T H E N E U R O - D E V E L O P M E N T A L T R E A T M E N T A S S O C I A T I O N • N OV E M B E R / D E C E M B E R 2 0 0 2 • V O L U M E 9 , I S S U E 6

MOTOR LEARNING MOTOR LEARNING THEORY

Walking Hand in Hand NDT AND CURRENT MOTOR

Putting It in Context NEURONAL GROUP SELECTION THEORY By Janet M. Howle, PT Presented at the NDTA Annual Meeting, May 2, 2002

N

euronal Group Selection Theory (NGST)

nected neurons, called neuronal groups, which act

offers a balance between theories of

as functional units (Sporns, 1994). This selection

neuro-maturation, such as reflex/hierarchical the-

acts to match possible motor commands to con-

ory, and theories of interactive physical systems,

straints poised by neural and body structures,

such as dynamic systems theory (DST). NGST, de-

rather than by self-organization as described in

veloped by physiologist Gerald Edelman, is a con-

DST. However, like DST, NGST incorporates the

NDT treatment concepts with the wide va-

ceptualization of brain development and func-

belief that brain development or recovery from

riety of options to “facilitate” motor learn-

tion that emphasizes the plasticity of the nervous

brain damage is aided when the individual en-

ing. Since completing my basic course this

system whose purpose is to create individuality.

gages in activities that occur in functionally or

past year, I have begun to feel more com-

Edelman (Edelman, 1987,1992, Edelman &

developmentally appropriate environmental con-

fortable with the handling aspects of treat-

Sporns, 1993) hypothesizes that individual be-

texts and when the individual generates move-

ment, but often still struggle to incorpo-

havioral functions are the products of variations

ment to meet specific task requirements. For this

rate practice strategies. The current

selected from neural populations during neu-

reason, this theory is particularly appropriate in

philosophy and theoretical perspective of

ronal evolution and organized to solve problems

supporting many of the principles of NDT.

the NDT approach offers strong evidence

that the individual must overcome to respond ef-

Three basic tenets describe how the anatomy of

for the inclusion of motor control and

fectively to environmental demands. The ability

the brain arises and takes shape during develop-

motor learning theory. In fact, the first

to solve problems requires both an adaptive ner-

ment, how experience strengthens certain patterns,

statement in the NDT Theoretical Overview

vous system and changing body systems. Edel-

and how the resulting maps of the brain give rise

reflects a combination of Bernstein’s sys-

man (1992) hypothesizes that the emergence of

tems theory, dynamical action, ecological

coordinated movement and successful adapta-

theories, and Gordon and Horak’s task-ori-

tion is tied equally to growth and change of the

ented theories of motor control (Shumway

body systems and development of the brain.

LEARNING THEORY By Trish West-Low, MA, PT

As

a graduate student and an advocate of the NDT philosophy,

one of my challenges has involved melding

–Cook and Woollacott 1995).

to uniquely individual behavioral characteristics.

TENET 1: DEVELOPMENT OF A PRIMARY REPERTOIRE The first tenet of NGST is concerned with devel-

According to NGST, the cortical and subcortical

opmental selection by which the characteristic

According to Bernstein’s systems theory,

systems are dynamically organized into variable

neuroanatomy of the brain is formed. Edelman

the control of integrated (functional) move-

structural and functional networks, which are se-

(1987) proposed that a genetic code forms the

ment is governed by many interacting

lected by development and behavior. The units

neuroanatomy but not the specific neuronal struc-

systems. Bernstein (continued on page 10)

of selection are collections of strongly intercon-

(continued on page 6)

I N S I D E

N E T W O R K :

4 NDTA News

T H E

5 Starting a Play Group

8 Caregiver’s Perspective

12 Holiday Therapy Talk

L E A D E R S H I P

NDTA

BOARD

PRESIDENT

Carly Crawford, MS, OTR/L, BCP 122 S. Forest Ridge Blvd. Broken Arrow, OK 74014 (918) 357-3868 (918) 357-2858 Fax [email protected] PAST PRESIDENT

Brenda Pratt, LPT 416 Yale Avenue Alma, MI 48801 (517) 463-4324 (517) 466-9037 Fax [email protected]

CHAIR OF INSTRUCTORS/ IG EXECUTIVE COMMITTEE

Kay Folmar, PT 73423 Foxtail Lane Palm Desert, CA 92260 (760) 346-9965 (760) 346-9965 Fax [email protected]

R E G I O N A L

REGION 3 Southern CA, Northern CA, NV Michelle G. Prettyman, PT 5460 White Oak Avenue #K301 Encino, CA 91316 (818) 986-7871 [email protected] Carrie H. Taguma-Nakamura, OT 1235 South Ogden Drive Los Angeles CA 90019 (310) 423-6281 [email protected]

IG EXECUTIVE COMMITTEE CHAIR-ELECT

DIRECTOR OF PUBLICATIONS

Cathy Hazzard, PT Foothill Medical Center– Rehab. Dept. 916-31 Ave. NW Calgary, AB T2K OA5 CANADA (403) 670-4155 [email protected] Wendy Drake-Kline, OT Neurodevelopmental Therapy Associates 1314 Timber Ridge Ct. Waynesville, OH 45068 (937) 256-1411 [email protected]

Michael Workman,PT 817 E. 6th Avenue Salt Lake City, UT 84103 (801) 359-6690 [email protected]

REGION 2 NB, NF, NS, ON, PE, PQ East Canada Chair position available Please call Director Pam Moore (505) 876-5321

DIRECTORS

IG REPRESENTATIVE

SECRETARY/TREASURER

REGION 1 WA, OR, ID, MT, West Canada Barry Chapman PT W. 2922 Dean Ave. Spokane, WA 99201 (509) 473-6-6079 [email protected]

OF

D I R E C T O R Y

DIRECTOR OF REGIONS

Pam Moore, MOT, OTR 3509 South Richmond Ave. Tulsa, OK 74135 (918) 747-6947 [email protected]

Susan Ducote, PT, PCS 824 Heather Drive Baton Rouge, LA 70815 (225)926-1838 (225) 926-1860 Fax [email protected] MEMBER-AT-LARGE

Rachel Garber, OTR Siskin Hospital P.O. Box 725 Hixson, TN 37343 423-6341571 [email protected] MEMBER-AT-LARGE

Kim Westhoff, OTR/L Kids Upward Bound 4250 E. Broadway, Suite 1015 Columbia, MO 65201 (573) 441-2220 [email protected]

I N S T RU C TO R S G RO U P IG EXECUTIVE COMMITTEE Chair: Kay Folmer Chair Elect: Cathy Hazzard Vice Chair: Timmie Wallace Treasurer: Sherry W. Arndt Secretary: Teresa Gutierrez Peds Subcommittee Chair: Lauren Beeler IG Liaison/Dir. Of Education/Marketing: Linda E. Caldwell CI Working Group Chair: Karen Brunton OT Working Group Chair: Leslie Adler PT Working Group Chair: Teddy Parkinson SLP Working Group Chair: Judy Jelm CI Representative: Judi Bierman OT Representative: Mechthild Rast PT Representative: Linda Kliebhan SLP Representative: Rona Alexander IG STANDING COMMITTEES

DIRECTOR OF MEMBERSHIP

NDTA OFFICE

Renee Leimgruber, Grievance Committee Chair

Gina Best, PT, MS 203 Woodrow Street Marietta, OH 45750 (740) 376-1422 (740) 376-9739 Fax [email protected]

1540 S. Coast Hwy, Suite 203 Laguna Beach, CA 92651 800/869-9295 • 949/376-3456 Fax [email protected] www.ndta.org

Tom Diamond, Peer Review Committee Chair Judith C. Bierman and Lois L. Bly, Theoretical Base Committee Co-Chairs Kristen E. Birkmeier, Curriculum Committee Chair

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

REGION 4 WY, CO, UT, NM, AZ Marybeth Aretz, PT 878 S. Alkire, Lakewood, CO 80228 (303) 861-6633 Fax: (303) 861-6066 [email protected] REGION 5 TX, LA Carol S. Nuñez-Parker, OTR and Teresa De La Isla, MS, OTR NTS, Inc. 4423 Shadowdale Houston, TX 77041 Work: (713) 466-6872 Ext 221 Fax: (713) 466-9547 [email protected] REGION 6 KS, MO, OK, AR Ms. Myles Claire U. Quiben, PT, CSCI 550 Files Rd., P200 Hot Springs, AR 71913-5464 (501) 525-3917/ 282-0731. [email protected] or at

REGION 7 ND, SD, MN, WI, NE, IA, IL, Middle Canada Chair position available Please call Director Pam Moore (918) 747-6947 REGION 8 MI, IN, OH Kristine Waffle, PT 827 Upland Ridge Dr. Ft. Wayne, IN 46825 (219) 446-0100, #3105 [email protected] Kristie Swoverland, PT 10911 Old Oak Court Fort Wayne, IN 46845 (219) 484-6636 ext 31310 [email protected]

REGION 10 ME, NH, VT, NY, MA.CT, RI, PA, DE, NJ, MD, WV, DC Laura Zacharewicz The Sage Colleges, Box 1580 Troy, NY 12180 (518) 244-2066 • [email protected] REGION 11 AK Dee A. Berline-Nauman, OT 6705 Lunar Drive Anchorage, AK 99504-4575 (907) 550-3004 Fax: (907) 563-3172 [email protected]

Cara Ann Leckwold PO Box 221945 Anchorage, AK 99522-1945 (907) 561-8775 [email protected] REGION 12 HI Sandra Kong, OT 99-033 Kaupili Place Aiea, HI 96701 (808) 433-6205 [email protected] Jan A. Miyashiro 1251 Ulupuni Street Kailua, HI 96734 (808) 483-4980

REGION 9 KY, VA, TN, NC, Al, MS, GA, SC, FL, PR Jeannette A. Beach, PT 220 Hemphill Ave. Chattanooga TN 37411 (423) 624-6175 [email protected]

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. 2 • N D T A N E T WO R K • N OV E M B E R / D E C E M B E R 2 0 0 2 • M O T O R L E A R N I N G

ABOUT THE NDTA NETWORK

M E S S A G E

F R O M

T H E

P R E S I D E N T

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.

