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T H E N E U RO - D E V E L O P M E N TA L T R E AT M E N T A S S O C I AT 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

INTENSIVE TREATMENT
BOOK REVIEW

Short and Sweet

Treatment
Frequency

A CASE STUDY OF THE INTENSIVE THERAPY MODEL


By Suzanne M. Davis, PT

IS IT MERELY TRADITION?

friend of mine, a fellow pediatric


therapist, is a rather iconoclastic
sort who likes to circulate during breaks
at conferences asking other therapists
about treatment frequency. How often
do you see your kids? hell ask mildly.
Regardless of the answer hell ask simply, Why? A representative sample of
most responses would include:
Thats the way weve always done it.
Thats what our schedule will allow.
They seem to make satisfactory
progress with that frequency.
My friends queries and the usual responses highlight, of course, that much
of what we do is based on tradition and
opinion rather than systematic evidence.
Trahan and Malouins pilot study contributes to a slowly growing body of systematic evidence comparing various physical therapy (PT) treatment frequencies
in children with cerebral palsy, and is one
of a very few that compares burst or
intermittent with routine treatment.
Five children, age (continued on page 18)

herapy intensive is a program designed to


enable children with neuromotor impairments 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. Depending upon the childs age and other considerations, 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 theory considers practice the
most important variable
when learning a new
motor skill (Schmidt &
Lee, 1999). Thus motorlearning theory and research support the intensive 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 quadriplegic cerebral palsy, was brought to Pediatric

I N S I D E

N E T W O R K :

By Barry Chapman, PT

A review of Intermittent intensive physiotherapy in children with cerebral palsy:


a pilot study by Johanne Trahan and
Francine Malouin in Developmental
Medicine and Child Neurology. 2002,
44(4), 233-239.

T H E

3 3Presidents Message
10 Caregiver Perspective

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 Wojcik. (Unfortunately Michael missed some sessions due to illness during the week.) The following 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 imaginative in his play with others. He attends a developmental preschool in
Fort Lauderdale, which
will soon be training him
in the use of a power
wheelchair. Michael is included and participates
in all family functions, although he requires assistance due to his significant motoric challenges,
as described below.

Motor learning

theory and research

support the intensive


therapy model.

4 NDTA News
15 Therapy Talk

CURRENT FUNCTION:Although Michael


loves toys, it is difficult for him to readily play
with them due to his impairments. He is unable to explore his environment. He sits with
support and is sometimes (continued on page 12)

4 Family Corner
9 Disaster Planning
16 Early Intervention
17 Question from the Field

L E A D E R S H I P

NDTA

BOARD

PRESIDENT

OF

D I R E C T O R Y

IG REPRESENTATIVE
IG REPRESENTATIVE

Wendy Drake-Kline, OT
Neurodevelopmental Therapy
Associates
1314 Timber Ridge Ct.
Waynesville, OH 45068
(937) 256-1411
wkline@woh.rr.com

MEMBER-AT-LARGE

Wendi McKenna, DPT


Pathway Center
2591 Compass Rd.
Glenview, IL 60025
847/729-6220
wendiwade@aol.com

Therese McDermott
1416 W.Thome Ave.
Chicago, IL 60660
(847) 729-6220
tandt114@aol.com

MEMBER-AT-LARGE

PAST PRESIDENT

DIRECTOR OF REGIONS

Brenda Pratt, LPT


416 Yale Avenue
Alma, MI 48801
(517) 463-4324
(517) 466-9037 Fax
prattndta@netscape.net

Pam Moore, MOT, OTR


3509 South Richmond Ave.
Tulsa, OK 74135
(918) 747-6947
planetpam@aol.com

SECRETARY/TREASURER

DIRECTOR OF MEMBERSHIP

Linda Markstein, PT
Miami Valley Hospital
1 Wyoming St., Dayton OH 45409
(937) 208-3519
lwmark@yahoo.com

Gina Best, PT, MS


203 Woodrow Street
Marietta, OH 45750
(740) 376-1422
(740) 376-9739 Fax
richardandginabest@hotmail.com

IG EXECUTIVE
COMMITTEE CHAIR

Cathy Hazzard, PT
916 31 Avenue, NW
Calgary, Alberta
Canada T2K 0A5
(403) 289-8249
cathyhazzard@shaw.ca

REGION 2
NB, NF, NS, ON, PE, PQ
East Canada
Chair position available
Please call Director Pam Moore
(918) 747-6947
REGION 3
Southern CA, Northern CA, NV
Michelle G. Prettyman, PT
5460 White Oak Avenue #K301
Encino, CA 91316
(818) 986-7871
Chellelapt@worldnet.att.net
Carrie H.Taguma-Nakamura, OT
1235 South Ogden Drive
Los Angeles CA 90019
(310) 423-6281
billn@pacbell.net

Kim Westhoff, OTR/L


Kims Kids Pediatric
Occupational Therapy
15900 S. Hawkins Road
Ashland, MO 65201 USA
(573) 657-0171
dkwest4@earthlink.net
PAST CHAIR OF IG
EXECUTIVE COMMITTEE

Kay Folmar, PT
73423 Foxtail Lane
Palm Desert, CA 92260
(760) 346-9965
(760) 346-9965 Fax
pkfolmar@aol.com

IG EXECUTIVE COMMITTEE
Chair: Cathy Hazzard
Vice Chair:Teddy Parkinson
Treasurer: Sherry W.Arndt
Secretary:Teresa Gutierrez
Peds Subcommittee Chair: Kacy Hertz
AH Subcommittee Chair: Cathy Runyan
CI Working Group Chair: Karen Brunton
OT Working Group Chair: Lezlie Adler
PT Working Group Chair:
Susan Breznak-Honeychurch
SLP Working Group Chair: Gay Lloyd Pinder
CI Representative: Judi Bierman
OT Representative: Mechthild Rast
PT Representative: Monica Diamond
SLP Representative: Rona Alexander
Nominating Committee Chair: Mona Miley, OT
IG STANDING COMMITTEES
Bonnie Boenig, Grievance Committee Chair
Tom Diamond, Peer Review Committee Chair
Judith C. Bierman and Lois L. Bly, Theoretical
Base Committee Co-Chairs
Linda Kliebhan, Curriculum Committee Chair

NETWORK LIAISON

Pamela Mullens, Ph. D., PT


5623 57th Ave. NE
Seattle,WA 98105
206/524-1743
pmullens@u.washington.edu

R E G I O N A L
REGION 1
WA, OR, ID, MT,West Canada
Nancy Garcia, PT
Shriners Hospital, 911 W. 5th
Spokane, Washington 99210
(509) 623-0416
ngarcia@shrinenet.org

I N S T RU C TO R S G RO U P

DIRECTORS

NDTA OFFICE

1540 S. Coast Hwy, Ste. 203


Laguna Beach, CA 92651
800/869-9295 949/376-3456 Fax
membership@ndta.org www.ndta.org

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

REGION 4
WY, CO, UT, NM,AZ
Tori J. Rosenthal, PT, MS
3718 Pioneer Ave.
Cheyenne,WY 82001
(307) 635-2900
Fax: (307) 634-0985
rmtorri@qwest.net
REGION 5
TX, LA
Carol S. Nuez-Parker, OTR and
Teresa De La Isla, MS, OTR
NTS, Inc.
4423 Shadowdale
Houston,TX 77041
Work: (713) 466-6872 Ext 221
Fax: (713) 466-9547
NTSTherapy@aol.com
REGION 6
KS, MO, OK,AR
Ms. Myles Claire U. Quiben, PT, CSCI
550 Files Rd., P200
Hot Springs, AR 71913-5464
(501) 525-3917or (501) 282-0731
smylesaway1@aol.com

REGION 7
ND, SD, MN,WI, NE, IA, IL,
Middle Canada
Stacy Reichmuth, OTR/L
7819 South 97th Circle
La Vista, NE 68128
(402) 339-2533
REGION 8
MI, IN, OH
Kristine Waffle, PT
827 Upland Ridge Dr.
Ft.Wayne, IN 46825
(219) 446-0100, #3105
jmwaffle@aol.com
Kristie Swoverland, PT
10911 Old Oak Court
Fort Wayne, IN 46845
(219) 484-6636 ext. 31310
ptswov@aol.com
REGION 9
KY,VA,TN, NC,Al, MS,
GA, SC, FL, PR
Jeannette A. Beach, PT
220 Hemphill Ave.
Chattanooga,TN 37411
(423) 624-6175
JeannetteBeach@cs.com

