Pediatrics Today - June 2013

VOLUME 3 • ISSUE 4

The Bobath concept ofneurodevelopmental treatmentwas conceived in the 1950s byphysiotherapist Berta Bobath andher husband, Dr. Karl Bobath, basedon her work with children and adultswith neuromotor impairments.

Utilizing an NDT approach totherapy, the patient's strengths andimpairments are identified in relationto his or her functional abilities.The therapist uses specific handlingtechniques and facilitation strategieswithin a functional activity,incorporating input from tactile,vestibular and somatosensoryreceptors in order for the patientto actively take over functionalmovement patterns and increase hisor her independence in executing theactivity. Therapeutic activities arechosen to optimize purposefulmovement patterns to maximizefunctional skills.

Neurodevelopmental treatmentinvolves close collaboration withpatients, their families and caregivers,physicians and other members of the

rehabilitation team todevelop and implement acomprehensive, customizedtreatment program that isbased on scientific principlesand current research.

Therapists trained in NDThave completed post-graduate training thatenables them to properlyassess and treat the varietyof neuromotor problems inpediatric patients – helping them tobecome as functional and independentas possible.

NDTCase StudyPatient: Admitted to GSRH

after 4months in NICULength of stay: 20 weeksThe patient was born at 25 weeksgestation, with no history ofintracranial hemorrhage, moderateBPD treated with oxygen andfeeding disorder with a nasogastrictube in place.

Continued inside ...

BobathNeurodevelopmentalTreatmentThe neurodevelopmental treatment (NDT) approach isused for management and treatment of individuals withcentral nervous system (CNS) pathophysiology. It is ahands-on, problem solving treatment approach usedby physical therapists, occupational therapists andspeech-language pathologists.

Meet aTherapistPaula Bell Jones, PT,specializes in the treatmentof pediatric patients. She isa physical therapist at GoodShepherd RehabilitationHospital Pediatric Unit inBethlehem, PA. Paulacompleted an eight-weekBobath Certification course inthe Treatment of Childrenwith Cerebral Palsy in 2002,as well as a one-weekAdvanced Handling andFacilitation course in 2010(both courses through theBobath Centre in London,England).

W h e r e Po ß ß i b i l i t i e ß A r e En d l e ß ß

A pediatric neuropsychologistis a doctoral-level, licensed,health-service provider who offersneuropsychological diagnostic andintervention services to childrenand adolescents.

A neuropsychologist appliesprinciples of assessment andintervention based upon the scientificstudy of developmental theory andbehavior, as they relate to normaland abnormal functioning of thedeveloping central nervous system.

A pediatric neuropsychologistuses standardized tests and observesbehavior to define a child’s pattern ofcognitive strengths and weaknessesand develops psychosocialinterventions based on these results.

Pediatric neuropsychologists play animportant role in the rehabilitationsetting and work closely withrehabilitation staff, patients andfamilies to help them:

• Understand the patient’s learningand behavioral challenges

• Monitor neurodevelopmentalprogress

• Alter the treatment plan accordingto changes in neurocognitivefunctioning.

Referrals often come fromneurologists, neurosurgeons andpediatricians. Appropriate patientreferrals include:• Traumatic brain injury, including

concussions

• Epilepsy• Stroke• Hematology/oncology disorders

(brain tumors, leukemia,neurofibromatosis, sicklecell disease)

• Complex medical conditions thatcan lead to learning challenges

• ADHD• Learning disabilities• Autism spectrum conditions

Pediatric NeuropsychologistSpotlight:Spotlight:

Meet Our Pediatric NeuropsychologistElona Suli-Moci, MD, Ph.D, is a pediatric neuropsychologistwho joined Good Shepherd Rehabilitation Network in 2011.Dr. Moci works primarily on the inpatient pediatric unit providingneuropsychological services, including evaluation, treatment andcoordination of school re-entry services to children and adolescentswith a variety of neurological and developmental conditions.

Dr. Moci also conducts outpatient neuropsychological evaluationsof children and adolescents who have experienced brain injury orother neurological conditions, as well as developmental disorders.