New Focus for the New Board of Directors HELLO ALL! As you read through this issue of the

Prior to this change,

EDITORIAL INFORMATION We invite members and non-members to submit articles, ideas and comments to the editor. Editorial assistance and guidelines are available for writers. Look below for upcoming deadlines and themes.

NDTA Network, you may notice that there have

Board members func-

been some changes in your Board of Directors.

tioned in a role to design

You, the members, through the Bylaws changes

policy for the Association,

ADVERTISING INFORMATION 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.

presented by the Board last May, voted a number

as well as in the role of

of these changes into the infrastructure of NDTA.

chairs for a variety of com-

The foundation for these changes began with the

mittees within the Associ-

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 Cindy Percival Rounds at 800/869-9295 ext. 268. 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 and 30 days on the NDTA Web site. Longer placement is available for an additional fee. For more information or to place your ad, contact contact Cindy Percival Rounds at 800/869-9295, ext. 268. EDUCATIONAL OPPORTUNITIES Organizing a workshop? Your educational opportunity can be placed in one issue of Network and for 30 days on the NDTA Web site for $200. Longer placement is available for an additional fee. For more information or to place your ad, contact Cindy Percival Rounds at 800/869-9295, ext. 268. NDTA-APPROVED COURSES Educational courses that are approved by NDTA can be placed in one issue of Network for $100. For more information or to place your ad, contact Cindy Percival Rounds at 800/869-9295, ext. 268. ARTICLE & ADVERTISING DEADLINES Copy received after the dates specified will be considered for the following issue. 2003 ISSUES THEME DEADLINE Jan/Feb . . . . . Balance. . . . . . . . . . . . . Dec 1, 2002 Mar/Apr. . . . . Research . . . . . . . . . . . . . Jan 15, 2003 May/Jun. . . . . Locomotion . . . . . . . . . . Mar 15, 2003 Jul/Aug . . . . . Assistive Technologies . . May 15, 2003 Sep/Oct . . . . . Alternative/Complementary Therapy . . . . . . . . . . . . Jul 15, 2003 Nov/Dec . . . . Hands . . . . . . . . . . . . . . . Oct 15, 2003 K.T. Anders, Editor, NDTA Network P.O. Box 521, Upperville, VA 20185 540/592-7002 • 540/592-7032 Fax [email protected] Susan Ducote, PT, PCS, Director of Publications 824 Heather Drive, Baton Rouge, LA 70815 (225) 926-1838 • (225) 926-1860 Fax [email protected]

Strategic Planning session held in September 2000, where current and past leaders of NDTA gathered to map out a direction for our future. One of the important planning outcomes of that meeting included a change in the structure of NDTA’s Board of Directors in a manner that integrated the key stakeholders of the Association, including mem-

ation. The aim of the changes as proposed through the Strategic Planning meeting was to focus the Board of Directors as a policy making body, which is more typical for associations like NDTA, and to gain more leadership and participation of members at the grass roots level on a variety of working committees to create and implement the business of NDTA.

bers, the Board of Directors, regional leaders, and the group of instructors.

Carly Crawford, NDTA President

An additional advantage to this structure is the opportunity for leadership development across

It was desirable to ensure that each of the stake-

many aspects of the organization. As was described

holders be represented at all levels of the organi-

in the ballot sent to you in the Spring, the newly

zation through representation on the Board and

structured BOD includes the President, a Presi-

committees.

dent-Elect or Past President (continued on page 4)

Your Board of Directors is comprised of the following individuals for 2002-2003:

As NDTA continues to phase in the new Board structure, members and vacancies for 2003-2004 will be as follows:

PRESIDENT

Board members and vacancies for 2004-2005 will be as follows, at which time the new Board infrastructure will be fully implemented:

Carly Crawford

PRESIDENT

PAST PRESIDENT

Carly Crawford

PRESIDENT

Brenda Pratt

PRESIDENT ELECT

To be elected

To be elected

PAST PRESIDENT

SECRETARY/TREASURER

Carly Crawford

To be elected

SECRETARY/TREASURER

IG EXECUTIVE COMMITTEE CHAIR

To be elected

Cathy Hazzard

IG EXECUTIVE COMMITTEE CHAIR

IGEC PAST CHAIR

Cathy Hazzard

Kay Folmar

IG EXEC. COMMITTEE CHAIR-ELECT

IG REPRESENTATIVE 1

To be elected

SECRETARY/TREASURER

Michael Workman IG EXECUTIVE COMMITTEE CHAIR

Kay Folmar IG REPRESENTATIVE 1

Wendy Drake DIRECTOR OF MEMBERSHIP

Gina Best IG EXEC. COMMITTEE CHAIR-ELECT

Cathy Hazzard

Wendy Drake IG REPRESENTATIVE 2

To be elected

DIRECTOR OF PUBLICATIONS

Susan Ducote

DIRECTOR OF MEMBERSHIP

Gina Best

IG REPRESENTATIVE 1

Wendy Drake IG REPRESENTATIVE 2

To be elected

IG EXEC. COMMITTEE CHAIR-ELECT

REGIONAL CHAIR REPRESENTATIVE

Pam Moore

Cathy Hazzard

To be elected

MEMBER-AT-LARGE 1

REGIONAL CHAIR REPRESENTATIVE

MEMBER-AT-LARGE 1

REGIONAL CHAIR REPRESENTATIVE

Rachel Garber

To be elected

MEMBER-AT-LARGE 2

Kim Westhoff

MEMBER-AT-LARGE 1

Rachel Garber MEMBER-AT-LARGE 2

Kim Westhoff

Rachel Garber MEMBER-AT-LARGE 2

Kim Westhoff MEMBER-AT-LARGE 3

To be elected

N D T A N E T WO R K • N OV E M B E R / D E C E M B E R 2 0 0 2 • M O T O R L E A R N I N G • 3

N D T A

N E W S

(continued from page 3)

in alternate years, a Secretary/Treasurer, three Members-at-Large,

These committees include: National Institute of Training and Education

one Regional Chair Representative, the Instructors’ Group Exec-

(NITE), National Conference Planning Committee (NCPC), Alliances, Research,

utive Committee Chair, the Instructors’ Group Executive Com-

Membership, Web site, and Publications.

mittee Chair-Elect or Past Chair in alternate years, and two Instructor Group Representatives. This structure will maintain an 11-member board with representation of the membership, the Instructors’ Group, and regional leadership. This structure was approved by the membership and became effective with this year’s elections. It will be phased into full implementation over the next two years.

We are currently in the process of establishing committee chairs and volunteers for these groups. Any member who is interested in participating on one of these committees should contact Headquarters so you may be included in their development. Many charges have been assigned to each of these and we are eager to get moving. There are many different jobs to be done; there is one waiting for you that

This year’s elections added new members on the Board, Rachel

matches your interests, special skills and talents, and time commitment. Please

Garber and Kim Westhoff, as two of the three members-at-large.

join us as we step up to the challenge presented to us in the last issue of the Net-

They assumed these roles, effective at the conclusion of the BOD

work by Debra Paul, Past President of NDTA, when she encouraged us to get in-

meeting held in October, which they attended. Cathy Hazzard

volved; it will not only enhance your personal and professional growth but also

also joined the Board as the Instructors’ Group Executive Com-

promote NDT and our Association. Your efforts will make a difference.

mittee Chair–Elect and Wendy Drake-Kline as the first of two InCarly Crawford, MS, OTR/L, BCP

structor Group Representatives.

President, NDTA

Several BOD members also completed their terms at that time. Barry Chapman served as Secretary, Carol Nuñez-Parker as the Director of Public Relations, Clare Guiffrida as the Director of Research and Linda Caldwell as the Instructor Group Liaison/Di-

NOW AVAILABLE!

rector of Education. Please join me and the entire Board in thanking these leaders for their dedicated service to this Association for many collective years. We look forward to their continued contributions to NDTA in other roles.

“Making the Difference with Babies” Concepts & Guidelines for Baby Treatment

With the conclusion of the October meeting, Michael Work-

by Mary B. Quinton, M.C.S.P., M.B.E.

man assumed his new role as Secretary/Treasurer and I began my role as President, after serving as President-Elect under Brenda Pratt’s leadership this last year. We salute Brenda and thank her for her hard work over many years of dedicated service to our Association. However, Brenda did not get off so easily into quiet retirement from the BOD!! As the Association was not able to complete a slate to include a President-Elect this year, a vacancy was created on the Board. Per the Bylaws, the Board is charged with filling any vacancies and voted to implement the role of PastPresident for this year, to which Brenda agreed. The Board will continue to work to implement this new structure and has plans to propose some additional Bylaws changes in the near future to ensure that this process continues to move forward smoothly. I know I speak for the entire Board of Directors and management, when I say that we are here to serve you, the membership of NDTA. We encourage your questions and

This book was written by Mary B. Quinton and completed just prior to her passing. It is the only detailed written documentation of her work in her own words. Along with her video tapes, in which she demonstrates many of her ideas and approaches to baby treatment, Clinician’s View™ has exclusively preserved the comprehensive work of Mary B. Quinton in her own words. COST:

15% Discount for CI’s ordering 12 or more for use in their baby courses. To order contact: Clinician’s View™ • 505-880-0058 or fax 505-880-0059

most of all your participation in many of the opportunities with the new committees created through this restructuring process.

