NDT - good or bad?

One of my favorite classes this semester has been neurorehabilitation. I've always been interested in working in rehab and many people needing intensive inpatient rehab have some type of injury to the central nervous system whether that be because of a stroke, a spinal cord injury or a traumatic brain injury. It is fascinating to me to learn more of how the brain and nerves work and what can be done to help people return to doing the things they need and want to do. Over the course of the semester different OTs have taught specific topics based on their area of practice and expertise. Last week the reading was on Neuro-Developmental Theory (NDT). Our textbook called it an outdated theory based on an outdated understanding of movement that has very little evidence to support it. Evidently we were studying this theory so we would have an understanding of what older therapists may be doing with their patients.

We got a completely different take on NDT during our class session which was led by Theresa, an OT that I got to know when I was volunteering at HCMC. (You can read about some of what I learned from her here and here.) She talked about how she had felt ineffective as a therapist until she took a three week course on NDT and learned how to help patients regain movement that had been lost. By the end of our three hours together, most of us were wanting to sign up for that three week course. And we all would love to have Theresa as our Level II fieldwork supervisor. The passion and stories told by one OT convinced us the only reason the evidence doesn't support the effectiveness of NDT is because of the difficulty of designing a study that shows that it is those techniques that make a difference.

I left class that day thankful for God bringing me across Theresa's path. I contacted HCMC about volunteering in their OT department because it was close to where I lived. Theresa took me under her wing and got me involved in patient care as much as possible during the 9 months I was there one morning a week. She communicated to me her passion for her job and her patients giving me as many tips as I could absorb. My essay for the application to the OT program was far better because of what I learned from her. I asked if she would be a reference for me on my application because she was the only OT who might know me well enough to have an opinion. Later on I found out she was connected with the program at the U. I really couldn't have asked for a better person for a reference. It's a small thing that worked out really well. And as I look forward to all the changes that are coming in the next year, it is comforting to know that God is in control of the people I will meet, the therapists I will work with and learn from, and wherever I end up finding a job.

Pediatric clinic

A couple of weeks ago I spent a day with an OT in a pediatric clinic. Each child we saw is a story in itself, but I'll stick to just one. A 1st grade boy I'll call Marcus came in with his mother for the first time.  The four of us headed into a small room where the OT could get some information from his mom while observing what Marcus was like. I quickly observed that Marcus was a bright boy with a large vocabulary for his age. He also had a ton of energy, went at a faster speed than most and the volume was rather loud. The toy trucks and cars were flying across the floor and the table mat. I figured if the rest of us were going to remain sane, he might need some help staying somewhat in control so I got down on the floor to play with him. As we built several things with legos and played with the trucks, I was listening in on the conversation with the mother. Not surprisingly Marcus had a hard time paying attention at school. He also had a hard time getting to sleep.

After all the questions were asked we head out to the big room where the OT checked his coordination and ability to do things like hop, skip, stand on one leg, jump and run. She also verified that he could sense where his body was in space. Before she finished, she had him lay down on his stomach and she rolled an exercise ball up and down his legs and back as she put pressure on it. Marcus said she was being a masseuse. Then he sat up and the OT did joint compressions. That  involves pushing the two parts of the major joints together. You don't pull them apart, just push in 10 times fairly rapidly for each joint. (Google it for demonstration videos.) She did the shoulder, elbow, and wrist of each arm and then the hips, knees and ankles. When we headed back into the little room Marcus was a different kid. He actually crawled under the mat table and laid down. Somehow those last two activities had slowed him down.

I was telling one of my friends about my day. She has a daughter who has a hard time winding down at the end of the day and getting to sleep. For the past several evenings my friend has been doing joint compressions on her before she goes to bed and it's made a big difference. Nobody really knows why they work, but for those they help don't really need an explanation.