NDTA 2014

CONFERENCE THE NEURO-DEVELOPMENTAL TREATMENT ASSOCIATION • JANUARY/FEBRUARY 2014 • VOLUME 21, ISSUE 1
see pages 16-19

DEVELOPING THE PLAN OF CARE

CLINICIAN’S CORNER

How the NDT Developing a Plan of Care

Certificate One Step at a Time
Course Changed By Abby Leibrand, PT, DPT and Jennifer Tenney, MS, CCC-SLP

My Professional
Life Within a
Few Days
By Kaushal Bhatt, MPT, C/NDT
I work with a child named Kabir, a three-
year-old diagnosed with Williams
syndrome. Williams syndrome is a devel-
opmental disorder that affects many parts
of the body. This condition is charac-
terized by mild to moderate intellectual
disability or learning problems, unique
personality characteristics, distinctive
facial features, and heart and blood vessel
(cardiovascular) problems.
People with Williams syndrome typically
have difficulty with visual-spatial tasks such
as drawing and assembling puzzles, but
they tend to do well on tasks that involve
spoken language, music, and learning by
repetition (rote memorization). Affected
individuals have outgoing, engaging
personalities and tend to take an extreme
interest in other people. Attention deficit
disorder (ADD), problems with anxiety,
(continued on page 15)
M any times, caregivers of children with
therapeutic needs feel overwhelmed by
the complexity of their child's impairments.
They often enter treatment with the idea that
their child’s diagnosis will require a lifetime
of therapy. When children with medically-
based therapeutic needs arrive at one of
Weisman Children's Rehabilitation outpatient
centers, Episodic Care is the model of choice
Episodic Care focuses on a partnership between
a family and a therapist to achieve a functional goal
during an established time period.
we use to structure a patient’s plan of care.
Episodic Care focuses on a partnership
between a family and a therapist to achieve a
functional goal during an established time
period. This model aids the caregivers in
breaking down their child's functional limi-
tation(s) into several components to make a
specific and measurable goal targeting each
component one step at a time.
The episode of Care Model
The Episodic Care model is a patient-centered
approach that emphasizes caregiver partici-
pation as an essential component of the
treatment plan. Upon initial evaluation, the
therapist talks with the caregivers about their
specific therapy goals and their expectations.
After completing a hands-on assessment of
the patient, the therapist facilitates a conver-
sation with the caregivers that aims to merge
the patient’s functional goals as seen by the
therapist with the caregivers’ long-term expec-
tations for the patient. Based on this conver-
sation, specific and measureable goals with a
projected date of achievement are established.
Every episodic care plan requires a set
duration and frequency. Some children benefit
from a short period of regular weekly therapy.
Other children benefit from periodic therapy
with a stronger emphasis on a home exercise
program. The frequency at which the patient
will receive services is based on the amount
of skill-based thera- (continued on page 7)

I N S I D E T H E N E T W O R K :
3 President’s Message | 5 NDTA Membership Spotlight | 6 NDTA Seminars
9 Benefits of a Team Approach | 12 NDT in Action | 16 NDTA 2014 Conference Program | 20 Member Research
 L E A D E R S H I P D I R E C T O R Y

NDTA BOARD OF DIRECTORS I NS TRUC TOR S GRO U P

PRESIDENT / IG REP / NATIONAL CONFER- IG REP / THEORY IG EXECUTIVE COMMITTEE
CENTERS OF EXCELLENCE ENCE PLANNING / Barbara H. Hodge, PT, C/NDT Chair: Lauren Miller Beeler, PT, DPT, PCS, C/NDT
Jennifer Inglett, DPT, PCS, PUBLICATIONS Needham, MA Chair Elect: Gay-Lloyd Pinder, PhD, CCC-SLP, C/NDT
C/NDT Jacqueline Grimenstein, PT, C/NDT (781) 449-8892 Vice Chair: Pam Ward, PT, DPT, C/NDT
Oakland, NJ Audubon, NJ Secretary/Treasurer:
bhdennett@gmail.com
(973) 801-0314 Phone (856) 547-0078 Phone Therese McDermott, MHS, CCC-SLP, C/NDT
ok_kyung@hotmail.com jgrimenstein@ President: Jennifer Inglett, DPT, PCS, C/NDT
IG CHAIR ELECT /
weismanchildrens.com IG Liaison to BOD: Barbara H. Hodge, PT, C/NDT
CURRICULUM
PRESIDENT ELECT / IG Liaison to BOD: Jacqueline Grimenstein, PT, C/NDT
Gay-Lloyd Pinder, PhD,
NOMINATIONS MEMBER AT LARGE / Adult Hemi Chair: Kris Gellert, OT, OTR/L, C/NDT
CCC-SLP, C/NDT Pediatric Chair: Ann E. Heavey, MS, CCC-SLP, C/NDT
Teresa Gutierrez, PT, MS, PCS, MEMBERSHIP
Renee Cortise, PT, PCS, C/NDT (253) 854-5660
MSPT, C/NDT IG STANDING COMMITTEES
San Jose, CA glpin@mac.com
Lakewood, WA Grievance Committee Chair:
(253) 582-5776 (408) 646-0286 Phone Timmie Wallace, PT, C/NDT
anisa@msn.com rcortise@yahoo.com MEMBER AT LARGE / Peer Review/Quality Assurance
EDUCATION Committee Chair: Karen Brunton, PT, C/NDT
SECRETARY / TREASURER / MEMBER AT LARGE / Sara Kerrick, MPT, C/NDT Theory Committee Chair: Judi Bierman, PT, DPT,
FINANCE CERTIFICATION C/NDT
Puyallup, WA
Cheryl Peters, PT, MPT, C/NDT Astrid Gonzalez-Parrilla, OTR/L, Curriculum Design Chair: Linda Kliebhan, PT, C/NDT
(253) 697-5200
San Diego, CA C/NDT Course Review Committee: (Co Chairs)
sara.kerrick@multicare.org
(619) 992-6961 Phone Fort Myers, FL Beth M. Tarduno, MS. Ed., OTR/L, C/NDT and
cheriepeters2011@hotmail.com (239) 343-3675 Phone Wendy L. Kline, OTR/L, C/NDT
MEMBER AT LARGE /
astrid.gonzalez-parrilla@
IG Chair leememorial.org RESEARCH
Lauren Miller Beeler, PT, DPT, Sue Ann Muenks, OT, C/NDT
PCS, C/NDT Houston, TX
NDTA OFFICE
Cypress, CA (832) 309-6289 Phone 1540 S. Coast Hwy, Ste. 203
(714) 893-7399 Phone smuenks@caregrp.com Laguna Beach, CA 92651
sctdir@cox.net 800/869-9295 • 949/376-3456 Fax
info@ndta.org • www.ndta.org

N D T A C O M M I T T E E C H A I R P E R S O N S

CENTERS OF EXCELLENCE CURRICULUM NATIONAL CONFERENCE

Tori Rosenthal, DPT, C/NDT Linda A Kliebhan, PT, C/NDT PLANNING
torirosenthal@yahoo.com lindakliebhan@yahoo.com Kimberly Westhoff, OTR/L, C/NDT
dkwest4@gmail.com
CERTIFICATION THEORY
Carmen Pagan, SLP, CCC-SLP, C/NDT Judith (Judi) C. Bierman, PT, DPT, C/NDT EDUCATION
Carmen@milestonestx.com ndtprograms@gmail.com Sara Kerrick, MPT, C/NDT
sara.kerrick@multicare.org
RESEARCH INSTRUCTOR GROUP EXECUTIVE
Janet Powell, OTR/L, PhD, C/NDT COMMITTEE PUBLICATIONS
jmpowell@u.washington.edu Lauren Miller Beeler, PT, DPT, PCS, C/NDT Marcia Stamer, PT, MH, C/NDT
sctdir@cox.net paul-stamer@att.net
MEMBERSHIP
Julie Ricklefs-Haggerty, DPT, PCS, C/NDT FINANCE
juliehaggerty@aol.com Cheryl Peters, PT, MPT, C/NDT
cheriepeters2011@hotmail.com

Views expressed in the NDTA Network are those of the authors and are not attributed to the NDTA, the Chair of Publications or the Editor, unless ex-
pressly stated. The NDTA does not endorse any non-NDTA instructors, courses, educational opportunities, employment classifieds, products or
services mentioned in the NDTA Network. Copyright © 2014 by the Neuro-Developmental Treatment Association. Materials may not be reproduced
without written permission from the Editor.

NDTA NETWORK • JANUARY/FEBRUARY 2014 • DEVELOPING THE PLAN OF CARE • 2

ABOUT THE
M E S S A G E F R O M T H E P R E S I D E N T
NDTA™ NETWORK
A subscription to the Network, which is published
six times annually to more than 2600 members, is
included in every NDTA membership. Copies of
archived articles/editions dating back to 1998 are
available online. Developing the Plan of Care
EDITORIAL INFORMATION
We invite members and non-members to submit ar-