$56.00

For information about Mary’s video programs go to: www.clinicians-view.com

4 • N D T A N E T WO R K • N OV E M B E R / D E C E M B E R 2 0 0 2 • M O T O R L E A R N I N G

A D V O C A C Y

Playtime GUIDELINES FOR A PLAYGROUP By Susan McGrath

WHEN MY SON, ETHAN, WHO HAS DOWN

months now and is going ex-

Syndrome, turned 18-months old, I wanted him

tremely well, not only for my

to be in a more formal group setting for social-

son with the disability, but for

ization with children near his own age. I re-

the other children also involved.

Having fun with silly putty. L to R: Kyle, Cade, Clifton and Ethan.

searched my options, and after not finding any

Ideally the play group will meet in one person’s

weather, or show and tell. We have two activities

I felt would meet his needs, I decided to start my

home on a consistent basis. Our group meets

focusing on our theme for the day, singing time,

own play group. It has been in session for two

Mondays and Wednesday for

2 1/2

hours. There

are four children involved: my son, who is now

OOPS! PARDON OUR ERROR GIVING CREDIT WHERE ITS DUE In the last issue of Network, the byline for Therapy Talk—Perfect Companions, Therapy and Dogs—was inadvertently omitted. The story was by Tara Harvey-Gros, LOTR.

story time, snack time, and lots of time for free play. Once a month we go on a field trip.

two, and three “typical” children who are three

I have taken goals and activities that Ethan

years old. Two moms are assigned each day, en-

is working on in therapy and incorporated them

abling a lot of one-on-one attention. Themes

into his activities during playgroup time. He is

are designed for the month and each mom has

learning cooperation, turn taking, and devel-

a turn being “head teacher” for the day. I usually

oping more confidence in trying new things. We

have the other mom work with Ethan.

are still fine-tuning our playgroup, but it has

Our days consist of table time (working on fine

been an enriching experience for all of us. ■

motor skills), circle time that includes each child

Susan McGrath can be reached at 5621 Jane Marie, Zachary, LA 70791

having a turn either with the pledge, calendar,

Alternate to Nestibenches Film at Printer

N D T A N E T WO R K • N OV E M B E R / D E C E M B E R 2 0 0 2 • M O T O R L E A R N I N G • 5

N E U R O N A L

G R O U P

S E L E C T I O N

(Putting It in Context continued from page 1)

tures of a species. This genetic code and local

“secondary repertoire” of functional circuits

behavior of specific molecules establish the

thereby develops from the neuronal groups that

This differs from Bernstein’s systems theory

borders of different neuronal areas in the brain

are part of the primary repertoire of behaviors

in which the control of degrees of freedom is

whose connections are not preprogrammed.

and which have proved to have value for the

solely dependent on the body systems and the

Neural cells compete to make interactions, pro-

individual infant. This second repertoire is adapt-

environment. NGST proposes that the devel-

ducing a brain that is unique within the ge-

ed to the development of body systems and to

opment of synergies is the means by which the

netic constraints of the species. Because of this

environmental experiences.

nervous system solves the problem of redun-

ments that could be effective.

competition and the interaction of neural ele-

As the experience of moving in the environ-

dant degrees of freedom (Latash 1998). The

ments, diversity develops as a result of the dy-

ment occurs, the neuronal groups that are se-

precise editing of secondary repertoires con-

namic way in which the brain is formed. Con-

lected and receive input become more strong-

tinues throughout the individual’s life, main-

sequently, each individual has a unique brain

ly interconnected. Less frequently selected

taining plasticity with the nervous system in

yet one that is characteristic of its species.

neural circuits are weakened, but continue to

response to the adaptive value of an experi-

This neuronal development is capable of de-

exist and can be called upon to enhance move-

ence and changing spontaneously with re-

tecting and recognizing movements that have

ment performance if certain contextual ele-

quirements consistent with growth, matura-

value to the infant. Along with neural develop-

ments are present to trigger them, such as the

tion, or aging (Sporns & Edelman, 1993).

ment, somatic development of muscles and joints provides the infant with a “primary repertoire” of species-specific yet unique behaviors not developed by experience to permit accommodation and adaptation to the environment. Primary repertoires identified in newborns include: 1) Orienting the head and eyes toward light 2) Bringing the mouth to the hand

need for increased strength or speed or damage to the brain. As a result, many synaptic connections or neural circuits are available for immediate selection in the event of a brain lesion that renders the primary synergy nonfunctional (Hadders-Algra, 2001). Movement, experienced in the context of given tasks and appropriate environments and utilizing the characteristics of the muscu-

This tenet supports the NDT treatment principle that intervention can influence the formation of secondary repertoires in individuals with CNS pathology by enlarging the potential for linking elements of posture and movement and guiding practice opportunities to strengthen the activation of appropriate synergies for solving motor problems.

loskeletal system, competitively selects neu-

TENET 3: FORMATION AND EXPANSION OF GLOBAL MAPS

ronal groups that meet motor requirements

The third tenet describes how the first two se-

efficiently. For example, a newborn has very

lection processes interact to form global maps.

poor postural responses; therefore, part of the

These global maps are connections of neural

formation of a secondary repertoire must in-

maps distributed among large areas of the ner-

clude the strengthening of synaptic connec-

vous system. They are organized so that very

tions that organize posture. This is necessary

distinct and sometimes distant areas of per-

for anticipating the forces created by the acti-

ception, cognition, emotion, posture, and

TENET 2: FORMATION OF SECONDARY REPERTOIRES

vation of muscles, as well as anticipating the

movement control are spontaneously select-

need to link posture and movement to create

ed and activated in response to the task con-

The second tenet proposes that the experience

efficient actions while maintaining stability of

ditions and the environments. Because of the

of moving (which activates the sensory receptors

the body in space (Campbell, 1999). This se-

parallel and reciprocal connections among

and the ability to perceive the effects of vari-

lection process creates favored muscle syner-

many global maps, the combination of neu-

ous movements in the environment) eventual-

gies or functional strategies for performing

ronal groups from selected multiple maps al-

ly strengthens or weakens selective activation

movements associated with desired actions

lows the production of a movement that is pre-

by adaptive value (Sporns & Edelman, 1993). A

from among the many combinations of move-

cisely adapted to the contextual demands for

3) Sucking and rooting on the fist or nipple 4) Following moving objects with the eyes 5) Preference for the human face 6) Projecting the arm toward moving objects 7) Kicking 8) Orienting the head toward the vertical and toward sound. (Campbell 2000, Ronnqvist & Hopkins 2000).

6 • N D T A N E T WO R K • N OV E M B E R / D E C E M B E R 2 0 0 2 • M O T O R L E A R N I N G

N E U R O N A L

performance, yet unique to the individual’s

G R O U P

tion for various tasks.

S E L E C T I O N

Conceptual Framework for Examination And In-

nervous system capacity for receiving sensory

5. Selection acts to match possible motor com-

tervention, Part II. Neurology Report 24(2): 42-46.

inputs and selecting neural groups from indi-

mands to constraints posed by the body

3. Edelman, G.M. 1992. Bright Air, Brilliant

vidual regional and global maps.

structures and environment. Varying the

Fire: On the Matter of the Mind. NY:Basic

Because each person has variations in his or

environmental constraints and requirements

Books.

her neural maps based on individual body sys-

of various body systems provides increased

4. Edelman, G.M. 1987. Neural Darwinism:

tems, experience, values, and past experiences,

opportunity for individuals to select their

The Theory of Neuronal Group Selection.

own strategy to solve motor problems.

N.Y.: Basic Books.

individuals show unique yet similar strategies for accomplishing common tasks (Edelman, 1992). As children and adults solve motor problems daily, they blend the discovery of the most

6. Clients with CNS dysfunction will develop

5. Hadders-Algra, M. The Neuronal Group Se-

only a limited set of global maps with

lection Theory: Promising Principles for Under-

strongly linked movement synergies that

standing and Treating Developmental Motor Dis-

stable trajectory, joint coordination, patterns of muscle activation, preferred posture, and energy level with memory and prior experience to create their personal global maps. Essential to the development of global maps is sufficient experience with slightly different tasks to permit the neuronal groups to respond differently to various objects and events in the environment and still produce movement synergies that solve the problems (Sporns, 1994). Edelman’s NGST provides support for NDT intervention strategies in the following ways: (Campbell, 1999, Hadders-Algra, 2000): 1. Repeated experience is necessary to create functional maps that can easily be accessed for reliable yet flexible motor performance to achieve multiple functional outcomes.

orders. Dev. Med. Child Neurol. 42 (10): 707-715.

NGST proposes that the development of synergies is the means by which the nervous system solves the problem of redundant degrees of freedom.

6. Hadders-Algra, M. 2001. Early Brain Damage and the Development of Motor Behavior in Children: Clues for Therapeutic Intervention? Dev. Neurology 8(1-2) 31-49. 7. Latash, M.L. 1998. Progress In Motor Control: Bernstein’s Traditions In Movement Studies. Champaign, IL: Human Kinetics. 8. Ronnqvist, L, and B. Hopkins. 2000. Motor Asymmetries in the Human Newborn Are State Dependent, But Independent of Position in Space. Experimental Brain Res. 134 (3): 378-

the individual then applies to all tasks. The

384.

repeated use of these limited movement

9. Sporns, O: 1994. Selectionists And Instruc-

synergies will hinder progress in function-

tionists Ideas In Neuroscience. International

al positions.

Review of Neurobiology 37: 3-26.

7. The earlier intervention begins the less like-

10. Sporns, O, and G. M. Edelman. 1993. Solv-

ly is the possibility that the client will form

ing Bernstein’s Problem: A Proposal for the

3. Activity correlates the requirements of sta-

global maps with limited repertoires with

Development of Coordinated Movement by Se-

bility of the body, movement strategies, cog-

poorly organized connections among se-

lection. Child Dev. 64: 960-981.

nition, memory, experience, and changing

lected multiple maps.

