Pre-conference Training Day 6th June 2010
Course Details
A. POSTURAL MANAGEMENT FOR PEOPLE WITH CEREBRAL PALSY
Course Leader: Jo Jex MCSP PG Cert Clinical Education
Full Day: Intermediate
COURSE DESCRIPTION
The aim of the course is to review postural management intervention for young people with CP according to the ICF framework, using the GMFCS for children with CP to classify their level of function and need for intervention.
You will develop your skills of postural analysis to assess postural ability, and be able to interpret these findings to utilise effective biomechanical principles to improve postural stability and control, as young people grow and develop.
Important components of the day will include the neuromotor development of postural control, postural dysfunction, management of pelvic symmetry and windsweeping, and reduction of the progression of deformity.
This training course is particularly relevant to therapists and engineers who want to develop their clinical reasoning to improve the provision of postural management systems. The day will include slide presentations and practical workshops to enable you to share your skills with colleagues, and update clinical practice.
PRESENTER BIOGRAPHY
Jo’s roles have included neuro-developmental assessment, acute and community paediatric practice for a number of years, and more recently working with Active Design to provide support and formal training to anyone using postural management intervention. The post-graduate qualification enabled her to develop a learning programme based on the research and development of the approach to postural management at Chailey Heritage Clinical Services. She has taken part in provision of national guidance on hip management for children with cerebral palsy, is a committee member of PMG, and regularly provides educational courses on postural management.
B. NORMAL MOVEMENT DEVELOPMENT AND NEUROPLASTICITY: APPLYING THEORY IN PRACTICE.
Course Leaders: Marion May and Peter Lane, Exeter Mobility Centre
Half Day: Intermediate
COURSE DESCRIPTION
Aims and Learning Objectives
The purpose of this course is to allow intermediate level seating practitioners to revisit the theories of normal movement development and neurodevelopment. Participants will enhance their knowledge of key pointing. We will look at the growth and maturation of the central nervous system and improve participants’ awareness of the potential windows of opportunity for therapeutic intervention using neuroplasticity.
Course participants will then discuss how these theories can be applied within a seating assessment to identify the individual’s postural requirements. In this manner the clinician will be able to identify the appropriate equipment to meet the client’s clinical needs and to plan a client-centred intervention.
Finally, in a practical session, a demonstration will be given showing how this NHS seating team have used the customisation of Lynx backrests to potentially influence neuroplastic changes and thus improve postural ability and functional motor control.
PRESENTER BIOGRAPHIES
Marion May MSc Bsc (Hons). Marion has worked in the field of occupational therapy for over twenty years, initially working as an occupational therapy assistant in general medicine and neurology in an acute hospital. She graduated in 1996 and returned to acute hospital work, completing a rotation and holding special interests in neurology and paediatrics. Since 2000 Marion has specialised in the field of wheelchairs and special seating at Exeter Mobility Centre, where she works as a senior centre therapist. Clients present with a variety of diagnoses, mild to complex disabilities, and an age range from paediatrics to elderly care. She completed an MSc in advanced occupational therapy in 2008 and has presented her research at BAOT annual conference and PMG NTE 2008. She has recently had an article accepted for publication in the BJOT.
Peter Lane Senior Rehabilitation Engineer. Peter worked originally as an aerospace design and development engineer but, after 10 years, left to study Chinese medicine and acupressure. In 1994 he joined the NHS as an Occupational Therapy Technician, and incorporated Qi Gong and Tai Chi techniques as relaxation exercises for clients. Since 1997, Peter has worked in specialist seating and wheelchair provision at Exeter Mobility Centre. He currently works with all age groups, prescribing and adapting all types of equipment from buggies to EPIOCs.
Peter has been involved with the presentation of two posters at PMG conferences in recent years.
C. CHOOSING AN OUTCOME MEASURE FOR YOUR SERVICE
Course Leaders: Rory O’Connor MD DCH FRCP FHEA and Mark Schmeler
Half Day: Intermediate
COURSE DESCRIPTION
The aim of the course is to give delegates the skills to choose and present the most appropriate outcome measures suitable for their clinical work based on the ICF framework.