In
ticles, ideas and comments to the editor. Editorial
all honesty, my private practice of pedi- The function of a
assistance and guidelines are available for writers.
Marcia Stamer is the NDTA Publications Committee atric physical therapy often includes a plan of care is closely
Chair and Network Editor. Contact Marcia via email
plan of care that is a quickly written statement associated with NDT
at paul-stamer@att.net.
of frequency and duration on a quite lengthy practice. It is a require-
ADVERTISING INFORMATION
report. Each child’s initial report is about 8- ment for therapists to
To reach health care professionals who practices
using NDT, advertise your products, services, em- 10 pages in length with a large portion dedi- deliver intervention
ployment classifieds, educational opportunities
cated to examination and data collection, eval- appropriately and is a means to communicate
and NDTA-approved courses in the Network. All
ads are placed on a first-come, first-served basis. uation and analysis, noting functional the necessity of services. It is also a critical
Payment is required prior to insertion. assessment and clinical analysis, listing of goals element of the NDT Practice Model for
DISPLAY AD RATES and objectives, and descriptive intervention. guiding both the therapists and the client
Advertise your products and services in multiple
My plan of care takes not more than a few and family towards meaningful outcomes.
themed issues to maximize your investment.
For more information or to place your ad, contact sentences and is typically dictated by variables
the NDTA Office at (800) 869-9295, ext. 314, or including the family’s schedule availability,
email advertise@ndta.org.
resources for payment (third party payers or
Space Per issue 4 or more issues
Full page . . . . . . $800 . . . . . . $600 per issue self-pay capability), and timeframe for
Half page . . . . . . $500 . . . . . . $400 per issue projected outcomes. I realize that this varies
Quarter page . . $350 . . . . . . $250 per issue
from each individual’s practice setting and Jennifer Inglett, PT, DPT, PCS, C/NDT
EMPLOYMENT CLASSIFIEDS experience level, but perhaps you also feel the President, NDTA
Have an open position? Find your next employee
here. NDTA members can place employment clas- same about a briefly written plan of care.
sified ads for $100 for the first 50 words, plus $1 In rev iew ing Neuro-De velopmental resourCes
for each additional word. Non-members may place
classifieds for $150 for the first 50 words, plus $1
Treatment Approach: Theoretical Foundations 1. Howle JM. Neuro-Developmental Treatment
for each additional word. Placement is for one issue and Principles of Clinical Practice, I am Approach: Theoretical Foundations and Prin-
of the Network and 60 days on the NDTA website.
reminded that the plan of care is inclusive of ciples of Clinical Practice. Laguna Beach, CA:
Longer placement is available for an additional fee.
For more information or to place your ad, contact not only frequency and duration of services, The North American Neuro-Developmental
the NDTA Office at (800) 869-9295, ext. 314, or
but also anticipated goals and specific inter- Treatment Association; 2002.
email advertise@ndta.org.
ventions based on interpretation of the exam-
EDUCATIONAL OPPORTUNITIES
Organizing a workshop? Your educational opportu- ination and evaluation process in collabo-
nity can be placed in one issue of Network for $250. ration with the client and caregivers. Some
This is a text advertisement of no more than 200
words. The NDTA reserves the right to refuse the of the elements to developing a plan of care
publication of any advertisement it does not deem include: identifying and prioritizing critical
appropriate. Longer placement is available for an ad-
ditional fee. For more information or to place your impairments and functions that can be
ad, contact the NDTA Office at (800) 869-9295, ext. addressed in NDT treatment, recommending
314, or email advertise@ndta.org.
frequency and duration, setting team func-
ARTICLE & ADVERTISING DEADLINES
Copy received after the dates specified will be
tional outcomes and goals, identifying
considered for the following issue. Contact us for strategies the client is currently using and
current deadlines and special opportunities for
suggesting alternatives, identifying measures
NDTA Corporate Partner members!
to promote wellness, describing the role of
Marcia Stamer the family and others involved in the client’s
Editor, NDTA Network
Chair, Publications Committee care, and means for re-examination.1
2949 Millboro Rd., Silver Lake, OH 44224
330-923-0696
paul-stamer@att.net

NDTA NETWORK • JANUARY/FEBRUARY 2014 • DEVELOPING THE PLAN OF CARE • 3

 N D T A N E W S

IS YOUR FACILITY A CENTER OF EXCELLENCE?

NDTA proudly continues the Centers of Excellence program by linking NDT to
education and research, therapy facilities and clients, and membership and
NDTA. To be considered a Center of Excellence your facility must meet the basic
requirements:
• Your center must be a Facility Partner. A Facility Partner is an NDTA
membership category for a group of therapists under the same employer.
• Ideally, your facility must have a minimum of four NDT certified therapists
currently employed, representing two of three disciplines (OT, PT, SLP). Facil-
ities that do not meet this minimum criterion are still encouraged to apply.
• Your facility must have the ability to host an NDTA educational course (seminar,
certificate, or advanced course) a minimum of once every 12 months.
• Your facility must have the ability to submit one article to the Network a
minimum of once every 12 months.
• Your facility is encouraged to host one NDT study group per 12 months.

For more information on centers of Excellence and to receive a copy of the application packet,
please contact the National Office or visit www.ndta.org/COE.

INTERESTED IN BECOMING
NDT CERTIFIED™ ?
Great, let’s get you started! Certification is available to those who currently
hold active NDTA membership and have successfully completed either the
Peds or Adult Certificate course.

HOW DO I APPLY FOR NDT CERTIFICATION?

First, you must login to your NDTA membership account and select the “Get
NDT Certified” link on the right hand side of your My Account page. Then
proceed with the steps of entering in your Certificate course information. The
final step will be to pay the $150 fee. Once approved your certification will be active for 3-years (active
membership is required all 3-years of certification).

HOW DO I RE-CERTIFY?
In order to recertify you will need to hold active membership, have 20 hours of continued education
and pay the $150 re-certification fee. Of the 20 required hours, a minimum of 8 hours must be of NDT
training and the remaining 12 hours can be profession-related. For more detailed information regarding
recertification, please visit the NDT Certification home page at www.ndta.org.

NDTA NETWORK • JANUARY/FEBRUARY 2014 • DEVELOPING THE PLAN OF CARE • 4

 N D T A N E W S

By the NDTA Membership Committee

NDTA’s Membership Committee highlights an NDTA member each edition of the Network. This edition’s
member spotlight will be shining on Vanessa Passos. Vanessa is a physical therapist specializing in treating
adult hemiplegia throughout the continuum of care. She graduated with a Bachelor of Science degree in
business and a Master of Science degree in physical therapy from Florida Gulf Coast University. She is an
active clinical instructor for PT students and mentor for new staff at The Rehabilitation Hospital. The
Rehabilitation Hospital is part of the Lee Memorial Health System in Fort Myers, Florida. Lee Memorial is
an NDTA Center of Excellence for the adult population.

Q: What is your discipline? Q: How did you change the way you treat patients after taking
A: Physical Therapist your NDT course?
A: I was better able to integrate function and participation
Q: What setting do you currently work in?
into evaluation and treatment.
A: I work at an Inpatient Rehab Facility

Q: How long have you been practicing?
A: Six years
Q: How did you become aware of NDT?
A: I became aware of NDT through my pediatric internship
as a PT student. My pediatric internship was with Debbie
Flannigan-Thornton at Naples Community Hospital (Green
Tree Plaza), which allowed primarily pediatric neuro and one
day a week adult TBI exposure through their day program.
This was a voluntary additional rotation for which, I believe,
made a huge difference in my clinical experience.
Q: When did you take your first NDT course?
A: I took my first NDT course in fall of 2010. It was an Adult
Hemiplegia course by Kay Folmar that was hosted by Lee
Memorial Health System. Since then, I have completed both
advanced and master classes with Kay and have attended the
last two NDTA conferences. At the last conference, I submitted
a poster presentation.
Q: Can you describe the approach that you take to treat or look
at your patients?
A: It’s a compilation of a functional problem solving approach
with reflective practice.
Q: What would be the one thing about NDT that you would tell
a therapist who is interested in learning more about NDT
treatment techniques?
A: It’s a thorough problem solving approach that promotes
effective and efficient strategies while engaging your patients
in their participation roles. It prioritizes impairments and
promotes function.
Q: Can you tell us how much influence NDT has had in your career?
A: It has enriched my clinical rationale, expanded my profes-
sional goals and engaged my passion to consistently promote
skilled interventions to all survivors of stroke throughout the
continuum of care. ■

NDTA NETWORK • JANUARY/FEBRUARY 2014 • DEVELOPING THE PLAN OF CARE • 5


U P C O M I N G N D TA S E M I N A R S
FEBRUARY 28-MARCH 1, 2014
Blending NDT and Modified CIMT
Interventions to Enhance Function for
Children with Hemiplegic CP
MUSC – College of Health Professions,
Charleston, SC
MARCH 15-16, 2014
Starting Out Right, Using NDT Treatment
with Infants and Young Children
St. Luke’s Rehabilitation Institute, Spokane, WA
APRIL 25-26, 2014
Functional Changes Through Aquatic
Therapy: An Intermediate Level Course
Children’s Mercy Hospital, Kansas City, MO
MAY 9-10, 2014
Using the Ball for Therapeutic Intervention
for Children with Movement Disorders
The HSC Pediatric Center, Washington, D.C.
JUNE 12-14, 2014
Rib Cage: Focus on the Rib Cage for
Improvement in Respiration, Phonation,
Postural Control
Allied Integrated Health System/Heinz Rehab,
Wilkes Barre, PA
REGISTRATIO N O PEN!
Register online at www.ndta.org or fax your form into the National NDTA™ office at 949/376-3456
NDTA NETWORK • JANUARY/FEBRUARY 2014 • DEVELOPING THE PLAN OF CARE • 6
N D T A N E W S
NEURO-DEVELOPMENTAL TREATMENT ASSOCIATION
JUNE 27-29, 2014
An NDT Guide to Baby Treatment
MedCare Pedatric Group, Stafford, TX
JULY 31-AUGUST 1, 2014
Neuro-Developmental Treatment Approach
to Infants and Toddlers
County of San Bernardino/Therapy Unit, Hesperia, CA
OCTOBER 17-19, 2014
Rib Cage: Focus on the Rib Cage for
Improvement In Respiration, Phonation,
Postural Control
Arlington Pediatric Therapy, Arlington Heights, IL
SEPTEMBER 26-27, 2014
Using the Ball for Therapeutic Intervention
for Children with Movement Disorders
Children’s Therapy Unit/MultiCare Good Samaritan,
Puyallup, WA
OCTOBER 17-19, 2014
NDTA C/NDT Master Class: Is the Arm
Really Connected to the Leg?
Texas Children’s Hospital, Houston, TX