2. Movement is the means of activating sensory receptors.

■

Janet Howle, PT, is co-owner of Kaye Prod-

environmental demands into a wide vari-

REFERENCES

ucts in Hillsborough, North Carolina, which

4. Active, self-generated movement strength-

1. Campbell, S.K. 1999. The Infant at Risk for

manufactures and distributes adaptive

ens and creates individual neural maps and

Developmental Disability. Decision Making in

equipment, therapy products and mobility

more strongly links requirements of pos-

Pediatric Physical Therapy. Ch. 7: 260-332.

aids for infants, children, adolescents, and

tural stability, sensory processing, and

NY: Churchill Livingstone.

young adults. She can be reached at

movement patterns to develop flexible ac-

2. Campbell, S.K. 2000. Revolution in Progress: A

[email protected].

ety of functional, secondary repertories.

N D T A N E T WO R K • N OV E M B E R / D E C E M B E R 2 0 0 2 • M O T O R L E A R N I N G • 7

C A R E G I V E R ’ S

P E R S P E C T I V E

Redefining Life MELDING THERAPY AND FAMILY NEEDS BY PENNY BLANCHARD

ON FEBRUARY 28, 1997, I FOUND OUT FIRST

jury unit at Touro in New Orleans, I learned a lot

wonderful people we have helping Larry, myself,

hand just how quickly life can change. My hus-

about love and patience. I prayed for Larry to

and the children. I am also thankful for the

band, Larry, was electrocuted while at work. In

speak again and speak he did, and yell he did,

wonderful outpatient therapists who see Larry

the split second it took for the electricity to trav-

and curse he did. I found out later that this is all

as a man and as a father, as well as a patient.

el through his body, the lives of our entire fam-

a part of brain injury recovery. But there were

It is so tough sometimes to differentiate the

ily were forever changed.

days when those words I prayed for really hurt.

three. Larry can’t be the same type of husband

Since that time, I have learned much about

The nurses, physicians, and therapist let me

or father he used to be, but he tries. It warms

the fragility of life, about myself, my family, my

know that these behaviors were normal; for that

my soul when the therapists remember that he

relationship with God, and a lot about rehabil-

I am eternally grateful. They allowed me to stay

is an adult, and even though he is brain-in-

itation. I am fortunate to have a wonderful sup-

during therapy sessions and encouraged my

jured, they treat him like an adult. He still needs

port system and extended family. I could not

input. They respected my needs as Larry’s wife

to feel worthy, and I need him to feel worthy.

have survived the last years with my sanity in-

and as a nurse to have information and to have

tact without them.

some control over our circumstances.

Also, for the most part, the therapists have seen me not only as his caretaker, but as his

Larry spent the first 2 1/2 months after his ac-

Either I or my in-laws were with Larry 24

wife and our children’s mother. They under-

cident in a coma in a hospital. Those months

hours a day, 7 days a week. It was important to

stand my need to miss therapy sometimes so

were a bumpy roller-coaster ride. Initially, we

us to be there so that we could be a part of his

that I can take care of me. I want Larry to get

were told that if Larry woke up within the first

recovery. Our children were also welcomed and

better so that he can take over more of his role

three days, there was a very good chance that he

it helped them to deal with their loss as well.

as husband and father. We understand from

would be OK. Three days and as many EEGs later,

Being a nurse, I know that families can some-

the therapists how important exercises, walking,

the news was not good. My colleague, a neurol-

times be overbearing, so I tried to help and not

and practicing ADLs are, but there is more to

ogist, looked at Larry’s EEG and said that we need-

hinder the nurses. But I know that being there

our lives than constant therapy.

ed a miracle, there wasn’t much brain activity.

to answer Larry’s questions when he started

Mostly, I think I have learned what it means to

She stayed to pray with me. We didn’t see the

talking and calming him when he was afraid

love someone unconditionally and what self-sac-

miracle then, but we are still witnessing what I be-

and encouraging him to keep trying made a

rifice really is. It is easy to take vows when you

lieve to be many miracles along a very long road.

difference. The days and nights were often long,

marry; it isn’t quite as easy to live them. Having

and the roller-coaster ride continued.

Larry anywhere but at home with our family has

It was very difficult to leave the hospital during that time. I was torn between wanting to

During Larry’s hospitalization and especial-

never entered my mind, and I would not trade

be there in case Larry woke up or something

ly after he came home, I found that no matter

places with anyone, but it is not always easy.

went wrong and wanting to be with my chil-

what, I have to find ways to take care of my-

Sometimes I just want to be taken care of, to

dren, who were eight and six at the time. I think

self. It isn’t easy. I vacillate between wanting to

have him there to ask me how I am doing, to

that the most difficult part of being a mom,

be with Larry, wanting to be with the children,

help with the bills, shuffle children, and to bear

wife, and also a nurse, is that I cannot make

and wanting to be by myself. Having very little

some of the physical burden.

things all better nor can I protect those I love.

time alone has been the biggest adjustment. It

But you know, God has provided for us and

There are so few things that I can control; my

is difficult to let go and to realize that I am not

Larry miraculously still has his sense of humor.

earthly worry will do absolutely no good. When

the only one who can care for Larry. Although

He still tells me I am beautiful and that he loves

things are not going as I would like them to, I

he would like me to be by his side constantly,

me. I know, if he could, he would bear all of

have a choice: I can either look for the blessings,

he is OK if I am not there.

the load. That makes it all worthwhile.

or I can choose to see only the negative and be miserable. I try to do the former. During Larry’s six-month stay on the brain in-

■

Now that we have been home for four-anda-half years, I have adjusted to having people

Penny Blanchard can be reached at 16805

around all of the time. I am so thankful for the

Turnbull, Zachary, LA 70791

8 • N D T A N E T WO R K • N OV E M B E R / D E C E M B E R 2 0 0 2 • M O T O R L E A R N I N G

Q U E S T I O N

Question from the Field

F R O M

?

T H E

F I E L D

?

Q: What can be done to reduce the aspects of breath holding during antigravity movement activities, such as sit to stand, or gait training? A: Factors underlying this problem may be: 1. Immature or inadequate respiration cycles, which cause the client to be uncomfortable and insecure 2. Lack of preparation of the trunk and neck for antigravity movement 3. Fatigue due to poor breath support 4. Fear due to lack of experience with movement in antigravity positions

?

Adequate trunk control for functional movement often is a key focus of therapy for clients with neuromuscular problems. Respiration relies on the rib cage and its musculature and is an essential aspect of trunk control. Breath holding interrupts the client’s typical respiratory pattern; the client volitionally “holds” the rib cage, diaphragm, and abdominal musculature in efforts to achieve more stability throughout the trunk. When moving from sitting toward standing, one leans forward, which may compromise the use of the abdominal musculature. In order to plan treatment, it is necessary to observe and identify the patterns of respiration used (inhalation and exhalation) in the various activities in which the client participates. This is followed by a thorough assessment of the client’s postural control and alignment. It is important to identify how movement is initiated in antigravity planes.

SUGGESTED TREATMENTS

•

Incorporate the shoulders and pelvic girdle, and the abdominal and intercostal musculature when focusing on improved respiration. This facilitates thoracic expansion of the rib cage on inhalation-exhalation and supports the controlled exhalation necessary for speaking with adequate breath support. When one talks, it is not easy to breath hold and still have sufficient exhalation for the utterance.

•

Use phonation to help reduce aspects of breath holding. With young children, simple sounds like “ah; uhuh”, or rote activities such as counting or saying the alphabet, or singing simple familiar songs or nursery rhymes can assist in facilitating breath support, thus reducing breath holding.

•

Have adults sing or hum a melody. This requires an active dynamic trunk during antigravity activities. Other activities may include reciting poetry, telling jokes, or reciting phone numbers and addresses. While working on motoric function in these antigravity postures, avoid asking questions. The purpose is for the client to engage in automatic speech activities rather than having to think about answers, which requires too much volitional activity.

• •

Make small transitions from sitting toward standing. Reduce the physical effort during the transition from sitting to standing in order to help reduce breath holding. This can be done by providing a partial support for the client in several ways: using a large ball or wall for the arms to weight bear; providing a pillow on the table surface on which the arms slide forward at the start of the transition from sit to stand; or positioning a table with wheels locked in front of the client when moving to standing and wheels released when starting to walk.

Always allow time for the client to accommodate to the postural change, maintain adequate respiratory cycles, feel secure, and maintain endurance. Merry Meek, MS, CCC, is in private practice in Portland, Oregon, and is an Assistant Professor of Speech Pathology and Audiology, Emerita, in Pediatrics at the Oregon Health Sciences University. She can be reached at 503/774-4502, or fax 503/494-6868.

