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THE NEURO-DEVELOPMENTAL TREATMENT ASSOCIATION · MARCH/APRIL 2001 · VOLUME 8, ISSUE 2

ASSESSMENTS

A Tribute to Mary Quinton

BY LOIS L. BLY, MA, PT

Tests Can Help Prove NDT Efficacy

USING TESTS TO OPTIMIZE OUTCOME DOCUMENTATION

BY SUSAN S. DUCOTE, PT, PCS, AND DARBI BREATH PHILIBERT, MHS, LOTR

OUR DEAR FRIEND and mentor, Mary B. Quinton, MBE, died on December 8, 2000, one week after her 88th birthday. Many people around the world will sorely miss Mary, but she will be remembered and honored through her family, friends, disciples, co-workers, students, patients and their families. The NDTA Instructors Group and Board of Directors honored Mary, as well as Dr. Elsbeth Kong, with the Award of Excellence in 1999. An honorary NDTA member, Mary was probably never aware of the extent to which she and Dr. Kong touched and changed the world. Her life started down a very special path in 1957 when she took an NDT course led by Berta Bobath and met Kong, who invited her to work with children in Switzerland. I remember Mary telling me that she took some time to consider the invitation because she had always thought that she would be a missionary somewhere. Switzerland didn't seem to fit into the plan. She had no way of knowing then that Switzerland was her mission call. Many of us are the products of that mission call. Together, the Quinton-Kong team changed the way we (continued on page 7)

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HE NEED FOR DOCUMENTING THE efficacy of NDT in the pediatric patient pop-

ulation is a well-established concern.The means of accomplishing this is much more difficult.The scope of this article is to review some examples of tests and measures, which have value in gathering objective and measurable data, and can be a part of preferred practice patterns for therapists.Test characteristics, the selection of appropriate assessment tools and the methods used to gather and integrate information into clinical practice will all be addressed.

ASSESSMENT VS. EVALUATION VS. EXAMINATION

Across disciplines and settings, the definitions of "assessment," "evaluation" and "examination" are different.These words are often interchanged when in fact they all have alternate interpretations depending on the setting or the therapist's discipline.The Individuals with Disabilities Education Act (IDEA) defines evaluation as the procedures used by appropriate qualified personnel to determine a child's initial and continuing eligibility, and the status in each developmental area. (303.16) The American Occupational Therapy Association (AOTA) defines evaluation as the overall process of obtaining and interpreting data for understanding the individual, system or situation, including documenting and planning for the process, results and recommendations. (Hinijosa & Kramer, 1998). The American Physical Therapy Association's (APTA's) definition of evaluation is a dynamic process of clinical based judgments based on data gathered during an examination (Guide to Physical Therapy Practice, 2001). The definition of assessment, on the other hand, in each of those organizations is as follows: · IDEA: The ongoing procedures used by appropriate qualified personnel throughout the period of a child's eligibility to identify the child's needs; the family's concerns, resources and priorities; and the appropriate services. (303.16) · AOTA: The specific tools, instruments or interactions that are used during the evaluation process, a component part of the evaluation process. (Hinijosa & Kramer, 1998) · APTA: The measurement or quantification of a variable or placement of a value of something. (Guide to Physical Therapy Practice, 1997). Best practice requires management of the child, which includes an examination (continued on page 4)

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N E T W O R K : Measures for Patients with Stroke

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3 The Collective Spirit

Continuing Education

L E A D E R S H I P

D I R E C T O R Y

NDTA

PRESIDENT

BOARD

OF

DIRECTORS

IG EXECUTIVE COMMITTEE CHAIR

Debra J. Paul, OTR 1400 Dixon Ave. Lafayette, CO 80026 303/775-2357 303/665-2648 fax [email protected]

VICE-PRESIDENT

740/374-1400 Work 740/376-0203 Home [email protected]

DIRECTOR OF PUBLICATIONS

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

IG EXECUTIVE COMMITTEE

Brenda L. Pratt, LPT 416 Yale Ave. Alma, MI 48801 517/463-4324 517/466-9037 Fax [email protected]

SECRETARY

Susan Ducote, PT, PCS 824 Heather Drive Baton Rouge, LA 70815 225/926-1838 25/926-1860 Fax [email protected]

DIRECTOR OF PUBLIC RELATIONS

Kay Folmar, PT 401 S. El Cielo #36 Palm Springs, CA 92262 (760) 322-5258 (760) 416-9074 Fax [email protected]

INSTRUCTOR GROUP LIAISON/ DIRECTOR OF EDUCATION

Barry Chapman, PT W. 2922 Dean Ave. Spokane,WA 99201 509/473-6079 [email protected]

TREASURER

Carol S. Nunez Parker, OTR NTS, Inc. 4423 Shadowdale Houston,TX 77041 713/466-6872 713/466-9547 Fax [email protected]

DIRECTOR OF REGIONS

Linda E. CaIdwell, MS, PT 855 Lowery Loop Rd. New Market,TN 37820 423/475-6049 [email protected]

INTERNATIONAL LIAISON

Linda Markstein, PT 4524 Rosemont Court Middletown, OH 45042 937/208-4620 937/208-4856 Fax [email protected]

DIRECTOR OF MEMBERSHIP

Pamela Moore, MOT, OTR NTS, Inc. 4423 Shadowdale Houston,TX 77041 713/466-6872 [email protected]

DIRECTOR OF RESEARCH

Nicky V. Schmidt, LPT 5400 Shamrops Dr. Kenner, LA 70065 504/456-1563 504/456-1563 Fax [email protected]

NOMINATING COMMITTEE CHAIR

Kay Folmar, Chair Timmie Wallace,Vice-Chair Sherry W.Arndt,Treasurer Kacy M. Hertz, Secretary Lauren M. Beeler, Peds Subcommittee Chair Linda E. Caldwell, IG Liaison/Director of Education Monica Diamond, CI Working Group Chair Madonna Nash, OT Working Group Chair Teddy Parkinson, PT Working Group Chair Judy M. Jelm, SLP Working Group Chair Marjorie P. Haynes, CI Working Group Representative Mechthild M. Rast, OT Working Group Representative Loren J.Arnaboldi, SLP Working Group Representative Linda A. Kliebhan, PT Representative

IG STANDING COMMITTEES

Gina M. Best, PT, MS 203 Woodrow St. Merietta, OH 45750

Clare G. Giuffrida, PhD, OTR/L 1000 S.W. 52 Ave. Gainsville, FL 32608 352/392-2617 352/846-1042 fax [email protected]

Evangeline Yoder, MS, PT 13057 Warwick Blvd. Newport News,VA 23602 757/249-2258 757/881-9709 Fax [email protected] See your membership directory or call NDTA at 800/869-9295 for additional contact information.

Suzanne M. Davis, Grievance Committee Chair Helene M. Larin, Peer Review Committee Chair Judith C. Bierman and Lois L. Bly, Theoretical Base Committee Co-Chairs Kristen E. Birkmeier, Curriculum Committee Chair

NDTA OFFICE

1550 S. Coast Hwy, Suite 201 Laguna Beach, CA 92651 800/869-9295 · 949/376-3456 Fax [email protected] www.ndta.org

R E G I O N A L

REGION 1 WA, OR, ID,MT,West Canada Barry Chapman, PT W. 2922 Dean Ave. Spokane,WA 99201 509/473-6079 [email protected] Micheal Spero, OTR/L 6213 N.Adler Point Ave. Boise, ID 83703 208/378-9333 [email protected] REGION 2 NB, NF, NS, ON, PE, PQ, East Canada Betty Chan, OT 55 Shellamwood Trail Scarborough, Ontario M152M9 CANADA 416/292-4174 [email protected] REGION 3 Southern CA, Northern CA, NV Michelle G. Prettyman, PT 5460 White Oak Ave., #K301 Encino, CA 91316 818/986-7871 [email protected]