REGION 10
ME, NH,VT, NY, MA.CT, RI, PA, DE, NJ,
MD,WV, DC
Laura Z. Gras PT, DSc ,GCS
The Sage Colleges
45 Ferry Street
Troy, NY 12180
(518) 244-2066
fax (518) 244-4524
Debra Berube PT
1270 Belmont Ave
Schenectady, NY 12308
(518) 382-4525
djberube@juno.com

REGION 11
AK
Dee A. Berline-Nauman, OT
6705 Lunar Drive
Anchorage, AK 99504-4575
(907) 550-3004
Fax: (907) 563-3172
nauman@alaska.net
Cara Ann Leckwold
4325 Laurel, St. #100
Anchorage, AK 99508
(907) 561-8775
Fax: (907) 562-8262
Cleckwold@aol.com
REGION 12
HI
Sandra Kong, OT
99-033 Kaupili Place
Aiea, HI 96701
(808) 433-6205
LeeKong@prodigy.com
Jan A. Miyashiro
1251 Ulupuni Street
Kailua, HI 96734
(808) 483-4980

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.
2 N D TA N E T WO 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 AT M E N T

ABOUT THE
NDTA NETWORK
A subscription to the Network, which is published
six times annually to more than 3,000 members,
is included in every NDTA membership.Additional
subscriptions and copies of archived articles are
available for a small fee.
EDITORIAL INFORMATION
We invite members and non-members to submit articles,ideas and comments to the editor.Editorial assistance and guidelines are available for writers.Look
below for upcoming deadlines and themes.
ADVERTISING INFORMATION
To reach health care professionals who practice
NDT, advertise your products, services, employment classifieds, educational opportunities and
NDTA-approved courses in the Network. All ads
are placed on a first-come, first-served basis. Payment is required prior to insertion.
DISPLAY AD RATES
Advertise your products and services in multiple
themed issues to maximize your investment. For
more information or to place your ad, contact
Cindy Percival Rounds at 800/869-9295 ext. 268.
Space
Per issue 4 or more issues
Full page . . . . . . $800 . . . . . . $600 per issue
Half page . . . . . . $500 . . . . . . $400 per issue
Quarter page . . $350 . . . . . . $250 per issue
EMPLOYMENT CLASSIFIEDS
Have an open position? Find your next employee here.
Members can place employment classified ads for $100
for 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 days
on the NDTA Web site. Longer placement is available
for an additional fee.For more information or to place
your ad, contact contact Cindy Percival Rounds at
800/869-9295, ext. 268.
EDUCATIONAL OPPORTUNITIES
Organizing a workshop? Your educational opportunity can be placed in one issue of Network and
for 30 days on the NDTA Web site for $200.Longer
placement is available for an additional fee.For more
information or to place your ad,contact Cindy Percival Rounds at 800/869-9295, ext. 268.
NDTA-APPROVED COURSES
Educational courses that are approved by NDTA can
be placed in one issue of Network for $100. For
more information or to place your ad,contact Cindy
Percival Rounds at 800/869-9295, ext. 268.
ARTICLE & ADVERTISING DEADLINES
Copy received after the dates specified will be
considered for the following issue.
2004 ISSUES THEME
DEADLINE
July/August . Pain Management . . . . . . . . . . . . . May 1
Sept/Oct . . . Respiration & Feeding . . . . . . . . . . July 1
Nov/Dec. . . Dystonia. . . . . . . . . . . . . . . . . . . . Sept 1
K.T. Anders, Editor, NDTA Network
P.O. Box 521, Upperville,VA 20185
540/592-7002 540/592-7032 Fax
ktanders@crosslink.net
Pamela Mullens, Ph.D., PT, Network Liaison
5623 57th Ave. NE
Seattle,WA 98105
206/524-1743
pmullens@u.washington.edu

M E S S A G E

F R O M

T H E

P R E S I D E N T

Growth Through Service

s we move into 2004 I feel compelled to


look at a topic close to my heart: growth
through service. What does this have to do with
NDT and NDTA? For me, and I believe for many
in our organization, service is at the center of
our professional and personal identities. It is certainly critical to our association.
NDTA has been one of the avenues for my
growth through purposeful service. Serving involves time, energy, and commitment. It can be
frustrating and irritating. It can make you wonder what in the world you were thinking when
you volunteered.
It can also be exciting and rewarding. Through
service we have an opportunity to follow our
calling to give of ourselves, to use some talent,
gift, or passion for the good of others. The funny
thing about serving is that we usually get much
more in return!
Serving brings us close to other individuals
who have a similar passion or interest. Through
NDTA, I have met many wonderful clinicians
from across the country whom I now include as
my friends, not just my peers. We have served
together as regional chairs, as board members, as
instructors. We have laughed, planned, struggled, and succeeded. Together. We have frustrated each other, respected each others beliefs
and values, and most importantly, learned from
each other in the process of giving. Through
NDTA, I have acquired clinical skills, relationship skills, teaching techniques, and management strategies. Best of all, I am still learning
and growing as a person and as a therapist!
Involvement in NDTA gives me first-hand
awareness of what is happening within the association and as a team member to decide how
we move forward. I am empowered to think and
to voice my opinions. And I am held accountable for my part in making things happen. As
board members, we share ideas, plan together,
and work to achieve the goals we establish. I can
tell you with much pride that you have a board
of directors and many committee members who
work diligently for YOU.
I continue to be amazed at the number of
people it takes to keep the association running.
And, how important it is to have many diverse
backgrounds and views for keeping us a vibrant

organization in todays
healthcare arena.
A few months ago, in
Wendy Drake-Kline
the interest of office efficiency, I asked our members to renew their membership online and to
make a donation toward enhancing program development. Many thanks to those who responded. I am happy to report that nearly half of
renewing members did so online. Members contributed over $3800.00!
NDTA is moving forward with a new Web site
design, which will make its debut at the NDTA
Annual Conference in Orlando this May. The
second printing of our theory book will soon be
available. Research chair Janet Powell and her
committee are working to develop a research
plan that fits within our larger strategic plan.
Were reviewing our regional structure and planning for ways to better utilize our regional chairpersons on a local level. Our 2004 NITE courses are up and running, with locations and
information available on our Web site. The Alliance Committee is working on increasing our
Web site links, our university connections, and
the development of a mentoring program.
This is an exciting time within NDTA! Our
goal is to be a vital professional organization focused on meeting your needs. But we need your
help. We need you to join in the process. Can we
count on you? Please contact the NDTA office,
or me at wkline@woh.rr.com, if you are interested in our associations future.
I encourage you all to take this opportunity
for personal growth through service and become
active in YOUR association. It is definitely a winwin situation.

Wendy Drake-Kline
President, NDTA

N D TA N E T WO 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 AT M E N T

F A M I L Y

C O R N E R

F A M I LY C O R N E R

Web Links Connect You


to Information
By Pamela Curtiss-Smith, OTR/L
WELCOME TO ALL YOU DEVOTED FAMILY MEMBERS!
Were thrilled to have you join us as members of NDTA! Through this column and
other NDTA sites, we hope you will find information, support, and resources about how
Neuro-Developmental Treatment can benefit you and your family.
Please visit the NDTA Web site. This valuable resource presents information about our
members and research opportunities and includes 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. Youll 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, youll 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 national 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 recommended readings for parents as well.
Exceptional Parent Magazine
(www.Eparent.com). Articles and advertisements here are related to disability. The library
includes software in 50 different categories.
National Institute of Neurological Disorders
and Stroke (www.ninds.nih.gov). Information about all types of neurological injuries,
current research articles, and a diagnostic list
of studies searching for subjects is available.

CALLING FOR
AUCTION
DONATIONS!
NDTA Silent Auction
At the NDTA Annual Conference
May 7, 2004, 5:30pm7:00pm

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


The focus here is on pregnancy, prematurity, 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). Youll find details
about a variety of sports events and organizations 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 Washington 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 information about CP.
Cerebral Palsy and Aging (www.geocities.com/
Tokyo/7970/cpage.htm). Created and maintained by an older adult with CP, this site has
links to other sites, personal stories, lists of articles, 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 connections you have made by taking the initia
tive to join NDTA. Happy surfing!!
Pamela Curtiss-Smith is an occupational therapist in Omaha, Nebraska. She can be reached
at pcurtisssmith@earthlink.net.

4 N D TA N E T WO 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 AT M E N T

HOT BIDS FOR COOL STUFF!


NDTAs silent auction is a fun-filled event
and a worthwhile cause. Now is the time
to clean out and donate those no-longer
needed items: gift items, fine artwork, collectibles, products and services, baskets of
goodies, etc. Proceeds go directly to the
NDTA Equipment Assistance Fund to help
patients of NDTA member therapists.
Bring your items to the conference or
contact the office to make a donation.

