Pediatrics Today - June 2013

Bobath Neurodevelopmental Treatment The neurodevelopmental treatment (NDT) approach is used for management and treatment of individuals with central nervous system (CNS) pathophysiology. It is a hands-on, problem solving treatment approach used by physical therapists, occupational therapists and speech-language pathologists.

The Bobath concept of neurodevelopmental treatment was conceived in the 1950s by physiotherapist Berta Bobath and her husband, Dr. Karl Bobath, based on her work with children and adults with neuromotor impairments.

Utilizing an NDT approach to therapy, the patient's strengths and impairments are identified in relation to his or her functional abilities.

The therapist uses specific handling techniques and facilitation strategies within a functional activity, incorporating input from tactile, vestibular and somatosensory receptors in order for the patient to actively take over functional movement patterns and increase his or her independence in executing the activity. Therapeutic activities are chosen to optimize purposeful movement patterns to maximize functional skills.

Neurodevelopmental treatment involves close collaboration with patients, their families and caregivers, physicians and other members of the

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rehabilitation team to develop and implement a comprehensive, customized treatment program that is based on scientific principles and current research.

Therapists trained in NDT have completed postgraduate training that enables them to properly assess and treat the variety of neuromotor problems in pediatric patients – helping them to become as functional and independent as possible.

NDT Case Study Patient: Admitted to GSRH after 4 months in NICU Length of stay: 20 weeks The patient was born at 25 weeks gestation, with no history of intracranial hemorrhage, moderate BPD treated with oxygen and feeding disorder with a nasogastric tube in place.

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Meet a Therapist Paula Bell Jones, PT, specializes in the treatment of pediatric patients. She is a physical therapist at Good Shepherd Rehabilitation Hospital Pediatric Unit in Bethlehem, PA. Paula completed an eight-week Bobath Certification course in the Treatment of Children with Cerebral Palsy in 2002, as well as a one-week Advanced Handling and Facilitation course in 2010 (both courses through the Bobath Centre in London, England).

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Spotlight: Pediatric Neuropsychologist A pediatric neuropsychologist is a doctoral-level, licensed, health-service provider who offers neuropsychological diagnostic and intervention services to children and adolescents.

A neuropsychologist applies principles of assessment and intervention based upon the scientific study of developmental theory and behavior, as they relate to normal and abnormal functioning of the developing central nervous system.

A pediatric neuropsychologist uses standardized tests and observes behavior to define a child’s pattern of cognitive strengths and weaknesses and develops psychosocial interventions based on these results.

Pediatric neuropsychologists play an important role in the rehabilitation setting and work closely with rehabilitation staff, patients and families to help them: • Understand the patient’s learning and behavioral challenges

• Monitor neurodevelopmental progress • Alter the treatment plan according to changes in neurocognitive functioning.

Referrals often come from neurologists, neurosurgeons and pediatricians. Appropriate patient referrals include: • Traumatic brain injury, including concussions

• Epilepsy • Stroke • Hematology/oncology disorders (brain tumors, leukemia, neurofibromatosis, sickle cell disease) • Complex medical conditions that can lead to learning challenges • ADHD • Learning disabilities • Autism spectrum conditions

CEU Programs Good Shepherd Pediatrics is pleased to offer nursing CEU programs at no charge for office and hospital groups. Each program is pre-approved for one hour of continuing education. Topics include: • An Introduction to Pediatric Rehabilitation • Traumatic Brain Injury: The Basics • Baby Steps: Programs for the NICU Graduate • Spinal Cord Injury: Functional Outcome by Level of Injury • An Introduction to Burn Rehabilitation We offer flexible scheduling to best accommodate your group's preferences.

For more information, call Shelley Rayburn, nurse liaison, at 484-788-5492.

Meet Our Pediatric Neuropsychologist Elona Suli-Moci, MD, Ph.D, is a pediatric neuropsychologist who joined Good Shepherd Rehabilitation Network in 2011.

Dr. Moci works primarily on the inpatient pediatric unit providing neuropsychological services, including evaluation, treatment and coordination of school re-entry services to children and adolescents with a variety of neurological and developmental conditions.

Dr. Moci also conducts outpatient neuropsychological evaluations of children and adolescents who have experienced brain injury or other neurological conditions, as well as developmental disorders.