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

Oklahoma City, OK 73112 405/943-5814 REGION 7 ND, SD, MN,WI, NE, IA, IL, Middle Canada Lisa Nebel 3301 Blueberry Lane Appleton,WI 54915 920/831-0120 REGION 8 MI, IN, OH Kristine Waffle, PT 827 Upland Ridge Dr. Ft.Wayne, IN 46825 219/489-8329 [email protected] Kristie Swoverland, PT 10911 Old Oak Court Fort Wayne, IN 46845 219/483-5134 [email protected] REGION 9 KY,VA,TN, NC, AL, MS, GA, SC, FL, PR Jeannette A. Beach, PT 220 Hemphill Avenue Chattanooga,TN 37411 423/624-6175 [email protected] REGION 10 ME, NH,VT, NY, MA, CT, RI, PA, DE, NJ, MD,WV, DC Joyce Yoffa, OT 14 Sandra Rd. Easthampton, MA 01027 413/527-5038 REGION 11 AK Dee Berline-Nauman, OT 6705 Lunar Dr. Anchorage,AK 99504-4575 907/338-1871 [email protected] Cara Ann Leckwold, SLP 1716 Moringtide Court Anchorage,AK 99501 907/561-8775 REGION 12 HI Sandra Kong, OT 99-033 Kaupili Place Aiea, HI 96701 808/487-6824 [email protected] Jan Miyashiro 1251 Ulupuni St. Kailua, HI 96734 808/261-0533

Carrie H.Taguma-Nakamura, OT 1235 S. Ogden Dr. Los Angeles, CA 90019 310/423-6281 [email protected] REGION 4 WY, CO, UT, NM, AZ Marybeth Aretz, PT 878 S.Alkire Lakewood, CO 80228 303/861-6633 [email protected] REGION 5 TX, LA Carol S. Nunez Parker, OTR NTS, Inc. 4423 Shadowdale Houston,TX 77041 713/466-6872 [email protected] Pamela Moore, MOT, OTR NTS, Inc. 713/466-6872 [email protected] REGION 6 KS, MO, OK, AR Monica Watson, OT 2522 N.W. 46th St.

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.

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ABOUT THE NDTA NETWORK

One of the NDTA's best educational tools continues to be its publication, 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 welcome articles, ideas and comments from members and non-members.Editorial assistance and guidelines are available for writers.Look below for upcoming deadlines and themes.We invite you to submit your articles, ideas and comments to the Editor. ADVERTISING INFORMATION There's no better place than the Network 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 the Editor. 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. Longer placement is available for an additional fee. For more information or to place your ad, contact the Editor. EDUCATIONAL OPPORTUNITIES Organizing a workshop? Your educational opportunity can be placed in the Network for a mere $50. Placement is for one issue of the Network. Longer placement is available for an additional fee. For more information or to place your ad, contact Andrea Sellers, Course Coordinator, at 800/869-9295, ext. 222. NDTA-APPROVED COURSES Educational courses that are approved by NDTA are placed in the Network at no charge. For more information or to place your ad, contact Andrea Sellers, Course Coordinator, at 800/869-9295, ext. 222. DEADLINES The following upcoming Network deadlines are for all copy, including articles and advertising. Copy received after the dates specified will be considered for the following issue. July/August 2001 Theme: Vision Deadline: May 15, 2001 September/October 2001 Theme: Speech/Early Communication Deadline: July 13, 2001 CONTACT Michelle Carvin, Editor, NDTA Network 1550 S. Coast Hwy, Suite 201 Laguna Beach, CA 92651 800/869-9295, ext. 313 · 949/376-9839 Fax [email protected]

M E S S A G E

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The Collective Spirit

LIFE IS A JOURNEY.

Take a moment to formation.The success of this collaborative effort will be repeated in May in Albuquerque, N.M. Remember, together we are a force; if we become fractured, we are not a force. Everyone has something unique to bring to the collective table. Don't hesitate to bring yours. Likewise, as we share and contribute to the growth of NDTA, we must respect one another's ideas. Celebrating each other's success is what it should be all about.Your contributions are welcome.You should feel a strong sense of pride in your efforts and the efforts of your colleagues. reflect on your journey, both on a personal and a professional level. I have given a great deal of thought about the direction of our association and, more specifically, where we have we been and where we are we going. In the last issue of the NDTA Network, I wrote about leadership. Mary Quinton was a great example of the type of leader we should all strive to be. I am anxious for you to read the tributes that are written by Mary's friends and colleagues on pages 7-9. Now more than ever, we must focus on the things that are truly important to the success of NDTA. We have identified programs that will carry us into the future. How best can we facilitate the success of these programs and create a legacy we can all be proud of? Each of us must have a vision. The common goal must be one of cohesiveness and consensus. As an organization, we must act as one, and elevate the acceptance and viability of NeuroDevelopmental Treatment (NDT) to the broader health care community.This requires us to bridge the gap between having a vision and taking action. An educational videotape entitled "Discovering the Future: The Power of Vision" by Joel Arthur Barker discusses how a positive vision of the future is essential for providing meaning and direction to the present. He further states that "vision without action is merely a dream. Action without vision just passes time.Vision with action can change the world".This is a philosophy I believe our organization needs to embrace as we solve the problems and handle the obstacles, with which we are faced while accomplishing the goals of the NDTA. What actions can we undertake individually to support our programs, and lift NDT and the association to its full potential? · Maintain a sense of collective spirit. · Commit to give unselfishly. · Increase your involvement for the common good of the organization. · Realize our barometer for success is not measured individually; rather it is based on the acceptance of NDT as an evidence-based approach. More than a year ago, the Board of Directors, Instructor's Group and regions had the opportunity to come together for combined meetings and share inN D TA N E T WO R K · M A R C H / A P R I L 2 0 0 1 · A S S E S S M E N T S · 3

VISION + PLANNING + ACTION = SUCCESS

Our vision is clear. The purpose of the association is to further the unique qualities of the NDT approach by providing specialized clinical training for health care professionals, offering educational services to the membership and the community, supporting clinical research, and promoting client and family advocacy. We have planned well and have identified four critical areas, which we must nurture and develop.The four focus areas are leadership, research, alliances and education. Action must come from all of us. It must come unselfishly and it must come with conviction. It must be received graciously by the whole of the organization. I cannot stress enough that for us to succeed, we must celebrate each other. Let's check our egos at the door and actively encourage each other to step up and be team players. If we are to reach the level of success that we all desire, it must be a team effort. I have been involved with NDTA since 1988. During this time, I have had the opportunity to meet and work with many of you. I am humbled by the conviction I see in our members. I am also constantly struck by the caliber of people we have within this association and feel blessed to be a part of such a rich organization. As I ponder the future of NDT and NDTA,I can't help but get excited. Unite with each other and let's steer this wonderful organization into the future.

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("Tests Can Help Prove NDT Efficacy" continued from page 1) with three components: patient history, systems review, and test and measures.The tests and measures are the exact means of gathering data from the patient or client. In the pediatric population, this is where the difficulty lies. The authors believe that the disuse of tests and measures is a contributing factor in the paucity of research on the efficacy of NDT therapy. As the push toward evidence-based practice continues, NDT therapists need to utilize assessment tools, tests or measurements that document outcomes; demonstrate progress; and are reliable, valid and reproducible. The lack of a good instrument to measure change in children who have significant impairments continues to be a challenge.The best "picture" of a child's capabilities will not be captured in one instance by observation by one individual, but rather from a collaboration of perspectives from significant sources. the patient in function, so this is perhaps second nature to most. dardized for use with older children, up to 14 years of age. Domains that are covered in this test are fine motor and gross motor, but the subtests are divided into eight different dimensions to include balance, bilateral coordination, strength and dexterity. Other benefits include the ability to give the subtests separately and the expression of the raw scores in objective measures of time, duration and accuracy. Canadian Occupational Performance Measure (COPM) is a relatively new assessment tool. It was designed by occupational therapists, but can be administered by others after training.The COPM identifies problem areas, and evaluates the patient's perception of performance and their satisfaction with performance. It measures changes in the patient's perception, not the actual change in function.The greatest strength of the COPM is that it partners the therapist with the patient at the time of the initial interview. It crosses over all environments, and looks closely at the patient-determined function and priorities. It includes three domains: self-care, productivity and leisure. It has no external validity because it is based on the patient's perception. It is an excellent tool with which to measure patient satisfaction with outcomes--an item many insurance companies and managed care companies are requesting.This tool would be difficult to use with a child younger than about 10 years of age, but could be used as a caregiver's perception, a priority measured at any age. Early Intervention Developmental Checklist (EIDP), useful in the early intervention patient population, ages zero to three, this test is criterion-referenced, not standardized. It is quick and easy to administer, giving the tester or the family member information about how the child compares to typical peers. It is an accepted assessment tool for determining eligibility for services under the IDEA in many states. Its shortcomings include that it is not sensitive to small increments of change, and does not address the quality of movement or the difficulty of performance of the motor tasks. As the child ages, the number of items tested for each age group is minimal. The

WHAT TESTS DO I USE?