N D T A N E T WO R K • N OV E M B E R / D E C E M B E R 2 0 0 2 • M O T O R L E A R N I N G • 9

M O T O R

L E A R N I N G

T H E O R Y

(Walking Hand in Hand continued from page 1)

believed that the coordination of movement is a

set of processes associated with practice or ex-

dissociation, and improved balance in half-kneel-

process of controlling the redundant degrees of

perience leading to relatively permanent

ing, these improvements will most likely not

freedom offered by the many joints of the body.

changes in the capability for performing a skilled

carry over into the functional context of gait, al-

He hypothesized that groups of muscles, which

action (Shumway-Cook and Woolacott 1995).

though, they are all necessary in the gait process.

act together, help to somewhat solve the degrees-

Therefore, it would be premature to state that

To be truly generalized, training or treatment

of-freedom problem by making a variety of move-

motor learning has occurred on the basis of

of these issues should be performed in the con-

ments possible. While Bernstein’s “systems” the-

perfect performance of a skill at the end of a

text of standing or gait.

ory focused primarily on the neuromotor and

treatment. The determination that motor learn-

musculo-skeletal systems, it was eventually blend-

ing has occurred can be made only after a sub-

ed with dynamical action theory to become a dy-

ject performs the skill without assistance dur-

PRACTICE SCHEDULES AND INTENSITY

namical systems model. The end result was a

ing subsequent sessions in varied environments,

Other factors affecting motor learning include

model of human motor organization in which

or under varied environmental conditions. This

the type of practice schedule, intensity, or set up.

all of the systems in the body interact with and

is known as retention or transfer of training,

The type of practice may refer to block practice

are interdependent upon each other. This model

and is as critical to gauging the success of past

in which one skill is practiced repetitively for a number of repetitions before another skill is prac-

would suggest that functional movement is the result of interaction between physical and neural elements. Add to these theories Gordon and Horak’s task-oriented approach, which suggests that movement control is linked inextricably to the performance of goal directed functional movements, and it becomes clear that current motor theories can be used to explain and support cur-

Current motor theories can be used to explain and support current NDT principles

NDT philosophy and treatment principles,

to sessions in which a number of skills may be practiced in random order. In general, while block practice improves performance of the skill during the practice session, random practice has been found to improve learning (performance on retention or transfer tests). Varying the environment or the practice conditions is another method

rent NDT principles (Howle, 2002). Despite the inclusion of motor learning into

ticed. Or it may be random practice, which refers

treatments as pre-tests are to gauging whether

of random practice, and this also has been found

a client has reached a treatment goal.

to improve transfer or generalization of a skill. Massed versus distributed practice describes

many clinicians receive very little training in the various available motor learning strate-

SPECIFICITY OF TRAINING

the intensity of practice. During massed prac-

gies. A brief review of basic motor learning

What are the factors that impact motor learning?

tice sessions, the amount of practice time gen-

concepts may be helpful. It is important to re-

First and foremost is the allowance for practice

erally exceeds the amount of rest time. During

alize that many of the studies of motor learn-

of the desired skill or task during the treatment.

distributed practice, the amount of practice

ing strategies such as practice and feedback

Dean and Shepherd (1997) found that the more

time either equals or is less than rest time. Most

schedules, have been conducted with healthy,

closely training related to a specific task, the

studies of massed versus distributed practice

non-disabled individuals, or CNS-injured adults

more effectively a group of stroke patients im-

have found that while massed practice may

who may have had more ample experience in

proved sitting balance. These authors also re-

promote motor learning, it can lead to fatigue

developing strategies for functional movement.

ported that training for sitting balance did not

which may not only degrade performance, but

Nevertheless, it is wise for all pediatric thera-

result in improved gait. This has direct applica-

lead to injury. Therefore, massed practice

pists to familiarize themselves with the vari-

tion to pediatric therapy, where often therapists

should be used with caution.

ous factors that impact motor learning.

may work on components of a task out of the

Another factor to consider is the choice of part

task context. For instance, it might be theorized

versus whole training. Part-whole training has

RETENTION AND TRANSFER

that while assuming and maintaining a half-

been found to be an effective way to train some

First, how do we determine if motor learning

kneeling position may lead to improved disso-

tasks, as long as the task can be broken into units

has taken place? Motor learning is defined as a

ciation of right and left femurs, femoral-pelvic

that reflect the goals and demands of the task.

1 0 • N D T A N E T WO R K • N OV E M B E R / D E C E M B E R 2 0 0 2 • M O T O R L E A R N I N G

M O T O R

L E A R N I N G

T H E O R Y

ness in helping improve the overall function of

For example, if one were interested in improv-

Other motor learning factors to explore in-

ing stance-phase stability, the strength of the

clude the type and schedule of feedback. Is

right hip may need to be improved. It may not

knowledge of results more important than

be effective to train the gluteus medius and max-

knowledge of performance? How, when, and

REFERENCES

imus with isolated open chain exercises on a

how often should such feedback be given (Khol

Bernstein, N. 1967. The Coordination and Reg-

mat. It would be far more effective to work on

& Guadagnoli 1996)? Unfortunately these ques-

ulation of Movement. Oxford, England: Perga-

activating these muscles together and with the

tions remain unanswered for the population of

mon Press.

correct timing and coordination in a stride-stand-

children served by most NDT trained therapists.

Dean, C.M., & R. B. Shepherd. 1997. Task Re-

ing position and continue this during training

These are but a few of the many motor learn-

lated Training Improves Performance Of Seat-

of the whole gait cycle, so that the patient can

ing concepts to consider in the structuring of

ed Reaching Tasks After Stroke: A Randomized

generalize the ability to activate these muscles

a therapy session, as well as the time between

Control Trial. Stroke 28(4): 722-728.

in a dynamic standing context.

sessions. The challenge to an NDT therapist is

Howle, Janet M., PT, MSCT, Editor, in collabora-

Finally, and perhaps most applicable to the practice of NDT therapy, is the use of physical guidance during the learning of a skill. While Singer and Pease (1980) suggest that physical guidance is detrimental to motor learning, according to Wulf, Shea and Whitacre (1998) physical guidance can have beneficial effects on performance during practice and long-term learning. These authors point out that coaches and dance teachers often use physical guidance to teach a movement or skill during the

tion with the NDTA Theory Committee. Due for

Handling, a specific manner of physical guidance, is used by NDT therapists to inhibit unwanted movements and facilitate more desirable or efficient movements.

publication in December 2002. Neuro-Devel-

not only understanding the concepts, but also

Shumway-Cook, A. & M. Woolacott. 1995. Motor

skillfully incorporating them into treatment.

Control Theory and Practical Applications.

The most difficult part may be withdrawing

Baltimore: Williams and Wilkins.

initial phases of skill acquisition. Such guidance is faded or withdrawn as the learner gains mastery over the movement. Likewise, handling, a specific manner of physical guidance, is used by NDT therapists to inhibit unwanted movements and facilitate

the clients that they seek to help.

the therapist’s “handling” and allowing some

opmental Treatment Approach: Theoretical Foundations and Principles of Clinical Practice. Khol, R.M., & M. A. Guadagnoli. 1996. The Scheduling Of Knowledge Of Results. Journal of Motor Behavior 28(3):233-240. Prather, D.C. 1971 Trial And Error Versus Errorless Learning Training, Transfer And Stress. American Journal of Psychology 84(3):377-385. Schmidt, R. A. 1988. Motor Control and Learning. 2nd ed. Champaign Il: Human Kinetics.

Singer, R. N., & D. Pease. 1980. A Comparison Of

less desirable movements to occur, as clients ex-

Discovery Learning And Guided Instructional

plore their own error detection. It may be help-

Strategies On Motor Skill Learning, Retention And

dance teacher, this “handling” should be faded

ful, as a bridge, to structure the environment

Transfer. The Research Quarterly 47(4). 788-795.

or withdrawn as the client gains some control

or the task to facilitate a desired movement

of a functional movement. In addition, cur-

in the absence of the therapist’s hands to allow

rent NDT principles allow for errors to occur

the client to explore the movement more in-

during practice with and without manual guid-

dependently in a controlled context.

more desirable or efficient movements. Like the physical guidance offered by a coach or

Wulf G, C. H. Shea, & C. A. Whitacre. 1998. Physical Guidance Benefits In Learning A Complex Motor Skill. Journal of Motor Behavior 30(4):367-380. ■

ance to allow the client to begin to use his or

Motor learning is something that all thera-

Trish West-Low, MA, PT, is Manager of Pediatric

her own intrinsic feedback mechanisms, rather

pists help their clients do. The strategies em-

Contract Rehab, Meridian Health Systems, Point

than constantly relying on extrinsic feedback

ployed are what differ. It is incumbent upon

Pleasant, NJ. She is currently working on a doc-

provided by the therapist or parent (Prather

NDT-trained therapists to incorporate well-

torate in Movement Sciences at Seton Hall Uni-

1971, Singer & Pease 1980).

studied strategies and assess their effective-

versity. She can be reached at [email protected].

N D T A N E T WO R K • N OV E M B E R / D E C E M B E R 2 0 0 2 • M O T O R L E A R N I N G • 1 1

T H E R A P Y

T A L K

Goodies from Santa’s Pack TOYS FOR FUN AND FUNCTION BY KRIS BARRIOS, M.A., CCC-SLP

I

t’s Christmas and once again we are faced

can be left under-inflated for easier grasp-

opment, concept development, object per-

with the age-old problem of deciding which

ing. Colorful beanbags can have numbers,

manence, figure/ground, etc.).

toys to recommend to the parents of our clients.

letters, or shapes on them for teaching

Why not give toys that can be both fun and ther-

identification, sequencing, patterns, etc.

much fun! (Great for sensory development,

apeutic? (Just don’t tell the kiddies.) Good toys:

as well as physical skills.)

fine motor skills, etc.)

• Can be played with in a variety of ways. • Stimulate imaginations and develop creative thinking skills.

• •

•

Clay or Play Dough: Messy, yes; but sooo

STIMULATING COGNITIVE DEVELOPMENT

STIMULATING CREATIVITY AND INTERACTIVE SKILLS

Toys that develop cause-effect, learning, cre-

Toys for developing imagination, creativity,

Promote development, meaning that they

ative thinking, concept development, orga-

originality, and communicative skills:

grow with the child.

nized thinking, memory, problem solving, rule-

•

Are safe, fun, and durable.

making and following, inferencing, etc.:

STIMULATING PHYSICAL DEVELOPMENT

•

Books: For early years, choose those that

Games: Address skills such as turn-taking, explaining rules, following rules, etc.

