This article is one I have wanted to write for about 40 years.
I started my P.T. career in 1965 with the certainty that I wanted to work with children. My faculty advisor at Uni. thought I was mad. Maybe. But for sure, paediatric P.T. was where I was headed after graduation. I got the urge when I worked at a centre supporting people with cerebral palsy in Columbus Ohio. I drove the centre’s van and transported people home from the centre, using my income to help pay for university.
In the centre was a room dedicated to treating children and I got to know the physio working there. She showed me what she was trying to do with the kids and how they responded. It looked like she really enjoyed what she was doing. She and the children were having fun. Looked good to me, and besides, I have always liked interacting with children.
Once I qualified and started my practice I held several positions where children with disabilities were my main focus at “work”. I found, after a while, that there was a pattern of typical interaction between the physio and the Parents of the children being treated. The physio was to be the expert, was expected to determine what needed to be done. The child was brought to the treatment area by the Parent, handed over and the Parent disappeared for the duration of the session. It was not unusual to me as that is what I had always seen at the centre and other places I had received training.
But, after a while, and a bit of experience and further education, I began to see the system as flawed. The first flaw is the fact that if a movement pattern is to be changed, by anyone, the newer pattern must be repeated frequently by the person trying to acquire it. But, the only time the children I was seeing had the opportunity to try the new pattern of movement was when they were in the treatment area. I might try to impress upon the Parent the need to do a particular activity with the child, but since I was the expert and the Parent rarely saw the result of the intervention, it was difficult to convince them that they had that much to offer. Having a restful cup of coffee seemed more appealing than staying in the treatment area.
The second flaw was that the treatment areas where we saw the children were specialized for that purpose, but the children were expected to try to use the patterns learned in that environment in their homely areas at home.
The third flaw was that different children, with very similar difficulties, progressed at very different rates. The difference, I found over time was entirely due to the interest and involvement of the primary care giver, read Parent. Parent might mean a sibling, it might be a nana, but whoever was taking most care of the child had great influence on the outcome. That’s why Parent has been capitalized throughout.
I changed my practice. I instituted a system of Parent mediated intervention where no child was ever seen without the primary care giver. The most important goals of treatment were the goals of the Parents, the treatment area was furnished with typical household furniture. One result was that our staff of 5 physios increased the number of children assisted from 39 to 250 a year after the change in system, and with the same staff. We were not longer the ones primarily responsible for changes in the children, trying to see each child at least 3 times a week. The pains of change were overcome in about a year, with almost everyone buying into the new system, especially Parents. The Parents were now the focus of our educational and support efforts and gradually became the main advocates for the children, armed with information and new skill. It was gratifying to see and experience.
It all boiled down to the eventual recognition of a fact, all kids come with Parents attached.
Dave Rohe is a recently retired physio having practiced in New Zealand since 2004. He originally qualified in the USA, subsequently practicing in Malawi, Egypt and Cambodia prior to emigrating to New Zealand in 2003. He has enjoyed management positions in pediatric and adult outpatient facilities as well as taught physiotherapy for 15 years at the University of Georgia. He is currently living in Parakai with his wife, Sharon Robinson, a local midwife, near his adult children who are working, and one of whom is studying to qualify as a physio through the programme at the University of Otago. His articles previously appeared in local newspapers in Taranaki and on the blog site sponsored by NZSPT.