CONGRATULATIONS!
Trisha Moratorio has completed the
process to become an AH PT
Instructor. She will be announced as a new Instructor at
the upcoming IG meeting in
Orlando. Please join me in congratulating
her, and AH CIs, please keep her in mind
for your next course!
Sandy Kurosaki, Chair, PT Instructor Candidate
Review Committee

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

May 1-4, 2004: Saturday Arrivals &


Executive Committee Meeting
Meeting Schedule: Sunday 8:00 am
through Tuesday 12:00 Noon
Return your Instructor Meeting
Registration Form today!
CORRECTION. In the last issue, at
the end of Mary Rose Franjoine's article
on the Pediatric Balance Scale, the name
of Joan Gunther, one of the co-authors
of the article that first appeared in
Pediatric PT Journal, was misspelled. We
regret the error.

N D T A

NDTA Institute for


Training and Education

( N I T E )

Neuro-Developmental
Treatment Association
2004 Course Calendar

N E W S

DC
WASHINGTON,
March 26-28: Utilizing Neuro-Developmental Treatment for
Children with Neuromotor InvolvementPractical Clinical
Applications
Wendy Drake-Kline, NDTA OT Instructor
OHIO
DAYTON,
May 21-23: Creative Routes to Outcomes
Kay Folmar, PT
OKLAHOMA
TULSA,
June 18-20: Applying Theoretical Concepts to
Produce Functional Outcomes
Lezlie Adler, NDTA OT Instructor
NEW YORK
TROY,
July 19-23: NDT Five Day Intro to Adult Hemiplegia
Teddy Parkinson, PT, and
Cathy Hazzard, PT, NDTA Coordinator Instructors
WASHINGTON
SEATTLE,
August 19-21: NDT Introduction to Pediatrics
Brett Nirider, PT
MI
SHEPARD,
August 27-29: NDT Introduction to Pediatrics
Linda Kliebhan, PT

FOR MORE INFORMATION


CONTACT NDTA AT
cindy@ndta.org
or visit www.ndta.org
1540 South Coast Hwy., Ste. 203
Laguna Beach, CA 92651
800-869-9295
949-376-3456 Fax

NITE

TEXAS
HOUSTON,
September 24-26: Beyond Weight Bearing: Developing Hand
Function in Children and Adolescents
Lezlie Adler, NDTA OT Instructor
OH
MARIETTA,
October 1-3: An NDT Gait Course
Monica Diamond, NDTA Coordinator Instructor
LAKE CITY, UTAH
SALT
October 8-10: Introduction to NDT in Managing Adult
Hemiplegia
Kay Folmar, NDTA Coordinator Instructor
TEXAS
AUSTIN,
October, 15-17: Pediatric NDT for Children with
Different Kinds of Cerebral Palsy
Lauren Beeler, NDTA Coordinator Instructor
NEW YORK
TROY,
November 5-7: An NDT Key to Baby Treatment: Identifying
and Using Trunk Components for Functional Movements in
the Baby From 3-12 months
Sherry Arndt, NDTA Coordinator Instructor

N D TA N E T WO 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 AT M E N T

N D TA

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 AY

5 - 8 ,

2 0 0 4

NDTA 2004 PRE-CONFERENCE


Dont Miss These Informative Pre-conference Workshops
WEDNESDAY, MAY 5, 2004 Orlando, Florida
A separate registration fee is required for each of these special programs, which
includes continental breakfast, refreshment breaks, and all course materials.
Registration in each of the workshops is limited to 50 participants.
Pre-Conference Workshop

Pre-Conference Workshop

THERAPEUTIC AQUATICS FOR CLIENTS


WITH NEUROLOGICAL IMPAIRMENT

USING TAPING AS AN ADJUNCT TO NDT

Jane Styer-Acevedo, PT

This one-day workshop will review principles of taping as applied to


the treatment of individuals who are receiving therapy in an NDT
framework. A brief lecture will be followed with practice with a
variety of materials and an opportunity to learn specific strategies
to use with clients with neuromotor impairments that influence posture
and movement. Videos will be used to supplement lab sessions.

This workshop is designed for the health care


professional and paraprofessional currently
working in the aquatic environment or desiring
to begin work in aquatics. A problem-based
approach is used to determine the aquatic
treatment strategies best suited to the client
based on functional goal, the task analysis of
that goal, and the impact of water on the
clients movement.
A variety of treatment techniques will be
taught to emphasize the strengthening and
symmetry of the trunk while activating and
strengthening the extremities. Safety and
swim skills will be reviewed as they can be
applied to land function. A videotaped
treatment will be used to assist in planning
and integrating aquatic and land-based
interventions.
Strong emphasis is placed on the pool lab
to practice the techniques with supervision.
Therapists should wear bathing suits for the
afternoon sessions.
Morning Session: 8:30 am 12:00 pm
Held at the Caribe Royale Resort.
Afternoon Session An in-pool lab session
held in the therapy pool at Florida Hospital.
Transportation provided. Afternoon attendees
will 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 over
100 workshops since 1983 on therapeutic
aquatics and NDT. She has also authored multiple chapters and articles and is the recipient
of the Pennsylvania Physical Therapy
Association 2000 Carlin-Michels Achievement
Award for her contribution in patient care,
education, research, and community service.

Judi Bierman, PT and Monica Diamond, MS, PT

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 client
assessment, you will be able to:
Discuss the theory and basic principles of using taping for the
treatment/management of posture and movement problems
in children and adults with neuromotor impairments
Demonstrate at least 10 strategies to improve posture and
movement utilizing at least 3 different materials in the upper
extremities, lower extremities and trunk.
Select the type of tape, placement, timing of application and
removal suggestions.
Therapists should wear lab clothes, such as a two-piece bathing
suit, to allow taping of the arms, legs and trunk. Each participant
should also bring a pair of safety tipped scissors. Participants will
receive the various tapes to take home as part of the course
materials included with registration.

REGISTER TODAY FOR NDTA 2004


Three full days of outstanding educational sessions
presented by a distinguished faculty of NDTA
Instructors & featured Guest Speakers
Conference format that includes provocative general
sessions, 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 Neurological
ImpairmentJane Styer-Acevedo, PT
Taping As An Adjunct to NDT Treatment
Judith Bierman, PT & Monica Diamond, MS, PT

MAY 5-8, 2004

Conference Sessions

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

OPENING KEYNOTE ADDRESS:

Skill Acquisition: The Functional Outcome of Therapy

The Vast Spectrum of the PossibleKay Folmar, PT

Janice Hulme, PT, DHSc

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

Skill Learning As An Essential Substrate for Functional Recovery

Intervention in Neurologic RehabilitationJames Gordon, EdD, PT

Carolee Winstein, PhD, PT, FAPTA

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

Constraint-Induced Movement Therapy: Another Form of NDT or


Something Completely Different?Carolee Winstein, PhD, PT, FAPTA
Functional Strategies for Recovery of Cognition, Communication

of NDT (Bobath) While Integrating Specific Concepts of CIMT

& Executive Functions After Brain Injury in Children & Young Adults

Catherine Runyan, OTR

Mark Ylvisaker, PhD

Plasticity & Recovery Randolph Nudo, PhD

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

Enriched Environments Randolph Nudo, PhD

Exercise After StrokeRichard Macko, MD

An Introduction to Functional Strategies for Recovery of Cognition,

The Role of Constraint: Panel Discussion

Communications & Executive FunctionsMark Ylvisaker, PhD

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

Practical Approaches to Enriched Therapy Environments in

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

PediatricsBrett Nirider, PT & Gay-Lloyd Pinder, SLP

Catherine Runyan, Chris Cayo.

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

N D T A

N E W S

Colleague Close-Ups
NDTA MEMBER NEWS. By Gina M. Best, PT, MS, NCS
NDTA MEMBERS RECOGNIZED AT AMERICAN

BRAVO FOR POSTER PRESENTATIONS

PHYSICAL THERAPY ASSOCIATION

MARY ROSE FRANJIONE, PT, MS, PCS and colleagues

NDTA was well represented at the American Physical

authored two excellent poster presentations. The

Therapy Associations's Combined Section Meeting held

posters were entitled, Performance on the Standard-

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

ized Walking Obstacle Course for Matched Pairs of Chil-

NDTA members were recognized at the Opening Cer-

dren with Cerebral Palsy and Typical Development and

emony as Certified Specialists by the American Board

The Performance of Six School-Age Children with Cerebral Palsy

of Physical Therapy Specialities:

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

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

tional Balance.

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


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

CONGRATS TO THE NEW MOM


Best wishes to and congratulations to RACHEL GARBER,

Neurology: GINA M. BEST, PT, MS.