Developing a Plan of Care One Step at a Time (continued from page 1)
peutic intervention the child needs on a weekly basis and
whether he or she is at risk for potential regression at this time.
When determining the most appropriate duration of treatment,
the therapist also takes into account the patient’s current period
of skill acquisition, his or her medical needs, and any caregiver
and/or patient barriers that may negatively impact the treatment
plan. The frequency and duration may be adjusted due to the
identified barriers, including any insurance limitations.
Throughout the duration of treatment, a patient’s progress
towards goals is assessed continuously to determine the effec-
tiveness of the current treatment approach and the frequency
or duration of therapy may be adjusted as necessary.
frequenCy Models aT our faCiliTy
Weisman Children’s Rehabilitation utilizes four models of
frequency when implementing Episodic Care. These models
[W]e have found that reviewing the patient’s plan of care at the time of the
progress evaluation prepares the family and eliminates some of the fear
caregivers may experience when the discharge date arrives.
are Intensive, Weekly, Periodic, and Consultative. Intensive
therapy is offered 3 or more times per week and is utilized for
a patient after an acute injury or illness and/or for a patient
quickly accomplishing their established goals. Weekly therapy
is offered 1 to 2 times per week and is ideal for a patient with
the potential for consistent progress utilizing a home exercise
program, which is performed daily by the family. Periodic
therapy is provided at regularly scheduled intervals (e.g., bi-
weekly) and is appropriate for children who are progressing
more slowly towards their goals. These patients typically need
a longer time between therapy sessions to practice a skill within
their activities of daily living. Consultative therapy is an appro-
priate recommendation for children who are making minimal
progress but need to be reevaluated periodically or when an
update to their current equipment or technology is warranted.
planning Care wiTh The Caregivers
The details of the established treatment plan, including the
duration and frequency of services and the therapy goals for the
Episode of Care, are reviewed with the caregivers at the time of
the initial evaluation. Given that active caregiver participation
NDTA NETWORK • JANUARY/FEBRUARY 2014 • DEVELOPING THE PLAN OF CARE • 7
F E A T U R E A R T I C L E
during treatment sessions and home practice activities are essential,
the therapist must gain the caregivers’ commitment to the
treatment plan. The therapist provides all of the information
discussed to the family in a written brochure format. The caregivers
are then asked to sign this document which serves as a contract
and signifies their commitment to the treatment plan.
During each treatment session, the therapist routinely reviews
the patient’s progress towards the goals and updates the home
program as necessary. The caregivers are provided with written
educational materials whenever possible to support what was
reviewed during the treatment sessions. Ideally, families participate
during each treatment session. This participation allows for the
practice of the therapeutic interventions prescribed for home
exercise along with the therapist to ensure caregivers’ complete
understanding and confidence in facilitating the targeted skill.
While conversations about progress are happening during
each treatment session, the therapist must also complete a
formal progress evaluation with the patient and caregivers a
few weeks before the established ending date for the plan of
care. This evaluation establishes the next step for the patient.
Some possibilities for the next step may include: a discontin-
uation of services, a transition from one service to another, a
discharge from therapy services, or the start of a new episode
of care with advanced goals. A discontinuation of services may
occur when the patient is making minimal progress towards
the established goals and/or the goals are not achieved. Many
times, this is a result of patient or caregiver barriers such as
poor attendance, non-compliance with a home program, and/or
financial hardship. The therapist will make every effort to make
adjustments to the plan of care and provide ongoing parental
education as needed at this time to facilitate progress and
accommodate for any newly identified patient or caregiver
barriers to treatment. However, if these attempts fail, a discon-
tinuation of therapy services is typically recommended.
A transition of therapy services may occur when the therapist
and/or caregivers feel the patient may benefit from a different
therapy frequency or another therapy (continued on next page)
 F E A T U R E A R T I C L E

Developing a Plan of Care One Step at a Time (continued)

service. For instance, a speech-language pathologist may
recommend that a patient receiving dysphagia services to treat
a sensory-behavioral feeding disorder participates in an occu-
pational therapy evaluation to address the patient’s global sensory
needs. The speech pathologist may also recommend that the
patient return for a dysphagia re-evaluation in 3 to 6 months
following his or her participation in occupational therapy.
Finally, the completion of a progress evaluation may result
in the therapist recommending that the patient be discharged
at the end of the established duration of the current episode
of care. Discharge is recommended when a patient has achieved
his or her goals and when establishing additional goals is not
considered clinically appropriate at this time.
Following the completion of the progress evaluation, the
therapist will review the patient’s progress towards the estab-
lished goals and review the set discharge date with the caregivers.
This is an excellent time to map out the plan for the remaining
duration of the episode of care and also answer any questions
and/or concerns the family may have at that time. At Weisman
Children’s Rehabilitation Hospital, we have found that reviewing
the patient’s plan of care at the time of the progress evaluation
prepares the family and eliminates some of the fear caregivers
may experience when the discharge date arrives.
When the discharge date arrives, the therapist often times
makes recommendations for the patient to return for a follow-
up evaluation. This follow-up typically occurs 3 to 6 months
post discharge date. Upon reevaluation, the therapist is able
to determine whether a new episode of care is appropriate at
that time. The caregiver(s) also bring forth new functional
goals for the patient and again the therapist and caregivers
work together to take the next step.
suMMary
Overall, episodic care is a “one step at a time” approach for imple-
menting a patient’s plan of care. This approach emphasizes parental
involvement during treatment and is an essential component to
the success of this model. From the time of initial evaluation, the
family is asked to commit to the treatment plan. They are included
in the goal writing process and empowered by the therapists to
complete daily practice through the use of a home exercise program.
In this model, the caregivers and therapists truly work together
as a team to address the patient’s functional goals. ■
Abby Leibrand, PT, DPT is the Clinical Educator for the Physical
Therapy Department at Weisman Children’s Rehabilitation Hospital.
Jennifer Tenney, M.S., CCC-SLP is the Assistant Director of
Outpatient Services and Senior Speech Therapist at Weisman
Children’s Rehabilitation Hospital.
Weisman Children’s Rehabilitation Hospital is a leading
provider of pediatric rehabilitation services in the Delaware
Valley. Rehabilitation therapy for children from infancy through
teens is provided through four outpatient pediatric rehab
centers, medical day care facilities, as well as an inpatient and
day hospital program located in the Southern New Jersey Area.

NEURO-DEVELOPMENTAL TREATMENT ASSOCIATION

THE NDTA CONSUMER CATEGORY

COMPLIMENTARY MEMBERSHIP PROGRAM
The NDTA continues the Consumer Category Complimentary Membership Program. A membership will
be provided at no cost to new applicants in the NDT Consumer Category of membership for one year.
This consumer membership category is comprised of non-therapist individuals including parents, patients,
spouses, or caregivers who support NDTA and its goals. Current NDTA members are asked to invite their
clients, patients, and families of those with neurological impairments to visit NDTA.org and apply for the
consumer membership category. Once their application has been approved, membership will be granted
for one calendar year from date of acceptance. Once a member, they receive full access to members-
only webpages and the newly expanded and redesigned family/caregiver site full of articles and resources.
They also receive membership discounts on most NDTA educational products.

Visit www.ndta.org or call 800-869-9295

NDTA NETWORK • JANUARY/FEBRUARY 2014 • DEVELOPING THE PLAN OF CARE • 8
 F E A T U R E A R T I C L E

A Child, a Family, a Therapist,

and a Plan of Care
Benefits of a team approach
By AmrutaThatte, PT, C/NDT

I work with a young girl named Samaira who is five years

old. She has spastic diplegia and functions at Gross Motor
Function Classification System Level III. She has a twin brother.
He has developed typically and is now a first grader. The twins
were born via C-section, with Samaira delivered four minutes
after her brother. The C-section was necessary due to malpo-
sitioning. Samaira’s motor delay was noted by the family at the
age of 13 months, as she did not achieve sitting. Her pediatrician
advised her family to begin therapy.
saMaira’s faMily
Samaira lives on the fourth floor of an apartment. They do
not have a lift in their building, and her mother has to carry
her everywhere she goes. She lives in a joint family with grand-
parents, uncle, aunty, and her cousins. Her mother had a tough
There were issues with acceptance that Samaira was born
with special needs and required specific care to meet them.
This further delayed the intervention and the therapy in total.
Samaira is the princess in her family. They never allowed her
to cry or to struggle for her wishes. If she would cry, her parents
would discontinue the therapy. They still get worried when
they see her crying. But they also know that crying is Samaira’s
learned behavior to avoid therapy.
Samaira is loved and cared for a little more than the other
kids in the house. Initially when Samaira came in for therapy,
her mother was reluctant to start the therapy as they had been
to other places, and there was no result. She would howl and
cry, resisting the therapy. With us also she cried, but then in a
couple of weeks she became accustomed to the exercises. Her
mother also understood that therapy was necessary and needed

With time, all the family members also started taking interest in
her rehabilitation, and they began to give me goals that they wanted
Samaira to achieve.

time convincing the family members of the benefits of Samaira’s
therapy, as they were very sure that whatever was said and done
would not improve Samaira. We had to work a little extra to
prove to her family that a change was possible with some effort.
The twins were always subjected to comparison – Samaira’s
brother always has the upper hand. Her siblings would boss
Samaira to watch TV or play games on cell phones. Her grand-
parents were very protective of her, handing everything to her
so that she did not move much. They feared that she might
spoil something or end up in a mess. After she went to school,
she was made to sit and study separately, as she was lagging
behind her siblings.
to be continued. But because Samaira’s twin does not have any
disabilities, Samaira’s family members would say that she would
be okay too, so why have therapy?
Then I realized that just explaining to Samaira’s mother or
trying to convince her to continue her daughter’s therapy was
not helping. To convince Samaira’s entire family, I had to
involve them in the rehabilitation program. I requested that
her family members accompany Samaira to therapy. Some
days her uncle would bring her, other days her granny or her
aunt would come along, and near the end of the week it would
be either her dad or grandpa. We also involved her twin in
the therapy, as he would encourage her (continued on next page)