The following tests are considered by the authors to represent a broad spectrum of purposes, ages, domain areas and functional limitations. By no means is this a complete list or an endorsement, but rather a documentation of appropriate tests for our patient population. [A table, which summarizes the statistical parameters of each test (if available) and where they may be purchased, is available at www.ndta.org.] Alberta Infant Motor Scale is an observational measure of motor behavior. It is standardized for use with infants from zero to 18 months of age. It is meant to be a discriminative tool to identify infants who are delayed or impaired in their motor development. It does not show functional change, so it should not be used to measure progress.The score is indicated by percentile ranking, compared to typically developing infants. Assessment, Evaluation and Programming System (AEPS) is a widely used test in early intervention centers. Its strength lies in the fact that it strongly links assessment, intervention and evaluation components. It measures functional skills that have potential to be intervention goals. Domains that are covered in the AEPS include fine motor, gross motor, adaptive behavior, cognition, social development and communication. Therefore, it is valuable if the goal is to determine eligibility under the IDEA act. It also can be administered in a child's natural environment, making it a good choice for home-based interventionists.The AEPS does not look at the quality of movement. The reliability among different disciplines has been poor. Different than some developmental scales, this test also allows for consistent/inconsistent performance; behavior qualifiers; and assistance or modification given. Bruininks-Oseretsky Test of Motor Proficiency is an older, more familiar test to many therapists. Designed by physical educators, it follows the neuromaturational model.The Bruininks is one of the few tests that is designed and stan-

CHOOSING AN ASSESSMENT TOOL

The selection of the appropriate tool depends upon the purpose. Assessment tools can be designed for several purposes: screening, diagnostic, program evaluation, outcome prediction, discriminative aids, research, the establishment of family goals, the determination of eligibility and the determination of the efficacy of therapy intervention. First, selection must be determined by the purpose of the evaluation.The way in which the data is gathered is as varied as our patient population. Parent interview, play observation, clinical observation, rating scales, checklists, standardized tests and videotape assessment are just a few. The person from whom the information can be obtained is not limited to the health care provider. Family members, caretakers, teachers, the referral source and the child are all valuable contributors to the process.With the federal legislation trend toward natural environments, some of these standardized tests are more difficult to administer. Therapy clinics, schools, day care centers, homes, hospitals, early intervention centers and physicians' offices are all arenas where evaluations are being performed. NDT-trained therapists have long recognized the value of observing

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EIDP is best used as an adjunctive developmental assessment tool in most clinical settings. Gross Motor Function Measure (GMFM) and its more recently revised version, GMFM66, is an excellent evaluative tool for children with cerebral palsy.The authors of this tool actually used a patient population of children with cerebral palsy to standardize the instrument. It measures change in gross motor function over time. The five domains covered in the test are lying; sitting; crawling and kneeling; standing; and walking, running and jumping. With the revisions, the test items included were subjected to the Rasch analysis and the 66 items included in the test are ranked in order of increasing difficulty. Since it is a standardized instrument, this tool is beneficial for the clinician involved in research, as well as for evaluating efficacy of clinical treatment. The GMFM is an observational tool of the child's performance without any facilitation or assistance from the parents, test-giver or therapist, which many NDT-trained therapists may consider a shortcoming of the test.Another disadvantage of the GMFM is that most skills in the five domains are those usually mastered by the typically developing child by the age of five, which doesn't make it a very sensitive test for high functioning children with mild motor impairments. Miller Assessment for Preschoolers (MAP) is a standardized assessment instrument for the same age population as the EIDP. The MAP looks at both sensorimotor skills and cognition. One of its strengths is the test-retest reliability of 0.81 and the inter-rater reliability of 0.97. It is creative in the test item selection and holds the attention of the child but can be lengthy to administer. The MAP was not designed to obtain age-equivalency scores, so school-system requirements may not be met with this standardized test. Evaluation of treatment, programs and children's performance can be ascertained with high reliability. Peabody Development Motor Scale-II (PDMS-II) is the newest updated version of the old PDMS.This scale is a norm-referenced and cri-

terion-referenced test designed to obtain information in both the fine motor and the gross motor domains.The PDMS-II can be utilized for children with moderate to severe impairments and allows for accommodations for specific requirements. It identifies skills mastered, partially mastered and skills not developing.This makes it an excellent tool for use in plan remediation, goal-setting and the evaluation of functional outcomes. The fact that it can compare the child with himself or with typically developing peers makes it multipurpose, both in the educational or clinical setting. It also has an advantage over the GMFM in that it includes both fine motor and gross motor skills. The sensitivity to minor changes in partially mastered skills is also a limitation of this test. Pediatric Evaluation of Disability Inventory (PEDI) is one of the only tests that has the measurement of the level of disability in children at its core.With the three domains of selfcare, mobility and social function, the PEDI obtains information about the functional deficits in the roles required of our pediatric patient population. The information is gathered by interview, observation and professional judgment. It has an advantage in that it actually ranks the level of caregiver assistance and the use of modification or assistive devices. Normative scores can be obtained for children from six months of age to seven and a half years of age, allowing the evaluator to compare the child to age expectations. Developed with the Rasch analysis, the PEDI also provides scaled scores indicating the child's performance in relation to the ease or the difficulty of the test item. This test has been compared to the WEE-FIM for content validity. It is useful across many settings, natural environments, hospitals, clinics, early intervention centers and home settings. School Function Assessment (SFA) is almost an extension of the PEDI, but it is developed for the school setting.The age population is specific--kindergarten to fifth grade--and the information must be gathered in the natural environment for which it was designed.The authors

of the SFA also created the PEDI, so there are many similarities in measurements.The SFA is a wonderful tool to assist in goal-setting for an IEP, collaborating with many team members and justifying the use of assistive devices or child-specific aides. It is less useful as an instrument to measure outcome of a particular treatment. NDT therapists who serve as consultants or outside independent reviewers for due process may find this tool indispensable. One of the authors of this article has used it for transitioning students to private school settings, allowing the teacher, student and support staff to make valuable contributions in maximizing the child's participation in all arenas at school. Transdisciplinary Play Based Assessment is one of the few tests that has the ability to gather pertinent information from all disciplines for children with multiple impairments or severe disabilities.The collaborative effort of gathering information with one facilitator is child- and family-centered in its approach and is meant to take place optimally in the child's natural environment. That could possibly include the child's home, day care center or special education preschool.The disadvantages of this measurement tool are the logistic hardship of gathering all significant team members together at one time and the obvious cost of personnel time to do so. Used more frequently in early intervention programs and nonprofit centers, it has the obvious advantage of individualizing treatment goals and measuring outcomes in the most natural way, through observation of play. The Toddler and Infant Motor Evaluation (TIME) shows great promise as a research and evaluative tool that considers quality of movement.The TIME is time-consuming and the scoring is burdensome at first. But for experienced therapists who are used to looking at the subtle changes in movement and posture, this instrument may be the standardized measure that can substantiate efficacy of treatment with the NDT approach. The test itself is divided into five subtests--mobility, stability, motor organization, functional performance and so-

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cial-emotional abilities--providing a very comprehensive picture of a child's sensorimotor system. In addition, it includes three clinical subtests: quality rating, component analysis and atypical postures. The TIME can be used to diagnose motor delays, identify motor problems, plan intervention and evaluate changes over time. Broad in scope, design and domain, the TIME has high reliability and validity, making it a highly recommended assessment tool for the experienced therapist's practice.