OTR, who gave birth to WILLIAM REED GARBER on

THANKS TO THE BOOTH STAFFERS

December 8, 2003.

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

If you have news for the Colleague Close-ups column, fill out the
form below or contact Gina Best at richardandginabest@Hotmail.com. This form can also be found on our Web site at
www.ndta.org

COLLEAGUE CLOSE-UPS INFORMATION FORM


NAME ____________________________________________________________________________________________________
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.) youd like to share: ________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
8 N D TA N E T WO 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 AT M E N T

A D V O C A C Y

Are You Ready or Not?


DISASTER PLANNING CAN MAKE THE DIFFERENCE BETWEEN LIFE AND
DEATH OF YOUR COMPANY. By Ronald Nyman

s with any business, the daily life of a


therapy company is filled with clients
and the issues of billing, personnel, marketing, and finance. It is therefore no surprise
that short shrift is given to preparing for a disasterafter all, it may never happen. Yet fire,
theft, and natural disasters do happen. And in
todays precarious world, disaster seems closer 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 companys profits or
even force a business to cease operations.
This risk is especially severe for the therapy company because it must operate in an efficient and timely manner to properly serve its
clients. The destruction of computer hardware 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 disaster 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 operating, such as walls, insulation, venting, air
conditioning, heat, and carpeting. Partial or
complete destruction of your physical plant
can occur due to numerous eventsfire, hurricane, flooding, theft, or utility disruption.
If you lease the premises, your main source
of protection is the terms of the lease. A welldrafted lease will require the landlord to make
repairs to partially destroyed premises within a certain period. If the landlord does not
abide by the lease terms, the tenant either

should have the opportunity to make the repairs 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, youll want to protect the contents of your office with a comprehensive insurance policy. Regardless of whether you lease
or own, all therapy companies need to insure
against lost income during the period of reconstruction or relocation. Consider also coverage
for debris removal, fire department service

A calamity can cause


significant disruption
in business
operationsand have
a negative impact
on the companys
profits.
charge, pollutant clean-up and removal, glass
and signage, fire extinguisher recharge, key
and lock replacement, inventory, and appraisal.
Dont stop your recovery plan with insurance. 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 companies lease out office space on a month-tomonth basis and can provide you with a receptionist, reception area, copier, fax,
computers, and conference room.

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 vendors ability
to deliver replacement equipment when disaster 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 therapy 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 backup run once a week. The full backup should
be stored off-site in a secure location. All backups 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

2.HARDWARE & OTHER EQUIPMENT

All furniture needs to inventoried and valued, with the replacement cost of each noted.
The insurance policy should cover the replacement value of all furniture to ensure that
the billing company does not have to shoulder the depreciation cost of the furniture lost
in the disaster.
According to Murphys 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.

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

Ronald Nyman is president of MediStar Billing


Center in Trumbull, Connecticut. He can be
reached at nyman@medistarbilling.com.

N D TA N E T WO 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 AT 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

Should we take a trip to Disney World? Thats

to know, including where to stay, information

a hard question for anyone with a disabled

about the parks, and even travel agent rec-

child. We had been asking it for five years,

ommendations, one of which we used to

and we finally took the plunge in Novem-

book our trip. We decided to stay at a Disney

ber 2003. Yes! We made it to Disney World

Resort so we could access the buses to and

and it was great! Here are a few tips based

from the parks and take advantage of early

upon our experience that might help you,

park hours offered to resort patrons. We

too, say yes to a Disney adventure.

chose a spacious two-bedroom condo at Old

Elise visits with Alice in Wonderland at


Disney World

We are a family of five with three daugh-

Key West that had a full service kitchen, so we

Disability Pass, which allows up to five mem-

tersAmanda 6, Grace 9, and Elise 12. Elise

were able to buy groceries and eat many

bers of a party to go through the fast-pass

has CP, more specifically, a white matter dis-

meals at the condo or carry lunch and snacks

line without a fast pass. This decreased wait

ease, possibly vanishing white matter. She

into the park.

time and was good for our entire stay at all the

has low tone with all limbs affected. Although

The buses were very accessible and com-

parks (just dont forget it, like I did one day).

confined to a wheelchair, she can moder-

fortable. We took along a soft cooler and blue

We also asked if Elise could ride twice.

ately assist with sit-stand transfers.

ice for meals, snacks, and drinks. Through a

Once they saw how difficult it was to trans-

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

company Disney recommended, we were

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

pictures, a talker, and her smile to communi-

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

ridessuch as the train, Its a Small World,

cate. She is timed toilet trained when her mom

to us, for Elises feedings.

sticks to the schedule. She is an independent

Next, we had to plan our stay. Which parks

eater with finger foods and had a g-tube put

on which days? Which rides, shows, and

in two years ago for minimal night feedings.

restaurants? The Passporter was an invalu-

Her seizure disorder is well controlled with

able source of information. We also talked

Depakote. Our other daughters are typical

with friends who go every year to determine

and were dying to experience Disney!

what might be appropriate for Elise.

and Buzz Lightyearcould 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-

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

We wrote out our schedule for each day.

summers are hot, and because Elise does not

The girls chose the rides and shows they really

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

wanted to do. Once their favorites were done,

vember was ideal, with temps in the mid to

we could be more flexible and go for repeats

high 70s and only an occasional sprinkle. It

or second choices. It was also important to

was also considered off-season, so prices

plan rest periods. We tried to come home for

were lower and crowds thinner. We stayed

lunch or in early afternoons and then go to a

for six nights.

different park later or in the evening. Elise

were all glad that wed answered Yes to the

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

Magic Kingdom.

Lodging was the next decision. We relied


on a book we highly recommend: PassPorter

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 Cinderellas castle (none of ours
came out well). At the end of our visit, we

ed, and shopped in Downtown Disney.

Walt Disney World Resort by Jennifer Watson,

The Magic Kingdom offered the most ap-

Stephanie Miserocchi, PT, MHS, lives in

Dave Marx, and Allison Marx (available at

propriate rides and shows for Elise. At the

Nashville, TN, with her family. She can be

book stores). It covers everything you need

Magic Kingdoms City Hall, we obtained a

reached at miserocm@bellsouth.net

1 0 N D TA N E T WO 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 AT M E N T

N D TA 2 0 0 4 C O N F E R E N C E

CALL FOR POSTER DISPLAYS


The NDTA Conference Committee invites you to participate in the Poster Display being held in the Exhibit Hall during
the 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 5:307:00 pm.You are invited to submit an ABSTRACT
of your clinical research. Each submitting Author may enter a maximum of three Abstracts. Please follow the instructions 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 philosophy
and 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:

SUBMISSION DEADLINE: APRIL 5, 2004

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 Letters
AUTHOR(S): Underline submitting author
SITE/AGENCY: Indicate where the research study was done (if applicable)
SUBMIT THE RESEARCH/CLINICAL APPLICATION
INFORMATION:

For ABSTRACT submission, please provide ALL of the


requested information. For DISPLAY submission, please
provide information as applicable to your presentation.
PURPOSE: Study hypothesis/questions
SUBJECTS: Number and characteristics
METHODS: Techniques/materials used
DATA ANALYSIS: Statistical tests used
RESULTS: What did data analysis reveal?
CONCLUSIONS: Do results support the research hypothesis?
RELEVANCE: Significance of the study relative to healthcare
ACKNOWLEDGEMENTS: Site/Agency funding/supporting
the study

S A M P L E

THE RELATIONSHIP OF HAMSTRING SPASTICITY & CONTRACTURE TO GAIT IMPAIRMENT IN CHILDREN


WITH 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 spasticity measurements; 2) reliability of popliteal angle measurements; 3) relationship of hamstring
spasticity to step length, stride length & gait velocity; 4) relationship of hamstring contracture to step
length, stride length & gait velocity. SUBJECTS: Eleven children (8M/3F) with spastic diplegia (ages
3-15 yrs) were studied. All walked independently with or without appliances. METHODS: Two raters
twice graded hamstring spasticity in both legs of subjects using the modified Ashworth scale while
subjects simulated the Terminal Swing (TSw) Phase position in standing. Raters twice goniometrically
measured subjects popliteal angles in the supine position. Each subject walked 20 with inked shoe pads
to determine stride & step length distances. Gait velocity was determined using a stopwatch. DATA
ANALYSIS: Intraclass correlation coefficients (ICC) and percent of agreement (0-100%) were used
to 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 spasticity
measurement was fair (.487) to good (.941); intertester reliability was poor (.242) to fair (.613); the
percent of agreement ranged from 0% - 10%. The reliability of popliteal angle measurements was
good (.884) to high (.962). Negative correlation between hamstring spasticity & gait measurements
was 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 Phase
gait was significant at the .05 level. CONCLUSIONS: The reliability of spasticity measurements was
variable, and the relationship of spasticity to gait was equivocal with respect to the right and left
sides. Measurements of hamstring range were reliable, and there was a significant relationship between hamstring range of motion and swing-phase gait. RELEVANCE: Reliable examination procedures are required to assess patient impairments and their impact on functional movement. Assessment of the efficacy of treatment on patient functional outcomes requires the heath care provider to
analyze the relationship between measured impairments and measured functional performance.
ACKNOWLEDGEMENT: This research was supported by Grant No 652 awarded by Young University, Pungo, VA.

