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Rehab facilities have limited education and training budgets these days, so it helps when a therapist decides to share new information through informal staff education sessions.
"Every Thursday we have a group meeting where therapists share expertise with those who don’t pursue certification in a particular area," says Jackie Kirkwood, LMSW, program director for acute rehab at Tuomey Health Care System in Sumter, SC. The 250-bed hospital has 19 acute rehab beds.
One therapist, in particular, has provided weekly training and demonstrations of neurodevelopment technique (NDT), and has been very well-received by the staff, Kirkwood says. "We’ve gotten very good feedback," she says. "Particularly, the patient demonstrations have been very helpful."
Archna Chadha, OT, a clinical coordinator for the rehab facility, completed the extensive NDT training, passed the certification tests, and then shared her education with colleagues. NDT was founded in England by Berta Bobath, MBE, PhD, who has worked with cerebral palsy patients.
"Since October 1999 I’ve been teaching every Thursday what I learned about positioning and handling techniques for stroke patients," Chadha says.
Her first free courses were attended by up to 15 therapists, and while that number has dropped, she still speaks to about four colleagues each week. "It was very motivating to me that there are people who want to learn more about this," Chadha says. "People are interested in learning about stroke patients and using these very specialized techniques that you don’t learn a whole lot about in school."
Chadha’s weekly educational sessions have received positive feedback from staff, Kirkwood says. "We’ve had some new graduates, and it’s been very helpful to them because they haven’t gotten this experience working with neurological patients in school."
Chadha also developed a stroke support group for the Sumter community, which has a very high stroke rate. There have been times when more than 60% of the patients on the inpatient unit have been stroke patients, Chadha says. "National studies show that Sumter is the stroke belt for the whole nation," Chadha says. "We have a large number of people having strokes because of a lack of education, poor socio-economic lifestyles, and poor diets."
The educational classes are marketed with bulletins advertising a "Neuro-Interest Group" that meets every Thursday afternoon. The bulletins read, "These classes will help you to gain understanding of neurodevelopmental treatment techniques; improve the ability to analyze normal/ abnormal movements; apply NDT techniques with function in adult hemiplegia; learn handling skills useful in gaining range of motion and mobility with CVA patients; and most importantly, apply teamwork and overall management of the adult hemiplegia."
The bulletins are directed toward physicians, nurses, therapists, therapy assistants, rehab techs, social workers, nursing assistants, and any caregivers, including family members, Chadha says.
The weekly sessions are hands-on, with patient demonstrations using former patients who have volunteered to participate, Chadha says. "I believe in teaching by hands-on participation," she explains.
She also discusses patients’ emotional needs in the course. For example, Chadha says she does not believe therapists and clinicians should speak to a stroke patient by referring to "your good arm" and "your bad arm." These labels send patients a message that they have a "bad" arm, and that negative message could be a self-fulfilling prophecy.
The NDT training involves learning a whole new language, rehab techniques, and a different philosophy in dealing with patients, and Chadha has tried to impart that knowledge to her colleagues at the hospital. "I don’t want to tell therapists what to do but I thought that a free education would be the best way to show them NDT," Chadha says.
After the educational sessions continued for a year, Chadha found that therapists were using these to clarify certain points about NDT or to solve certain therapy problems.
Therapists might ask her how they should address an upper body problem, for instance. "So we problem solve and when the time permits I’ll co-treat with them," she says. "The team we have is excellent and very interested in learning," Chadha says. "They say, I don’t know what I was doing before coming to these classes,’ and they say, My patient is doing much better than he did before.’"
Chadha’s objectives for the NDT educational group are:
• to gain an understanding of neurodevelopment (Bobath) treatment principles (NDT);
• to improve the ability to analyze normal and abnormal movement;
• to apply NDT techniques to the management of the adult with hemiplegia;
• to identify problems interfering with function necessary for controlling postural tone and facilitating normal functional activity.
The group sessions focus on the following:
• observation and analysis of normal postures and functional movement;
• observation and analysis of various problems interfering with postural control and movement;
• assessment and management of the adult with hemiplegia;
• handling skills useful in gaining range of motion and mobility;
• positioning of the affected side, bed mobility, transfers training, seating in a chair and wheelchair;
• handling skills to promote normal movement, postural control, and functional activity;
• teamwork and overall management of the adult with the hemiplegia.
• Archna Chadha, OT, NDT-certified, Clinical Coordinator, Tuomey Health Care System, Acute Rehab, 4th Floor, 129 N. Washington St., Sumter, SC 29150-4949. Telephone: (803) 778-9454.
• Jackie Kirkwood, LMSW, Program Director, Tuomey Health Care System, Acute Rehab, 4th Floor, 129 N. Washington St., Sumter, SC 29150-4949. Telephone: (803) 778-9000.