INSTRUCTOR SPOTLIGHT: September/October, 2019
Jodi Renard, PT, DPT, C/NDT
Jodi Renard is an instructor for the “NDTA Contemporary Practice Model™ Certificate Course in the Management of Adults with Stroke and Brain Injury.” She currently works as a physical therapist for a large hospital system in Ohio, providing specialized neurological outpatient physical therapy (PT) alongside a team of speech and occupational therapists.
Her desire to become a physical therapist started young when she had the opportunity to experience many different clinical settings as a volunteer during high school. She started her PT career by spending her first year of practice in pediatrics working in outpatient and school settings, which exposed her to the use of NDT. She also kept her hand in the adult world working extra hours on weekends. Jodi was given the opportunity to change jobs to an acute inpatient rehabilitation setting with OhioHealth and left the pediatric world at that time. She was fortunate enough to be exposed to many NDT courses, as Marie Simeo, PT, MS, Coordinator Instructor, also worked within the same hospital system. Within three years of graduating, she took the NDT certification course. She also worked with other amazing therapists that were NDT trained, helping her develop as a clinician. Jodi transitioned to outpatient care in 2004 and has continued her clinical work there solely. She has been given the opportunity to serve as the acquired brain injury PT program coordinator for outpatient services for her hospital system for the past two plus years, although her love and primary job is with the clients.
When asked how she became interested in becoming an NDT instructor Jodi stated, “Marie Simeo, PT, MS, gave me the opportunity to serve as a lab assistance for many introductory courses. I loved these opportunities and realized that each time I attended the courses, I would not only get to develop my handling skills but would also learn another clinical pearl. I was driven by the opportunity to help my patients get better. As I began the instructor process, I always had the mindset that each time I would teach or take an advanced course, I was becoming a better therapist with the sole intent to benefit my patients. I consider myself a life-long learner, and teaching gives me this opportunity as I need to stay on top of the evidence available. I am driven to problem-solve with peers regarding our patients. I truly believe that the NDT problem-solving and movement analysis approach can change a therapist’s perspective, and a therapist is given the ability to link impairments with distinct treatment strategies to address those impairments.”
Jodi has found using the NDT Practice Model to be of great benefit to her clients. “NDT has allowed me to start my assessment with my patients who have sustained a stroke, head injury, or other acquired brain injuries from the moment I say hello. The movement strategies they chose as they start to move gives me a head start on what impairments I may need to address. The handling skills that I have gained from my NDT training have given me ‘another set of eyes’ to be able to feel their alignment and movement and then be able to predict their movement, aid in correcting their alignment, and help facilitate muscular activation and timing. I believe that if we allow compensation, we block motor learning, and in the adult world, most functional activities are actual re-learning since we have already experienced moving around our world. NDT has given me the skills to limit compensation and given me the knowledge to teach efficient motor sequencing to my patients to successfully move again for the purpose of re-engaging in activities that are important to each individual. You wouldn’t believe the number of individuals that want to mow their lawn again!”
Clients who have suffered a stroke, traumatic brain injury, or other type of neurologic insult often face ongoing challenges as they recover, age, and learn to adapt to their limitations. Taking this into consideration Jodi states, “As I get further into my career, I have had the opportunity to follow many patients over many years. As we age, our bodies change, and we experience new challenges. It is even more so with patients that have sustained a stroke or traumatic brain injury. Many patients have residual deficits that leave them vulnerable to orthopedic dysfunction and pain. Spasticity changes as they move through the recovery phases, and they generally need a therapist to navigate medical consultations, prevent secondary impairments, and help them with any orthosis needs. Activity levels can change, and deconditioning can be detrimental to functional mobility and community access. I generally check in with a patient annually to determine any new needs.”
“Treating, teaching, and collaborating with colleagues makes for a rewarding career that benefits ourselves, our clients, and fellow therapists with whom we have the privilege of interacting.” .
INSTRUCTOR SPOTLIGHT: MAY/JUNE, 2019
Kris Gellert, OTR/L, C/NDT
Kris is an occupational therapy instructor in the treatment of adults with stroke and other neurological disorders. She was introduced to NDT in college and then had the very good fortune to work in a free-standing rehabilitation hospital where several therapists were NDT trained. She quickly saw that the NDT-trained therapists were very focused, and they got great results with their patients.
“I wanted to do what they did,” Kris states. “However, it wasn’t until I took what is now the NDTA Adult Certificate Course that I had a more comprehensive thought process to guide my assessment and interventions with patients. My treatments became much more focused. Through NDT training, I learned about how movement evolves. Having an in-depth knowledge of typical movement patterns and an understanding of what may occur after a neurological insult or injury has profoundly changed my practice as an occupational therapist (OT).”
Early in her career when Kris worked in the freestanding rehabilitation hospital, she worked predominately on the stroke and then the brain injury team. Also, Monica Diamond, PT, was on that team as the clinical educator. Her influence was strong in this setting and in their region. She taught an NDT course every year in their facility and trained several staff each time. Because of this, there was a strong NDT presence in the early part of Kris’ career. “When I left that facility and moved across the country to North Carolina, I missed that unifying presence and invited Monica to come and teach a certificate course for my team in NC. Because I was helping to coordinate the course, I learned a great deal about what is involved to run a course, and she allowed me to join in as much as my schedule would allow. I knew that NDT training was a game changer for me, and I had the unique opportunity to view a course from a different perspective. I was hooked, and I began seeking information to become an instructor.