SUBMIT BY APRIL 5, 2004


Send via mail, fax or email to:
NDTA 2004 Poster Exhibit, C/O Evangeline Yoder
13057 Warwick Blvd., Newport News,VA 23602
E-mail: eyoder007@aol.com
Phone: (757) 249-2258 Fax: (757) 881-9709
The Conference Committee will acknowledge acceptance of your
submission by sending Poster Display Instructions.

A B S T R A C T

N D TA N E T WO 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 AT M E N T

11

M
I NE TS E
S A
N G
S IE V F
E R CO AMR ET H S ET UP DR YE S I D E N T

(Short and Sweet continued from page 1)

able to sit with minimal support on the floor


if he has been loosened up and if he is supported correctly, with no outside distraction.
During supported sit and stand, his head control 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 interferes 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 impairments contributed to Michaels functional
limitations.
1. Significant weakness of the postural muscles, 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 compensate by activating his superficial movement muscles. This prevents him from being
able to bring his arms forward for contact.
2. Asymmetric extension pattern, which influences 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 phonation. He translates this into extension with
adduction of his legs, hyperextension in
the trunk around the thoraco-lumbar junction 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

Michael tries to
cognitively figure out
how to make his body
move, and with that
intention comes a
strong increase
in extensor stiffness.
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 impeding the very movement he wants to do.
6. Musculoskeletal tightness of the extrinsic 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 resulting in MCP extension with distal flexion 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 accompanied by muscular tightness in the intercostals.

1 2 N D TA N E T WO 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 AT M E N T

POSTURE AND MOVEMENT STRATEGIES: Michael attempts to solve his difficulty


with generating movement by creating stiffness from his head through his lower extremities in an extension pattern and pulling with his
upper extremities in bilateral flexion or a combination of asymmetrical flexion and extension. 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) permit 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 wheelchair, and 4) allow him to have some form
of floor mobility.
TREATMENT STRATEGIES: The following strategies were found to be successful
with Michael:
1. Focus on symmetry. This is a critical initial treatment strategy. Alignment provides the opportunity for postural muscles to activate and movement muscles
to be freed. For Michael, symmetry allowed 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 activation of trunk flexors to balance extension, 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 Michaels arms to positions of flexion with abduction and adduction, crossing the midline of the body,
and symmetrical arm posturing.
3. Activate Michaels 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

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 alignment in extension, like Superman, in the
therapists arms, with one leg bent forward into flexion (LE dissociation),
Michael was able to use more isolated extension control. Next we added linear
vestibular movement. This helped activate 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 control about the hips and pelvis. To build
on #3 above, Michael was positioned either in the therapists 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 therapists
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 pattern. This had to be done in a graded way
that did not use Michaels 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 Michaels trunk active. Michael addressed table top work in supported sitting 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 supported arms. A slippery substance applied
to the table surface reduced resistance.
6. Keep Michael posturally active by generating 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 cushion when participating in looking activities or watching TV, videos, 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 forearm in neutral, wrist in extension, and
hands together in exploration. The therapists 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

Choice of activities
had to be
engaging and had
to require
sustained visual
contact.
together to hold objects and explore bilateral finger play.
8. Create a pattern of hip flexion with dynamic spinal extension rotation. The
purpose was to help decrease Michaels
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 rotating 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 latissimus dorsi and stabilizing his rib cage.
As he returned to upright sitting, he needed to be reminded to keep his chin down
so that he did not compensate with head

C A R E

S T U D Y

and neck hyperextension.


9. Counteract Michaels tendency to use
the upper body for extension. To prepare Michael for his own independent
transfers, he was placed in sitting and allowed 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 movement in space with contact on an object
rather than with any manipulation.
Choice of activities had to be engaging
and had to require sustained visual contact. Activity choices included:
a. Finger painting with shaving cream,
lotion, Vaseline, powder, pudding, applesauce, 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 the
hand. It was essential to use lotions,
creams, etc. in a hand-massage modeling program.
13. Allow Michael to use dynamic graded
pelvic girdle muscles. This involves the
hip extensors, abductors, and oblique abdominals. 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 getting Michael into quadruped, rotational
(continued on page 14)

N D TA N E T WO 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 AT M E N T

13

I N T E N S I V E

C A R E

S T U D Y

(Short and Sweet continued from page 13)

movements through his trunk or pelvis


were provided with the therapists hands.
As Michael felt his inhibitory movement,
he could move his legs reciprocally as in
an assisted creeping pattern. As he practiced, 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 of
the upper rib cage. This was accomplished through massage and deep sensory 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 holding
within the abdominal cavity. This required specific work to the lower anterior rib cage. Throughout the handling,
Michael was encouraged to phonate and
take deep breaths.
17. Increase length and mobility of the lips
and 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 articulation. Specific attention was given to
the tongue tip through manual manipulation and the use of tastes to the tip to
heighten awareness. Michael was given
exercises in tongue tip placement in graded ranges inside and outside of the mouth.
18. Graded jaw movement. This was facilitated through some biting and chewing
exercises with placement of the hands to
the occiput and the TMJ to obtain a better alignment during the oral exercises.
PROGRESS MADE DURING THE
INTENSIVE:
1. Free movement of arms on a non-resistive 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 contacting 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 supported 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 placement for specific speech sound production
The above progress was experienced over a
short period of time and the intensive program 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 recommendations 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 Emphasis. Human Kinetics, third ed.
Suzanne Davis, PT, is co-owner of Pediatric
Therapy Associates in Plantation, Florida. She
can be reached at davisrpt@aol.com.

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1 4 N D TA N E T WO 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 AT M E N T

T H E R A P Y

T A L K

Seating and Stability


AN 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-

clients functional position in space to determine postural needs.


Because we are dynamic creatures, a seating
system must allow for maximum use of weight
shift throughout all planes of the pelvis. To enhance the effectiveness of weight shift, one must
also look at full weight bearing through the femurs in sitting and weight bearing on the soles
of the feet. To say that the hips and knee need
to be at 90 degrees does not take into consideration functional reach and dynamic postures.

necessary to allow the legs to wind sweep to


the right to compensate for left lateral trunk
flexion. To effectively allow this posture, the
front angle of the seat had to reflect the
windswept angle. It is often mistaken that this
correction should occur at the posterior portion of the seat. But logic dictates correcting
the seating system where the anatomical site
is mal-aligned, not necessarily where the abnormality originates. When we did this, it allowed us to provide high thoracic support on
the left while stabilizing the pelvis to correct
her non-structural rotational scoliosis.
Throughout the assessment process we were
mindful of her efficiency for visual fields and
the biomechanics of head and neck alignment. After each adjustment of her trunk and
pelvic alignment, we asked her to scan her environment and reach bilaterally so we could
determine when proximal stability met distal mobility with function as key. Abnormal
tone, functional postural tone, and primitive
reflex patterns are also part of the equation.
Their influence on posture, movement, and
function must be carefully considered.
When evaluating multiply impaired individuals it is paramount to include all members
of the treatment team, caregivers, and relevant family members. Understanding a clients
changing needs throughout the day, a week,
and a year leads to a comprehensive view of
their needs. A seating specialist alone cannot
determine a clients needs.
Regardless of your role in the seating team,
it is important to remember that although
the pelvis is the base of stability, it is also the
base of mobility and should be afforded appropriate weight transference. Stability does
not mean symmetry but functional alignment. Function is complex and includes all
activities that are involved from a seated posture. While challenging, careful and thoughtful positioning analysis enables optimal func
tional life pursuits for the client.

TRUNK STABILITY AND FUNCTION


To enhance trunk stability for a multiply impaired client, consider the entire lower body
as the basis of support and not the pelvis alone.
With the child I mentioned above, we found it

Teresa Plummer OTR/L, ATP is a clinical instructor at Belmont University School of Occupational Therapy in Nashville, TN, and the
owner of Community Mobility Resources. She
can be reached at plummert@mail.belmont.edu.