•

Stuffed animals, puppets, dolls: Encour-

can be touched, squeezed, chewed, etc. Later,

age creative pretend play. (These can be

cardboard chunky books are great for ob-

playmates and can provide opportunities

Toys that facilitate the transition from random,

ject identification and page turning skills.

for practicing language skills.)

reflexive movements to refined, coordinated

(Pages pop up easily for easy turning or

jumping and running:

small squares of sponge can be glued to

•

Blocks: Can be used for holding and touch-

corners of pages to spread them for easier

ing, stacking and knocking down, building

turning.) Simple books with repetitive lines

roads and cities. (Velcro helps blocks stick

are super for language development. (The

together easier for less steady hands.)

Very Hungry Caterpillar; The Very Busy Spi-

logue of a little boy totally engrossed in play

Construction sets: Duplo, Leggo, K’Nex, Lin-

der; Brown Bear, Brown Bear by Eric Carle)

with his favorite action figure?

•

coln Logs, and Tinker Toys are available for

•

• •

Games and Puzzles: Teach sorting, classi-

Art supplies: Great language builders between children or with parent and child.

•

Costumes: Old hats, gloves, shoes, jewelry, etc. make fabulous props for creative play.

• •

Play figures: Have you ever heard the dia-

Musical instruments: Great for forming

a variety of ages and skill levels.

fying, compare/contrast, matching, as well

bands, having parades, etc. (Blow toys such

Push and pull toys: Grocery carts, con-

as more complex strategic and logical think-

as recorders, harmonicas, and horns are

struction trucks, etc. can be found in large,

ing skills. (Battery-operated games with an

great for oral-motor development as well.)

sturdy versions to help walking skills and

on/off switch, such as Lucky Ducky, Mr.

can later fit into pretend play schemes.

Mouth, etc., can be adapted for switch use

great gifts for special needs children. Touch

(Weights or bags of sugar in the carts make

allowing the action to be controlled by

screens, adapted keyboards, switch inter-

them more sturdy so they don’t fall over

someone who does not have the physical

faces, etc. make it possible for all children

when used to pull up.)

skill to actually play the game.)

to benefit from computer fun.

Rattles or infant toys: Made to be twisted

•

•

Adaptive computer equipment also makes

Art Supplies: What could be more fun than

and turned, squeezed, and chewed on.

Almost any toy or game can be adapted for a

a big box full of crayons, markers, paints, dif-

Beads or buttons: Large-sized for early ages

child to participate in some way, either inde-

ferent kinds of paper, glitter, glue, etc.? Check

and smaller ones for older children can be

pendently or with some help. A little Velcro,

out the scrap book isle in the craft stores.

strung or threaded to develop fine motor skills and eye-hand coordination (great for

•

•

•

•

Containers: Fill boxes, water tables or just

tape, a switch adapter, etc. can go a long way to help a child play. Think creatively.

■

large plastic containers with materials such

teaching colors, sequencing, patterns, etc.).

as sand, water, bird seed, raw noodles, rice,

Kris Barrios, M.A., CCC-SLP, is a speech and

Throwing toys: Balls, Frisbees, basketball

or beans, etc. Add graduated stacking cups,

language pathologist at NeuroTherapy Spe-

goals, etc. encourage running, kicking, jump-

trucks, spoons or scoops, etc. for hours of

cialists, Inc. in Baton Rouge, LA. She can be

ing, and throwing. (Softer, inflatable balls

fun and learning (great for sensory devel-

reached at [email protected]

1 2 • N D T A N E T WO R K • N OV E M B E R / D E C E M B E R 2 0 0 2 • M O T O R L E A R N I N G

E Q U I P M E N T

C H A R I T Y

NDTA Regions Equipment Charity Fund Application DEADLINE: ALL APPLICATIONS MUST BE RECEIVED BY FRIDAY, APRIL 15, 2003. APPLICATIONS RECEIVED AFTER THIS DATE WILL NOT BE CONSIDERED. WHO CAN APPLY: Any NDTA Category-One member therapist may apply for his/her client (child or adult) with a neurological diagnosis. HOW: All applicants must submit the following items:

• This application form, printed below or available on the NDTA Web site at www.ndta.org.(form will also appear in the Jan/Feb issue of Network)

• A letter of justification for equipment • A letter of denial from the client’s primary funding source (i.e. insurance, Medicaid, Medicare) for the intended piece of equipment. A copy is adequate.

• A videotape (one that fits a standard VCR) of the client in a trial use of the piece of equipment for which the application is being made or photographs of the client in a trial use of the piece of equipment for which the application is being made (videotape is preferred). Letter of Justification for equipment for client: A typed letter of justification must state why this equipment is necessary, how it will benefit the client, how it is intended to be primarily used, and anticipated length of time client will be able to use equipment. Application packets must include: application form, a typed letter of justification, letter of denial from primary funding source, and videotape or pictures. Send to: NDTA Regions Equipment Charity Fund, 1540 South Coast Highway, Suite 203, Laguna Beach, CA. 92651 Name of Applying Therapist ___________________________________________________________________________________________ NDTA Membership Number____________________________________________________________________________________________ Therapist Address _____________________________________________________________________________________________________ City ___________________________________________________ State/Province ___________________

Zipcode ________________

Therapist Contact Phone _______________________________________________________________________________________________ Therapist Contact E-mail ______________________________________________________________________________________________ Name of Applying Client _______________________________________________________________________________________________ Primary Diagnosis of Client ____________________________________________________________________________________________ Secondary Diagnosis(es) of Client (if applicable) __________________________________________________________________________ Client Address ________________________________________________________________________________________________________ City ___________________________________________________ State/Province ___________________ Client Phone ___________________________________________ Client Age: ________

Zipcode ________________

Client Gender: ■ Male

■ Female

Equipment Applying for _______________________________________________________________________________________________ Cost of Equipment ____________________________________________________________________________________________________ Has client applied for charitable donation for equipment through another local or national organization: ■ Yes

■ No

If “yes,” what is the name of the organization? ___________________________________________________________________________

THANK YOU FOR APPLYING FOR THE NDTA EQUIPMENT CHARITY FUND! N D T A N E T WO R K • N OV E M B E R / D E C E M B E R 2 0 0 2 • M O T O R L E A R N I N G • 1 3

C U S I C K I N C OLORADO! February 19-22, 2003

New Rehab Strategies, Orthoses, Taping, and TheraTogs™ for Children and Adults with CNS Dysfunction INSTRUCTOR: BEVERLY CUSICK, PT, MS Telluride, Colorado (No, it’s not too expensive! Call for info.) REVIEW CURRENT ADVANCES IN:

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Neuromotor and LE development Foot pathomechanics & orthotic posting Musculoskeletal assessments Contracture management options and kinetics of gait re orthoses TheraTogs™, R-Wrap© AFO, E-stim uses, and Flex-casting Taping and strapping techniques Progressive GaitWays, LLC 888-634-0495 [email protected] • www.gaitways.com

YOUR HELP CAN MAKE A DIFFERENCE! VOLUNTEERS ARE NEEDED FOR THE NDTA BOOTH... NDTA will be sponsoring an i n fo r m at i o n a l booth at the APTA Combined Sections Meeting to be held in Tampa, Florida February 1216, 2003. Volunteers will be needed to provide representation during exhibit hours as well as to install and dismantle our booth. This will be an excellent opportunity to inform colleagues, attend educational sessions, and contribute to the growth of NDT and the NDTA! If you are planning to attend the conference or live in the Tampa area and would like to volunteer your time, please contact Cindy at 1-800-869-9295 or [email protected].

CITY KIDS COURSES 2003 5669 N. Northwest Hwy., Chicago, Illinois • [email protected] February 24-28, 2003: 5 days for $700 May 19-23, 2003: 5 days for $700 Five Days of NDT: An Intro Pediatric Course for Non-NDT Trained Therapists Instructors: Madonna Nash OTR/L, and Kacy Hertz, PT April 4-6, 2003: 3 days for $325 Three Days About Babies: Intro to Baby Treatment Instructors: Madonna Nash OTR/L, and Kacy Hertz, PT April 25-27, 2003: 2 days for $350 Taping for Improved Alignment and Neuromuscular Re-education Instructor: Trish Martin, PT May 3-4, 2003: 2 days for $275 Cascade Orthotics: Learn How to Cast and Order Customized Orthotics! Call Cascade for registration and information: 1-800-848-7332 May 18-19, 2003: 2 days for $275 2 Days in the Mouth Instructor: Lyndelle Jones-Owens MCD, CCC-SLP May 30-June 1, 2003: 3 days for $350 Neuromuscular Electrical Stimulation for Children Instructor: Gad Alon, Ph.D., PT June 21-27, 2003: 6 days for $900 Lower Extremity Deformity Management for Children with CNS Dysfunction: Developmental/Closed-Chain Biomechanics; Implications for Orthoses and Taping Instructor: Beverly Cusick, MS, PT June 28-29, 2003: 2 days for $300 Serial Casting and Splinting Techniques: Part II (Practicum) Instructor: Beverly Cusick, MS, PT July 11-12, 2003: 2 days for $275 Clinical Gait Course–Treatment, Not Theory Instrictor: Kacy Hertz, PT July 13-14, 2003: 2 days for $275 SI for PTs Instructors: Madonna Nash OTR/L, and Linda Kinderlehrer, MA, OTR/L July 26-27, 2003: 2 days for $275 Treatment Strategies to Enhance UE Function Instructors: Madonna Nash OTR/L, and Angelica Barraza, OTR/L October 13-31, 2003: 3 weeks for $2000 Three-Week NDTA Approved Baby Course Instructors: Losi Bly, PT, Madonna Nash OTR/L, and Kacy Hertz, PT For further information, please call Sheila de Armas at 773-467-5669 ext.150 or fax 773-631-2926.