We will present a range of outcome measures that we have found useful when measuring the outcome of interventions by the rehabilitation team. These measures are available for use by clinicians to score themselves and for clients/families to score.
In addition we will cover the design and administration of questionnaires to ensure maximum completion of the measures and ensure a high rate of response.
This course is relevant to clinicians who work with clients and their families and need to record the outcome of their interventions. The course will comprise didactic presentations, small group work and practical sessions to cover the range of measures and their practical application.
PRESENTER BIOGRAPHIES
Rory O'Connor trained in Rehabilitation Medicine at the National Rehabilitation Hospital in Dublin and the National Hospital for Neurology and Neurosurgery in London. He was awarded the Philip Nichols Prize in 2003, the European Society of Physical and Rehabilitation Medicine Trainee Award in 2004 and the 2006 Prix from the Académie Européenne de Médecine Physique et de Réadaptation. He obtained an MD in 2005 from the Institute of Neurology in Queen Square in London for his research on outcome measurement in neurological rehabilitation.
He was appointed a Consultant Physician in 2005 at the National Demonstration Centre for Rehabilitation in Leeds Teaching Hospitals NHS Trust and NHS Leeds. He was made a Senior Lecturer in Rehabilitation Medicine in 2007 at the University of Leeds. He was made a Fellow of the Higher Education Academy in 2005 and a Fellow of the Royal College of Physicians in 2009. His work has focused on innovations in rehabilitation in technology, outcome measurement and education. He is also involved in developing and delivering learning and teaching rogrammes in undergraduate and postgraduate rehabilitation.
He is deputy honorary secretary of the British Society of Rehabilitation Medicine and on the committee of the UK branch of the International Society of Prosthetics and Orthotics.
Mark R. Schmeler, Ph.D., OTR/L, ATP - Mark is an Assistant Professor and Director of the Continuing Education Program in the Department of Rehabilitation Science & Technology at the University of Pittsburgh. He is the course director for the International Seating Symposium and directs several other continuing education venues including web-based post-professional education and training. He also directs a national contract to develop Assistive Technology Clinics within the Veterans Administration’s four regional Polytrauma Rehabilitation Centers. He has 20 years of clinical practice experience and currently practices as an Occupational Therapist and Assistive Technology Professional in the Center for Assistive Technology at the University of Pittsburgh Medical Center which he helped establish and directed until 2005. His graduate teaching responsibilities are in the area of assistive technology funding & policy as well as clinical applications of wheelchair seating and mobility applying case-based and evidence based practice. His area of research is in the development and application of functional outcomes measures, product development, and telerehabilitation. He also works closely with national organizations as an advocate for appropriate coverage policies related to assistive technology.
Course Leaders: Dr Margaret Phillips & Prof Damian McCormack
Half Day: Intermediate
COURSE DESCRIPTION
This course aims to review the seating and postural needs of people with muscular dystrophy, and give participants skills in assessing these needs. The term ‘muscular dystrophy’ covers a wide range of often rare conditions affecting people from all age groups, and so at first, addressing these patients’ needs may seem daunting. We will therefore start with reviewing the types of muscular dystrophy that patients who have postural and mobility needs might present with, explore common features and important differences between conditions, and explain how our understanding of the muscular dystrophies has changed in recent years. We will then review the more frequent postural and mobility needs that this group has, with an emphasis on assessment and clinical examples. This will include how such needs may be recorded using an ICF framework. Finally we will address how these needs may be met, and some of the systemic difficulties there are in providing solutions.
PRESENTER BIOGRAPHIES
Dr Margaret Phillips has worked at the University of Nottingham as an Associate Professor in Rehabilitation Medicine and in the Royal Derby Hospital as an Honorary Consultant in Rehabilitation Medicine since 2001. She trained in Rehabilitation Medicine in Liverpool at the Walton Centre for Neurology and Neurosurgery and University Hospital, Aintree, and in muscle disease at the Welsh Institute of Medical Genetics and the Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry. She has worked with people with muscular dystrophy since 1993 and was awarded an MD in 2000 in the field of myotonic dystrophy. Current clinical and research involvement with muscular dystrophy include a recently completed study on physical activity in muscular dystrophy and running a service for people with muscle conditions that includes multidisciplinary working, by means of joint clinics and community liaison, regarding respiratory and orthopaedic needs.