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.
It is well known that seating stability comes
from a stable pelvis. But for individuals with
multiple impairments, a stable pelvis is not synonymous with a lack of obliquity or rotation.
In other words, stable does not mean symmetrical, nor does it imply a fixed, rigid pelvis. All
of us must be able to weight shift forward and
laterally in order to have both stability and functional reach. That is the point at which therapeutic handling meets assistive technology.
FACTORS IN SEATING POSITIONING
Understanding the principles of NDT techniques has aided me in understanding the dynamics of positioning, and specifically custom seating, for neurologically impaired
individuals. A thorough mat assessment provides more than linear and angular measurements for seating; it allows one to ascertain
the point at which seating technology in wheelchair prescription substitutes for the hand
placement we use in treatment to gain alignment and control. While pelvic stability is critical, it should not be the main focus of seating.
Function is the focus. It is imperative to understand the full range of function, including
vision, swallowing, and functional reach.
For many folks with multiple impairments,
it is most logical to consider seating in a tiltin-space wheelchair, a recline wheelchair, or
even opening the back-to-seat angle. However, this may lead to an altered visual field
and altered biomechanics of the head and
neck, with potential impact on swallowing
and breathing. Furthermore, it can encourage the individual to scoot forward and assume a posture dominated by posterior pelvic
tilt, thoracic kyphosis, and cervical hyperex-

tension [particularly with individuals with


functional vision].
A seat depth that is too long will also cause
this to occur. Vision can dictate posture and
alter trunk and pelvic stability. A clients need
to find visual efficiency can override trunk
postures. Therefore, one must evaluate a

To enhance
trunk stability,
consider the entire
lower body as the
basis of support and
not the pelvis alone.

N D TA N E T WO 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 AT M E N T

15

E A R L Y

I N T E R V E N T I O N

Early Treatment Can Mean a Brighter Future


OUTCOMES SUPPORT INFANT INTERVENTION
By Kris Corn, DPT
How incredibly rewarding it is to treat an infant
with a CNS involvement within the first
few weeks of its life! During 25 years of
practice, Ive had the good fortune to treat
many infants. A large percentage of these
children do exceptionally well; they gain
gross and fine motor skills as well as speech
and language.
One child I began treating at three months
of age is an excellent example. She was born
with a Grade III bleed, left hemisphere, and
Grade IV bleed, right hemisphere. She was
diagnosed with moderate to severe involvement and given a very poor prognosisshe
would never walk or talk. When I began treatment, she weighed five lbs. Today, at 12 years,
she ambulates independently with a right
AFO, uses her right hand as an assist, and has
normal cognition, speech, and language. She
is a cheerleader for Disabled Leisure Sports.
We have all encountered various medical
and educational professionals who negate
the value of therapy and the importance of
early treatment. They believe that children
who make remarkable recoveries were either misdiagnosed or not very involved. Fortunately, MRIs have recently been able to
provide documentation of the original insult that has helped demonstrate the value of
early treatment.1
CASE STUDY
In January 2003, a five-week-old male infant
with right medial cerebral artery infarct and
seizures was referred to me for treatment. His
diagnosis was documented by MRI. He required intensive medical treatment in the first
few weeks of his life, as well as physical therapy in the NICU. At five weeks, he was released
from the hospital and referred for outpatient
physical therapy. Initial outpatient physical
therapy evaluation documented low postural
tone and high tone in the left extremities. Ashworth Scale for left extremities was 1+. There
was severe sensory disorganization with resulting irritability.

The doctor monitored the child over his


first year. At three months of age, the baby
was developing head and trunk control, although he remained highly irritable. The
doctor remained concerned but slightly optimistic. By six months of age, the child developed skills for crawling and coming to
stand. The doctor was more than enthusiastic about his recovery. By nine months, the
child was crawling, and at 10 months, he
stood alone and began taking steps, presenting motorically without any clinical signs
of CNS involvement. At 11 months, he ambulated independently, climbed, babbled,
and was beginning to jargon. The neurologist reported that he no longer had any signs
of cerebral palsy, he was normal.
This child was my patient early in infancy. He is one of many children that I have
been able to treat early with end results much
like his. I believe several contributing factors produced these results:
1. The baby received excellent care in the
NICU.
2. Physical therapy was instituted immediately in the hospital and then as an outpatient, with both therapists trained in
neuropediatrics and Neuro-Developmental Treatment.
3. The parents were intensely involved in
his care.
4. My years of experience treating older and
often severely involved children provided the knowledge and expertise to assist
in the development of appropriate components for motor (gross and fine) and
cognitive skills as they emerged.
Research is beginning to demonstrate how
early, appropriate, and intensive treatment
positively alters the outcome for infants with
CNS damage and resulting motor and cognitive impairments.2 The physicians with
whom I work can see the results of their in-

1 6 N D TA N E T WO 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 AT M E N T

tensive treatment, as well those of early, intensive therapeutic intervention. They are
becoming the therapists advocate.
LEARNING FROM EXPERIENCE
In working with infants, the importance of
experience and the skills learned in working with the older, more severely involved
CNS child must be emphasized. From these
children therapists learn what is needed
when treating the infant, what to facilitate
and enhance, and what to inhibit and prevent. Every child I have ever treated has
taught me valuable information and skills,
and every child has made some positive gains
related to his or her impairments. The improvements may appear small to the practitioner, but to the child and the family they
are very important.
Therapists are extremely important in the
lives of these children and their families. As
NDT therapists, we recognize that treatment
affects every system of the bodycardiopulmonary, musculoskeletal, neuromuscular, integumentery, cognitive, and emotional. Treatment must be approached
holistically, as taught and demonstrated by
the NDT approach.
Being able to use our skills to treat an infant
and to change the course of that individuals
life is a moving experience. We are fortunate

to be part of a wonderful profession.


REFERENCES:
1. Faerber, E. 1995. CNS Magnetic Resonance
Imaging in Infants and Children, Cambridge
University Press.
2. Nass, R. and D. Tauner. 2003. Cognitive
Development after Congenital Stroke and
Recovery after Stoke in Childhood Review,
December 2003.
Kristine Corn, DPT, is owner of Sierra Pediatric Therapy Clinic, Granite Bay, California.
She can be reached at kriscorn@lanset.com.

Q U E S T I O N

F R O M

uestion from the Field

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

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

Factors that may contribute to reduced


head/neck control:
Poor postural stability reduced balance
of flexion/extension through the trunk
Range of motion limitations that interfere 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 different ways depending upon the childs
unique strengths and weaknesses. For some,
it may be a reduced ability to maintain the
head upright (strength/endurance), with the
head falling forward when positioned upright against gravity. In other children, the
head/neck may be similarly flexed forward
and downward, or upright and hyperextended
back due to poor eccentric/concentric control
of head/neck flexion/extension. Therefore,
the first step should be to assess all components and impairments that may contribute
to the childs poor head control. A thorough
assessment of all systems (neuromotor and
musculoskeletal, as well as, sensory and gastrointestinal) will guide treatment.
TREATMENT STRATEGIES:
Address limitations in range of motion
that may impact upon alignment. For example, the child who more habitually
postures with head/neck hyperextension
may require lengthening of cervical extensors. Another child may require elongation through anterior chest musculature to achieve greater thoracic extension
for improved alignment to support appropriate head/neck alignment.

Address improving balance of neck flexors and extensors for improved head/neck
alignment relative to the trunk and support surface. Initially, assist the child by
placing him or her in correct head/neck
alignment, and then ask the child to sustain this appropriate alignment during
visual or oral activities presented. Gradually, begin to provide facilitation for
more dynamic head/neck control and
alignment. With the child who exhibits
excessive flexion, focus on activities for
increased graded extension. Attempt to
strengthen flexion in a child for whom
extension dominates.
Address weaknesses within specific muscle
groups to allow the child to achieve and
maintain neutral head/neck alignment
Facilitate postures and/or movement patterns that encourage alignment throughout the body. For example, you may attempt to facilitate scapular adduction with
thoracic extension for more appropriate
alignment through the trunk and then assess the balance of head/neck flexion/extension upon this new base of alignment.

T H E

F I E L D

Therese McDermott, MHS, CC-SLP

tivities to establish coordination of vision


with appropriate head/neck alignment.
Work with the child in positions that
minimize the impact of gravity and that
require some degree of activation for
head lift, but not within a full range. Partial support of weight can also be used to
reduce the impact of the weight of the
head in elevation.
Full external support and control may
be necessary with feeding. In this situation, maintaining appropriate head/neck
alignment is essential, with greater support provided through oral control
(Helen Mueller). While you are providing a greater level of assistance or control
to maintain alignment, it is important
to maintain dynamic handling (allowing the child to move his head/neck as
he feels is needed). The same principles
of observing and managing alignment
of the entire body apply when you are
also giving external oral control. Continue to think about alignment from the
base of support upward even though
your direct input is provided at the
head/face and neck.
Because vision may be a critical piece in
motivating the child to achieve and
maintain neutral head/neck alignment,
it is essential to place stimulus materials
and/or yourself in the appropriate visual range to facilitate this alignment.

