Senior Physiotherapist Amy Blencowe recently retuned from a professional development course held in the Northern Territory. Read on as we pick her brain about all aspects of her trip from Bobath to Barometry!
What was Darwin like?
I have to say I couldn’t complain about having the opportunity to escape wintery Melbourne for a week. I hadn’t been to Darwin before and would definitely like to go back and see a bit more of it. It is a very different place to Melbourne. It was really interesting to speak with the therapists at the hospital about the challenges involved in working in a resource-poor setting. The health service is quite stretched and the discharge planning challenges are immense. It’s one thing to plan to send someone home to a suburban environment where they will have at-home physio, and a whole other ball game to plan to send someone to a remote community where someone may be living with a dirt floor, with no options for ongoing rehabilitation.
Most people that I met in Darwin aren’t from Darwin originally – it is quite a young, transient population, but because of this, everyone is super friendly. I was also lucky to be there for Territory Day and watch some impressive fireworks displays both official and unofficial! On my one free day I also managed to pack in a visit to Litchfield National Park and to the Rodeo so I feel like I got to experience a few aspects of NT life!
What exactly is the Bobath concept?
The Bobath concept is defined as “a problem-solving approach to the assessment and treatment of individuals with disturbances of function, movement and postural control due to a lesion of the central nervous system (IBITA 1996). This concept has evolved over more than 50 years. Current practice is based on up-to-date knowledge of biomechanics, motor control, motor learning and neuroplasticity, as well as the experience of expert clinicians. The aim is always to work towards achievement of normal movement patterns rather than encouraging compensation. The courses focus on developing excellent movement analysis skills and use of appropriate sensory cues to facilitate movement.
What does it mean to be advanced?
Bobath training is completed as a Basic Course which is a three week course that comprehensively covers assessment, clinical reasoning and treatment approaches for neurological injury. Clinicians can then go on to complete a week-long Advanced Course which focusses specifically on one aspect of the Bobath Concept. The assessment and clinical reasoning is more in-depth and detailed and the treatments are more specific.
This advanced course focussed specifically on rehabilitation of clients with damage to the cerebellum (Latin for ‘little brain’). The cerebellum has a vital role in movement control. Individuals with damage to their cerebellum present differently from people with damage to the cortical parts of the brain, and experience difficulty with coordination, balance and vision. They can be a challenging patient group to treat as their mobility is often very complex and they are at very high risk of falls.
How many people were on the course and how was it structured?
There were six people on the course- 4 physios including myself and two occupational therapists. The course included some lectures with neuroanatomy and neurophysiology of the cerebellum, but mostly it is practical. The course is largely practical based with participants practicing assessment and treatment techniques on each other as well as having the opportunity to work with a patient across the week which is a great opportunity to expand your clinical reasoning skills. Due to the small number of participants I had lots of direct feedback from the tutor which was an invaluable experience.
What have you taken away from the course?
The course allowed me to be more specific in my assessment, to be more aware of more subtle alterations to posture and movement particularly in regards to the patient with cerebellar disorders. This in turn will translate in to more specific treatments. It was an excellent opportunity to have an expert critique my handling skills and provide feedback so that I could really improve the specificity of the way I use appropriate cues to teach patients to move in more efficient ways.
How will it change your practice or the practice of NRG?
My handling skills have improved and this will allow me to achieve more within a treatment session. I also have more of a range of skills to problem solve more complex patient presentations. I will consider use of different postures to achieve the desired treatment goal. I always use sensory feedback when retraining movement but will be more specific with this now particularly in this patient cohort. I’ve been doing lots of joint sessions with other therapists to put my new skills into use. We will also explore some of these techniques in our staff ‘handling workshops’ where we practice and refine our handling skills.