In early September a contributor on the icsp discussion asked what alternatives there were to ‘Doing a Bobath Course’? Here is a summary of the suggestions:
Contributor 1 suggested that Universities offer a variety of evidence based courses. Depending on where you are based, are available to NHS staff via LBR contracts. Nottingham and Oxford are two that I know off the top of my head.
Another contributor recommends Nottingham University’s 30 credit MSc level module in Movement Science in Stroke Rehab, which is part of a full neurorehab MSc, but you can complete it as a stand alone module. She says it was excellent. It was well run, evidence based and completely transferrable straight to clinical practice (including other neuro conditions). It was challenging to complete; the course days ran mostly at weekend, but you do have to do a presentation and MSc level essay. However, it had a huge influence on my clinical practice, my teaching of others and the outcomes for my rehab patients.
RogerM suggests looking at the Stroke-Specific Education Framework (SSEF) website (http://www.stroke-education.org.uk/). They have searchable courses and you can filter them to those relevant to physio. However, most of the courses are not exclusively focussed on physios (but maybe a good thing?). They also have a handy “job role profile” with the level of knowledge and skills needed for different physio staff bands. Another possible source of courses is Harrison education (http://www.harrisontraining.co.uk/) who do a course on how to do CIMT and other topics. I think there were also a couple of courses advertised in the last issue of Frontline
I posted that: I agree that there are evidence-based alternatives to Bobath courses. But it isn’t a matter of Bobath against motor relearning (although I have heard many good reports about the Motor relearning module at Uo Nottingham). Several universities offer modules (if not whole masters programmes) in evidence-based neurological physiotherapy or rehabilitation. Which, I assume, will look at the overall evidence for different types of interventions (with varying practical elements), rather than advocating and teaching a specific approach. Don’t be limited to looking in your locality – many CPD opportunities are offered by distance learning now-a-days so you don’t have to physically attend the Uni. Also it isn’t always necessary to ‘go on a course’ to learn/ work out how to deliver EB interventions. Many researchers publish details of how to deliver the interventions they have been testing, so that they can be implemented into clinical practice – which is the whole point of the research in the 1st place!
A couple of examples: Janice Eng in Vancouver has developed excellent exercise programmes for people with stroke – for the upper limb (GRASP) and the lower limb (FAME) which can be delivered in hospital or community settings. She and her team have completed gold-standard quality RCTs which has demonstrated their effectiveness. The manuals/ instructions about how to run the programmes are available from here http://neurorehab.med.ubc.ca/fame/ and here http://neurorehab.med.ubc.ca/grasp/ . Also my team and I recently developed and tested a framework for the MDT use outcome measures in stroke rehabilitation and to structure MDT meetings. The details of how to apply that are available here https://www.escholar.manchester.ac.uk/uk-ac-man-scw:230101.
We have also recently published a RCT of patient-led therapy during in-patient stroke rehabilitation which contains sufficient detail to deliver the intervention and you can always contact me if you want more details. (NNR 2015; 29;9; 818-826)
Another place to look is in the original papers. Many (but not all, it has to be acknowledged) provide sufficient detail give sufficient detail to apply the interventions. The treadmill and electro-mechanical training and TENS trials are good examples. It is considered a matter of good research practice now-a-days to report the detail of the intervention and how it was applied. This is often impossible within the word limit of a scientific paper so authors make them available on their websites, in on-line supplementary material and/or by contacting them directly. So if you are interested in implementing an EB intervention and are not sure how to do it, then contact the authors. It may be that the intervention then needs to be adapted to meet your local situation – that’s where the much discussed clinical experience and judgement comes in. There is an important debate to be had about how far these interventions can, and should, be ‘tweaked’ before they are no longer the intervention described. But that’s for another day….
Finally, manufacturers / providers of equipment such as FES, Saeboflex, treadmills etc, etc worth their salt will provide training in how to use them effectively. If they don’t, don’t buy them! It is only human nature that they will spin the evidence in the best possible light, so I’d read up on it independently before deciding whether to purchase. But they should be able to support you to use their stuff effectively and make those tricky pragmatic decisions about how to implement.