Utilize postures and positions that allow


activation of specific muscle groups to
support improved balance of head/neck
flexion/extension. Upper extremity
weight bearing (even in an upright position) may allow for greater activation
of the paraspinals for improved alignment through the trunk, again as a base
from which to build increased head/
neck alignment.

Although the presenting symptom or problem may be viewed as poor head control, in
order to impact upon this component, treatment must address aspects of alignment
through the base of support to head/neck.
This perspective must be maintained in the
selection of equipment, supports to the
equipment (head rest, harness, etc.), as well

as during direct treatment.

Encourage the child to activate the postural system from the base of stability upward, balancing spinal extension with eccentric activation of the abdominal
musculature. Incorporate vision into ac-

Therese McDermott, MHS, CCC-SLP, is a


speech/language pathologist and NDT speech
instructor working at Pathways Center in Glenview, IL, and is in private practice in Chicago,
IL. She can be reached at tandt114@aol.com.

N D TA N E T WO 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 AT M E N T

17

R E V I E W
(How Often... continued from page 1)

range 10 to 37 months (mean 22.6; S.D 9.9),


all with quadriplegia (two were diagnosed
with double hemiplegia) were studied. All
were previously enrolled in a rehabilitation
program at the same institution through
which they received outpatient PT services.
On the Gross Motor Function Classification
System (GMFCS) (Palisano et al. 1997), four
were classified at Level IV and one at Level V.
Children who were candidates for surgery or
who had other conditions which might interfere with an intensive treatment program
were excluded from the study.
The GMFM (Russell et al. 1989) was used
as an outcome measure and was administered at the beginning of each childs baseline
period and every four weeks subsequently
throughout the study period. GMFM administration was by a single trained therapist who did not know the children, was unaware of the study aims, and who was not
provided with results of previous assessments.
Mean baseline GMFM scores ranged from
9.4 to 39.2. At the outset of the study, all children except one could roll prone to/from
supine, three could crawl 1.8 meters, and
none could stand, even with support.
A multiple-baseline design was used, with
the duration of the baseline phase ranging
from eight to 20 weeks. Children received
their routine treatment of twice per week PT
(45 minute sessions) during the baseline. Two
experimental phases followed immediately,
each consisting of four treatments per week
for four weeks, followed by an eight-week
rest period with no treatment. For example,
child 1 had an eight-week baseline during
which she had 16 treatments. During the first
treatment phase she then had 16 treatments
over four weeks (4x/wk for 4 wks), followed
by eight weeks with no treatment.
The second experimental phase repeated the
first, with16 treatments during four weeks, followed by eight weeks with no treatment. During rest periods, parents were asked to refrain
from initiating replacement therapy and were
given general advice without a specific home
program. All treatment was performed by the
childs usual therapist at the rehabilitation center and was based on the neurodevelopmental approach described by Mayston (1992).
OUTCOMES
All children showed improvements in total
GMFM scores following the experimental
phase, with increases ranging from 3% to

15.6%. However, performance improvement


was significant (p<0.05) for only three of
the five. Notably, performance did not improve or decline significantly following the
eight-week rest periods. It is also noteworthy
that attendance at therapy sessions increased
from a mean of 83% during the baseline to
93% during the experimental phases.
The aim of a pilot study was to provide
preliminary results and focus research questions; sample size was obviously a limitation,
and the relatively homogeneous sample of
children with quadriplegia limits the ability
to generalize to the larger population of children with CP. The authors also acknowledge
that lack of a control group means that
changes cannot be definitively attributed to
the treatment regime under study. The multiple-baseline design, however, provides a
way to monitor stability of performance during the baseline period and the trends in the
data strongly indicate that changes may indeed be due to the treatment regime.
In terms of delivering therapy services,
this type of intermittent treatment has several advantages:

Children with severe involvement make


significant improvements in relatively
short periods with intensive treatment.

Those improvements do not deteriorate during relatively long (2 month)


rest periods.

Compliance (attendance) may be better


with this sort of burst therapy than
with a more routine weekly regime.

Therapists reported that seeing a child almost daily helped establish a stronger therapist-child interaction, optimized actual therapy time, and allowed for frequent updating
of goals. Once parents learned that there was
no deterioration in their childs function
after the first eight-week rest period, they
reported enjoying a more normal family
life during those rest periods.
Finally, there are possible economic advantages to this type of intermittent therapy. In this study, the actual mean number of
weekly treatments was 25% less during the
experimental phase than during the baseline phase. If this treatment regime were carried out over a years time, that 25% difference would translate into 20 fewer actual
treatmentsclearly a significant number to
those concerned with providing high-qual-

1 8 N D TA N E T WO 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 AT M E N T

ity care with increasingly limited resources.


The authors are appropriately careful in
drawing conclusions from their data. They
provide an overview of other studies that
have investigated treatment frequency, and
point out the disadvantages as well as the advantages of intermittent therapyincluding
possible interference with other types of therapy and increased scheduling difficulties. The
children in their study were provided transportation by the rehabilitation center; the
authors do not mention how a lack of center-provided transportation or non-centerbased treatment might affect the practicality of this sort of treatment regime.
This study shares with many others an inadequate description of the actual therapy
provided. The Mayston article they reference,
while giving a good overview of the history
and evolution of the Bobath concept (and
well worth reading in its own right), is much
too general to allow replication of their study.
Until therapists who use the Neuro-Developmental Treatment approach begin accurately
describing what theyre doing, whether by
using microanalytic or other techniques, our
research and our methodology will continue
to be questioned. This problem is certainly
not limited to the NDT approach; it is true
for most studies of pediatric therapy. In spite
of these limitations, Trahan and Malouins
pilot study provides a sound methodology
and raises intriguing questions about the way

weve always done what we do.


REFERENCES
Mayston, M.J. 1992. The Bobath concept
evolution and application. In Forssberg H,
Hirschfield H, editors. Movement Disorders in
Children. Basel, Switzerland: Karger. p 1-6.
Palisano R, P. Rosenbaum, S. Walter, D. Russell, E. Wood, and B. Galuppi. 1997. Development and reliability of a system to classify gross motor function in children with
cerebral 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. Gross
motor function measure: a means to evaluate
the effect of physical therapy. Developmental
Medicine & Child Neurology 31: 341-52.
Barry Chapman, PT, is a pediatric therapist at
Carle Foundation Hospital in Urbana, IL.
He can be reached at pedspt@sbcglobal.net.

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CITY KIDS COURSES 2004

Share Your Expertise!


NDTA Network Needs You.

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NDTA members are a wealth of information and experience about


NDT. Network is looking for contributors. Share your knowledge with
your peers!
Have you had success with a particular treatment for our Question
from the Field column?
Do you have a technique or piece of equipment that has been useful for our Therapy Talk column?
Do you have a client or family member who would like to tell others about his or her experience with NDT treatment for our Caregiver/Patient perspective?
Have you read an interesting article or seen interesting research
youd like to review for our Review column?
Do you have any business tips for colleagues for our Advocacy column?
You dont have to be a writer to contribute to Network. Network editor
K.T.Anders will be happy to work with you to refine your information
into an article.
The strength of NDTA is in getting the NDT message out!
Help spread the word by contributing your knowledge through Network.
For more information, contact Cindy Rounds at cindy@ndta.org or
Publication Committee Chair Marcia Stamer at paul-stamer@att.net.
Were waiting to hear from you!

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Instructor: Beverly Cusick, MS, PT.
July 5-30, 2004: Eight Weeks for $3300
October 18-Nov. 12, 2004: Eight Weeks for $3300
8 Week NDTA Pediatric Course
Instructors: Madonna Nash OTR/L and Kacy Hertz, PT Therese
McDermott, MA-CCC-SLP
September 10-12, 2004: Three Days For $300
Three Days About Babies-Intro To Baby Treatment
Instructors: Madonna Nash OTR/L, Kacy Hertz, PT,
For further information please call Sheila de Armas at
773-467-5669 X150 or fax 773-631-2926.