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Upcoming NDTA-Approved Courses NDT/BOBATH THREE-WEEK COURSE IN THE TREATMENT OF ADULT HEMIPLEGIA Course #: 03A101 Dates: 6/18/2003–6/21/2003 6/24/2003–6/28/2003 9/17/2003–9/20/2003 9/22/2003–9/24/2003 Location: Columbus, OH Instructors: Marie Simeo, Pat Bonner Contact: David Rupp Ohio Health N.E. Health Center 6200 Cleveland Ave., Columbus, OH 43231 614-566-0562 _______________________________________

Course #: 03A102 Dates: 1/20/2003–1/24/2003 1/27/2003–1/31/2003 3/23/2003–3/28/2003 Location: Chico, CA Instructors: Waleed Al-Oboudi, Caryn Ito Contact: Waleed Al-Oboudi Phone/fax 310-378-5300 www.ndttraining.com _______________________________________

Course #: 03A103 Dates: 2/3/2003–2/7/2003 2/10/2003–2/14/2003 4/27/2003–5/2/2003 Location: Redondo Beach, CA Instructors: Waleed Al-Oboudi, Caryn Ito Contact: Waleed Al-Oboudi Phone/fax 310-378-5300 www.ndttraining.com _______________________________________

Course #: 03A104 Dates: 4/7/2003–4/11/2003 4/14/2003–4/18/2003 6/22/2003–6/27/2003 Location: Redondo Beach, CA Instructors: Waleed Al-Oboudi, Caryn Ito Contact: Waleed Al-Oboudi Phone/fax 310-378-5300 www.ndttraining.com

Course #: 03A105 Dates: 5/12/2003–5/16/2003 5/19/2003–5/23/2003 8/3/2003–8/8/2003 Location: Redondo Beach, CA Instructors: Waleed Al-Oboudi, Caryn Ito Contact: Waleed Al-Oboudi Phone/fax 310-378-5300 www.ndttraining.com

Location: Perth, Ontario, Canada Instructors: Karen Brunton, Cathy Hazzard, Beth Tarduno Contact: Velma Desjardins Perth and Smiths Falls District Hospital 33 Drummond St. W Perth, Ontario, Canada K7H 2K1 613-267-1500 ext. 4211 [email protected]

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Course #: 03A106 Dates: 8/11/2003–8/15/2003 8/18/2003–8/22/2003 10/5/2003–10/10/2003 Location: Redondo Beach, CA Instructors: Waleed Al-Oboudi, Caryn Ito Contact: Waleed Al-Oboudi Phone/fax 310-378-5300 www.ndttraining.com

Course #: 03A110 Dates: 6/16/2003–6/27/2003 8/10/2003–8/15/2003 Location: Schnectady, NY Instructors: Teddy Parkinson, Cathy Hazzard Contact: Laura Zacharewicz or Debra Berube The Sage Colleges, Box 1580 Troy, NY 12180 518-244-2066 or 518-382-4525 [email protected] or [email protected]

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Course #: 03A107 Dates: 10/13/2003–10/17/2003 10/20/2003–10/24/2003 12/14/2003–12/19/2003 Location: Redondo Beach, CA Instructors: Waleed Al-Oboudi, Caryn Ito Contact: Waleed Al-Oboudi Phone/fax 310-378-5300 www.ndttraining.com _______________________________________

Course #: 03A108 Dates: 2/15/2003–2/26/2003 4/25/2003–4/30/2003 Location: San Jose, CA Instructors: Bonnie Jenkins-Close, Karen Brunton, Cathy Runyan Contact: Recovering Function 408-268-3691 www.recoveringfunction.com _______________________________________

Course #: 03A109 Dates: 2/8/2003–2/11/2003 2/22/2003–2/25/2003 3/22/2003–3/25/2003 4/12/2003–4/15/2003

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Course #: 03A111 Dates: 11/3/2003–11/14/2003 2/8/2004–2/13/2004 Location: Johnson City, TN Instructors: Teddy Parkinson, Cathy Hazzard Contact: Helen Barry Quillen Rehabilitation Hospital 2511 Wesley St., Johnson City, TN 37601 423-952-1700 [email protected] _______________________________________

Course #: 03A112 Dates: 12/1/2003–12/5/2003 12/8/2003–12/12/2003 2/22/2004–2/27/2004 Location: Redondo Beach CA Instructors: Waleed Al-Oboudi, Caryn Ito Contact: Waleed Al-Oboudi Phone/fax 310-378-5300 www.ndttraining.com _______________________________________

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Upcoming NDTA-Approved Courses Course #: 03A113 Dates: 7/17/20037/20/2003 8/21/2003–8/24/2003 9/25/2003–9/28/2003 10/30/2003–11/2/2003 Location: Memphis, TN Instructors: Kay Folmar, Sandy Kurosaki Contact: Amy Barringer Baptist Rehabilitation Germantown 901-757-3402 [email protected]

Course #: 03A117 Dates: 9/11/2003–9/14/2003 9/25/2003–9/28/2003 10/16/2003–10/19/2003 10/23/2003–10/26/2003 Location: New Orleans, LA Instructors: Nicky Schmidt, Karen Brunton, Pat Bonner Contact: Nicky Schmidt, PT 5400 Shamrops Drive, Kenner, LA 70065 Phone/fax 504-456-1563

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Course #: 03A114 Dates: 2/24/2003–3/14/2003 Location: Greensboro, NC Instructors: Monica Diamond, Lyndelle Ownes, Beth Tarduno Contact: Monica Diamond 414-298-6758 • [email protected] www.home.earthlink.net/~diamondpt _______________________________________

Course #: 03A115 Dates: 3/30/2003–4/10/2003 5/25/2003–5/30/2003 Location: Toronto, Ontario, Canada Instructors: Karen Brunton, Nicky Schmidt Contact: Anna Morgan Toronto Rehabilitation Institute 550 University Ave. Toronto, Ontario M5G 2A2 416-597-3422 ext. 3693 416-597-6202 [email protected] _______________________________________

Course #: 03A116 Dates: 3/24/20033/28/2003 3/31/2003–4/4/2003 7/13/2003–7/18/2003 Location: Chicago, IL Instructors: Jan Utley, Susan Woll Contact: Rehabilitation Institute of Chicago–Dixon Education & Training Center 345 East Superior Street, Suite 1641 Chicago, IL 60611 312-238-2861

NDT/BOBATH EIGHT-WEEK COURSE IN THE TREATMENT OF CHILDREN WITH CEREBRAL PALSY Course #: 03B101 Dates: 3/10/2003–3/28/2003 8/4/2003–8/15/2003 10/13/2003–10/24/2003 Location: Huntingdon Valley, PA Instructors: Jane Styer-Acevedo, Margo Prim Haynes, Kate Bain, Loren Arnaboldi Contact: Denita Newsome-Johns 7247 Lindbergh Blvd. Philadelphia, PA 19153 215-815-4880 _______________________________________

Course #: 03B102 Dates: 3/31/2003–4/12/2003 5/12/2003–5/23/2003 6/16/2003–6/27/2003 9/8/2003–9/19/2003 Location: Whitehall, PA Instructors: Lois Bly, Diane Fritts-Ryan, Gay Lloyd Pinder, Kathleen Ganley Contact: Cindy Miles Cindy Miles & Associates 3721 Cresent Court West Whitehall, PA 18052 610-820-7667 • Fax 610-820-7671 [email protected] _______________________________________

Course #: 03B103 Dates: 4/10/2003–4/13/2003

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5/15/2003–5/18/2003 6/16/2003–6/20/2003 6/23/2003–6/27/2003 7/24/2003–7/27/2003 8/21/2003–8/24/2003 10/2/2003–10/5/2003 11/13/2003–11/16/2003 Location: Green Bay, WI Instructors: Barbara Cupps, Gail Ritchie, Linda Kliebhan, Rona Alexander Contact: NDT Educational Program 2233 Wauwatosa Ave., Wauwatosa, WI 53213 414-771-0388 • [email protected] [email protected] _______________________________________

Course #: 03B104 Dates: 6/23/2003–8/15/2003 Location: Tacoma, WA Instructors: Teresa Gutierrez, Pam Mullens, Mechthild Rast, Gay Lloyd Pinder Contact: Teresa Gutierrez Mary Bridge Children’s Health Center 311 S. L Street, Tacoma, WA 98405 253-403-1173 • Fax: 253-582-2113 [email protected] _______________________________________

Course #: 03B105 Dates: 6/23/2003–6/27/2003 6/30/2003–7/3/2003 8/11/2003–8/15/2003 8/18/2003–8/22/2003 8/25/2003–8/29/2003 10/9/2003–10/11/2003 10/16/2003–10/18/2003 10/23/2003–10/25/2003 10/30/2003–11/1/2003 11/6/2003 –11/8/2003 Location: Los Angeles, CA Instructors: Lauren Beeler, Mary Hallway, Gay Lloyd Pinder Contact: Melissa Hernando Play Studio/ Therapy West, Inc. 6382 Arizona Circle Los Angeles, CA 90045 310-337-7115 • Fax: 310-216-6153

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Upcoming NDTA-Approved Courses Course #: 03B106 Dates: 7/14/2003–7/18/2003 7/21/2003–7/25/2003 8/14/2003–8/17/2003 9/18/2003–9/21/2003 10/16/2003–10/19/2003 11/13/2003–11/16/2003 12/7/2003–12/13/2003 Location: Long Island, NY Instructors: Susan Breznak-Honeychurch, Bonnie Boenig. Rona Alexander Contact: Elizabeth Maglari, OT & Valerie Mace, PT Kid in Action 152 Islip Ave, Suite 21 Islip, NY 11751 631-581-6800 631-581-6814 www.kid-action.com