Brookes Publishing Company. Bruininks, R. (1978). Bruininks-Oseretsky Test of Motor Proficiency. Circle Pines, MN: American Guidance Service, Inc. Campbell, S.K. (1999). Models for decision-making in pediatric neurologic physical therapy. In S.K. Campbell, Decision-making in pediatric neurologic physical therapy (pp.1-22). New York: Churchill Livingstone. Cole, B., Finch, E., Gowland, C. & Mayo, N. (1995). Physical rehabilitation outcome measures. Baltimore:Williams & Wilkins. Coster, W., Deeney, T., Haltwanger, J. & Haley, S. (1998). School Function Assessment (SFA). San Antonio:The Psychological Corp. Folio, R. & Fewell, R. (1983). Peabody Developmental Motor Scales (PDMS). Chicago:The Riverside Publishing Co. Furuno, S., O'Reilly, K.A., Hosaka, C.M., Inatsuka, T.T.,Allman,T.A. & Zeisloft, B. (1994). Hawaii Early Learning Profile (HELP), revised. Palo Alto, CA: VORT Corp. Guide to Physical Therapy Practice (1997). Physical Therapy, 77, 1163-1650. Haley, S.M., Coster,W.J., Ludlow, L.H., Haltiwaner, J.T. & Andrellos, P.J. (1992). Pediatric Evaluation of Disabilities Inventory (PEDI): Developmental standardization and administration manual. Boston: New England Medical Center Hospitals, Inc. Hinojosa, J. & Kramer, P. (1998). Evaluation:Where do we begin? In J. Hinojosa and P. Kramer (Eds.), Evaluation: Obtaining and interpreting data (pp. 115). Bethesda, MD:American Occupational Therapy Association. Individuals with Disabilities Education Act (IDEA)

Linder, T.W. (1993). Transdisciplinary Play-Based Assessment: A functional approach to working with young children, revised edition. Baltimore, MD: Paul H. Brookes. Miller, L. & Roid G. (1993). Toddler and Infant Motor Evaluation (TIME). San Antonio, TX: The Psychological Corp. National Institutes of Health. Research Plan for the National Center for Medical Rehabilitation Research. NIH Publication No. 93-3509. Bethesda, MD: National Institutes of Health, 1993. Piper, M.C. & Darrah, J. (1994). Motor Assessment of the Developing Infant. Philadelphia: Saunders. Rogers, S.J. & D'Eugenio, D.B. (1981). Early Intervention Developmental Profile (EIDP).Ann Arbor: University of Michigan Press. Rothstein, J.M. & Echternach, J.L. (1986). Hypothesis-oriented algorithm for clinicians:A method for evaluation and treatment planning. Physical Therapy, 66, 1388-1394. Rusell, D., Rosenbaum, P., Gowland, C., Hardy, S., Lane, M., Plews, N., McGavin, H., Cadman, D. & Jarvis, S. (1993). Gross Motor Function Measure manual (second edition). Toronto, Canada: McMaster University. s

CALL FOR RESEARCH

The call for research--to prove the efficacy of NDT and of therapy in general--requires that clinicians gather data in a more systematic way for documentation of outcomes. Standardized tests are recognized in other disciplines and carry weight in peer-reviewed journals, where simple case studies do not. NDT-trained therapists have not needed these tests to raise the standard of care, but perhaps using them in our documentation will raise the level of respect among physicians, academics and other professionals. Not all of them will fit into your practice, setting and patient population. It is the intent of the authors of this article to present a multitude of choices, so you may select a few and implement them as your needs dictate. It is important to mention again that the above is not a complete list of available tests nor is it the only way to document outcomes. Pedographs, gait analysis, ROM and balance tests, to mention a few, are certainly credible and reproducible ways to document changes in our patients throughout the course of intervention. As the sneaker manufacturer Nike says, "Just do it!" Consider the above tests and measures when you document outcomes.

Susan S. Ducote, PT, PCS, NDTA's Director of Publications, is a physical therapist at NeuroTherapy Specialists, Inc., a private practice in Baton Rouge, La. She has been treating children with motor impairments for more than 20 years. She can be reached at 225/926-1838 or at [email protected] Darbi Breath Philibert, MHS, LOTR is a clinical instructor at the Early Intervention Institute at Louisiana State Universityís Health Science Center in New Orleans, La. She lectures nationally on topics such as positioning, feeding, assessments for pediatric clients and sensory intergration. She is also president of the Louisiana chapter of the Occupational Therapy Association and has also co-authored a chapter of a book on positioning for feeding. She can be reached at 504/482-7361 or at [email protected]

REFERENCES

Bricker, D. (Ed.). (1993).Assessment, Evaluation and Programming System (AEPS) for Infants and Children, Vol. 1: AEPS measurement for birth to three years. Baltimore, MD: Paul H.

Amendments of 1997, Report of 105-17. Law, M., Baptiste, S., Carswell, A., McColl, M.A., Polatajko, H. & Pollack, N. (1991). The Canadian Occupational Performance Measure. Toronto, Canada: COAT Publications.

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(continued from page 1) work with babies. Actually, they developed the way we work with babies. Dr. Karl and Berta Bobath always advocated early intervention. The Quinton-Kong team accepted that advice, and eventually developed a unique and incredibly invaluable way to identify very subtle problems in very young infants.They saw the relationship between subtle movement problems in infants and major movement problems in older children. Beyond identifying these minimal problems, the team created a way of addressing them before they became major problems. In 1975, therapists in North America were treating children as young as three years; but very few were treating babies under 12 months of age. Many Bobath-trained therapists, myself included, became eager to learn how to identify and treat such young babies.Thus, treks to Switzerland began.We had to know what Mary and Dr. Kong were doing! During the course in Bern, we spent many days and nights practicing the techniques with our dolls and the movements on our bodies. Mary taught us that subtle original problems lead to compensations, which lead to habit patterns, which lead to deformities, which eventually lead to surgery.To "save" the babies, you must identify the subtle problems and intervene before the habit begins. Mary always emphasized that she learned the treatment from Berta Bobath, and that anything and everything that she added was a gift from God. She was doing God's work. Her difficulties with the German language actually became a blessing for us because she compensated by developing incredible ways to communicate with her hands and body. This communication with the body made her treatment very precise and effective, and taught us how to understand our own body movements. She stressed that therapists and parents must understand their own body image in order to handle and treat effectively. We needed to develop our "inner eye." She stressed that we had to move from our intellectual understanding (outer eye) to our experiential understanding (inner eye) of movement. Mary's unique teaching methods also included the use of many analogies, which helped us to understand scientific treatment principles. Some who studied with Mary designed T-shirts bearing her analogies. Some examples include: · Symptoms collect like clouds in a blue sky. · When treating, stop when the quality goes wrong. Don't paint in the wrong quality or wrong body image. · Your hands must guide, not dominate. Use butterfly free hand. · Use millimeters and micro-millimeters of movement when treating. · Work for the past, present and future simultaneously. Mary also stressed the importance of respecting the baby, not imposing oneself on the baby. She instructed us to: · Let the baby lead the movements. Thank you to NDTA members Judi C. Bierman, PT from Augusta, Ga.; Rhoda P. Erhardt, MS, OTR, FAOTA, from Maplewood, Minn.; and Ada C. Canto, RPT, from Miami, Fla. who provided additional photos for this article. In 1978, NDTA member Pamela A. Mullens, PhD, PT, arranged for Mary and Dr. Kong to come to Seattle,Wash. to teach a 10-week course for therapists who were interested in becoming NDT instructors. Many of us jumped at the chance to study with these two remarkable women. Mary's presence in North America influenced the lives of all NDT instructors. In many ways, her work and presence helped to unify us. Mary was responsible for NDT baby treatment as we know it today! She touched the lives of hundreds, thousands and probably millions of therapists and children around the world. Our greatest gift to Mary is to humbly walk in her footsteps and continue her work, so that many more babies will be "saved." s · Use the baby's own tempo, not yours. · Give the baby the feeling that he can do something. · Give pleasure to the baby. Above left: Mary Quinton (left) accepts the 1999 NDTA Award of Excellence from Director of Public Relations Carol S. Nunez-Parker, OTR. Above right: Mary Quinton and her pal Hans Peter at a course in Roosevelt, N.Y. in June 1981.

