| Author | Post |
|---|
plor
Instructor
|
Posted: Tue Jan 16th, 2007 03:03 pm |
|
hmmmm
I merely thought that since the original question from Cindi B requested research, it would be useful for each responder to offer it.
with that in mind to add a little more fuel for thought.......
The following study demos the effectiveness of time in NDT, but does not speak to BWSTT at all:
Dev Med Child Neurol. 2004 Nov;46(11):740-5. Effect of intensive neurodevelopmental treatment in gross motor function of children with cerebral palsy. and the following study speaks to the benefits of time in therapy as opposed to treatment type but again does not speak to BWSTT:
J Dev Behav Pediatr.2001 Jun;22(3):153-62. The effects of early motor intervention on children with Down syndrome or cerebral palsy: a field-based study. If you're interested in "the quantity of therapeutic movement events" you might find this article interesting,
Phys Occup Ther Pediatr.2002;22(3-4):37-50. The effect of therapeutic horseback riding on gross motor function and gait speed in children who are developmentally delayed. Department of Physical Therapy, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8876, USA.
I've worked in hippotherapy and found that many of the reasons I use Walkable with the treadmill are the same reasons I recommend hippotherapy (or, speaking of time spent, often riding with a skilled instructor; more hours for the same $$$)
I'd share more, but today it's time to be off to work....
plo'r
|
Andrew M. Ball, PT, DPT, PhD
Instructor
| Joined: | Tue Dec 26th, 2006 |
| Location: | Charlotte, NC |
| Posts: | 6 |
| Status: |
Offline
|
|
Posted: Mon Jan 15th, 2007 11:43 pm |
|
..... Of the several studies that have been done on (or related to the subject) one (and one that's old enough that every practicing pediatric PT should be familiar with by now), is Fetters L, et al. The effects of neurodevelopmental treatment versus practice on the reaching of children with spastic cerebral Palsy. Physical Therapy. 1996 Apr; 76(4):346-58. This is a fairly well known study that states that following 5 days of either type of treatment movement time reduced, movement displacement reduced, and reaction time was not reduced . . . but when time in treatment was the independent variable, the data showed significant changes.
More recent studies, that I talk about in my course, raise the idea of "therapeutic events" which occur FAR more frequently during the course of a BWSTT session than a traditional NDT session.
Hope that's both helpful, preserves the intellectual property of the course . . . and sparks interest in hosting my course.
Andrew M. Ball, PT, DPT, PhD
Last edited on Tue Jan 16th, 2007 03:30 pm by
|
plor
Instructor
|
Posted: Mon Jan 15th, 2007 01:45 pm |
|
Andrew,
I think it would be helpful for all if you cited some of the articles you are thinking of when you refer to the "current state of the literature"
plo'r
|
Andrew M. Ball, PT, DPT, PhD
Instructor
| Joined: | Tue Dec 26th, 2006 |
| Location: | Charlotte, NC |
| Posts: | 6 |
| Status: |
Offline
|
|
Posted: Tue Dec 26th, 2006 11:48 pm |
|
I agree that NDT'ers were slow to get on board with BWS-TT systems, but that all began to change in the late 90's as those vocal NDT'ers who were using the system (such as Ginny, Phil, Susan Attermier, and myself), began to describe the system in public forum not as an alternative to an NDT approach, but rather an "alternative treatment environment" to treat the child --- and one in which THOUSANDS (as opposed to, at best, several hundred) core balance reactions could be facilitated over the course of a treatment session.
I hate to break this down into an "east-coast/west-cost" thing, but I think I can speak for the tfour of us in saying that none of us were NDT purists to begin with --- that is to say that I think we all approach NDT from a philosophy of core stability impact upon distal movement quality . . . and not as a rigid and strictly sequential treatment technique of specific neurodevelopmental handling. Those with an NDT relationship described by the former, jumped right into using the LiteGait as a tool to accomplish treatment (just like a ball or bolster). Those with a more sequential and rigid philosophical relationship with NDT seem to have a harder time integrating LiteGait into their own personal treatment approach.
The current state of the literature seems to suggest, for a variety of reasons, that TIME in therapy is more important than the specific type/specificity of handling used by the therapist. Closer inspection of the literature would suggest that it's not the time, per se, but rather the quantity of "therapeutic movement events" or TME's That being the case, the Litegait allows for a far greater number of TME's than facilitation of TME's whith a child on a ball, bolster, or mat.
This, in addition to the points raised in this thread to date, have resulted in a much wider acceptance of the LiteGait among PT's who, in years past, could be quoted as calling the LiteGait a "passing fad."
Andrew M. Ball, PT, DPT, PhD
|
plor
Instructor
|
Posted: Mon Dec 11th, 2006 12:38 am |
|
I think when discussing NDT and "gait trainers" it is important to remember there is a HUGE difference between Litegait/Walkable and the other products on the market that refer to themselves as gait trainers. The MOVE program was initially created by Rifton for young adults in remote locales who had no access to therapy on a regular basis; to allow aides and attendants, after brief training with a therapist, to get these young people into an upright position on a regular basis (which can cause a dramatic improvement in overall health and in an individual's happiness and quality of life). Even the more modern Rifton Pacer provides significant support through the trunk via a "chest prompt" and through what is essentially a seat, called a "hip prompt"; a peek at the individuals in the current Rifton promotion for the Pacer
http://www.rifton.com/resources/catalogpagepdfs/PacerGaitTrainers.pdf
will reveal the clients to be in a forward lean with ongoing hip flexion using body weight to "fall forward" and their legs to push forward; even neutral hip postion (not to mention full hip extension) cannot be achieved.