Dr. Moci earned her doctorate in clinical psychology, specializing in clinicalneuropsychology, from Brigham Young University in Provo, UT. She completed her

internship in pediatric neuropsychology and behavioral medicine at Miami Children’sHospital in Miami, FL. Dr. Moci completed a two-year clinical and research postdoctoral

fellowship in pediatric neuropsychology at Children’s National Medical Centerand George Washington Medical School in Washington, D.C.

CEUProgramsGood Shepherd Pediatrics is pleased to offer nursing CEU programs at nocharge for office and hospital groups. Each program is pre-approved forone 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.

BobathContinued from front cover

Following a 32-week stay in theneonatal intensive care unit, shewas transferred to Good ShepherdRehabilitation HospitalPediatric Unit for comprehensiverehabilitation and feeding to preventgastrostomy tube placement.

On admission (at a corrected age of3.5 months), she presented withmild to moderate hypotonicity, ableto take 5-10 ml formula by bottle,significant disorganization of fineand gross motor skills, poorself-regulation strategies and delayedmotor skills. She was unable to lifther head against gravity or propherself on elbows and demonstratedno antigravity movement ofextremities. Her motor skills wereat the 1-2 month level.

Treatment consisted of therapeutichandling, tone normalizationtechniques and facilitation of normalmovement patterns via key pointsof control utilizing neurodevelop-mental treatment strategies. Specifichandling and positioning strategiesalso were used during feedingsessions to improve her posturalstability and suck, swallow andbreathing sequences.

The patient’s caregivers attended andparticipated in her therapy sessions,learned the treatment strategies andfacilitation techniques and carriedthe tactics over into the patient’sactivities of daily living.

The patient made steady gains inmotor and developmental skills aswell as in feeding and decreasedneed for oxygen. At the time of her

discharge, her corrected age was8 months, and she was rollingindependently, bringing toys to-gether with both hands, maintainingan independent sitting position andworking on transitioning in and outof sitting independently. Her overallmotor skills were at the 6-7 monthlevel. She was able to maintainadequate nutrition via PO feeds andno longer required supplements viathe gastrostomy tube.

The patient continued weeklytherapy on an outpatient basis.At present, she does not require theuse of any assistive devices and isfully independent in her home andcommunity.

Good Shepherd Pediatricsis now offering outpatientpediatric therapy services ateight convenient locations.Services vary according tolocation, but include treatmentfor a variety of conditions,including autism spectrumdisorders, concussion, cerebralpalsy, feeding and swallowingproblems, orthopedic injuriesand neurological conditions.

Good Shepherd Health& Technology Center850 S. 5th Street, Allentown610-778-1000

Good Shepherd Rehabilitation –CedarPointe1651 North Cedar Crest Blvd.,Allentown484-788-0701

Good ShepherdPhysical Therpy – Blandon850 Golden Drive, Blandon610-944-6504

Good ShepherdPhysical Therapy – East Greenville622 Gravel Pike, Suite 110,East Greenville215-679-4105

Good ShepherdPhysical Therapy – Easton Hospital250 South 21st Street, Easton610-250-4232

Good ShepherdPhysical Therapy – Hamburg500 Hawk Ridge Drive, Suite 2A,Hamburg610-562-3523

Good ShepherdPhysical Therapy – Palmerton3295 Forest Inn Road, Palmerton610-824-7440

Good ShepherdPhysical Therapy – Souderton4036 Bethlehem Pike, Telford215-721-1871

Pediatric Outpatient Services Available atMore Locations

850 South 5th StreetAllentown, PA 18103

Non-Profit Org.US POSTAGE

PAIDLehigh Valley, PAPermit No. 158

Inpatient rehabilitationfor children is availableat the Good ShepherdRehabilitation HospitalPediatric Unit inBethlehem. With a teamof caring, experiencedrehabilitation specialists,Good Shepherd’sinpatient units haveearned a reputationfor excellence. The

GSRH Pediatric Unit received an "Exemplary"designation from the Commission on Accreditationof Rehabilitation Facilities (CARF).

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

Inpatient Pediatrics

Questions?Contact our nurse liaison.Shelley Rayburn, CRRN, CCM

484-788-5492 [email protected]