MEMBER SPOTLIGHT: MARCH/APRIL, 2019
Monica Diamond PT, MS, NCS, C/NDT
Monica is an NDT instructor who teaches the “NDT/Bobath Certificate and Advanced Courses in the Management of Adults with Stroke and Brain Injury” course and other short courses on the treatment of adults with acquired disabilities. In her early years as a physical therapist, she was fortunate to work in a facility that greatly valued education and training. Monica was encouraged to be trained in NDT and then to work toward becoming an instructor. She had wonderful opportunities to pass along what she was learning to the rest of the staff during in-services and during the certificate courses that they sponsored regularly. She found the benefits to their patients were huge, as was the enthusiasm of the staff at seeing their patients make progress.
Monica currently works in an outpatient neurorehabilitation program associated with an inpatient program at Ascension Sacred Heart Hospital in Milwaukee with a great group of colleagues. Of her worksite she states, “We also have a dedicated Brain Injury Day Program that provides services to individuals who have just been discharged from inpatient rehabilitation or who spent some time at a residential rehabilitation facility prior to being ready for the outpatient program. Although things have been reorganized and changed over my many years at this facility, it’s still my patients and co-workers that make me want to come to work each day.”
Returning to work and the community following stroke or brain injury presents numerous challenges. When asked about the challenges Monica sees she stated, “We are fortunate to work closely as a team. Depending on the patient’s needs, the team may include PT, OT, SLP, psychology, therapeutic recreation, nursing, and vocational rehabilitation, as well as the physician. We also have availability of orthopedic PT, work conditioning, and other services within our system.
“There are so many variables to be considered when helping someone decide whether or not to return to work. Often, the question needs to be investigated with a wider focus – considering the individuals’ interests, family involvement and support, their current and potential abilities and limitations (physical, cognitive, behavioral), as well as their ability to sustain attention and physically tolerate specific situations. Our team works together and shares progress, questions and considerations, observations, etc. As a group we may recommend part time work, investigation of volunteer involvement, or focus on a hobby or leisure activity. After investigating the job duties, and depending on the situation, we may provide guidelines to the physician who writes the work release, specifying the number of hours to be worked per day, particular limitations (sitting, standing, lifting, etc.), environmental constraints, and other factors that we feel are most likely to make the individual’s return to work be successful.
“It’s important to know the employer’s willingness to work with the individual – someone who returns to work too early may be denied the opportunity to continue due to his or her limitations or may become discouraged and decide not to continue to work. Safety is a huge consideration, especially since so many of our patients demonstrate cognitive and behavioral limitations. Within our Brain Injury Day Program, patients are encouraged to work on attention, social skills, and group activities that will prepare them for success in the workplace or wherever they choose to find meaning in their lives. Junior, a recent patient, experienced a stroke with left hemiplegia, but was amazingly motivated to return to work in the Facilities Management Department at Miller Park (Milwaukee Brewers Stadium). Fortunately, as we continued to challenge him, we noted that his cognition and judgement appeared to be good, so we were able to challenge him with higher level activities and continued to instruct him in what to work on at home (usually this involved more of what not to do). We continued to evaluate his balance, coordination, and endurance for the activities he hoped to progress to at home and eventually at work. We used a combination of simulations (as much as was possible in the clinic, eventually including climbing ladders, and reaching overhead to perform two-handed tasks as though working on the HVAC system) as well as careful progression of home activities. He successfully returned to work and now welcomes current day program participants during their yearly outing to a Brewers game.”
In addition to the physical challenges of returning to work or the community, we discussed how Monica and her team deal with not only the physical needs, but the social challenges of getting back into activities people may have participated in before their stroke or accident. “Some of my greatest rewards as a PT have involved working with people who were getting back to their life. One of my greatest inspirations is Marilyn. I met her when we were both really young – I was probably a few years out of PT school and she was a new graduate registered nurse, a couple of years younger than me, injured in a hit and run accident on her way home from the night shift at a local hospital. We worked together for many weeks and for many different admissions, since she was back in the hospital repeatedly for surgeries to correct her problems. She had a primary brain injury with significant ataxia, but also many fractures and other orthopedic issues
“She introduces herself on the phone and on Christmas cards as your favorite patient but also reminds me that she used to be my favorite guinea pig! At the time I was treating her, I was doing my NDT training and attending a lot of continuing education courses. She would greet me on Monday morning and ask, ‘So what did you learn this weekend?’ and we would explore my new knowledge together.