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Mary Quinton--Remembered

The following abridged eulogy was read at Mary B.Quinton's funeral in Bern,Switzerland on December 15,2000 by Dr. Elsbeth Kong, an honorary NDTA member. Mary B. Quinton, MBE, was born on December 1, 1912 in Ipswich/ Suffolk, Great Britain. Her father was a dentist, an Englishman, and her mother was from Scotland. Her brother and she had a happy childhood. Mary died on December 8, 2000 in Bern, Switzerland. Mary completed her physiotherapy training at St.Thomas Hospital in London and was certified as a physiotherapist in 1935. After two years of general experience in Ipswich and East Sussex Hospital, she returned to the St.Thomas Hospital in London as a member of the staff with the responsibility for the students' practical work. During World War II, Mary was sent to Malta with a colleague to deal with an epidemic of poliomyelitis and to build the first physiotherapy department on the island. She loved this job. Back in England, she worked at the Wingfield Morris Hospital in Oxford, chiefly with poliomyelitis patients. In 1952, she returned again to the St. Thomas Hospital in London, now in charge of the Neurologic Unit. But she was soon longing for a new challenge in an underdeveloped country. I first met Mary Quinton in 1957, when we both participated in a threemonth training course in the treatment of cerebral palsy given by Berta Bobath in London. In Switzerland, we had started to build ambulatory treatment centers for cerebral palsy and we needed therapists. Bertha Bobath recommended Dr. Elsbeth Kong (left) worked with Mary Quinton for more than 40 years. Mary Quinton to me. It was rather hard to convince her that Switzerland, which in her mind had everything, was still underdeveloped in the treatment of handicapped children. At that time, countries that had been involved in the war had more experience in rehabilitation. Finally, Mary agreed to come to Bern for a year. She arrived in April of 1958 and, fortunately for Bern and Switzerland, she stayed on. With great engagement, Mary started to treat our children according to the Bobath concept--children of all ages and all degrees of handicap.With her fantasy and creativity, she was able to give pleasure and fun during therapy without neglecting the aim of treatment.This was motivating for both child and family. From the beginning, Mary had good contact with parents and taught them with patience (often taking extra time to do it). She integrated therapy into everyday life and always respected the personality of the child. Many of the children improved considerably. Our number of cerebral palsied children was growing rapidly. Thus after taking a s e c o n d course, and with the blessing of the Bobaths in London, we started our own training courses in Neuro-Developmental Treatment (Bobath) at the Insespital in Bern in the autumn of 1959. Mary developed into an excellent teacher.Although she was handicapped by the German language and instead spoke "Quinton-Deutsch," she was able to get through to the students with her expressive body language. The treatment of young babies was a new challenge for Mary. How could she adapt the same treatment principles to such tiny beings? She found a way! It was a pioneer achievement and the results exceeded our expectations.To our surprise, Switzerland became the first country to experience early treatment of a large number of children. Mary remained very appreciative and grateful to Berta Bobath, who had created the basis of this fascinating work. From 1968 onwards, we were asked to help in building Neuro-Developmental Treatment (NDT) courses, according to Bobath, in other countries, first in Austria and France. In 1978, we were asked to help with the preparation of NDT instructors in the United States. Many "theoretically minded" therapists learned the importance of practical experiences from Mary. It was very important to Mary that students learned to feel their own body movements in many situations, normal and abnormal. Mary had experienced that it was easier for the therapist, and also for the parents, to learn movements by feeling first, rather than by thinking. She also learned that the carry-over of more normal senMary Quinton with her favorite demonstration doll, Hans Peter, during her acceptance of the 1999 Award of Excellence.

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sorimotor experiences to the child proved to be more successful when those who handled the child learned to feel their own movements. Mary and I were also encouraged to give special courses in early treatment, so-called "baby courses," as a supplement to the basic courses. We gave the first one in 1975 in Bern.There was soon a great demand for these. It was inspiring to watch Mary treat--to see the continuous dialogue between her and the infant, her eye contact with the baby, the dialogue between her hands and the reactions of the baby, and her creative adaptation to new situations. After her retirement in 1979, Mary was invited to teach basic, refresher and baby courses in many countries.With continued enthusiasm, she

siasm until her recent illness. Mary was a wonderful friend who truly enjoyed life! I enjoyed working with her. We have many happy, rewarding memories with friends, colleagues, students and her family in England. Mary had a wonderful sense of humor. She loved to talk and laugh with people, and to tell stories. Mary was honored by Queen Elizabeth of England and received the Member of the British Empire (MBE) award for her lifelong contribution to her profession and her pioneer work all over

the world. She was the first physiotherapist to receive the Sunshine Medal, a merit to her significant influence on developmental rehabilitation, from Professor Hellbrugge in Munchen, Germany. She also received honorary membership from the European Bobath Tutor's Association, the American NDTA and the German Bobath Therapist Association. May her work, combined with her loving care, stay alive and have an impact on future generations. s

memories

`` '' ``

of the course.

from members

--Ada C. Canto, PT, Miami, Fla.

I was very lucky to attend Mary's baby course in Spokane, Wash. in August of 1986. It was a wonderful experience to meet her. I still have the little bell she gave to each of us as a present at the end

On October 23, 1999, the Abradimene, the Brazilian Neuro-Developmental Treatment Association, honored Mary for her great international contribution in relation to the detection of the progression of pathological motor signals in at-risk babies. The plaque she received bore the following message: With all our love and gratitude, for everything you have done for all the babies of the world.

--Pessia Grywac Meyerhof, PhD, OT Academic Vice-President, Abradimene, San Paulo, Brazil Sherry W. Arndt, PT, coordinator of Mary Quinton's 1986 baby course in Spokane,Wash., assists participants. taught in Western and Eastern Europe, especially Slovenia and Poland, the U.S., Canada, Mexico, Brazil and South Africa. She involved herself deeply in the local problems of the children, their parents and her students. Gradually, Mary realized that she had received a wonderful gift in her hands, a gift from God, both a joy and an obligation at the same time, to use for the benefit of the children.Through the love of her work and her prayers, she was able to continue to teach with liveliness and enthu-

''

``

I first met Mary in 1985 when I participated in a NDT Baby Course in Spokane, Wash. As I was a young mother at that time with a three-year-old and a four-month-old, I came to the course with them. I had a babysitter during the day, but not in the evenings. It was then that Mary spent many hours with us, enjoying my children and sharing her warmth. I also had the good fortune for Mary to visit my family and I in Seattle a few years later. She spent Easter with us and engaged in a egg hunt. Mary was a mentor for many therapists, a woman who appreciated the beauty and warmth of children. She facilitated that warmth and comfort. As much as I think of Mary as my teacher in the treatment of young infants, I think of her more in her wonderful interactions with my family and I.

--Rosemary White, OTR/L, Seattle, Wash.