NDTA NETWORK • JANUARY/FEBRUARY 2014 • DEVELOPING THE PLAN OF CARE • 9


A Child, a Family, a Therapist, and a Plan of Care (continued)
to reach out in different directions, play with her, and encourage
her to complete the task.
Along with Samaira, her family members who accompanied
her to therapy would be given a weekly task, such as having her
write numbers from 1 to 10 or drawing her a figure and asking
Samaira to colour it, or taking her to the garden. It was not simply
that her aunt or granny would give something to Samaira; they
also had to attend to the task and make sure that the work was
done. With time, all the family members also started taking
Samaira works . . . and plays in therapy.
interest in her rehabilitation, and they began to give me goals
that they wanted Samaira to achieve. It took almost six months
to get the family together and work for Samaira.
With all the vigorous therapy and home programs, Samaira now does her
task as if it was ever so easy and attempts to stand holding the milkshake
with both her hands without support for about twenty seconds.
planning and inTervenTion wiTh
saMaira and her faMily
When Samaira came to our therapy clinic a year ago, she had
scissoring in her lower extremities, her feet were plantar flexed,
she had very little trunk movement in the transverse plane,
she sacral sat, she would flop onto one side to move in and
out of sitting, and she would pull to stand by weight bearing
on her toes. She had partially restricted shoulder external
NDTA NETWORK • JANUARY/FEBRUARY 2014 • DEVELOPING THE PLAN OF CARE • 10
F E A T U R E A R T I C L E
rotation and forearm supination with a weak grasp. She
showed postural insecurity with a fear of being erect. She is
obstinate, very talkative, and daddy’s girl.
The only task identified for her summer break was to learn
to stand holding a chair at its armrest and drink a strawberry
milkshake all by herself. This was a difficult task but was
selected specifically as this milkshake was the thing Samaira
wanted to reach for.
Selecting this task allowed me to determine a specific plan
of care. Samaira would not have
learned the task just by standing
against a chair. We started with
therapy for Samaira and four months
later she received Botox therapy for
both her lower extremities in her
hamstrings, tendo-achillies, and hip
adductors, and with the plaster casts
on, we started with exercises in long
sitting, legs abducted,picking up toys
from one side and dropping them on
the other side, reaching with both
hands in front and behind; prone on
a ball, reaching up and to the front;
and prone to sit on the ball.
Once the plaster was removed, she
underwent vigorous therapy sessions
twice a day. We assisted her with reaching activities with disso-
ciated standing, stepping up, sit to stand, and reaching up for
her teddy bear, walking up the bolster placed inclined on a bench,
and bear walking on the floor. Small goals were set to be attained
for a duration of two to three weeks. With continued therapy,
her sitting improved. Now she only needs a reminder to sit erect.
She also improved in her supported standing. She learned to
transition from half kneel to stand. We also used activities such
as balancing over the tilt board with moderate support, one leg
standing, transitions such as bear stand to standing upright,
quadruped to half kneel to bear stand to (continued on next page)
 F E A T U R E A R T I C L E

A Child, a Family, a Therapist, and a Plan of Care (continued)

Samaira demonstrates her new standing skills.

stand, bear climbing up the exercise balls, crossing a small bolster,

and stepping over a small table with support.
Back home, she was asked to write capital letters and small
letters in a four-line notebook, do math workbooks to learn
writing numbers, draw and colour, make hand prints on the
paper, bang the table with both hands alternately, eat by herself,
open a lock with the key, play a piano, make toys with clay, and
play games such as catch the ball and kick the ball. She was
asked to wear her hip abduction/knee extension splints for
about 6-7 hours a day.
000 000 0

saMaira and her faMily Today

Samaira’s family is now very supportive of therapy, and they
motivate her to co-operate. They also divert her at times by talking
about her favorite cartoon series or her favorite food. Her father Client, Family, and
sometimes bribes her with a chocolate box or a surprise gift.
With all the vigorous therapy and home programs, Samaira Advocacy Links
now does her task as if it was ever so easy and attempts to stand
holding the milkshake with both her hands without support for
about twenty seconds. And yes, Samaira is now bored with the
milkshake. She now aims for the chocolate and blueberry donuts
O N LIN E!
kept on the top shelf of the refrigerator and so do we. ■ These links offer clients, parents, and caregivers
access to reliable health care information and
Amruta Thatte, PT, C/NDT is an NDT Certified physical general advocacy resources.Visit today at:
therapist associated with Sukrut Pediatric Rehabilitation
Center, Vadodara, Gujarat, India. She can be reached at www.ndta.org/familylinks.php
coolamu8988@gmail.com.

NDTA NETWORK • JANUARY/FEBRUARY 2014 • DEVELOPING THE PLAN OF CARE • 11

 F E A T U R E A R T I C L E

NDT in Action
excerpts aBout the plan of care

These excerpts are reprinted with permission from the forthcoming book NDT in Action.The plan of care is presented in the book
within the context of the NDT Practice Model. These excerpts serve only as glimpses into the book’s content, which includes NDT
practice and case report examples.

Stamer M. Evaluation and developing the plan of care. In: ■ prepare for the next intervention session
Bierman J, Franjoine MR, Hazzard C, Howle J, Stamer M, eds. ■ educate the client and family
NDT in Action. Forthcoming. ■ advocate for the client’s civil rights and personal needs
So far in the examples in this chapter, the clinician wrote a • Referral, discussion, and planning with other team members
prioritized list of functioning → disability in all domains that to address intervention and management needs of the client
relates to current function/dysfunction, long and short term and family
outcomes, and a range of prognoses. Now the clinician docu- • Anticipated assistive technology and intervention strategies
ments the following: needed to optimize outcomes
• Length of session, frequency of sessions (number of sessions • Date of next formal re-examination and re-evaluation with
per week or month), and duration (episode of care). measurement of outcomes
Although this determination is made according to outcomes • Discharge planning (continued on next page)
and the client and family’s abilities to
engage in intervention and management
sessions, often third party payers and family
financial and time resources weigh heavily
The plan of care organizes intervention around
in determining session length, frequency, Information Gathering, functional outcomes. The clinician then
and duration. Examination, Evaluation determines specific intervention strategy
• A general outline of intervention strategies choices and combinations of strategies to
to address the impairments, activity limita- address the domains of functioning that
tions, and participation restrictions in the interfere with the outcomes. Clinicians may
context of the client and family when inter- address single system impairments, the
Management interaction of system impairments, activity
vention is the choice of client management.
Direct Intervention is One Option limitations, and participation restrictions with
This includes time with the clinician and intervention strategies. The clinician determines
activities recommended outside of inter- the ordering of the selected strategies.
vention sessions to Constant evaluation of the client’s responses to
■ practice newly learned portions or entire intervention determines future choices of
Intervention Strategies Sequenced
posture and movement sequences within According to Plan and to Constant strategies, what to practice outside of
Client Responses intervention sessions, and strategies to interact
functional activities and participation
with society. This happens within each session
■ address impairments, activity limitations,
Practice Schedule and Advocacy
Outside Intervention Planned as well as across sessions.
and participation restrictions that require
time or place to complete (i.e. night
splinting for muscle length, ability to sit
for an hour or two at a time, ability to
A general intervention plan of care
eat a meal in a favorite restaurant)

NDTA NETWORK • JANUARY/FEBRUARY 2014 • DEVELOPING THE PLAN OF CARE • 12


NDT in Action (continued)
The following information is in the “Evaluation
and Developing the Plan of Care” chapter and
is based on the case report presented later in the
book by Karen Guha and Sherry Rock.
J.W. is a 51-year-old woman post stroke. After
information gathering, examination, and eval-
uation, her PT and OT focused intervention
on outcomes that J.W. saw as requirements for
return to work: putting on a coat, typing speed,
walking with or without an assistive device on
a large university campus, negotiating stairs.
Bierman J, Franjoine MR, Hazzard C, Howle J,
Stamer M. NDT intervention – A session view.
In: Bierman J, Franjoine MR, Hazzard C, Howle
J, Stamer M, eds. NDT in Action. Forthcoming.
Intervention is the part of the plan of care that
the clinician puts into action strategies to
address the restrictions in participation, limi-
tations in activity, and impairments in body
systems. During the intervention session, the
clinician applies procedural knowledge to
achieve functional outcomes that have been
written in the plan of care, with problem
solving in the moment to address the thera-
peutic needs of the client in all ICF domains:
participation, activity, and body systems, in
functional contexts. All domains are addressed
within each intervention session.
The session outcome forms the foundation from
which the session is planned, designed, imple-
mented, and evaluated. It is an independent,
stand-alone measure of performance for the
client. The session outcome provides a frame
of reference, an expectation of what is to be
achieved during the therapy session. Work
within an intervention session sets the stage for
motor learning. ■
F E A T U R E A R T I C L E
The functional outcome for intervention is
JW Outcome determined first because the plan of care and
Putting on Coat its subsequent intervention strategies are
specific to the outcome. The strategies
indicated show what J.W.’s therapists
hypothesize will be necessary for her to
accomplish in order to put on her coat.
Intervention choice is procedural; client Intervention strategies that address
instructions; team communication impairments, often within functionally
simulated tasks, are ordered in this case:
• postural stability work
• mobility of restricted motions while
continuing active postural work
Plan of Care for procedural inter-
vention for putting on coat includes • closed chained and then modified closed
strategies to increase proximal chained UE movements
stability in trunk, shoulder, and hip; • open chained UE movements
sustain activity in scapular depres- • practicing portions or all of the task of
sors, elbow extensors; stretch shoul- putting a coat on
der internal rotators, progress to
closed chain movement then open • home program: management of tasks she
chain movements can complete on her own (or with help of
a family member)
Intevention Choices
Activities often interweave and are
modified as client changes
• Closed chain upper extremity activi-
ties to facolitate scapular stability
and elbow extension
• Simultaneous stretching of shoulder
internal rotators
• Change body postures and move-
ment plane/direction while continu-
ing UE closed chained activities
• Modified closed chain with UE while
surface and/or hand moves
• Progress to distal UE open chain
movements including practice with
portions or all of targeted outcome
(putting on coat)
• Home program to reinforce portions
of posture and movement that
could be achieved on her own
• What time of day and where to
practice part or all of putting on
coat
J. W.’s plan of care
NDTA NETWORK • JANUARY/FEBRUARY 2014 • DEVELOPING THE PLAN OF CARE • 13
 N D T A N E W S

nDta approVeD courses now online!

the nDta Board of Directors and education committee are excited to announce that the nDta Distance
learning program (online education) has expanded to now include streaming video!
the nDta Distance learning Videos are an online mechanism for providing continuing education credit
for courses regarding topics of interest for therapists that are felt to be relevant and appropriate for review.
access them through www.ndta.org/distance-learning. these videos are awarded ceus by the
nDta for use in the nDt re-certification program only. on completion of the online course, the indicated
number of ceus will automatically be added to your ceu Bank in your nDta membership account.

