Videos teaching Lab Skills to Patients with Spinal Cord Injuries

 

The University of North Carolina at Chapel Hill

SCI Video Demonstrations

By Karl Lutschewitz

Background:

This project is inline with the research performed during the Evidence based practice II course and my interest in spinal cord injury rehabilitation. During EBP II, I investigated and compared two types of locomotor training intervention to see which is the most effective according to the available research. Here is a link to my critically appraised topic Lutschewitz_CAT. I originally became interested in locomotor training after reading about the use of functional electrical stimulation combined with body weight supported treadmill training and cycling in the Christopher and Dana Reeve Foundation’s Paralysis Resource Guide¹ and a clinical experience where I was a first hand witnesses to body weight supported treadmill training in action. Here a link to the Christopher and Dana Reeve Foundation’s website where resource guide can be obtained for patients and therapists Paralysis Resource Guide.  I began to wonder which intervention would be able maximize functional walking ability in patients with traumatic spinal cord injury, while also utilizing equipment and resources available. Recovery of walking is considered highly important among people with spinal cord injury and paralysis², however, before a person recovering from a spinal cord injury can get to that level, they need to learn the basic skills that are taught during this lab. This current project is relevant clinically because future DPT’s graduating from this program and during their clinical experience will be able to use these skills.

Overview:

Every spring, students embark on a learning experience during the Doctor of Physical Therapy Program at the University of North Carolina at Chapel Hill. This learning experience is the 4 and ½ hour neuro skills lab, which is part of the Neuromuscular intervention II course and is part of the core curriculum. During neuro skills lab, students practice teaching skills in groups of 3, taking turns being both the therapist and the patient. The skills in the lab are designed to teach patients, that have recently acquired a traumatic spinal cord injury, important mobility skills. The skills and capabilities are designed with the level of the spinal cord injury in mind. For example, one of the skills is teaching a sliding board transfers to a patient with a C6 spinal cord injury. These videos are aimed to enhance future student’s clinical skills by providing a visual medium and reference point during their learning experience.

Students learn this material through hands on practice and “discovery” through attempting to teach these skills and “acting” as the patient during lab time. Teaching these skills with little experience at the same time the student is learning how to teach these skills results in an interesting position for the student, leaving some students “unsure” if they are performing these tasks correctly. After the class of 2016 participated in this lab in the spring of 2015, feedback from the students indicated that the inclusion of videos showing “how to” teach these skills to patients would be valuable to students learning these important skills. While participating again as a helper during the class of 2017’s neuro skills lab in the spring of 2016, a few students agreed that these videos would be a helpful supplementation for their learning experience. This represents a real need for these videos to enhance the educational experience for students. While it is understood that there are a variety of unique situations, these videos will provide a video reference where students will be able to go to when they have questions regarding specific skills and help to streamline the learning experience.

The Project:

The intended audience is future 2^nd year UNC-CH DPT students learning how to teach new skills to patients with recently acquired SCI. The videos will be available through the Sakai website for easy access during the semester. Products that have emerged from the project are videos showing a ‘therapist’ teaching the following mobility lab skills.

• Dependent transfers
  • High low table
  • “airlift” method’
  • Using a chair/stool

• Scooting forward in chair 3 ways (C6)

• Supine to long sitting (C5-C6)
• Part 1

• Part 2

 

• Short sitting at edge of mat to long sitting (lifting legs) (C5-C6)

• Independent transfer from wheelchair to mat (C6)

• Tub transfers (C7-C8)

• Teaching wheelies

• Floor to chair (T12)

• Sit to stand with long leg braces and lofstrands (T12)

• Ambulation with long leg braces and lofstrands (T12)

• Ascending and descending the stairs (T12)

In addition to the videos, I have made a Lab Skills Worksheet with important points to remember when teaching skills. Here is a link to the Lab Skills Sheet. The worksheet includes motor learning principles and notes for each lab skill. For example, remembering to teach patients with a C6 lesion to transfer with fingers flexed to retain tenodesis grasp. Here is a Motor Learning Principles CVA recovery Inservice that I did during my inpatient neuro rotation for more on motor learning.

Evaluation:

Evaluation component of the project will be obtained through a short online Survey regarding, the overall quality of the videos, the sound quality, the accuracy and reliability of the skills they attempt to teach, an opinion on when the videos should be released, descriptors, the likelihood of recommending the videos, and a blank space for any comments regarding specifics. Feedback was also provided directly by advisor and committee members through email in order to be sure that the videos are clear, concise, and show the correct technique. The majority of responses felt the videos would best serve the class if released 1 week prior to the day of the lab.

Acknowledgements:

I absolutely could not have done this project without the acting skills of Andrew Kohler, SPT, Korre Scott, SPT, Gabrielle Scronce PT, DPT, and Rob Sykes, SPT. Thank you so much for taking your time to help shoot and star in the videos. I am nominating all of you for the UNC Academy Awards! I am grateful to Karen McCulloch, PT, PhD, NCS, my capstone advisor, helping me throughout the project, providing both guidance and feedback. A big thank you to my committee members, Vicki Mercer, PT, PhD and Christie Clem, SPT for watching the videos and providing valuable feedback. Thanks to Gregory Klaiber, UNC’s Media Lab Manager and all of the media lab personnel who helped with all of my questions during the editing process and for providing the equipment. I would also like to thank Mary Beth Osborne, PT, DPT, NCS, who originally suggested the project. A tip of the hat to this project which I believe has helped me to become a more competent teacher and future physical therapist. It is important to be able to effectively and efficiently teach skills to patients. This project has served to enhance those skills as I was able to watch and evaluate myself teaching skills to others.

 

References:

1. Christopher and Dana Reeve Foundation. Paralysis Resource Guide.; 2009. http://www.christopherreeve.org/site

2. Ditunno PL, Patrick M, Stineman M, Ditunno JF. Who wants to walk? Preferences for recovery after SCI: a longitudinal and cross-sectional study. Spinal cord  Off J Int Med Soc Paraplegia. 2008;46(7):500-506. doi:10.1038/sj.sc.3102172.