The current Covid-19 pandemic brought an immediate impact to my role as a Bobath Tutor. Having completed Module 1 of the Basic Bobath Course in February, I had returned to my daily life and role as both Physiotherapy Clinical Specialist in ABI; and as part of a team leading a project on “Developing a Framework and Culture of Interdisciplinary Teamwork in the National Rehabilitation Hospital (NRH)”.
As in many organisations, projects and committee meetings were put on hold and I returned to full time clinical work in the 56 bedded Brain Injury Programme of the NRH.
As for everyone, our work patterns, and working arrangements, have changed frequently, as the hospital has navigated its way through this current crisis period. I have been fortunate and have been able to continue alongside all the members of the IDT to continue providing rehabilitation to our in-patients, progressing to achieving their goals and being discharged home.
Changed patient flow as distance requirements have been met, and in response to reduced staffing levels in some areas, have resulted in the unexpected benefit of us being able to offer increased intensity of therapy to some of the current patients.
Among our current caseload we have a number of people with left hemisphere stroke presenting with aphasia, profound weakness of the right side and profound or total sensory loss on the right. Treatment has been described as a two-way exchange between the therapist and the patient. We often take for granted the ease of verbal communication and really value the knowledge, skills and collaboration with SLT colleagues, to establish the best methods of communication within treatment sessions.
It is always so easy to ask a patient to perform a task and to give verbal feedback in response to the performance, which works well for many patients. Alternative strategies might include demonstration of a movement or activity, and I can also “communicate” using the specificity of handling skills and utilizing environmental supports to “communicate” via the sensory systems.
Facilitation can be seen as communication to make an activity or action easier whether that is done verbally, using the environment or manually, using handling skills.
With my recent patient “Joe” early in his rehabilitation, words were of limited benefit, simple one-word instruction could be used; demonstration was limited in effect, and profound sensory loss and profound weakness left him dependent on assistance for all transfers, with no ability to balance in standing.
Improving his independence in moving between sitting and standing was an essential component of his goal of getting back to walking.
Anyone who has been on a Bobath course knows how often an unassuming towel is used! So of course as a tutor I used a rolled towel under the right hip/pelvis to ensure a more level base for the initiation of pelvic tilt essential for transfer towards the feet. Using tables either side to support his arms allowed Joe to work on developing a more appropriate movement between his TWO sides rather than relying on PULLING-to-standing, towards only the left side.
The profound weakness in the right arm meant it was not used to assist in the movement, but by maintaining an appropriate alignment and posture on the table it didn’t interfere with the forward movement of his body.
An absence of conscious sensation through the right leg made standing challenging and scary for Joe. As always when both legs were more appropriately aligned for standing i.e not hyperextending on the left leg and collapsing on the right, flickers of activity were apparent on the hemiparetic right side; this was activity to build on and strengthen.
Adapting and modifying the instructions for using the standing transfer aid on the ward and in other settings, using the support under the pelvis during dressing in the morning all added opportunities to reinforce use of both legs and reduce the pulling-to-standing.
And what about my life as a Tutor? - well the ‘case reports’ from the Belfast Basic Bobath course participants have been arriving and I am now reading and seeing the use of the skills acquired in module 1 applied in clinical practice.
Module 3 of our course should have been starting this week! Like for so many things at the moment, we don’t know when it will happen… but I know I’ll be back!
If you would like to deepen your clinical reasoning with your patients, and work more effectively towards your patients rehab goals – consider joining us on one of our BBTA courses as soon as the Corona Virus Lockdown allows us to open them up again. Visit www.bbta.org.uk and look at the ‘courses’ section and we will see you soon!