ViDeos
integrating ndT with other adjuncts: optimizing extremity function
christine cayo, otr/l, c/nDt & mary hallway, otr/l, c/nDt • 2 ceu credits available

getting the Best out of every Child: emphasizing function for the
Child with severe Challenges
Jane styer-acevedo, pt, c/nDt • 2 ceu credits available

online ceu articles

The language of disability

stacey lehrer, med, otr/l, atp • 1 ceu credit available

The Conceptualization of ndT-Based handling Techniques for infants: Two perspectives

Gerard J Demauro, ms, pt, c/nDt • 1 ceu credit available

The relationship of the quality of posture and Movement to outcomes of intervention

marcia stamer, mh, pt, c/nDt • 2 ceu credits available

Cerebellar pathophysiology in Children Born preterm: implications for ndT practice

marcia stamer, mh, pt, c/nDt • 1 ceu credit available

integrating Motor development, Motor Control, and Motor learning

Theories in ndT practice
sara Kerrick, pt, pcs, cnDt • 2 ceu credits available

social participation and quality of life in adults with Cerebral palsy

laura K.Vogtle, phD, otr/l, faota • 1 ceu credit available

www.ndta.org/distance-learning

NDTA NETWORK • JANUARY/FEBRUARY 2014 • DEVELOPING THE PLAN OF CARE • 14


How the NDT Certificate Course Changed My Professional Life... (continued from page 1)
and phobias are common among people with this disorder.
Kabir has developmental delay and other sensory issues. He
is unable to play when standing with his cousins. In play group,
he is unable to run and play with his peers. He has attention
deficit. He gets easily distracted to even small noises or small
movements in his surroundings. He is irritable when he is unable
to play with his cousins or peer group or when he doesn’t get
things he wants. He is fearful of falling and is not comfortable
doing exercises on a therapeutic ball, especially in standing. His
family wants him to run and play with his peer group in school.
Until I joined the NDT course, I was treating him with
strengthening exercises for his abdominal obliques on the
therapy ball in supine, quadriceps strengthening with sit to
stand, and standing and reaching with weight shifts. He was
not enjoying treatment sessions. I did not choose age appro-
He started enjoying the sessions when I included play in therapy.
priate toys for him to play with. But seven weeks with Jane
Styer-Acevedo in the NDT course changed my abilities to
observe, assess, and handle patients. I learnt the three ‘Fs’ during
the course: FUNCTION, FUN & FACILITATION.
As I returned to work after the course, I worked on Kabir’s core,
especially on the obliques, since he was using the rectus more than
his obliques. We worked on alignment of his feet, knees, and hips.
After therapy, his feet were aligned neutral from supination, and
he could coactivate his postural muscles, especially the gluteals
and abdominals. I could facilitate movements with play using
games of ball throwing and puzzles. He started enjoying the sessions
when I included play in therapy. He responded well in just three
sessions. He stood with support and walked with neutral alignment
of his feet and his knees extended rather than hyperextended. His
hips were extended and mildly externally rotated, and his pelvis
was neutrally aligned. His lumbar spine was extended, and his
thoracic spine flexed while holding onto a chair in front of him.
His parents were amazed to see these changes in three sessions.
As I’ve treated him only for three sessions post NDT, I’ve not yet
given any ideas about a home program. But I’ll continue to see
him three times/week for 45 minute sessions. I predict that he
may go to school within a year by himself and will be able to take
part in school activities but his short attention span may interfere
with his learning. He has a great interest in music, and we hope
NDTA NETWORK • JANUARY/FEBRUARY 2014 • DEVELOPING THE PLAN OF CARE • 15
C L I N I C I A N ’ S C O R N E R
that he continues to enjoy it as he grows.
NDT taught me about function and facilitation. As I work
with Kabir and my other challenging kids coming to me for
treatment, I see them changing within a week. NDT allows
changes in many families’ lives like Kabir’s. Facilitation and
fun contribute to his function. And the changes give me positive
feedback for myself. ■
Kaushal Bhatt completed his MPT degree with a paediatric
specialty in 2008 and worked as a lecturer and head of the
paediatric physiotherapy department at CU Shah Physio-
therapy College for two years. He has been a full time clinician
in Bhavnagar, Gujarat since 2010, working with all types of
paediatric conditions, including patients with orthopedic,
cardiac, and neurological impairments. Thanks to mentor Jane
Styer-Acevedo, who added a new dimension to treatment.
Kaushal can be reached at kaushaldbhatt007@yahoo.co.in.
Geographically, he can be reached at: KIDS Paediatric Phys-
iotherapy Centre, 2nd floor, Sukhshanti Complex, Kalanala,
Bhavnagar, Gujarat, India.
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nDta sponsored seminar
THE BEN DABLE BRAIN

PROGRAM INFORMATION
 CONTACT HOURS
SCHEDULE AT-A-GLANCE Friday . . . . . . . . . . 6 hours
Saturday . . . . . . . . 7 hours
THURSDAY, MAY 15, 2014 Sunday . . . . . . . . . 4 hours
Total Available . . . . 17 hours
3:00 – 7:00 pm. . . . . . Registration Subject to change.

7:00 – 9:00 pm. . . . . . Welcome Reception

FRIDAY, MAY 16, 2014

7:00am – 8:00am . . . . Registration and Continental Breakfast

9:30am – 10:30am . . . Exhibitor Showcase and Morning Break
12:15pm – 1:45pm . . . Networking Lunch/NDTA Membership Meeting
3:00pm – 4:00pm . . . . Exhibitor Showcase and Afternoon Break www.ndta.org
6:00pm – 8:00pm . . . . Exhibitor Showcase /Wine & Cheese Reception

GENERAL SESSIONS
8:00 am – 12:00 pm . . KEYNOTE ADDRESS: Brain Plasticity-Based Therapeutics – Dr. Michael M. Merzenich,
Professor Emeritus, UCSF; Director, Brain Plasticity Institute; CSO, Posit Science.

2:00 – 6:00 pm . . . . . . CONCURRENT SESSIONS / LABS

PEDS P1. Handling: A Lot More Than Hands On… Emphasizing the Power of Sensation C/NDT Required

Added Handling to Support Gaining Function

Lezlie Adler, OT, C/NDT
PEDS P2. Tapping into the Postural System C/NDT Required
Margo Prim Haynes, MA, PT, DPT, PCS, C/NDT
Mary Rose Franjoine, PT, C/NDT
PEDS P3. Movement Organization: Starting, Stopping and Synchronizing
Brenda Lindsay, PT, C/NDT
Sheila Frick, OTR/L
PEDS P4. Bouncing Back: A Look at Pediatric Brain Injury
Jacqueline Grimenstein, PT, C/NDT
Kathy Hall-Olsen, MA, CCC-SLP, C/NDT
AH A1. Intervention Doesn’t Need to be a Gamble: Maximizing Your Session C/NDT Required

with the Client for Maximal Functional Gain

Karen Brunton, PT, C/NDT
Cathy Hazzard, B.Sc, MBA, PT, C/NDT
AH A2. Creating Lasting Changes: Considerations from a Whole Body Perspective
Takashi Misuda, PT, C/NDT
Kris Gellert, OTR/L, C/NDT

REGISTER BY APRIL 16 AND SAVE! GO TO www.ndta.org

SCHEDULE AT-A-GLANCE
SATURDAY, MAY 17, 2014
7:00 – 8:00am . . . . Continental Breakfast
9:30 – 10:30am . . . Exhibitor Showcase, Staffed Poster Session, Morning Break
12:15 – 1:45pm . . . Award of Excellence Lunch

GENERAL SESSION
7:00 – 8:00 am . . . . . . Exhibitor Presentations
8:00 am – 12:00 pm . . KEYNOTE ADDRESS: (continued) Brain Plasticity-Based Therapeutics
Dr. Michael M. Merzenich, Professor Emeritus, UCSF;
Director, Brain Plasticity Institute; CSO, Posit Science.

2:00 – 6:00 pm . . . . . . CONCURRENT SESSIONS / LABS

PEDS P1. Blending of NDT and Modified CIMT to Enhance Function C/NDT Required

Margo Prim Haynes, PT, MA, DPT, PCS, C/NDT

Christine Cayo, OTR/L, C/NDT
PEDS P2. Neuroplasticity, Contemporary NDT and Evidence – Interconnected? C/NDT Required

Suzanne Davis, PT, C/NDT

Kate Bain, HScD, OT, C/NDT
PEDS P3. Movement Organization: Starting, Stopping and Synchronizing (repeat)
Brenda Lindsay, PT, C/NDT
Sheila Frick, OTR/L
PEDS P4. The Role of Exercise in Oral Motor Treatment
Rona Alexander, PhD, CCC-SLP, C/NDT
Marybeth Trapani-Hanasewych, MS, CCC-SLP, C/NDT
AH A1. Practice Makes Perfect: Designing Home Programs That Work C/NDT Required

Monica Diamond, PT, MS, C/NDT

AH A2. Upping the Ante: Neuroplasticity Principles that Change Outcomes
Jason Knox, PT, C/NDT

SUNDAY, MAY 18, 2014

10:00 – 10:15 am . . Morning Break

8:00 am – 12:15 pm . . ROUNDTABLE BREAKFAST / GENERAL SESSION

DON'T DELAY REGISTRATION, SESSIONS FILL UP FAST!