“Marilyn taught me that recovery is not quick. Due to her many surgeries and recoveries, and to the fact that she could no longer do hands-on nursing, she was not able to return to work for many years, but always planned to continue. Today she walks slowly and stiffly and lives alone but is able to drive and manage her own affairs. She reports difficulty with some cognitive tasks, but has developed and can describe, strategies she uses to stay on track. She is amazing! She has family support but also functions as a strong support to family members, which included caring for her parents as they aged.
“Marilyn returned to work eight years after her accident and has been working since. She is a phone triage nurse, and due to difficulty she has in getting going in the morning, she prefers to work the shift that starts at 3:00 PM. She recently celebrated 25 years at her job and has joked with me that even though she is near retirement age, she needs to pick up all the extra shifts she can, since she ‘missed out on eight years of earning.’ She is a great communicator, and in spite of difficulties controlling her voice, she is on the phone all day at work. We are in touch at least 2-3 times a year, so we can get together and catch up on our latest activities.”
Being able to work with and continue to follow patients over longer periods of time can help us learn valuable lessons that we carry through our career and life. Some of the lessons Monica learned from working with Marilyn include:
- Recovery may take a lot longer than we expect due to medical, emotional, and other issues. It takes a long time to get going if you have challenges, and sometimes a period of adjustment is OK.
- People may need to consider many options – sometimes these are related to their before injury lifestyles, but not always. We can help explore options, as well as the possible challenges. We can also help develop solutions.
- We are in a great position to be cheerleaders: encouraging, problem solving, or gently nudging.
Monica utilizes all this knowledge and experiential learning to assist the students in her NDT classes to learn and grow. When asked what she likes best about being an NDT instructor Monica states, “I love the teamwork that goes along with teaching and learning, working with other instructors to assist course participants to help their patients to do things they could not do and sometimes could not even imagine doing. I am fortunate to teach with a great team. We consider our chance to teach together as the ultimate in advanced continuing education. We challenge ourselves and each other in our teaching successes and challenges, as well as in patient treatment and problem-solving during demonstrations and patient practicums. It’s always exciting to watch therapists learn how effective they can be in helping patients achieve their goals. I feel that by training others, I have a wonderful opportunity to help so many more individuals conquer their challenges.”
Monica would like to thank the many patients who have shared so much with her over the years. Many thanks also to the many members of the NDTA Instructors Group from whom she has learned so much.
MEMBER SPOTLIGHT: JANUARY/FEBRUARY 2019
Helen "Timmie" Wallace, PT, C/NDT
I have had the privilege of teaching with Timmie on several occasions across the world. She is a seasoned clinician with a wealth of knowledge about NDT and treating children. She was fortunate to do her initial NDT training directly with Mrs. Bobath. When she was a physical therapy student, she heard about the Bobaths in her therapeutic exercise course. She knew she wanted to work with children, so this approach intrigued her. She explored her options and chose a clinical experience at a children’s residential hospital that had a physical therapy supervisor who was Bobath-trained and included NDT in her clinic. As it happened, the Bobaths visited that hospital during the time Timmie was there, and she was totally hooked after watching Mrs. Bobath work with the children.
When asked what made her take the step to become an instructor Timmie replied, “This was by mistake. I had the opportunity to have a second course (once part of the criteria for becoming an NDT instructor), took the course, was asked to assist in other courses, realized I could reach more kids and families if I taught other therapists – and the rest is history! I really appreciated the opportunity to share this wonderful approach with other therapists and learned more and more about teaching as I assisted many amazing instructors.”
Teaching and treating children have been passions for Timmie throughout her career. Over her career she has worked in all aspects of treatment settings. She currently provides home-based services to the birth to three population. Her love of the children and desire for them to achieve more is evident every time you see her treat a child. She has a fun way of relating to children of all ages and getting them on board with therapy through creative, fun activities. She is currently a sole practitioner but has worked in settings with other NDT-trained therapists in the past. When we talked about the advantage of working in those settings, Timmie stated, “In other eras, I have worked with therapists following the same philosophy / basic premises and concepts as NDT / Bobath. This makes communication easier and the total approach, to me, has greater impact on positive results for child and family.”