Why, in my opinion, are NDT professionals happily using Litegait/Walkable over the treadmill?
1. Because of the normalized posture in this device: upright without hip flexion but with full hip extension achievable; it is not necessary for the client to hold on, normalized arm movement, even small amounts of trunk rotation/counter rotation are achievable,
2. because of the method of reloading weight; when properly applied (pull those straps til they twang like a guitar string!!!) the harness transfers the load primarily to the pelvic region: abdomen and outer hip, much the same way that I as an NDT therapist would chose to place and use my hands to support the client without a device, no body weight goes through the arms or into a seat or seat-like device,
3. because with the client safe in the harness the therapist has full access to trunk and limbs to facilitate movement (NDT therapists are all about those small unobtrusive facilitations, we have to sit on our hands to keep them off of our clients); there are no device uprights in the way and the therapist is not scooting down the hall on a stool or even worse creeping along on his or her knees....
Anyone have additional thoughts? Comments???
plo'r
|
Ginny Paleg, MS, PT
Instructor
| Joined: | Fri Jul 14th, 2006 |
| Location: | |
| Posts: | 6 |
| Status: |
Offline
|
|
Posted: Fri Dec 8th, 2006 01:02 pm |
|
| I got my pediatric NDT Certification in 1989 from Joan Mohr. I was already using gait trainers and MOVE back then. As I became active in MVE and was a trainer for many years, Jan attended one of the trainings, but disagreed with the premise of gaittrainers. In 1994 I heard they were using one (the English model with the horse head) and last year Joan taught a Body WEight Support course thru Up and Go. I know of at least 5 NDT instructors, including the current head of research that use a Lite Gait SYstem and NDTA asked me and an NDT instructor friend to offer a BWSGT course at the annual conference last year. I'd say that most NDTers still don't like kids in gait trainers that are using detrimental patterns, and will wantthe best biomechanical alignment possible. Hope that helps!
|
CindiB
Instructor
| Joined: | Tue Dec 5th, 2006 |
| Location: | |
| Posts: | 2 |
| Status: |
Offline
|
|
Posted: Tue Dec 5th, 2006 07:34 pm |
|
Thanks so much for your reply. I too am totally sold on PWBGT, and have seen incredible results with my patients that I have used LG with. I appreciate your description of "NDT trained" vs using NDT as one thing in their bag of tricks - that really helps make sense of the differnt approaches.
THANKS AGAIN!
Cindi
|
plor
Instructor
|
Posted: Tue Dec 5th, 2006 05:40 pm |
|
Cindi,
When I first did my Master's to specialize in pediatrics I was NDT trained, so this has been a tool in my bag for my entire career. NDT per se has really become wide open since the Bobaths died. Formerly it was quite a closed practice and even NDT trained instructors like Reggie Boehme were considered renegade if they integrated NDT into a broader practice or used their skills in a more eclectic manner. Many therapists who have taken NDT courses are not formally NDT trained (and the courses may not have been given by a fully trained NDT instructor), but have learned some techniques to broaden the scope of their own therapeutic abilities.
In my own practice I have been sold on using PWBTT since the first time I met Steve and Amir!!!! I think my NDT training mostly affects the way I interact with and handle the clients that I put in the walkable and on the treadmill; the judgement calls on how much weight, how fast a pace etc and perhaps most specifically the where's and how's of using my hands (and arms and legs and feet and body and head [hahahahaha]) to facilitate gait. I say this because I am frequently struck by the difference in how I facilitate during PWBTT as compared to other instructors and trainers with whom I have been working as well as therapists I have trained in a variety of venues (inpt, outpt, schools etc).
Other therapists who have been more classic and less eclectic in their use of NDT (NDT being what they DO rather than one of many tools in their therapist's bag) may have a very different response.
plo'r
Last edited on Tue Dec 5th, 2006 05:42 pm by plor
|
shanna
Administrator
| Joined: | Fri Jun 2nd, 2006 |
| Location: | Tempe, Arizona USA |
| Posts: | 61 |
| Status: |
Offline
|
|
Posted: Tue Dec 5th, 2006 04:36 pm |
|
| Cindi: It is my experience that the NDT trained clinicians are now very sold on the importance & concepts of BWS. They were a bit slow to respond, but they have featured 2 articles on the subject- that I know of - in their newsletters. They invited us to write 2 feature articles. I will try to get electronic copies of those for your review. I know Ginny Paleg is NDT trained, as well as numerous other "champions".
|
CindiB
Instructor
| Joined: | Tue Dec 5th, 2006 |
| Location: | |
| Posts: | 2 |
| Status: |
Offline
|
|
Posted: Tue Dec 5th, 2006 04:27 pm |
|
In one of my last training sessions we were discussing the justification for LG and one person asked "Do the NDT folks buy into it". I think there has been some research regarding NDT and the use of LG but I can't put my fingers on it. Are any of y'all NDT trained? What about research articles?
Thanks!!
Cindi Began, MS, PT, CSCS
|
Current time is 01:40 am | |
|
|
|