To ensure you are able to attend the sessions of your choice, we recommend you register as soon as possible.

N E U R O - D E V E L O P M E N TA L T R E AT M E N T A S S O C I AT I O N
SESSION PREVIEW
Intervention Doesn’t Need to Be a Gamble
MAXIMIZING YOUR SESSION WITH THE CLIENT FOR
MAXIMAL FUNCTIONAL GAIN
CONCURRENT SESSION • FRIDAY, MAY 16, 2014 • 2:00 – 6:00 pm

Presenters:
Cathy Hazzard, C/NDT, NDTA Coordinator Instructor
Karen Brunton, C/NDT, NDTA Coordinator Instructor

How often have you felt that you never have enough time with your patients in acute care or acute rehabilitation
to help them improve to the functional level that you feel they have the potential to accomplish? When faced
with the limited time we have in therapy, do you feel pressured to make choices in intervention that lead to
compensatory recovery versus true functional recovery? Research in the fields of neuroplasticity and neurore-
covery provides us with the evidence that true recovery can happen for our patients. The evidence is limited
but is growing, demonstrating that the long term effects of the use of compensatory movement strategies can
be detrimental, resulting in learned non-use, osteoporotic changes in the hemiparetic limbs, and increased
incidents of musculoskeletal overuse injuries in the less affected limbs. The concerns that the use of compensatory
strategies to achieve immediate functional gains may be detrimental to long term motor recovery has some
researchers further investigating movement quality.

Maximizing our time with our patients in the intervention session by making conscious choices about what
task(s) are practiced, practicing movement components versus movement solutions, setting up the environment
to optimize movement recovery, using our hands to stop what we don’t want and to encourage what we do
want are all components to successful outcomes. This workshop at the 2014 NDTA Conference “The Bendable
Brain” will extrapolate key concepts from the literature known to drive neuroplasticity and motor learning
and correlate implications of these concepts to the structure of an intervention session.

We need to be able to address multiple impairments at the same time while working in functional contexts.
We need to set up practice repetition that provides challenge and offers repetition without repetition. That
is, our patients need volumes of repetition but of functional movements and activities that offer them variety
and progressive challenge. It’s not enough to just have our patients do repetitive sets of exercises. We need
to find practice strategies that can be integrated into our patients’ daily routines on the hospital unit and that
our health care colleagues can support as well.

These choices can be easier than you think if you have a framework to work from. This conference session
will focus on a framework for organizing the intervention session to maximize patient outcomes. The framework
has been developed with consideration of the concepts from the neuroplasticity, motor learning, and NDT
literature. We will focus on the in-patient (acute and acute rehabilitation) settings with discussions about
how to work with all levels of patients in less than ‘real’ environments. ■

REGISTER BY APRIL 16 AND SAVE! GO TO www.ndta.org

 M E M B E R R E S E A R C H

Postural Control in Children with

Autism Spectrum Disorder
By Marcella Nelson, MOT, OTR/L and Mary F. Baxter, PhD, OT, FAOTA

inTroduCTion control deficits. Assessments should also measure general function

Movement and participation in context requires successful
processing of information from multiple sensory sources. The
vestibular, somatosensory, and visual systems contribute to
postural control through perception and responses to these cues.1
Postural control is essential to an individual’s participation in
daily occupations. Postural control is the ability to control one’s
center of mass over the base of support.2
The body’s ability to process information to control one’s center
of mass has been found to be different among children with autism
spectrum disorder (ASD). Sensory-motor deficits in children with
ASD have long been implicated as a cause of motor problems.
The deficits in motor coordination are negatively correlated with
qualitative impairments in social interaction and decreased partic-
ipation and function in everyday activities of children.3
and sensory processing factors which are highly represented in
children with autism. One assessment that measures posture
and sensory processing factors is the DeGangi-Berk Test of
Sensory Integration.
review of liTeraTure
neurobiology of posture
The vestibular, somatosensory, and visual systems are the afferents
involved in the complex process of maintaining upright balance
in humans.4 The sensory organization process of postural control
involves the interplay of one or more of the orientation senses:
vestibular, somatosensory, and vision.1 Adjustments in motor
control involving postural control require the individual to
execute coordinated and properly scaled musculoskeletal

The purpose of this study was to determine if children with autism spectrum
disorder (ASD) demonstrate decreased postural control, sensory processing and
function as measured by the DeGangi-Berk Test of Sensory Integration, the
Sensory Profile and the Pediatric Evaluation of Disability Inventory (PEDI).

Although the current trend in autism research is based around
etiology, a few studies look at postural control deficits in children
with autism. More research needs to occur in order to establish
whether children with autism present with decreased postural
control. Future studies should involve appropriate assessments
to measure postural control. The current literature is limited in
the assessments used to measure this factor: The Movement
Assessment Battery for Children, Peabody Developmental Motor
Scales, Bruiniks-Oseretsky Test of Motor Proficiency, and the
Test of Gross Motor Development are of the most common
assessments reported in studies. Although three of these assess-
ments measure pieces of postural control, their main focus is
gross motor and fine motor function. One can infer from scores
on a gross motor test that a low score could signify postural
responses automatically.1 In order for individuals to make these
adjustments and maintain an upright position, they must process
sensory information correctly during any activity. This processing
is found within the cerebral cortex within several cortical regions.5
neurological impairments in autism
The neurobiology and neuropathology of autism spectrum
disorder remains poorly defined but a few imaging studies (fMRI
and MRI) and post mortem cases have revealed subtle abnor-
malities in the cerebellum, limbic structures, brainstem and
cerebral cortex.6 Other areas of abnormalities include the medial
temporal lobe, thalamus, basal ganglia, and vestibular system.7
A number of studies have found the areas of the brain respon-
sible for posture to be abnormal in (continued on next page)

NDTA NETWORK • JANUARY/FEBRUARY 2014 • DEVELOPING THE PLAN OF CARE • 20

 M E M B E R R E S E A R C H

Postural Control in Children with Autism Spectrum Disorder (continued)

children with autism spectrum disorder. One of the most repli-
cated structural findings in individuals with ASD is increased
total brain volume involving grey and white matter.8 Increased
total brain volume with a decrease in the size of the corpus
callosum in individuals with ASD affects the white and gray
matter of the brain; this has been linked to several clinical features
such as social deficits, repetitive behaviors and sensory abnor-
malities.9 Kemper obtained brain weights of 11 individuals with
autism and noted a significant increase in weight as compared
with a control group.7 Another study reported increased brain
volume and an enlarged head circumference (macrocephaly) of
infants and toddlers diagnosed with autism.10
Sensory abnormalities associated with decreased size of the
corpus callosum will affect an individual’s ability to maintain
an upright posture. The corpus callosum plays a role in commu-
focus to begin studying the effects these abnormalities have on
occupational performance of children diagnosed with ASD and
their effects on postural control, sensory processing and function.
postural Control and function in Children
Postural control serves many purposes, and its focus is on estab-
lishing a boundary between perception and action.13 Postural
control allows an individual to engage in hand functioning activ-
ities found in daily living. Such daily activities for children include
fastening buttons, drawing a picture of an animal, brushing one’s
teeth or hair, playing with Legos® or Barbie dolls and eating
finger foods.
In order for a child to move and engage freely in his or her
world, he or she must not be limited by the inability to sustain
an upright position. The body must be able to remain in an

The results of this study support the hypothesis that children with autism
spectrum disorder have deficits in postural control. In addition, the results support
that children with ASD also have difficulties in function – specifically, self-care and
social function. Lastly, the results characterize children with ASD as having various
sensory processing difficulties.

nicating perceptual, cognitive, learned and volitional information,
and alterations might affect the integration of these functions.9
When overgrowth of the cortical regions of the brain occurs,
growth arrest results in dysfunction of the brain leading to autistic
behaviors.11 Abnormalities in corpus callosum size may demon-
strate atypical neural development, which results in decreased
connectivity and processing of information.
In a report of a 16-year-old boy with autism, slight thickening
of the meninges and thinning of the corpus callosum were
apparent in the lower brainstem.12 Structural MRI studies have
consistently reported reductions in total corpus callosum size in
autism, and more importantly, most studies observed that fibers
originating in the motor cortex crossed through the posterior
half of the corpus callosum.9 With these motor connections
crossing through the altered corpus callosum, the trajectory of
information is impaired, which may cause dysfunction.
Children with ASD have abnormalities in the cerebellum,
corpus callosum, limbic system, and vestibular system and have
enlarged brain volume. These impairments give researchers a
upright position during challenges to stability as in brushing
teeth, combing hair, putting on clothes and putting shoes on.
Normal postural control and postural adaptation involve the
individual producing and controlling movements throughout a
variety of joint ranges.1 A disruption of skilled performance in
handwriting or fine motor skills can be indicative of postural
instability or malalignment of the body. Many children with
autism may show postural asymmetries while sitting and standing,
hindering their performance during tasks. This type of asym-
metrical postural alignment may be due to the presence of inter-
fering reflexes, such as an asymmetrical tonic neck reflex, which
would result in a child’s body being dominated by more extensor
tone on one side of the body14 or it could be a result of decreased
sensory processing or other neurological impairments.
research objectives
The purpose of this study was to determine if children with
autism spectrum disorder (ASD) demonstrate decreased
postural control, sensory processing and (continued on next page)