Prof Damian McCormack. I am a consultant orthopaedic surgeon in the Children's University hospital, Temple St, Dublin working also in the National Spinal Injuries Unit in the Mater Misericordiae hospital, and the National Orthopaedic hospital in Cappagh, Dublin. I am honorary orthopaedic surgeon at the Holles St Maternity hospital. I run a weekly neuromuscular clinic in the Central Remedial Clinic in Dublin and specialist clinics for spina bifida, muscular dystrophy, cerebral palsy and spasticity, specifically baclofen pump candidates. My training in orthopaedic surgery in Dublin was supplemented by a two year fellowship in paediatric orthopaedic surgery in Texas Scottish Rite hospital in Dallas and Atlanta Scottish Rite hospital in Atlanta.
My surgical management of scoliosis in muscular disease has evolved significantly over the last decade. The introduction of modern seating principles and methods has allowed me to greatly simplify the surgery required for scoliosis in Duchenne dystrophy in particular. This particular advance exemplifies the benefit of integrated treatment of complex disease processes.
E. MEASUREMENT, POSITIONING & MOBILITY CONSIDERATIONS FOR BARIATRIC CONSUMERS
Course Leaders: Stephanie Tanguay OTR, ATP and Jane Fontein BSc OT
Half day instructional course: Basic, Intermediate and Advanced
COURSE DESCRIPTION
Rehabilitation professionals worldwide are challenged to maximize function with basic daily activity and seating & mobility needs for many consumers who have obesity as a primary or a secondary diagnosis. While more commercially manufactured seating & mobility devices are available for bariatric consumers, properly measuring the client and configuration of the equipment is necessary to achieve successful results. Correct measurement and technology application can greatly enhance the functional outcomes for seating and mobility systems for this population. This instructional course will review the measurement process utilizing demonstration and a form designed specifically for bariatric client measurements. Application of these measurements to the mobility device and seating system will be presented utilizing case studies in a PowerPoint format.
Finding a wheelchair that fits a client and allows for true mobility is not easy. Though the bariatric client’s mobility issues are the same as a client who uses a standard size wheelchair, some features need to be designed specifically for the needs of the larger consumer. After all, a bariatric wheelchair is much more than just a wider chair. The benefits of proper fit and adjustment of the equipment to enhance function will also be presented.
Learning Objectives:
1. Attendees will be able to describe a minimum of four specific anatomical measurements critical to the bariatric evaluation process as well as the unique considerations and techniques for each.
2. Attendees will be able to describe at least three of the clinically recognized “bariatric body types” and how they impact (manual or power) wheelchair stability.
3. Participants will be able to list a minimum of four seated postures/positions which commonly occur and must be considered in the prescription of seating & mobility for bariatric consumers.
4. List three areas of adjustment critical to achieving optimal wheelchair mobility for Bariatric clients.
PRESENTER BIOGRAPHIES
Stephanie Tanguay: Stephanie Tanguay OTR, ATP/S worked as an Occupational Therapist for thirteen years at the Rehabilitation Institute of Michigan with six years experience on the spinal cord injury unit and six years in the seating & mobility clinic. She also spent seven years working as a Rehabilitation Technology Supplier as a provider of specialty seating and mobility devices. During her 23 year career, Stephanie has worked with consumers with various diagnosis requiring seating & mobility and still works closely with clinicians and suppliers prescribing seating systems. She has presented on numerous occasions at the International Seating Symposium, RESNA and the Canadian Seating & Mobility Conference and was recently a speaker at the 2009 European Seating Symposium in Dublin. Stephanie has been the Clinical Education Specialist for Motion Concepts since 2006, providing education seminars and product in-services throughout the U.S.