''

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Predicting the Patient's Outcome

A REVIEW OF MEASURES FOR PATIENTS WITH STROKE

BY LAURA ZACHAREWICZ

P

hysical therapists are key players in the rehabilitation of patients who have had a

Sitting balance limitations occur in people who have had a stroke due to impaired postural control. Lack of postural control has been found to

4

have fallen took longer to transfer, had a lower rate of rise in force, had asymmetric body weight distribution in their feet and an increased center of pressure compared to patients who haven't fallen.6 By using force plates with the method described by Cheng et al, patients who are at a risk for falling may be identified. During an evaluation, the physical therapist finds out what the patient's goals are. More often than not the goal is "to walk." Due to the physical impairments associated with a stroke, the patient may be able to walk again, but with deviations. Bohannon assessed how patients with stroke ambulated and studied their gait speed, cadence, independence and appearance.7 The researcher found that all four variables were related to each other (p < 0.01).The findings were that weightbearing ratio negatively correlated with gait cadence and appearance (p < 0.05), motor control as measured by alternating lower extremity movements correlated with all variables (p < 0.01), and balance correlated with all variables (p < 0.05).7 Muscle tone of the knee extensors and ankle plantarflexors were not found to be related to gait ability.7 The degree of impairment with one of the variables affected the patient's ability to ambulate.These findings are important in interpreting the results of weight-bearing ratio, motor con-

stroke. Of the people who suffer a stroke, 40 percent have moderate to severe impairments. Phys1

be a predictor for functional outcomes in patients with stroke.

4,5

ical mobility limitations occur due to stroke-causing problems with muscle tone, sitting balance, transfers, gait and function. The evaluations of these limitations are often performed by a physical therapist. Evaluative findings of physical therapy examinations are important to determine the patient's potential outcome and plan of care. Abnormal muscle tone occurs when there is a lesion in cortical structures.2 Clinicians have difficulty quantifying abnormal muscle tone and usually refer to the involved muscles as flaccid or spastic rated with a general clinical scale ranging from 0 for no response and 4 for a sustained response. There are two measures used to

2

The Balance System has been

used to determine the ability to maintain postural stability. The Balance System is made of force platforms that have shown to be reliable for symmetrical sitting (ICC = 0.86), leaning to the right (ICC = 0.86), leaning to the left (ICC = 0.92) and leaning forward (ICC= 0.96) in healthy subjects.5 Nichols et al correlated the measures obtained by patients with stroke to their Functional Independence Measure (FIM) scores.5 The FIM is an ordinal scale with seven independence levels, which is applied to many categories including activities of daily living and gait.The researchers found that the balance measures in patients with stroke for leaning forward and to the paretic side was correlated with activities of daily living FIM scores.

5

specifically assess muscle tone, the Tone Assessment Scale (TAS) and the Modified Ashworth Scale (MAS). Both of these measures use an ordinal rating scale, but assess different areas of abnormal muscle tone.The TAS looks at the patient's posturing at rest, response to passive movement and associated reactions. The MAS assesses muscle tone at a specific joint by the examiner moving the patient through the full passive range of motion. In a study by Gregson et al, only the response to passive movement section of the TAS was statistically significant for interrater reliability (kw = 0.79 - 0.92) and intrarater reliability (kw = 0.59 - 0.86). The

3

Patients who have better postural stability in sitting are able to do better in their activities of daily living skills. Morgan found that by correlating sitting balance using the static sitting balance scale by Sandin and Smith and the FIM, there is a moderate relationship between sitting balance and gait after six weeks ( = 0.49).4

TRANSFERRING SKILLS

Patients with stroke may have difficulty with transferring skills, the ability to go from one position to another, since it incorporates muscle strength and balance. It is important to be able to evaluate the patient's transfer ability in order to develop a plan of care for the observed impairments. Cheng et al researched sit-to-stand transfers with patients who had a stroke using force plates.6 They found that patients with hemiplegia who

trol and balance in an evaluation, and relating it to the quality of the patient's gait.

FUNCTIONAL LIMITATION

Functional limitation is defined as the "deviation from normal in the way an individual performs a task or activity, usually as the result of impairment."8 Physical therapists evaluate function by performing specific assessments such as the Fugl-Meyer hemiplegic assessment and the

MAS measurements have interrater reliability (kw = 0.83) and intrarater reliability (kw = 0.84) for the elbow only. The physical therapist can

3

use the TAS for response to passive movement section and the MAS scale for quantitative measurements for abnormal muscle tone.

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Barthel Activities of Daily Living Index. Dettmann, Linder and Sepic found that these two functional assessments correlated when used with patients with stroke (p < 0.01). The

9

teria need to be reliable to make sure that the measure is consistent and valid to know if the results are measuring what they are intended to measure. By using measures that are found to be statistically significant through research--such as TAS and MAS assessments to measure muscle tone; force platforms to measure balance and transfer ability; FIM, Fugl-Meyer and Barthel Index assessments to measure activities of daily living skills; and uninterrupted light photography to measure gait--the physical therapist will be more certain of the patient's expected outcomes and their plan of care.

8

Guccione A. In: O'Sullivan S, Schmitz T, eds. Phys-

ical Rehabilitation. 3rd ed. Philadelphia: FA Davis; 1994; 193-208.

9

Dettmann M, Linder M, Sepic S. Relationships

researchers also looked at gait, as measured by interrupted light photography, and postural stability, as measured by force platforms, to see if there was a relationship to the functional assessments of the patients compared to normal controls. In the gait assessment, it was found that the patients took shorter stride lengths and fewer steps per minute than the controls.9 The patients lacked symmetry as seen by the swing ratio, velocity index and duration of double limb support (p < 0.01).9 The results of the postural stability assessment revealed that the patients weight bear on their uninvolved lower extremity an average of 36.1 ± 14.6 percent as compared to 50 percent weight bearing with normal subjects. 9 Their center of pressure was smaller than normal with the area of stability being more towards the uninvolved side (p < 0.01).9 The more unstable a patient was with their postural stability, the poorer their gait (p < 0.05).9 Shifting of the center of pressure forward correlated to walking speed, stride length and length of steps taken (p < 0.05). The Fugl9

among walking performance, postural stability and functional assessments of the hemiplegic patient. American Journal of Physical Medicine. 1987; 66: 77-91. s

Laura Zacharewicz is an assistant professor at The Sage Colleges in Troy, NY, where she teaches adult neurorehabilitation.With a bachelor's in physical therapy and a master's in health services administration,

REFERENCES

1

she is currently working toward a doctorate of science with a specialization in geriatrics at Rocky Mountain University of Health Professions. Laura took the NDT/Bobath three-week adult hemiplegia course in 1996. She can be reached at Health and Rehabilitation Sciences, The Sage Colleges, P.O. Box 1580, Troy, NY 12180; 518/244-2066; [email protected]

National Stroke Association. Recovery and rehab.

http://www.stroke.org.NS804.

2

O'Sullivan, S. In: O'Sullivan S, Schmitz T, eds. Phys-

ical Rehabilitation. 3rd ed. Philadelphia: FA Davis; 1994; 111-131.

3

Gregson J, Leathley M, Moor A, Sharma A, Smith

T,Watkins C. Reliability of the Tone Assessment Scale and the Modified Ashworth Scale as clinical tools for assessing poststroke spasticity. Arch Phys Med Rehab. 1999; 80:1013-6. Has your contact in4

MOVING?

formation changed? Have you found outdated information in the latest NDTA Membership Directory? If so, please let us know. Complete a Membership Update Form (page 173 of your Membership Directory) and fax it to NDTA, or contact us at:

Meyer total score correlated with the gait and postural stability scores.8 The section scores of the Fugl-Meyer were less significantly correlated than the total score and the sensation score didn't correlate with walking.9 The results of this study are clinically important to help interpret the functional assessment scores.The Fugl-Meyer or Barthel Index may indicate the level of diffi6

Morgan P.The relationship between sitting bal-

ance and mobility outcome in stroke. Australian Physiotherapy. 1994;40:91-96.

5

Nichols D, Miller L, Colby L, Pease W. Sitting bal-

ance: its relation to function in individuals with hemiparesis. Archives of Physical Medicine and Rehabilitation. 1996; 77: 865-9. Cheng P, Liaw M,Wong M,Tang F, Lee M, Lin P.The

culty the patient has with his/her gait and postural stability.

sit-to-stand movement in stroke patients with its correlation with falling. Archives of Physical Medicine

NDTA 1550 South Coast Hwy, Suite 201 Laguna Beach, CA 92651 800/869-9295 949/376-3456 Fax [email protected]

There are many different areas of assessment for patients with stroke. It is up to the physical therapist to choose the appropriate measures to predict the patient's outcome. Evaluative cri-

and Rehabilitation. 1998; 79: 1043-6.