NDTA NETWORK • JANUARY/FEBRUARY 2014 • DEVELOPING THE PLAN OF CARE • 21


Postural Control in Children with Autism Spectrum Disorder (continued)
function as measured by the DeGangi-Berk Test of Sensory
Integration, the Sensory Profile and the Pediatric Evaluation
of Disability Inventory (PEDI).
MeThodology
participants
The participants (n=4) were children aged five years who had
been diagnosed with autism spectrum disorder (ASD) before
age three using the criteria established by the DSM-IV, a Diag-
nostic and Statistical Manual for Mental Disorders. All four
participants were male and had been receiving occupational
therapy or physical therapy services for no more than 12 months.
The participants were selected from a convenience sample at a
pediatric therapy clinic in Houston, Texas – The Care Group.
The participants were not excluded due to gender or ethnicity.
instruments
This study used three individual assessments: the DeGangi-Berk,
Sensory Profile, and the Pediatric Evaluation of Disability
Inventory (PEDI).
The DeGangi-Berk Test of Sensory Integration is a standardized
assessment measure of postural control, bilateral motor inte-
gration and reflex integration.15 This test is designed for use
with children ages three to five. The DeGangi-Berk is a criterion
referenced test which has an 81% accuracy rate for identifying
dysfunction and a 9% false normal error rate. Based on a sample
of 29 subjects, reliability coefficients of .85 to .96 were obtained
for total test scores.15 This test will determine if postural control
and balance issues are present in the participant. The scoring
for this test is either 0 to 4 or 0 to 3 for each item tested. Items
are then summed per domain (postural control, bilateral motor
integration, reflex integration) or they can be summed for all
test items together. For the purpose of this study only the postural
control domain was administered.
The PEDI is an evaluation tool to assess key functional abilities
of children. The therapist observes mobility, self-care and social
function to measure capability and performance. The PEDI is
standardized on a normative sample, which allows the scorer to
calculate the child’s results using both standard and scaled scores.
This assessment can be used on children from 6 months to 7.5
years old. In a study examining the reliability of the PEDI, the
inter-rater and intra-rater reliability showed excellent agreement,
indicated both by small differences and high intra class correlation
coefficients (ICC) (0.95-0.99).16 Berg found the discrepancies
NDTA NETWORK • JANUARY/FEBRUARY 2014 • DEVELOPING THE PLAN OF CARE • 22
M E M B E R R E S E A R C H
between different interviews was highest among reports from
parents and the kindergarten teachers (inter-respondent reliability)
indicated by ICC from 0.64-0.74.16 The study’s results indicate
that improved reliability is ensured when the same interviewer is
used for the same respondent, as well as when two trained inter-
viewers are used with the same respondent. When two different
respondents are interviewed, their scores should be reviewed for
consistency.16 The researchers suggest that interviewers and
personnel administering the PEDI should be well trained using
the required procedures to ensure consistency and reliability.
The Sensory Profile is a caregiver questionnaire designed to
measure the frequency of behaviors related to sensory processing,
modulation and emotional responsivity to sensory input in
children 3 to 12 years of age.17 Test reliability was established by
calculating internal consistency for each section using Cronbach’s
coefficient alpha. The alpha values ranged from .47 to .9. 17
Content validity was established during development of the
Sensory Profile by including various methods such as literature
review, a review by eight therapists trained in applying sensory
integration theory to practice and a category analysis based on
a national study.17 The Sensory Profile also has both convergent
and discriminant validity, which was established by correlating
the School Function Assessment with the Sensory Profile.
procedure
A sample population of four children aged five-years-old was
obtained. The inclusion criterion was children aged three to five
with autism spectrum disorder who were receiving occupational
therapy and/or physical therapy for no more than 1 year. Informed
consent was obtained from parents prior to participation. The
Pediatric Evaluation of Development Inventory (PEDI) was
performed by each participant’s OTR or PT either prior to the
study or during the study. Each participant’s guardian filled out
The Sensory Profile during a treatment session or prior to the study.
Each participant’s therapist provided the following information to
the researcher at the start of the study: 1) age in months and years
2) official diagnosis and 3) length of services provided. The scores
of the Sensory Profile and PEDI were obtained by the researcher
from the therapists during a designated time. The researcher
performed the standardized DeGangi-Berk Test of Sensory Inte-
gration during a scheduled treatment session within The Care
Group facility. The average length of administration lasted from 30
to 90 minutes. Several participants required two or more sessions
to complete all of the tasks required. (continued on next page)

Postural Control in Children with Autism Spectrum Disorder (continued)
resulTs
All four participants in this study scored with deficiencies in
postural control as measured by the DeGangi-Berk Test (Figure
1). Among the four participants, two of them scored within the
normative range for mobility function and two scored below
the normative range (mean = 31.65; normative range 30-70).
All four participants scored below the normative range for self-
care function (mean = 13.35) and social function (mean =
12.025). Figure 2 provides a visual representation of the scores
obtained from the Pediatric Evaluation of Disability Inventory.
A list of scores from the Sensory Profile can be found in
Figure 3. Among the 23 sensory processing factors tested, all
four participants scored definite difference in vestibular
processing. Three of the four participants scored definite difference
in sensory seeking, inattention/distractibility, auditory processing
and touch processing. Three of the four participants scored
either probable or definite difference in oral sensory sensitivity,
fine motor/perceptual, multisensory processing, oral sensory
processing, modulation related to body position, and movement
and behavioral outcomes of sensory processing. All four partic-
ipants scored typical performance in low endurance/tone, sensory
sensitivity, visual processing, and sensory processing related to
endurance/tone.
Figure 1. Results of the DeGangi-Berk Test of Sensory Integration,
Postural Control Subtest
Postural Control in Children with Autism Spectrum Disorder
DeGangi-Berk Test of Sensory Integration Normal
Postural Control subtest . . . . . . . . . . . . . . . . . . . 0. . . . . . . . . . 4
Figure 2. Results of the Pediatric Evaluation of Disability Inventory
Deficient Postural Control and Function
Pediatric Evaluation Mean of Range of
of Disability Inventory Scores Scores
Self-care function . . . . . . . 13.35 . . . . . . . . 9,9,12.6,22.8 . . . . . . . 30-70
Mobility Function . . . . . . . 31.65 . . . . . . 9,15.40,51.0,51.2 . . . . . 30-70
Social Function . . . . . . . . 12.025. . . . . . . 2.5,9,16.9,19.7 . . . . . . 30-70
disCussion
The results of this study support the hypothesis that children
with autism spectrum disorder have deficits in postural control.
In addition, the results support that children with ASD also have
difficulties in function – specifically self-care and social function.
Lastly, the results characterize children with ASD as having
various sensory processing difficulties.
M E M B E R R E S E A R C H
Figure 3. Results of the Sensory Profile
Deficient Postural Control and Sensory Processing
Sensory Profile Typical Probable Definite
Factors Performance Difference Difference
Sensory Seeking . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . 1 . . . . . . . . . . 3
Emotionally Reactive. . . . . . . . . . . . . 3 . . . . . . . . . . . 0 . . . . . . . . . . 1
Low Endurance/tone. . . . . . . . . . . . . 4 . . . . . . . . . . . 0 . . . . . . . . . . 0
Oral Sensory Sensitivity . . . . . . . . . . 1 . . . . . . . . . . . 1 . . . . . . . . . . 2
Inattention/ Distractibility. . . . . . . . . 1 . . . . . . . . . . . 0 . . . . . . . . . . 3
Poor Registration . . . . . . . . . . . . . . . 2 . . . . . . . . . . . 1 . . . . . . . . . . 1
Sensory Sensitivity. . . . . . . . . . . . . . . 4 . . . . . . . . . . . 0 . . . . . . . . . . 0
Sedentary. . . . . . . . . . . . . . . . . . . . . . 3 . . . . . . . . . . . 0 . . . . . . . . . . 1
Fine Motor/Perceptual . . . . . . . . . . . 1 . . . . . . . . . . . 1 . . . . . . . . . . 2
Auditory Processing . . . . . . . . . . . . . 1 . . . . . . . . . . . 0 . . . . . . . . . . 3
Visual Processing . . . . . . . . . . . . . . . . 4 . . . . . . . . . . . 0 . . . . . . . . . . 0
Vestibular Processing . . . . . . . . . . . . 0 . . . . . . . . . . . 0 . . . . . . . . . . 4
Touch Processing. . . . . . . . . . . . . . . . 1 . . . . . . . . . . . 0 . . . . . . . . . . 3
Multisensory Processing . . . . . . . . . . 1 . . . . . . . . . . . 1 . . . . . . . . . . 2
Oral Sensory Processing. . . . . . . . . . 1 . . . . . . . . . . . 1 . . . . . . . . . . 2
Sensory Processing related to
endurance/tone . . . . . . . . . . . . . . . 4 . . . . . . . . . . . 0 . . . . . . . . . . 0
Modulation related to body
position and movement. . . . . . . . . 1 . . . . . . . . . . . 2 . . . . . . . . . . 1
Modulation of movement affecting
activity level . . . . . . . . . . . . . . . . . . 2 . . . . . . . . . . . 1 . . . . . . . . . . 1
Modulation of sensory input
affecting emotional responses. . . . 3 . . . . . . . . . . . 0 . . . . . . . . . . 1
Modulation of visual input affecting
Deficient emotional responses and
activity level . . . . . . . . . . . . . . . . . . 3 . . . . . . . . . . . 0 . . . . . . . . . . 1
Emotional/ Social responses. . . . . . . 2 . . . . . . . . . . . 1 . . . . . . . . . . 1
Behavioral Outcomes of
Sensory Processing . . . . . . . . . . . . 0 . . . . . . . . . . . 3 . . . . . . . . . . 1
Items indicating thresholds
Normative
for response . . . . . . . . . . . . . . . . . . 1 . . . . . . . . . . . 0 . . . . . . . . . . 3
Range
The children with deficient postural control demonstrated
deficits in both self-care and social function as measured by
the PEDI. Problems in these areas could be a result of both
decreased postural control and decreased sensory processing.
A common characteristic of ASD is decreased social function:
these results help support current literature and also bring to
view the deficits found in self-care function. An important
factor for children within schools and the home is to be able
to perform basic self-care tasks such as going to the bathroom,
washing hands, feeding, and dressing. (continued on next page)
NDTA NETWORK • JANUARY/FEBRUARY 2014 • DEVELOPING THE PLAN OF CARE • 23