Dr. Moci earned her doctorate in clinical psychology, specializing in clinical neuropsychology, from Brigham Young University in Provo, UT. She completed her internship in pediatric neuropsychology and behavioral medicine at Miami Children’s Hospital in Miami, FL. Dr. Moci completed a two-year clinical and research postdoctoral fellowship in pediatric neuropsychology at Children’s National Medical Center and George Washington Medical School in Washington, D.C.

Pediatric Outpatient Services Available at More Locations Good Shepherd Pediatrics is now offering outpatient pediatric therapy services at eight convenient locations.

Services vary according to location, but include treatment for a variety of conditions, including autism spectrum disorders, concussion, cerebral palsy, feeding and swallowing problems, orthopedic injuries and neurological conditions.

Good Shepherd Health & Technology Center 850 S. 5th Street, Allentown 610-778-1000 Good Shepherd Rehabilitation – CedarPointe 1651 North Cedar Crest Blvd., Allentown 484-788-0701 Good Shepherd Physical Therpy – Blandon 850 Golden Drive, Blandon 610-944-6504 Good Shepherd Physical Therapy – East Greenville 622 Gravel Pike, Suite 110, East Greenville 215-679-4105 Good Shepherd Physical Therapy – Easton Hospital 250 South 21st Street, Easton 610-250-4232 Good Shepherd Physical Therapy – Hamburg 500 Hawk Ridge Drive, Suite 2A, Hamburg 610-562-3523

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Following a 32-week stay in the neonatal intensive care unit, she was transferred to Good Shepherd Rehabilitation Hospital Pediatric Unit for comprehensive rehabilitation and feeding to prevent gastrostomy tube placement.

On admission (at a corrected age of 3.5 months), she presented with mild to moderate hypotonicity, able to take 5-10 ml formula by bottle, significant disorganization of fine and gross motor skills, poor self-regulation strategies and delayed motor skills. She was unable to lift her head against gravity or prop herself on elbows and demonstrated no antigravity movement of extremities. Her motor skills were at the 1-2 month level.

Treatment consisted of therapeutic handling, tone normalization techniques and facilitation of normal movement patterns via key points of control utilizing neurodevelopmental treatment strategies. Specific handling and positioning strategies also were used during feeding sessions to improve her postural stability and suck, swallow and breathing sequences.

The patient’s caregivers attended and participated in her therapy sessions, learned the treatment strategies and facilitation techniques and carried the tactics over into the patient’s activities of daily living.

The patient made steady gains in motor and developmental skills as well as in feeding and decreased need for oxygen. At the time of her

Good Shepherd Physical Therapy – Palmerton 3295 Forest Inn Road, Palmerton 610-824-7440 Good Shepherd Physical Therapy – Souderton 4036 Bethlehem Pike, Telford 215-721-1871

discharge, her corrected age was 8 months, and she was rolling independently, bringing toys together with both hands, maintaining an independent sitting position and working on transitioning in and out of sitting independently. Her overall motor skills were at the 6-7 month level. She was able to maintain adequate nutrition via PO feeds and no longer required supplements via the gastrostomy tube.

The patient continued weekly therapy on an outpatient basis.

At present, she does not require the use of any assistive devices and is fully independent in her home and community.

Non-Profit Org. US POSTAGE PAID Lehigh Valley, PA Permit No. 158 850 South 5th Street Allentown, PA 18103

Inpatient Pediatrics Inpatient rehabilitation for children is available at the Good Shepherd Rehabilitation Hospital Pediatric Unit in Bethlehem. With a team of caring, experienced rehabilitation specialists, Good Shepherd’s inpatient units have earned a reputation for excellence. The GSRH Pediatric Unit received an "Exemplary" designation from the Commission on Accreditation of Rehabilitation Facilities (CARF).

At Good Shepherd, patients receive physical, occupational, speech and/or recreational therapy. Here, our goal is to return children to the highest level of function and independence possible.

Conditions treated include: • Acute and chronic pulmonary disorders • Amputation • Brain injury • Burns • Complex wounds • Feeding/swallowing disorders • Multi-trauma injuries • Oncology • Spinal cord injury • Stroke • Neurological and neuromuscular disorders • Impairments related to prematurity and perinatal difficulties

Questions?

Contact our nurse liaison.

Shelley Rayburn, CRRN, CCM 484-788-5492 or srayburn@gsrh.org