Under Construction: Entry-Level Student Development of NDT Skills

Feedback to Students from Their Clinical Instructors

CI feedback for student skill development in all areas of patient care is provided during weekly goal-setting sessions as well as mid-term and final evaluations. During weekly assessments, students and CIs each set goals based upon students’ needs for direction/assistance from their CIs regarding interventions used. The goals initially reflect the collaborative approach to patient treatment when using NDT skills, as the students typically lack expertise. As internships progress, the weekly goals reflect that students are taking a larger role in treatment proportional to skill development. In terms of formal evaluation, free-text comment boxes on formalized performance tools (such as the American Physical Therapy Association CPI) allow CIs to comment on specific skill development such as NDT. Additionally, mid-term conference calls between CIs and universities allow CIs to provide specific information to schools regarding student preparedness for and expectations of the facility. It is important for CIs to rate students’ overall performances based upon general expectations for entry-level graduates, but students interested in pursuing work in the rehabilitation environment quickly realize that NDT trained or certified therapists may exhibit higher expectations for handling skills in the best interest of their patients.

Additional Learning Sessions for Students

To assist students in meeting these expectations, there are a variety of learning experiences aimed at introducing and expounding upon NDT principles as well as honing handling skills. Scheduled learning sessions led by experienced clinicians allow students to learn/review concepts together and practice with each other. Students benefit from discussing NDT theory and treatment techniques as outlined in a therapist-prepared handout followed by practicing techniques for facilitation of the trunk and limbs to promote functional movement. Emphasis is placed on motor learning concepts, including task specificity and appropriate verbal cueing. If weekly student meetings are scheduled or student housing is available during their internships, students can be encouraged to spend time providing feedback to each other. This allows them to problem solve on their own before bringing their questions back to their CIs in the clinic setting.

Additionally, lunch time in-services and weeknight/weekend continuing education offerings taught by senior NDT trained and/or certified staff provide a venue for students to learn by interacting with seasoned peers. The combination of direct mentoring and group learning experiences helps the students to develop confidence when faced with challenging patients. More formalized competency training and testing utilizing case-studies can cement together theory, clinical reasoning and practice. Training can be provided first individually and then in the context of patient treatment via 1:1 mentoring and behavioral assessment with an NDT trained or certified therapist.

NDT and Clinical Education Across the Continuum of Care

The emphasis of NDT skill development stems from the importance placed on evidence-based practice, which combines research and experience to drive clinical decision making. In her presentation at the 2012 NDTA Annual Conference entitled “Using Your GPS to Chart a Route from Evidence to NDT Practice,” Gay Girolami, PT, PhD, C/NDT offered a wonderful synopsis of what NDT is, what it is not, and how it embodies current understanding of motor control, postural control, motor learning, and normal development/movement. Interning students are well-versed in theory; they benefit from seeing theory put into action when treating a variety of diagnoses throughout the continuum of care.

Students profit from learning to utilize NDT strategies in concert with other interventions. One example is High Intensity Gait Training, utilized by physical therapists. To address the four key subcomponents and criteria of HIGT as summarized by the Academy of Neurologic Physical therapy in the resource document entitled, Intensity Matters: Clinician Tools and Resources, PTs focus on Stance Control (absence of vertical limb or trunk collapse during stance); Limb Advancement (adequate foot clearance and a positive step length bilaterally); Propulsion (ability to move center of mass in a specific direction - forward, backward, etc. - during stance, separate from limb advancement); and Postural Stability (maintaining upright in sagittal and frontal planes, keeping center of mass within base of support), all of which are important tenets in NDT training.

Students also learn to apply safe patient handling techniques to make facilitation for patients functioning at a lower level more feasible. As a result of safe patient handling initiatives, staff and students are trained to utilize available equipment creatively to provide partial body weight support against gravity and reduce friction for movement, allowing therapists to safely facilitate movement rather than risk injury to patients or themselves. Overhead pulleys and lifts provide safe means of getting patients on their feet sooner while therapists hone in on motor control training within smaller ranges of movement in upright postures. Friction-reducing sheeting diminishes sheer forces while patients initiate movement in lying down or in sitting positions. Students benefit from observing multidisciplinary teams in all stages of rehabilitation focusing on appropriate patient positioning, loading of limbs for facilitation and/or inhibition, maintaining centers of mass over bases of support for balance, weight-shifting appropriately to initiate movement, applying principles of motor learning by performing motivating functional tasks and utilizing safe means to handle patients effectively.