Contact: Rachel Luyben Coastal Rehabilitation Hospital 2131 South 17th Street Wilmington, NC 28401 910-815-5653 [email protected] _______________________________________

Course #: 03M102 Course Title: Advanced Hand Function/Fine Motor Control Course Dates: 2/24/2003–2/28/2003 Location: Redondo Beach, CA Instructor: Waleed Al-Oboudi Contact: Waleed Al-Oboudi Rehab Institute of CA 1306 South Pacific Coast Hwy Redondo Beach, CA 90277 310-378-5300 www.ndttraining.com

Dates: 2/17/2003—2/21/2003 Location: Redondo Beach, CA Instructor: Waleed Al-Oboudi Contact: Waleed Al-Oboudi Rehab Institute of CA 1306 South Pacific Coast Hwy Redondo Beach, CA 90277 310-378-3500 www.ndttraining.com _______________________________________

Course #: 03U104 Course Title: Advanced Upper Extremity Course Dates: 7/7/2003—7/11/2003 Location: Redondo Beach, CA Instructor: Waleed Al-Oboudi Contact: Waleed Al-Oboudi 310-378-5300

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310-378-5300

Course #: 03B107 Dates: 6/16/2003—6/27/2003 9/15/2003–9/25/2003 11/11/2003–11/21/2003 1/26/2004–2/6/2004 Location: Plantation, FL Instructors: Suzanne Davis, Nancy Marin, Monica Wojcik, Lezlie Adler Contact: Nancy Chersin Pediatric Therapy Associates 447 NW 73rd Avenue Plantation, FL 33317 954-583-7383 [email protected]

Course #: 03M106 Course Title: Advanced Hand Function/Fine Motor Control Course Dates: 7/14/2003–7/18/2003 Location: Redondo Beach, CA Instructor: Waleed Al-Oboudi Contact: Waleed Al-Oboudi 310-378-5300 310-378-5300 www.ndttraining.com

www.ndttraining.com

NDT/BOBATH COURSES REQUIRING THE SUCCESSFUL COMPLETION OF A THREE-WEEK OR AN EIGHT-WEEK COURSE Course #: 03G103 Course Title: Advanced Gait Course Dates: 1/13/2003–1/17/2003 Location: Wilmington, NC Instructors: Nicky Schmidt, Marie Simeo

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Course #: 03M107 Course Title: Advanced Hand Function/Fine Motor Control Course Dates: 11/10/2003—11/14/2003 Location: Redondo Beach, CA Instructor: Waleed Al-Oboudi Contact: Waleed Al-Oboudi 310-378-5300 310-378-5300 www.ndttraining.com

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Course #: 03U105 Course Title: Advanced Upper Extremity Course Dates: 11/3/2003—11/7/2003 Location: Redondo Beach, CA Instructor: Waleed Al-Oboudi Contact: Waleed Al-Oboudi 310-378-5300 310-378-5300 www.ndttraining.com _______________________________________

Course #: 03Y108 Course Title: Advanced Baby Course Dates: 9/8/2003—9/26/2003 Location: Houston, TX Instructors: Sherry Lynn Wilson Arndt, Mary Hallway Contact: Mitzi Wiggin

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Texas Children’s Hospital

Course #: 03U101 Course Title: Advanced Upper Extremity Course

832-826-6107 832-825-5242 [email protected]

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Educational Opportunities Course #: 03N101 Course Title: If You Can’t Breathe, You Can’t Function: Integrating the Pulmonary, Neuromuscular, and Musculoskeletal Systems (A Pediatric Course) Dates: 3/7/2003–3/9/2003 Location: Miami, FL Instructor: Mary Massery Contact: Marlenne G. Burt, MS, PT 305-596-5458 • [email protected] _______________________________________

Course #: 03N102 Course Title: Focus on the Ribcage for Improvement in Respiration, Phonation, Postural Control & Movement Dates: 3/20/2003–3/22/2003 Location: Seattle, WA Instructor: Rona Alexander Contact: Gay Burton, MS, PT Boyer Children’s Clinic 1850 Boyer Ave. East, Seattle, WA 98112

206-325-8477 • Fax: 206-323-1385 [email protected] _______________________________________

Course #: 03N103 Course Title: New Rehab Strategies, Orthoses, Taping and TheraTogs Dates: 2/19/2003–2/22/2003 Location: Telluride, CO Instructor: Beverly Cusick Contact: Progressive GaitWays, LLC 536 Society Drive Telluride, CO 81435 888-634-0495 or 970-728-7078 970-728-7078 • [email protected] _______________________________________

Course #: 03N104 Course Title: NDT Introductory Course in the Treatment of Adults With Hemiplegia Dates: 2/7/2003–2/9/2003 Location: New Orleans, LA Instructor: Nicky Schmidt Contact: Nicky Schmidt, PT • 504-456-1563

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Course #: 03N105 Course Title: Lower Extremity Treatment from an NDT Perspective Dates: 5/1/2003–5/3/2003 Location: Seattle, WA Instructor: Linda Kliebhan Contact: Gay Burton, MS, PT Boyer Children’s Clinic 1850 Boyer Ave. East, Seattle, WA 98112 206-325-8477 Fax: 206-323-1385 [email protected] _______________________________________

Course #: 03N106 Course Title: Treatment of Gait Dysfunction in Children With Cerebral Palsy Dates: 2/21/2003–2/23/2003 Location: Nashville, TN Instructor: Marcia Stamer Contact: Nancy Darr • Belmont University School of Physical Therapy 615-460-6713 • [email protected]

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Employment Opportunities PEDIATRIC SPEECH/ LANGUAGE PATHOLOGIST

PHYSICAL THERAPISTS NEEDED

A multidisciplinary Special Education Preschool/Early Intervention Services agency in rural upstate New York seeking a full time, New York license eligible SLP/CFY. Knowledge of NDT preferred. CFY supervisor is NDTA certified in Pediatrics. Will be working with an experienced group of PT, OT and SLP professionls. Fax resume to Nancy@ (845)794-4429 or e-mail her at [email protected].

Contra Costa County Health Services Department is recruiting indi-

THE BOBATH CENTRE

Therapist issued by the Board of Medical Examiners of the State of

PHYSICAL THERAPIST I and II viduals on a continuous basis to fill both permanent, temporary, full-time and part-time Physical Therapist positions throughout Contra Costa County. Physical Therapist I Requirements: License Required: Either 1) possession of a valid license as a Physical California; or 2) graduation from an approved school of physical

for Children with Cerebral Palsy and Adults with Neurological Disability Head of Therapy Services Upwards of £40,000 per annum + Pension Scheme East Finchley, London The Bobath Centre, which comprises two registered Charities, currently employs 25 staff who provide treatment services for children with cerebral palsy and adults with neurological disability. The Centre also holds educational courses for professional staff, and engages in research in taking the Bobath principles forward. We wish to appoint a highly motivated and experienced Head of Therapy Services to be responsible for all therapy activities within the London Centre. The postholder will have been trained and be experienced in the Bobath concept, and will be responsible for: • managing the therapy staff within the Centre and ensuring their professional development • supporting the professional activities of the Therapy Managers at Bobath Wales and Bobath Scotland • developing and promoting Bobath Courses • preserving and promoting the integrity of the Bobath Concept, nationally and internationally

therapy and acceptance of an application to take the State of California Physical Therapy Licensing examination. Continued employment in this class under the latter requirement is dependent upon successfully passing the licensing examination. Experience: None required Physical Therapist II Requirements: License Required: Possession of a valid license as a Physical Therapist issued by the Board of Medical Examiners of the State of California. Experience: Two (2) years of full-time experience or its equivalent performing licensed physical therapist duties. Salary: P.T.-I: $4302-$4986; P.T.-II: $4466-5428 An application may be obtained by contacting the Contra Costa County Human Resources Department at (925) 335-1701 or by visiting us on-line at www.co.contra-costa.ca.us

PHYSICAL THERAPIST BELLINGHAM PUBLIC SCHOOLS Bellingham, Washington Bellingham School District, located in northwest Washington state and serving over 10,000 K-12 students, is seeking candidates to fill

The postholder will work alongside the Centre Manager, and will be accountable to the Governing Bodies of the two Charities. For further information or an informal discussion, please contact Kerry Dalton, Centre Manager, Bobath Centre, Bradbury House, 250 East End Road, London N2 Tel: 020 8444 3355 Fax: 020 8444 3399 • E-mail: [email protected] or visit our website at: www.bobath.org.uk

a full-time, non-continuing leave replacement position for the remainder of the 2002-03 school year. Salary determined by placement on the district salary schedule and provisions of the collective bargaining agreement. Contact Jeanette Herrera, Personnel Manager, at [email protected], or (360) 647-6869. Bellingham School District 1306 Dupont Street, Bellingham, WA 98225

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Order Your Copy Today! Neuro-Developmental Treatment Approach: Theoretical Foundations and Principles of Clinical Practice.

NOW AVAILABLE

Janet M. Howle, PT, MSCT, Editor, in collaboration with the NDTA Theory Committee Send completed form to: NDTA, 1540 S. Coast Hwy., Suite 203, Laguna Beach, CA 92651 Member Price: $65.00 Non-Member Price: $85.00 ❏ Check or Money Order (U.S. Funds only, payable to NDTA, Check# _________ ) ❏ Visa ❏ Mastercard ❏ American Express Credit Card Number _________________________________________________ Exp. Date _____________ Signature (required) _______________________________________________________________________ SHIPPING: There will be an additional $6.00 charge for shipping. Name______________________________________________ Phone Number ( ____ ) ________________ Mailing Address __________________________________________________________________________ City ________________________________________________ State _________ Zip Code _____________

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