Jane Fontein, BSc OT has been an Occupational therapist for over twenty-five years, working in a variety of areas including long-term care and rehab, as a manufacturer educator and as a supplier. She worked at GF Strong Rehab Centre on the spinal cord unit and coordinated the outpatient seating program. For several years Jane provided education seminars and in-services across North America for wheelchair cushion Manufactures. She has spoken at the International Seating Symposium on several occasions as well as RESNA, Medtrade and the Canadian Seating and Mobility Conference and Heartland Conference. She was recently a speaker at the 2009 European Seating Symposium in Dublin. Jane is the Clinical Specialist for PDG, providing education seminars across North America.
F. INFLUENCES ON THE SEATED POSITION
Course Leader: Menno van Etten
Half Day: Basic/intermediate
COURSE DESCRIPTION
How to sort out all the facts which influences on the seated position? What are all these facts? Where shall I start looking? How do parameters like gravity or the position of the head or the backrest shape influence on the seated position? How do these and all those other functions influence the client’s ability to function as intended? How does a wheelchair set up like a seat angle influence the client’s ability to eat or to propel a wheelchair or to keep stable while seated? Where does the client want to position his feet compared to where the footplates are positioned on the wheelchair? We will recognize and analyze these functions; we will experience these functions and possibly see how little difference there is between reaction patterns in able bodied people and those with a disability. We will discuss seating intervention strategies and define the equipment properties needed to address the client’s objectives; is the client able to function as intended?
Course aim and learning outcomes The purpose of this course is to provide the seating practitioners a different look at the client seated position, without getting lost in the amount of problems they might experience. Participants will learn to sort out and analyze parameters like the position of the head, gravity, stability, age, mobility, tone, contractures, activity levels and more. How these parameters interact and how wheelchair functionalities like seat angles and footplate position influences on these functions. Seating intervention strategies are discussed so that at the end of the course, participants should be better equipped to determine the equipment properties that are required to address the individual’s objectives, rather than simply choosing specific product solutions.
Presenter/ instructor biography: Menno van Etten, P.T. has more than 21 years clinical experience as a physical therapist, seating specialist and educator, specializing in the assessment and provision of wheelchair seating equipment. From 1988 to 1997 he was a seating and mobility specialist with a wheelchair provider in Norway; from 1997 to 2003 he was international product manager at a wheelchair manufacturer in Sweden. From 2003 to 2005 he worked at a Norwegian Technical Aid Centre with power chair assessments and car adaptations. From 2005 to 2007 he was International Product Manager for one of the leading wheelchair cushion manufacturers. Currently employed as a product specialist on pressure distribution and positioning in laying and seating in Norway. During all these years Menno has been a lecturer in a wide variety of countries over the world on wheelchair & seating assessment and pressure distribution.
G. EDUCATIONAL WORKSHOP ON TREATING SPASTICITY
Course Leaders: C W Roy, Alison Barclay, Nicola Munro (or deputy), Sarah Hyde, Joyce Nicol and Barry Meadows
Half day: Basic/intermediate
COURSE DESCRIPTION
This workshop is aimed at recognising, assessing, and treating spasticity. Aspects covered include differential diagnosis, assessment methods, neurophysiology, physical management, and medications available. Invasive measures, however, will not be discussed at length, as these are the subject of another workshop in the programme. Presentations will come from engineering, medicine, orthotics, and therapy, emphasising the close co-operation needed by the multi-disciplinary team in management to achieve optimal results. This will be illustrated by case presentations covering ambulant and non-ambulant cases. Finally, outcome measures will be discussed, and some results of studies performed in Glasgow presented.
CHRIS ROY BIOGRAPHY
I was brought up in Glasgow and, after school and University there, originally trained in General Practice. In 1982, I moved to Edinburgh to train in Rehabilitation Medicine, and in 1988 took up a post as Senior Lecturer in Rehabilitation Medicine at Wellington School of Medicine, New Zealand. I was responsible there for an integrated hospital and community Physically Disabled Service.