With her passion for teaching she has had the opportunity to train therapists all over the world regarding the benefits of using the NDT/Bobath treatment model. When looking at what she likes therapists to learn from this approach, she cites the areas of typical development and postural control as two of the most important aspects in helping children develop good movement patterns to improve functional outcomes. She states, “Understanding the refinements of typical movement development and the importance of postural control and postural stability in the role of function are areas all therapists need to know better. Using this base for establishing treatment objectives and strategies is one of the best (for me the best!) ways to observe functional gains in children with chronic conditions, as we are able to see the gains and not get held down by inabilities. Knowing how it all fits together challenges us to always look for the child’s abilities.” As we look at the importance of the role of postural control Timmie has found that “Postural control is more than a role; it is one of the primary bases for functional skill development. Postural control is not just the neuromotor or musculoskeletal systems. It incorporates the sensory systems, the digestive and respiratory systems, communication, and all body systems that we are challenged to address. Postural control puts the onus on alignment, which includes weight bearing, weight shifting, vestibular responses, strength, tone, influences of gravity, motivation, visual and hearing and tactile senses, as well as the understanding and integration of the feedback this provides in order to use this information to perform / perfect (through feed forward) the activity/skill. The NDT approach brings postural control into function by helping to provide a strong base for skill development. I believe this is as Mrs. Bobath originally intended us to understand.”
Whether teaching with Timmie or taking a course from her, her passion for both treating and teaching is evident. She is certified as an instructor in pediatrics and has taken the course on the treatment of adults with neurologic impairments. She has spent her career in pediatrics but found that being certified in the adult side of NDT has taught her that it is important that all of us (instructors) take the opportunity to have the other course so that we can better understand where we have come from and where we are going – that we understand the lifespan. She finds that sharing valuable information with other therapists and helping therapists realize the abilities of the kids as our teachers provides her the most joy in being an instructor. As an instructor she states, “I get to be a catalyst in this interchange between therapist and child. Watching the families become so connected to the therapists as the therapists learn ways to provide the basis for function is also a gift for me.”
Because Timmie has had the opportunity to teach around the world, I asked her what she has found to be the benefits of treating in a variety of cultures. She states, “Sharing the information with more people and learning how NDT fits with various cultures. In some situations, this is the first exposure the therapists have to this approach, and the word spreads very quickly that NDT really can make a difference. Another aspect is that families (parents and caregivers) often have not understood that there are great possibilities that their children can improve in their skills, and the intensity of this course is a real eye-opener for the families and the children.”
MEMBER SPOTLIGHT: NOVEMBER/DECEMBER 2018
Debra Kray, PT, C/NDT
The NDTA 2018 conference was a huge success thanks to NDT practitioners like Debra Kray, who has served on the Conference Planning Committee for the past four years. Having practiced for 32 years, Debra currently resides in Los Angeles, California. She works for the state’s Westside Regional Center in the birth-3-year-old early intervention program as both a treating therapist and as a consultant. She recalls being fortunate to work as a student intern at a hospital with Randy Jacobson, PT, who was NDT-trained. At graduation, Debra secured a job at that same hospital and was able to be guided in treatment ideas and continuing education course recommendations by Randy.
In 1987, Debra was able to take the five-day “Components of Movement” course taught by Lois Bly, which gave her an excellent introduction to NDT-oriented movement analysis. She then followed this with several other shorter courses with a variety of instructors, giving her well-rounded exposure to NDT treatment strategies. But she reports that she wanted to further understand strategies and how to determine when to use them. In 1999, Debra was able to take her certification course with Lauren Beeler and Mary Hallway.
Debra defines NDT as a philosophy that she has been able to keep in the forefront, applying its movement analysis and problem solving strategies in all the job settings where she has worked. She found this to be most important when her family had moved to another state where the awareness of NDT was quite limited. Being in this type of work environment forced her to become more self-reliant.
Debra recalls an 18-month-old child she treated there shortly after starting. She focused on improving postural control in standing and during walking because these were both age appropriate and important to the family. Her favorite treatment memory is of a fall afternoon when she and the child walked outside crunching leaves. She utilized home programs and community involvement to help the family understand the child’s functional possibilities and to become comfortable with their “differently-abled child.” When asked what advice Debra had for any therapist inquiring about NDT she stated, “It just makes sense! NDT certification is a journey that does require a strong commitment of time, energy, and finances, but the value of learning will continue long after your training is complete.”