“I love being an instructor, even though it means traveling away from my family and my home and talking in front of people – I am an extreme introvert. I have enjoyed the opportunity to teach and learn from my colleagues and visit places I may not have otherwise seen. I learn something every single time that I teach. Patients have taught me a ton, and my peers are incredibly knowledgeable and eager to continue to grow. I am very fortunate to work side by side with some of the greatest clinicians I can imagine.
“Mostly though, I feel a tremendous sense of pride when I see clinicians who are taking the certificate course change. It is awe inspiring – every time. Therapists come to these courses often because they wish to be better – to help their patients improve. They are so often transformed. I selfishly love to be a part of that process.
“Some therapists may initially resist trying something new because it is frightening to let go of something familiar. I try to stress that giving up or challenging some of our old habits is the only way for us to grow. I think most people who commit time and money to take the NDTA Certificate course are allowing themselves to be vulnerable and to grow so that they can help their patients get optimal results quicker.
“I am an adult course occupational therapy instructor, but I have worked with children with neuromuscular dysfunction throughout my career. I think having a good understanding of how movement develops and evolves, as well as how to engage people of any age, helps me to be a good clinician.
“I really like making a difference. I, like many of you reading this, became a therapist because I wanted to help people. Having NDT training has helped me connect to people of all ages and work with them to improve their participation in a meaningful life, whatever that may mean to them individually.”
As an instructor Kris tries to encourage other OTs to become NDT certified. When asked why she thinks this is beneficial to other OTs she states, “Katy Kerris, an adult course occupational therapy instructor from Alaska, and I did a presentation to the NDTA Instructor’s Group last year, and we depicted occupational therapy and NDT as the perfect pairing, like wine and cheese. I believe this is true.
“NDT is a fabulous tool for any OT who is working with patients who have had a neurological insult. Occupational therapy professionals are committed to finding ways to help their patients achieve the highest possible level of meaningful function and participation in life. The NDT approach is also designed to help patients achieve highest level of participation in life roles. With NDT, though, the OT really learns to understand how the body moves and what can go wrong after a stroke or brain injury. My training in school did not include looking at the whole body, and this is crucial for helping people to move to attain functional goals.
“Having NDT training has really helped me be more holistic in my approach to care. As an OT, this is essential. I use the thought process and clinical problem solving with all my patients, not just those with neurologic dysfunction. I use my problem solving with several of my orthopedic type patients to determine how their movement repertoires may be leading to the problems that they are trying to remedy. I treat musicians who have developed painful upper extremity conditions due to lousy posture during practice and performances. Often correcting the foundation and adjusting the posture can alleviate many symptoms.”
Kris has found that she is able to take her knowledge and treatment skills and apply them to her current practice at a large health center in their outpatient neurological rehabilitation clinic in Greensboro, NC. Within that health system and in the outpatient clinic, there are other NDT certified therapists, and Kris finds it is a pleasure to work with like-minded clinicians. In addition to teaching across the country, she has had the opportunity to teach for her health system on several different occasions, which she finds to be fun. She states, “I like to think of myself as a lifelong learner, and I get tremendous joy from seeing that in my colleagues. It’s great to learn new information together, and then problem solve on how to better assess and provide treatment to those we serve. I really enjoy a collaborative approach to patient care, and when I work with other disciplines, our goals and our paths to reach those goals may differ, but our thought process is similar, despite our discipline. It’s as though we are talking the same language.”
Part of working as a therapist is dealing with the challenges our patients present and helping them deal with the challenges they face living with a disability, whether it is from birth or acquired. The theme of this Network deals with adjusting to the unexpected. In discussing this with Kris she said, “I think so many of the patients we serve have shown true strength and grace in their ability to adjust to the unexpected. I now work in an outpatient clinic, so for many of my patients, this is the end of the line in terms of therapy. Our goals are geared to help them no longer live as patients who have been sick, but to help them get back into their lives, having lunch with friends, babysitting the grandchildren, returning to meaningful work or volunteer activities, etc.
“One story that comes to mind is about a young professional woman who I met shortly after her surgery to remove a large cancerous brain tumor. She started out as a shadow of her former self, but absolutely knew who she wanted to be. She teased that she was wanting to be the 2.0 version of herself. She came to us with significant hemiplegia on her dominant side, very strong visual and vestibular dysfunction, poor appetite, weakness/deconditioning, and diminished cognitive abilities, especially executive functioning. She was unable to be left alone and her parents were unable to work, as they needed to be with her all the time. I will never forget her walking in wearing sunglasses to dim the light, wrapped in a scarf blanket because she was always cold, and wearing a mask over her face to avoid any chance of germs. She needed to hold her mother’s hand because she was not able to safely take even one step unassisted. She was so frail and so frightened, so unsteady, and so determined that she would overcome her current state. Once her team had assessed her and worked to gain her trust, we started to see her true spirit come through. We worked steadily toward her long-term goals of being able to be left alone and take care of her basic needs, including dressing up for church, preparing a simple meal, and returning to her service work in the community.
“She met and exceeded all her goals, and on her last day of therapy, she proudly strutted out in 3-inch-high heels on her way out to lunch with her boyfriend! She stays in touch, and I was just invited to her bell ringing service celebrating her cancer-free year. She was such an inspiration to her team, and I am so proud that I got to be a part of her recovery.”
In addition to being an occupational therapy instructor, Kris sits on the NDTA Board of Directors, the Executive Committee of the Instructors Group, and several other committees of the Board and Instructor’s Group.
INSTRUCTOR 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.
INSTRUCTOR 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.”