In 1993, I returned to Glasgow, as Consultant in Rehabilitation Medicine to a new service. Responsibilities now include an inpatient Neuro-rehabilitation Unit, a continuing care unit, work with wheelchair and environmental control patients, a sub-regional Spasticity Clinic, and some work with the Community Physical Disability Rehabilitation teams in Glasgow. I am currently President-elect of the British Society of Rehabilitation Medicine. Previous committee work includes Honorary Secretary of BSRM, the Specialty Advisory Committee, and as a Committee member of the Scottish Seating and Wheelchair Group (now SPMN). Until recently, I sat on the Rehabilitation Technology Services Advisory group of the Scottish Executive.
Research interests include shoulder pain in paralysed people, and measuring the effectiveness of rehabilitation.
NICOLA MUNRO BIOGRAPHY
Nikki Munro graduated from NCTEPO in 1993. She is an Advanced Specialist Orthotist for NHS Greater Glasgow & Clyde and is lead specialist in the areas of adult neuro rehab and diabetes. She has been chair of the NHS Quality Improvement Scotland Prosthetics and Orthotics practice development network for the last 3 years.
H. A SPECIALISED EQUIPMENT SERVICE - THIS IS HOW IT’S DONE
Course Leader: Emlyn Williams, Steve Conlon and Sue Lord
Half day: Intermediate
COURSE DESCRIPTION
The establishment, development, funding and organisation of a large regional service providing electronic and computer-based technologies and supporting 1170 severely disabled users will be described.
The relevance of competent assessment, of on-going appraisal of user need and of equipment tracking and refurbishment programmes will be addressed.
The second part of the course will be practical.
Specialist engineering and therapy colleagues from North West Assistive Technology will demonstrate switching and mounting techniques, environmental control and computer access systems and Grid software applications.
The increasing functionality of electronic and computer-based technology in home, school and workplace already offers many disabled people enhanced independence without need for specialist input.
Nevertheless clinicians need to be aware of the opportunities presented by novel and more sophisticated systems and of how they can obtain specialist input when it is required.
PRESENTER BIOGRAPHY
Dr Emlyn Williams is Head of Service at an NHS service provider - North West Assistive Technology - and Consultant in Rehabilitation Medicine at University Hospital Aintree in Liverpool.
I. PHYSIOLOGIC RELATIONSHIP BETWEEN POSTURE, SKIN AND FUNCTION
Course Leader: Stephanie Tanguay OTR, ATP Motion Concepts
Half-day: Beginning to intermediate level
COURSE DESCRIPTION
Understanding the relationship between the pelvis and spine is the basis for comprehending the asymmetries and orthopaedic changes which can occur in seated posture. As consumers strive for independence, their posture effects performance of functional activities such as propulsion and transfers as well as respiration, digestion and bowel & bladder systems. Skin health and integrity is easily compromised by a number of intrinsic and extrinsic factors. Some postures have been identified as raising the risk for pressure sores and can lead to the development of pressure sores. Skin integrity is impacted by pressure distribution and is also dependent upon physiologic systems to maintain or regain that integrity. Aspects of posture, support, pressure and function must be considered in the equipment selection process. Many of these factors are interrelated, often influencing each other. It is not enough to think linearly. This course is designed for clinicians to revisit the interlocking components of seated posture and mobility. Case studies and published references will illustrate the relationship between posture, pressure, skin integrity, function activities and the correlation to physiological systems. Selecting the cushion and back support is ultimately more efficient when the broad scope of intrinsic factors is kept in focus.
Course Aim and Learning Objectives: This instructional course will focus on the direct correlation of posture & function to overall physiology and skin integrity of the wheelchair user. Upon completion of this session, participants will
1. Be able to list at least three postural effects of insufficient pelvic support and the resulting physiologic impact of those postures.
2. Be able to describe the interrelationship between at least three seated postures and the impact of each on consumer function.
3. Be able to describe the correlation between seated posture, skin integrity and the physiology.
4. Be able to list the three planes of pelvic movement and how those movements act on the spine as well as the impact of spinal changes on function.
