04G112Course Title: Advanced Gait Course

Dates: 7/12/2004–7/16/2004Location: Chicago, ILInstructors: Teddy Parkinson,Cathy HazzardContact: Danila Cepa or Sandra [email protected] [email protected]_______________________________________

Course #: 04U113Course Title: Advanced Upper ExtremityCourse

Dates: 9/19/2004–9/23/2004Location: Toronto, Ontario, CanadaInstructors: Karen Brunton, CI, PT,Pat Bonner, OTContact: Judy Ward

Toronto Rehab Institute, Conference Services

550 University Ave

Toronto, Ontario M5G 2A2 Canada

416-597-3422 x 3516 • 416-597-6202 Fax

[email protected]_______________________________________

Course #: 04Y101Course Title: Advanced Baby Course

Dates: 8/16/2004–9/2/2004Location: Orange, CAInstructors: Lois Bly, Lauren Beeler,Mary HallwayContact: Barbara Sargent

Children’s Hospital of Orange County

455 South Main Street

Orange, CA 92868

714-516-4265 • 714-516-4271 Fax

[email protected]

Upcoming NDTA-Approved Courses


E D U C A T I O N A L O P P O R T U N I T I E S

EMPLOYMENT OPPORTUNITIESATTENTION: PT’s, OT’s and SLP’s!Care Meridian is currently seeking PT's,OT's and SLP's to provide independent con-tracting in a subacute neurorehab setting. Facility locations are: North and SouthOrange County, Escondido, L.A. County, Oxnard, Fairfax and Gilroy areas. Pleasesend résumé to Bruce Kuluris, [email protected] or FAX 949-2610457.

PEDIATRIC THERAPISTS—GeorgiaGrowing therapist-owned pediatric practice has openings for occupational,physical, and speech therapists. We serve children from birth to 21-years-old inclinical, school, and natural environment settings. Flexible schedules. FT/PT.Contract or employee. Great opportunity for new grads and experienced ther-apists. Please contact: Sherry or Patti. 770 425-6661; 770 425-1189 [email protected]

Region 2 NDTA Members

YOUR CHANCE TO SERVE

NDTA offers you an exciting opportunity to become a Regional Chairperson.There is an opening now for the chair of Region 2.

The regions are a local focal point for NDTA members. Chairpersons welcome new members and provide a local source of information on NDTAactivities. It’s fun and educational and puts you in touch with your colleagues.

REGION 2: If you live in New Brunswick, Nova Scotia, Newfoundland,Ontario,Prince Edward Island,or Quebec, sign up to be a regional chair today!

Contact Cindy Rounds at NDTA headquarters, 800/869-9295 or e-mail [email protected].

Educational Opportunities

Neuro-Developmental Treatment Association1540 S. Coast Hwy, Suite 203Laguna Beach, CA 92651

PRESORTEDSTANDARD

U.S. POSTAGE

PAIDSANTA ANA, CAPERMIT NO. 3

More About the NDTA

T H E N E U R O - D E V E L O P M E N T A L T R E A T M E N T A S S O C I A T I O N • M A R C H / A P R I L 2 0 0 4 • V O L U M E 1 1 , I S S U E 2

The Neuro-Developmental Treatment Association (NDTA) is a nonprofit professional organization of

physical therapists, occupational therapists, and speech-language pathologists who are devoted to promoting the

theory and principles of the Neuro-Developmental Treatment approach.The NDTA furthers the development of this

unique approach by offering continuing education to the membership, providing educational services to the community,

supporting clinical research, and promoting client and family advocacy. How may we help you? Contact NDTA at

800/869-9295 or visit www.ndta.org for more information.

Our Mission

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