N D TA N E T WO 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 AT M E N T

21

E D U C A T I O N A L

O P P O R T U N I T I E S

Upcoming NDTA-Approved Courses


NDT/BOBATH CERTIFICATE
COURSE IN THE TREATMENT AND
MANAGEMENT OF INDIVIDUALS
WITH ADULT HEMIPLEGIA
Course #:04A114
Dates: 6/14/20046/25/2004
9/26/200410/1/2004
Location: Toronto, Ontario, Canada
Instructors: Karen Brunton, CI, PT,
Nicky Schmidt, PT, Pat Bonner, OT
Contact: Judy Ward,Toronto Rehab
Institute, Conference Services
550 University Ave.
Toronto, Ontario M5G 2A2 Canada
416-597-3422 x3516 Fax 416-597-6202
conferences@torontorehab.on.ca
_______________________________________

Course #:04A116
Dates: 8/6/20048/17/2004 Part 1
11/30/200412/5/2004 Part 2
Location: San Jose, CA
Instructors: Cathy Runyan, OT, Bonnie
Jenkins-Close, PT, Karen Brunton, CI, PT,
Trish Moratorio, PT
Contact: Recovering Function
408-268-3691
www.recoveringfunction.com
info@recoveringfunction.com

NDT/BOBATH CERTIFICATE
COURSE IN THE TREATMENT AND
MANAGEMENT OF INDIVIDUALS
WITH CEREBRAL PALSY
Course #: 04B102
Dates: 5/31/20047/16/2004
Location: Durham, NC
Instructors: Margo Prim Haynes,
Jane Styer-Acevedo, Lezlie Adler, Ann Guild
Contact: Shirley Howard
Duke Childrens Hospital, Department of
PT & OT
Box 3120, Durham, NC 27710
919-684-3733 919-681-7574
howar014@mc.duke.edu

Course #: 04B103
Dates: 6/14/20048/6/2004
Location: Colorado Springs, CO
Instructors: Suzanne Davis, Monica Wojcik,
Lezlie Adler
Contact: Nancy Chersin
Pediatric Therapy Associates
447 NW 73rd Ave., Plantation, FL 33317
954-583-7383 Fax 954-583-7388
_______________________________________

Course #: 04B106
Dates: 7/5/20047/30/2004
10/18/200411/12/2004
Location: Chicago, IL
Instructors: Madonna Nash, OTR/L,
Kacy Hertz, PT,
Therese McDermott, MA-CCC-SLP
Contact: Sheila de Armas, City Kids
5669 N. Northwest Hwy
Chicago, IL 60646
773-467-5669 x150 Fax 773-631-2926
citykidscourses@yahoo.com
_______________________________________

Course #: 04B107
Dates: 10/25/200411/19/2004
2/28/20053/25/2005
Location: Puyallup,WA
Instructors: Brett Nirider, Mechthild Rast,
Gay Lloyd Pinder
Contact: Colleen Collins
Childrens Therapy Unit
Good Samaritan
405 15th Ave SE
Puyallup,WA 98372
253-697-5200
colleencollins@goodsamhealth.org
brettnirider@goodsamhealth.org
_______________________________________

Course #: 04B108
Dates: 6/11/20046/13/2004
7/9/20047/11/2004
8/1/20048/7/2004
9/10/20049/12/2004
10/8/200410/10/2004
11/12/200411/14/2004
1/14/20051/16/2005

2 2 N D TA N E T WO 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 AT M E N T

2/11/20052/13/2005
3/11/20053/13/2005
Location: Houston,TX
Instructors: Judith Bierman, PT,
Gail Ritchie, OTR/L, Ann Heavey, SLP
Contact: Cassandra Devine
NDT Programs
817 Crawford Ave., Augusta, GA 30904
706-736-1255 Fax 706-736-1258
ndtp@aol.com
_______________________________________

Course #: 04B109
Dates: 9/10/20049/13/2004
10/8/200410/11/2004
11/8/200411/19/2004
1/17/20051/28/2005
2/18/20052/21/2005
3/11/20053/14/2005
Location: Glenview, IL
Instructors: Gay Girolami, PT, MS,
Diane Fritts Ryan, OTR/L,
Therese McDermott Winter, MHS, CCC-SLP,
Judy Gardner, MA CCC-SLP
Contact: Julie Lugiai
Pathways Center
2591 Compass Road
Glenview, IL 60025
847-729-6220 x242
847-729-1116
jlugiai@pathwayscenter.org
_______________________________________

Course #: 05B101
Dates: 3/19/20053/23/2005
3/26/20053/30/2005
6/1/20056/4/2005
6/8/20056/11/2005
6/15/20056/18/2005
7/27/20057/30/2005
8/3/20058/6/2005
8/10/20058/13/2005
Location: Houston,TX
Instructors: Sherry Lynn Wilson Arndt, PT,
MA, PCS , Lezlie Adler, OT/R, MS,
Marybeth Trapani-Hanasewych, MS,
SLP/CCC
Contact: Mitzi Wiggin

E D U C A T I O N A L

O P P O R T U N I T I E S

Upcoming NDTA-Approved Courses


Texas Childrens Hospital
832-826-6107
832-825-5242 Fax
mmwiggin@texaschildrenshospital.org

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

Course #: 04G112
Course Title: Advanced Gait Course
Dates: 7/12/20047/16/2004
Location: Chicago, IL
Instructors: Teddy Parkinson,
Cathy Hazzard
Contact: Danila Cepa or Sandra Young
dcepa@rehabchicago.org or
syoung@rehabchicago.org
_______________________________________

Course #: 04U113
Course Title: Advanced Upper Extremity
Course
Dates: 9/19/20049/23/2004
Location: Toronto, Ontario, Canada
Instructors: Karen Brunton, CI, PT,
Pat Bonner, OT
Contact: Judy Ward
Toronto Rehab Institute, Conference Services
550 University Ave
Toronto, Ontario M5G 2A2 Canada
416-597-3422 x 3516 416-597-6202 Fax
conferences@torontorehab.on.ca
_______________________________________

Course #: 04Y101
Course Title: Advanced Baby Course
Dates: 8/16/20049/2/2004
Location: Orange, CA
Instructors: Lois Bly, Lauren Beeler,
Mary Hallway
Contact: Barbara Sargent
Childrens Hospital of Orange County
455 South Main Street
Orange, CA 92868
714-516-4265 714-516-4271 Fax
bsargent@choc.org

Educational Opportunities
Course #: 04N104
Course Title: NDT
Concepts Applied to Orthotic
Fabrication (Requires
Successful Completion of an
NDT Basic Course)
Dates: 10/1510/18/2004
Location: Columbus, OH
Instructors: Nicky Schmidt, PT,
Debbie Merritt Plescia, CPO
Contact: David Rupp
614-566-0562

Course #: 04N106 & 04N107


Course Title: Pt 1: Developmental & Closed-Chain Biomechanics: Orthotic Selection,
Rehab, Using Tape & TheraTogs.
Pt 2: Practicum Sessions in
Below-Knee Serial Casting &
Splint Fabrication Techniques
Dates: 9/49/10/2004 Pt 1
9/119/12/2004 Pt 2
Location: Fresno, CA
Instructor: Beverly Cusick
Contact: Steve Davison

stevedavisonpt@yahoo.com
Mary at 559-449-0320
__________________________
Course #: 04N105
Course Title: Assistive Technology Strategies: A New Perspective in Enhancing Function
Dates: 11/411/6/2004
Location: Lisle, IL
Instructors: Gail Ritchie,
OTR/L, Anne Heavey, SLP
Contact: Dania Polly
630-898-2200

EMPLOYMENT OPPORTUNITIES
ATTENTION: PTs, OTs and SLPs!
Care Meridian is currently seeking PT's, OT's and SLP's to provide independent contracting in a subacute neurorehab setting. Facility locations are: North and South
Orange County, Escondido, L.A. County, Oxnard, Fairfax and Gilroy areas. Please
send rsum to Bruce Kuluris, bkuluris@caremeridian.com or FAX 949-2610457.

PEDIATRIC THERAPISTSGeorgia
Growing therapist-owned pediatric practice has openings for occupational,
physical, and speech therapists. We serve children from birth to 21-years-old in
clinical, school, and natural environment settings. Flexible schedules. FT/PT.
Contract or employee. Great opportunity for new grads and experienced therapists. Please contact: Sherry or Patti. 770 425-6661; 770 425-1189 fax.
ctccoffice@opexonline.com

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 NDTA
activities. Its 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
membership@ndta.org.

N D TA N E T WO 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 AT M E N T

23

More About the NDTA

Our Mission
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.

THE NEURO-DEVELOPMENTAL TREATMENT ASSOCIATION MARCH/APRIL 2004 VOLUME 11, ISSUE 2

PRESORTED
STANDARD
U.S. POSTAGE

Neuro-Developmental Treatment Association


1540 S. Coast Hwy, Suite 203
Laguna Beach, CA 92651

PAID
SANTA ANA, CA
PERMIT NO. 3