PRESENTER BIOGRAPHY
Stephanie Tanguay OTR, ATP/S worked as an Occupational Therapist for thirteen years at the Rehabilitation Institute of Michigan with six years experience on the spinal cord injury unit and six years in the seating & mobility clinic. She also spent seven years working as a Rehabilitation Technology Supplier as a provider of specialty seating and mobility devices. During her 23 year career, Stephanie has worked with consumers with various diagnosis requiring seating & mobility and still works closely with clinicians and suppliers prescribing seating systems. She has presented on numerous occasions at the International Seating Symposium, RESNA and the Canadian Seating & Mobility Conference and was recently a speaker at the 2009 European Seating Symposium in Dublin. Stephanie has been the Clinical Education Specialist for Motion Concepts since 2006, providing education seminars and product in-services throughout the U.S.
J. PRACTICAL WHEELCHAIR SKILLS
Course Leader: Roy Wild
Half Day: Open to all
COURSE DESCRIPTION
Course aim and learning outcomes
The purpose of this course is to give the practitioner a chance to experience some of the challenges faced by wheelchair using clients and to practise wheelchair skills techniques for overcoming these challenges. There will be a strong focus on how to teach these techniques to younger clients and how wheelchair games, sports and dance can help to encourage independent mobility. The course will cover how to ascend and descend kerbs independently, coping with slopes and ramps and emergency evacuation techniques, including use of evac chairs.
We will discus how the set up of the wheelchair, in particular the position of the rear axle can affect the user’s experience, as well as looking at other influencing factors such as castor size, tyres (solid verses pneumatic) and frame type (rigid verses folding).
Attendees should be aware that this is a practical course and that a reasonable level of fitness is required for some elements. They should also be aware that although the training aims to educate, it is also likely to be good fun and great for team building.
INSTRUCTOR BIOGRAPHY
Roy Wild is therapy manager for the north team of AWC and is responsible for running the charity’s wheelchair skills programme throughout the North of England, Scotland and Northern Ireland. Roy has also run many workshops for Occupational Therapists and Physiotherapists.
Previous to this post Roy worked for RNIB as social care worker and physiotherapy assistant at Rushton Hall, a residential school for young people with visual impairments and additional disabilities. Roy is qualified in a number of complimentary therapies including aromatherapy, reflexology and Indian head massage and used these skills as part of the therapy team at Rushton Hall. Roy has also been involved in devising and implementing mobility programmes for young people with a visual impairment. Roy is a level 2 wheelchair basketball coach.
Roy has worked on projects for children with disabilities in Romania and has also worked as a youth worker, an inclusion worker for NCH and on music projects in special schools. Roy has been a PMG member for 7 years and has attended 6 PMG conferences.
K. HEAD POSITIONING - Look me in the eye
Course Leader: Leslie Johnson Fitzsimmons PT ATP
Half day: Beginner to Intermediate
COURSE DESCRIPTION
Encompassing overview for the beginner to intermediate audience targeting the importance of good head position as it relates to numerous health and quality of life issues. The emphasis will be on review of common practice mat evaluation techniques, and how these findings relate to set-up and seating choices. Discuss the relationship between pelvic position and head position and how they both influence functional seating. A brief overview of primitive reflexes and their impact on seating Explore head support options and help determine which configuration best suits your client.
PRESENTER BIOGRAPHY
Leslie has been a licensed PT with 33 years of experience working with clients from birth to geriatric in a variety of settings, including hospital, rehab, school, office, homecare, and hospice. For the past 15 years she has been a treating therapist at Lakeview CP School in Edison, New Jersey, USA, where she developed a special interest in seating and adaptive equipment. She has received her ATP license from RESNA (Rehab Engineering and Assistive Technology Society of North America). In an effort to improve the quality of life for her clients with poor head control, she created the i2i head and neck positioning and support system which is now manufactured by Stealth Products. In addition Leslie is a certified M.O.V.E. international site trainer and was awarded the ASAH 2007 Related Services Provider of the Year winner for the state of New Jersey.