7

Bohannon R. Gait performance of hemiparetic

stroke patients: selected variables. Archives of Physical Medicine and Rehabilitation. 1987; 68: 777-781.

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Upcoming NDTA-Approved Courses

NDT/BOBATH THREE-WEEK COURSE IN THE TREATMENT OF ADULT HEMIPLEGIA Course #: 01A101 Dates: 5/7/2001-5/18/2001 8/5/2001-8/10/2001 Location: Novi, MI Instructors: Waleed Al-Oboudi, Caryn Ito Contact: Stephanie Ombrey-Hunter 248/424-5779 _______________________________________ Course #: 01A104 Dates: 4/16/2001-4/20/2001 4/23/2001-4/27/2001 6/25/2001-6/30/2001 Location: Pittsburgh, PA Instructors: Waleed Al-Oboudi, Caryn Ito Contact: Linda Gilles Healthsouth Corporation One Healthsouth Parkway Birmingham,AL 35243 800/765-4772, ext. 5708 205/969-4740 Fax _______________________________________ Course #: 01A107 Dates: 7/9/2001-7/27/2001 Location: Rochester, MN Instructors: Louise Rutz-LaPitz, Beth Tarduno Contact: Jill Maraganore 507/280-8717 [email protected] _______________________________________ Course #: 01A108 Dates: 7/16/2001-7/27/2001 10/14/2001-10/19/2001 Location: Toronto, Canada Instructors: Karen Brunton, Nicky Schmidt Contact: Toronto Rehabilitation Institute Conference Services 550 University Ave. Toronto, ON, Canada M5G 2A2 416/597-3422, ext. 3693 _______________________________________ Course #: 01A109 Dates: 10/1/2001-10/5/2001 10/8/2001-10/12/2001 Location: LaJolla, CA Instructors: Waleed Al-Oboudi, Caryn Ito Contact: Waleed Al-Oboudi NDT Training 310/543-1855 0-543-2131 (????????) _______________________________________ Course #: 01A110 Dates: 9/17/2001-9/21/2001 9/24/2001-9/28/2001 Location: Panama City, FL Instructors: Waleed Al-Oboudi, Caryn Ito Contact: Linda Gilles Healthsouth Corporation One Healthsouth Parkway Birmingham,AL 35243 800/765-4772, ext. 5708 205/969-4740 Fax _______________________________________ Course #: 01A111 Dates: 8/6/2001-8/17/2001 11/11/2001-11/16/2001 Location: San Jose, CA Instructors: Bonnie Jenkins-Close, Cathy Runyan Contact: Recovering Function 408/268-3691 [email protected] _______________________________________ Course #: 01A112 Dates: 7/16/2001-7/20/2001 7/23/2001-7/27/2001 10/28/2001-11/2/2001 Location: Loma Linda, CA Instructors: Waleed Al-Oboudi, Caryn Ito Contact: Waleed Al-Oboudi NDT Training PMB 50, P.O. Box 7000 Redondo Beach, CA 90277-8710 310/543-1855 310/543-2131 Fax _______________________________________ Course #: 01A113 Dates: 5/21/2001-6/2/2001 9/24/2001-9/29/2001 Location: Tulsa, OK Instructors: Jan Utley Contact: Bonnie Watkins 817/232-5082 · 817/269-1544 Fax _______________________________________ Alternate Format Course #: 01A114 Dates: 8/2/2001-8/5/2001 8/16/2001-8/19/2001 9/13/2001-9/16/2001 9/20/2001-9/23/2001 Location: Baton Rouge, LA Instructors: Nicky Schmidt, Karen Brunton, Waleed Al-Oboudi Contact: Dawn Swanson 225/765-7674 NDT/BOBATH EIGHT-WEEK COURSE IN THE TREATMENT OF CHILDREN WITH CEREBRAL PALSY Course #: 01B103 Dates: 4/2/2001-4/27/2001 7/2/2001-7/27/2001 Location: Columbia, MO Instructors: Sherry Lynn Arndt, Oacy Veronesi, Merry Meek, Jan McElroy Contact: Carla Thommassen Kids Upward Bound 4250 E. Broadway, Suite 105 Columbia, MO 65201 573/441-2220 573/442-7699 Fax _______________________________________ Course #: 01B104 Dates: 6/9/2001-6/15/2001 6/18/2001-6/22/2001 6/25/2001-6/30/2001 7/7/2001-7/13/2001 7/16/2001-7/20/2001 7/23/2001-7/28/2001 Location: Spartenburg, SC Instructors: Margo Haynes, Jane Styer-Acevedo, Leslie Adler,Ann Guild Contact: Cathy Shaffer South Carolina School for the Deaf and the Blind 355 Cedar Springs Road Spartenburg, SC 29302 864/577-7673

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Upcoming NDTA-Approved Courses

Course #: 01B105 Dates: 10/15/2001-10/19/2001 10/22/2001-10/26/2001 11/15/2001-11/18/2001 1/17/2002-1/20/2002 2/14/2002-2/17/2002 4/18/2002-4/21/2002 5/16/2002-5/19/2002 6/17/2002-6/21/2002 Location: Fredonia, NY Instructors: Susan Breznak-Honeychurch, Bonnie Boenig, Rona Alexander Contact: Patricia Castellano New Directions Child and Family Center 183 East Main Street Fredonia, NY 14063 716/672-4419 716/672-3465 Fax _______________________________________ Course #: 01B107 Dates: 6/11/2001-8/3/2001 Location: Topeka, KS Instructors: Linda Caldwell, Leslie Paul, Gay Lloyd Pinder, Bonnie Boenig Contact: Pat Bottenberg The Capper Foundation 3500 SW 10th Ave. Topeka, KS 66604 785/272-4060 · 785/272-7912 Fax _______________________________________ Course #: 01B108 Dates: 7/2/2001-7/27/2001 9/10/2001-10/4/2001 Location: Melbourne,Australia Instructors: Suzanne Davis, Kate Bain, Teena Caithness Contact: Lynn Gercke Australia 0352-783799 0352-215981 Fax [email protected] _______________________________________ Alternate Format Course #: 01B109 Dates: 10/5/2001-10/8/2001 10/8/2001-10/12/2001 12/6/2001-12/9/2001 1/31/2002-2/3/2002 3/14/2002-3/17/2002 4/24/2002-4/28/2002 6/27/2002-6/30/2002 Location: Toledo, OH Instructors: Linda Kliebhan, Bonnie Boenig, Rona Alexander Contact: Linda Kliebhan 3228 W. Joliet Ct. Mequon,WI 53092 262/242-2585 [email protected] _______________________________________ Course #: 01B110 Dates: 8/6/2001-8/10/2001 8/13/2001-8/17/2001 9/27/2001-10/1/2001 10/25/2001-10/29/2001 11/29/2001-12/3/2001 1/10/2002-1/14/2002 2/7/2002-2/11/2002 3/7/2002-3/11/2002 Location: San Francisco, CA Instructors: Lauren Beeler, Mary Hallway, Gay Lloyd Pinder Contact: Vincent (last name???) 415/647-4790 [email protected] _______________________________________ Alternate Format Course #: 01B111 Dates: 5/18/2001-5/20/2001 6/24/2001-6/30/2001 7/20/2001-7/22/2001 8/10/2001-8/12/2001 9/7/2001-9/9/2001 10/5/2001-10/7/2001 1/4/2002-1/6/2002 2/1/2002-2/3/2002 3/1/2002-3/3/2002 Location: Voorhies, NJ Instructors: Judith Bierman, Gail Ritchie, Loren Arnaboldi Contact: Susan McCullough NDT Programs 817 Crawford Ave. Augusta, GA 30904 706/736-1255 · 706/736-1258 Fax 820 [email protected]