Postural Control in Children with Autism Spectrum Disorder (continued)
These results suggest that children with ASD will have hindered
performance in all of these areas.
The Sensory Profile is a thorough examination of several
sensory processing factors involved in an individual’s ability to
process information from his or her environments. Although
all four participants were evaluated on all 23 items, several factors
were reviewed further when the majority of the participants
scored either definite difference in performance or typical
performance. When reviewing all 23 factors, the four participants
all scored definite difference in vestibular processing. Vestibular
processing is the ability to process input such as movement
(acceleration or deceleration) and gravitational pull. The
vestibular system affects function such as posture and balance
and works closely with tactile, auditory, and visual information
that the environment provides. As a reflection of the close
connection of the vestibular system to tactile and auditory
processing, three of the four participants scored definite difference
in performance in both auditory and touch processing. Having
definite difference in vestibular processing could transfer as
decreased postural control and decreased self-care function. If
a child is unable to process the environment’s stimuli appropri-
ately as well as his/her body’s own movements, he or she will
inherently be unable to perform tasks requiring movement or
interaction with the environment or context. Another factor
examined was modulation related to body position and
movement. This modulation correlates with the participant’s
decreased ability to process vestibular input. Three out of the
four participants scored either probable or definite difference in
this factor. For example, if a child is unable to process auditory
and tactile cues during functional tasks, his or her ability to
engage in a conversation will greatly be reduced.
Among the scores ranging from probable to definite difference,
several factors stood out as meaningful in this study. Participants
showed difficulties in fine motor/perceptual tasks. This could be
a result of both decreased sensory processing as well as deficient
postural control. As mentioned earlier, postural control allows an
individual to engage in table top tasks. If a child is unable to uphold
his or her posture, the ability to manipulate objects and to perceive
the world is decreased. Fine motor/perceptual skills are inherent
in self-care tasks such as dressing, grooming and feeding.
Of all 23 factors, all four participants scored typical performance
in low endurance/tone, sensory sensitivity, visual processing and
sensory processing related to endurance/tone. These results
suggest that children with autism spectrum disorder are not
NDTA NETWORK • JANUARY/FEBRUARY 2014 • DEVELOPING THE PLAN OF CARE • 24
M E M B E R R E S E A R C H
typically seen as children with low tone or children with decreased
endurance. This gives us a good understanding in regards to
postural control; decreased postural control is not a reflection
of decreased tone for the four participants in this study.
liMiTaTions and fuTure researCh
The study presented with several limitations. First, the study
consisted of a very small sample (n=4) and were all male. Future
research should incorporate both males and females and have
a much larger sample. Secondly, throughout the administration
of The DeGangi-Berk Test, participants were very distractible
and inattentive, therefore making it difficult to maintain
engagement in tasks. Although all four participants fit the age
criteria and were able to follow simple 1 to 2 step commands,
their attention to follow tasks in a proper sequence was low.
Future researchers should confer about possibly breaking up
tasks on a day by day basis as opposed to completing all tasks
on one day. Thirdly, most of the tasks found in the DeGangi-
Berk Test were novel to the participants. This novelty posed a
challenge for the researcher, the clinician and the participant.
Most participants required two or three sessions to complete all
tasks. During one session a task may have been introduced to
the participant but not necessarily tested that day. Throughout
the week, the clinician worked on developing interest and under-
standing of the task being asked of the participant. Eventually,
the participant was able to complete the task after several trials
and practice. This “practice” could have resulted in a learned
practice effect skewing results, but ultimately it was not a powerful
effect because all four participants scored deficient in postural
control. And finally, along with the novelty of the tasks, the stan-
dardized wording instructions associated with each task proved
difficult for the participants. Having standardized wording limited
the researcher’s ability to ensure that the participant understood
the task and how to complete it. As the study showed, children
with ASD have auditory processing difficulties, and this may
have been the issue. Further research should incorporate ways
to ensure participants are able to understand instructions given
to them whether visually or verbally.
CliniCal iMpliCaTions
Children with autism spectrum disorder exhibit varying levels
of deficiencies in sensory processing, postural control, and func-
tional skills. Postural control and sensory processing appear to
be linked in development and provide a (continued on next page)

Postural Control in Children with Autism Spectrum Disorder (continued)
foundation for functional and social skill development. This
study suggests that interventions addressing postural control
and sensory processing should be an integral part of occupational
therapy for children with autism spectrum disorder. More specif-
ically, interventions addressing self-care and social function
should be addressed early on in intervention.
Children with ASD are diagnosed at a much earlier age than
in the past. With this research, clinicians can begin intervening
and providing the resources for these children to develop social
and self-care skills through adaptation, compensation, and
learning. The Sensory Profile provides clinicians a great view of
specific sensory processing issues that are found in children with
ASD. Sensory diets and sensory integration treatment should be
focused on auditory, touch processing, and vestibular processing
to increase a child’s ability to interact with the environment.
Ultimately, occupational therapists should focus on developing
This study suggests that occupational therapy intervention should be
geared towards increasing postural control, self-care and social function
while also addressing specific sensory processing needs characterized in
children with autism spectrum disorder.
adequate postural control in children with ASD. As children age,
their ability to succeed in school is highly dependent on partic-
ipation in indoor and outdoor tasks. Postural control will allow
children the ability to engage in art classes as well as participating
in team sports such as soccer. Developing postural control and
increasing a child’s social participation and ability to care for
them are crucial skills that occupational therapists can provide.
ConClusion
The aim of this study was to determine if children diagnosed
with autism spectrum disorder demonstrate decreased postural
control, decreased function, and decreased sensory processing.
The results from this study help to identify common character-
istics of children with autism spectrum disorder. The children
with autism spectrum disorder can be identified as having defi-
cient postural control. When reviewing sensory processing among
these children with deficient postural control, sensory seeking
and vestibular processing were among the highest ranked factors
NDTA NETWORK • JANUARY/FEBRUARY 2014 • DEVELOPING THE PLAN OF CARE • 25
M E M B E R R E S E A R C H
as deficits, along with auditory and touch processing and fine
motor/perceptual differences. Among function, children with
deficient postural control scored below the norm in both self-
care and social function. This study suggests that occupational
therapy intervention should be geared toward increasing postural
control, self-care, and social function while also addressing
specific sensory processing needs characterized in children with
autism spectrum disorder. ■
Marcella Nelson, MOT, OTR/L completed this study in partial
fulfillment of her Master’s program at Texas Women’s
University. She works at Reach Therapy Center/The Care
Group, an NDTA Facility Partner as a Registered Occupational
Therapist. She can be reached at marcie.a.nelson@gmail.com.
Mary Frances Baxter, PhD, OT, FAOTA is an associate professor
at Texas Woman's University (TWU), School of Occupational
Therapy, Department of Health Sciences, Houston, TX. Dr.
Baxter earned her doctorate in kinesiology from the University
of Houston, an MA in occupational therapy with emphasis on
rehabilitation technology from Texas Woman's University, and
her bachelor’s degree in occupational therapy from Colorado
State University. At TWU, she teaches graduate and under-
graduate courses in neuroscience and neuro-based treatments.
Her research is based on neuroscience principles related to patient
intervention, including postural control across the lifespan.
referenCes
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Wilkins; 2009: 681- 711.
2. Horak FB. Motor control models underlying neurologic
rehabilitation of posture in children. Medicine & Sport Science.
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Postural Control in Children with Autism Spectrum Disorder (continued)

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April, 2011. pediatric evaluation of disability inventory (PEDI). Physical &
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NDTA NETWORK • JANUARY/FEBRUARY 2014 • DEVELOPING THE PLAN OF CARE • 26

 MONOGRAPH:

Components of Typical and

Atypical Motor Development
By Lois Bly, MA, PT, C/NDT

This monograph is an indispensable

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 N D T A C E R T I F T
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Dates: May 26 – July 9, 2014 Rio de Janeiro, Brazil
Location: International Centre Goa, Goa, India

Dates: June 9, 2014 – July 18, 2014
Location: Aconino, Bogota, Colombia
Dates: August 4 – June 12, 2015
Location: Genesis Health System/Maplecrest Pediatric
Outpatient Center, Bettendorf, IA
Advanced Course for Measurable Functional Outcomes:
Handling, Efficacy, and Research (Pediatrics)
Dates: February 27 – March 3, 2014
Location: Texas Children’s Hospital, Physical Medicine & Rehab,
Houston, TX

Dates: October 27 – December 19, 2014 Advanced Handling and Problem Solving Course
Location: Hyderabad, India, Hyderabad, India (Adult)
Dates: February 18, 2015 – June 15, 2015 Dates: March 5 – 9, 2014
Location: Hospital Tony Molleapaza Rojas, Arequipa, Peru Location: Halvar Jonson Centre for Brain Injury, Ponoka, AB

Advanced Handling and Problem Solving Course

ADULT (Pediatrics)
Dates: June 20 – 23, 2014
NDT/Bobath Certificate Course in the Management of Location: Milestones Therapeutic Associates, McAllen, TX
Adults with Stroke and Brain Injury

Dates: March 18, 2014 – April 4, 2014 Advanced Handling and Problem Solving Course
Location: Beaumont Hospital, Dublin, Ireland (Pediatrics)
Dates: July 23 – 27, 2014
Dates: March 30, 2014 – April 12, 2014
Location: Texas Children's Hospital Meyer Building, Houston, TX
Location: HealthSouth Mountain View Regional Rehabilitation
Hospital, Morgantown, WV Advanced Upper Extremity Course
Dates: August 4 – 9, 2014
Dates: May 8, 2014 – August 19, 2014
Location: Fundación IDEAL, Cali, Colombia
Location: Memorial Rehabilitation Institute, Hollywood, FL

Dates: June 13, 2014 – September 29, 2014

Location: Lee Memorial Hospital, Fort Myers, FL

NDTA NETWORK • JANUARY/FEBRUARY 2014 • DEVELOPING THE PLAN OF CARE • 29