NDT/BOBATH COURSES REQUIRING THE COMPLETION OF THREE-WEEK OR EIGHT-WEEK COURSE

Course #: 01F112 Title: Advanced Facilitating Normal Movement During Functional Activities Dates: 6/18/2001-6/22/2001 Location: Inglewood, CA Instructors: Waleed Al-Oboudi Contact: Waleed Al-Oboudi NDT Training 310/543-1855 310/543-2131 Fax _______________________________________ Course #: 01G101 Title: Advanced Gait Course Dates: 4/1/2001-4/5/2001 Location: Minneapolis, MN Instructors: Nicky Schmidt,Teddy Parkinson Contact: Mary Jo Hapy Courage Center 3915 Golden Valley Rd. Minneapolis, MN 55422 612/520-0455 612/520-0355 Fax [email protected] _______________________________________ Course #: 01G110 Title: Advanced Gait Course Dates: 10/22/2001-10/26/2001 Location: Toronto, Canada Instructors: Karen Brunton, Nicky Schmidt Contact: Toronto Rehabilitation Institute Conference Services 550 University Ave. Toronto, ON, Canada M5G 2A2 416/597-3422, ext. 3693 _______________________________________ Course #: 01H109 Title: Advanced Handling and ProblemSolving Course

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Upcoming NDTA-Approved Courses

Dates: 5/7/2001-5/11/2001 Location: Toronto, Canada Instructors: Karen Brunton Contact: Toronto Rehabilitation Institute Conference Services 550 University Ave. Toronto, ON, Canada M5G 2A2 416/597-3422, ext. 3693 _______________________________________ Course #: 01H111 Title: Advanced Handling and ProblemSolving Course Dates: 6/13/2001-6/17/2001 Location: Encinitas, CA Instructors: Waleed Al-Oboudi Contact: NDT Training 310/543-1855 310/543-2131 Fax _______________________________________ Course #: 01H114 Title: Advanced Handling and ProblemSolving Course Dates: 11/5/2001-11/9/2001 Location: Braintree, MA Instructors: Waleed Al-Oboudi Contact: Linda Gilles Healthsouth Corporation One Healthsouth Parkway Birmingham,AL 35243 800/765-4772, ext. 5708 205/969-4740 Fax _______________________________________ Course #: 01M104 Title: Advanced Hand Function/Fine Motor Control Course Dates: 4/2/2001-4/6/2001 Location: Toronto, Canada Instructos: Waleed Al-Oboudi Contact: Michelle Broderick Toronto Rehabilitation Institute 416/597-4494, ext. 3693 416/597-6202 Fax _______________________________________ Course #: 01Y106 Title: Advanced Baby Course Dates: 7/16/2001-7/27/2001 Location: New York, NY Instructors: Susan Breznak-Honeychurch, Bonnie Boenig Contact: Patricia Castellano New Directions Child and Family Center 183 East Main Street Fredonia, NY 14063 716/672-4419 · 716/672-3456 Fax Course #: 01Y107 Title: Advanced Baby Course Dates: 6/11/2001-6/29/2001 Location: Houston,TX Instructors: Sherry Lynn Wilson Arndt, Marjorie Adams, Jan McElroy Contact: Mitzi Wiggin 832/824-5312 832/825-5242 Fax _______________________________________ Course #: 01Y115 Title: Advanced Baby Course Dates: 7/30/2001-8/17/2001 Location: Spokane,WA Instructors: Sherry Arndt, Marge Adams, Jan McElroy Contact: Barry Chapman 2922 W. Dean Ave. Spokane,WA 99201 509/327-5918 [email protected]

Employment Classifieds

Pediatric Physical or Speech Therapist Kids in Motion, a pediatric center located in southwest suburban Chicago, has a part-time position available for an experienced pediatric therapist with advanced handling skills and sound clinical judgment with children. Energy and love for children a must! Flexible schedules and strong continuing education benefits. Come grow with our dynamic NDT-certified team! Fax resume to 708/371-7748 or call 708/371-7007 for details. ______________________________________ Organizing a workshop? E-mail Course Coordinator Andrea Sellers at [email protected] today to publish your courses in the NDTA Network. ______________________________________ Have an open position? E-mail Editor Michelle Carvin at [email protected] today to advertise your employment classifieds in the Network.

Educational Opportunities

Course #: 01N105 Title: Torticollis: Diagnosis,Assessment and Treatment of Infants 0-18 Months Dates: 5/4/2001-5/5/2001 Location: Chicago, IL Instructors: Karen Karmel-Ross, Michael Lepp Contact: Renee Rowley or Margie Mizera Kids In Motion, Inc. 4721 W. Midlothian Tpke., Suite 25 Crestwood, IL 60445 708/371-7007 _______________________________________ Course #: 01N106 Title: Advanced Gait Techniques and NDT Concepts Applied to Orthotic Fabrication Dates: 4/1/2001-4/9/2001 Location: Golden Valley, MN Instructors: Teddy Parkinson, Nicky Schmidt, Debbie Merritt Plescia Contact: Sharon Langland 763/520-0701 _______________________________________ Course #: 01N107 Title: Maximizing Functional Outcomes Through Effective Home Programs Dates: 7/6/2001-7/8/2001 Location: Olympia,WA Instructors: Waleed Al-Oboudi Contact: Barry Chapman 509/327-5918 [email protected]

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Call for Nominations

NDTA is calling for nominations to the Board of Directors and Nominating Committee.Now is an exciting time to be actively involved in a leadership role with NDTA.Serving on the Board of Directors and Nominating Committee provides members with a number of opportunities including: · Professional growth and personal development. · Professional recognition at a national level. · Opportunities to network internationally. · Opportunities to make a difference in the direction of a dynamic and growing association. · Assist in the development of innovative models that promote the NDT approach and address the educational needs of the professionals and consumers we serve. The following offices are open for election in 2001: VICE-PRESIDENT/PRESIDENT The positions of Vice President and President are one year each in duration. Individuals running for this office must have previously served on the NDTA Board of Directors in any position for at least one term.The Vice President coordinates the annual review of the NDTA Strategic Plan;has working knowledge of the NDTA by-laws and is responsible for updating the bylaws as necessary;and also oversees the election process.The President of NDTA is responsible for planning,presiding and managing biannual Board of Director meetings and telephone conferences;serves as Chair of the Executive Committee; and is responsible for providing a "President's Message" for every issue of the NDTA Network. TREASURER Develops an annual budget for NDTA in conjunction with the Finance Committee. Acts as Chairperson of the Finance Committee. Monitors income and expenditures of NDTA according to the approved budget.Interacts with NDTA accountant. DIRECTOR OF MEMBERSHIP Liaison between the membership and the Board of Directors. Chairperson of the Membership Committee. Monitors membership growth. Develops strategies to meet membership needs and attract new members. DIRECTOR OF PUBLICATIONS Serves as supervising editor of the NDTA Network. Chairperson of the Editorial Advisory Committee. Oversees publication of other NDTAprinted material. NOMINATING COMMITTEE Develops the slate of candidates for the board elections ensuring, to the maximum extent possible, that the individuals represent disciplines and geographic regions reflective of NDTA membership. If you are interested in placing your name on the ballot,or if you would like to nominate someone,please contact NDTA Nominating Committee Chair Evangeline Yoder, MS, PT, at 757/249-2258 or at [email protected]; or Vice-President Brenda Pratt at 517/463-4324 or at [email protected] Deadline for nominations is May 10, 2001.

THE NEURO-DEVELOPMENTAL TREATMENT ASSOCIATION · MARCH/APRIL 2001 · VOLUME 8, ISSUE 2

PRESORTED STANDARD U.S. POSTAGE

Neuro-Developmental Treatment Association 1550 S. Coast Hwy, Suite 201 Laguna Beach, CA 92651

PAID

SANTA ANA, CA PERMIT NO. 3

Our Mission

The Neuro-Developmental Treatment Association (NDTA) is a non-profit professional organization of physical therapists, occupational therapists and speechlanguage 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.

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