Techniques to Improve Respiratory Function in Patients with Neuromotor Delay
Picture from: Massery M [DVD] (1)
By: Chloe Smith
Background:
The Department of Physical Therapy at UNC has had a long-standing relationship with a long-term care facility, Las Obras Sociales del Santo Hermano Pedro (Las Obras), in Antigua, Guatemala. For the past several years, third year students in UNC’s PT department have been given the opportunity to go on a service trip to Las Obras to work with therapists and patients in this long-term care facility. During the service trip to Las Obras last year, Dana McCarty, a professor at UNC, noticed that a large part of the population, especially the pediatric population, demonstrated musculoskeletal changes in their ribcages due to neuromotor delay. Furthermore, these musculoskeletal changes caused poor respiratory function in these patients. The purpose of this project was to create a presentation that could be given to the therapists in Antigua to teach manual techniques that improve respiratory outcomes in these patients during the service trip to Guatemala this year.
This project initially caught my eye because of my interest in pediatrics and because it has the potential have a huge impact on the lives of the large pediatric population in Las Obras. Breathing is essential to life, and the easier one can breathe, the more involved s/he can be in other activities. Furthermore, the Spanish language has been a passion of mine since high school. I hope to have the ability to communicate with my future patients without an interpreter, so I welcomed the opportunity to practice my Spanish through this presentation, and looked for other opportunities to do so outside of this project to help prepare myself to give this presentation well. Unfortunately, the service trip to Guatemala was cancelled earlier this year, but I am in the process of planning a trip to Guatemala post-graduation to present my capstone project and to volunteer for a few weeks at Las Obras.
Products:
In my Evidence-Based Practice II class last semester, I researched the PICO question “For a 10-year-old patient with musculoskeletal changes in his trunk due to neuromotor delay, is ribcage mobilization or positioning most effective in promoting airway clearance and increasing lung vitality?” The results from this Critically Appraised Topic were disappointing as I found that there is a dearth of research on this topic, but they served as a starting point for this presentation.
I created a power-point presentation (ENGLISH / SPANISH) with an associated lab workshop to address manual techniques that could be useful to improve respiratory function in these patients. In addition to the power-point presentation, I also created a handout (ENGLISH / SPANISH) for the therapists so that they have a cheat sheet with the correct positioning for both the patient and the therapist, the instructions for the patient, and the action of the therapist while performing the techniques. I translated all the products initially and then sent them to Sarah Van der Horst and Jayson Garmizo, two fluent Spanish-speakers, to edit.
Evaluation:
Throughout the creation of this presentation, I was emailing and meeting with my committee members, Dana McCarty, PT, DPT, PCS, C/NDT, Lisa Johnston, PT, MS. DPT, and Julia King, PT, DPT, certMDT, to ask for feedback and suggestions for how to present the material in a way that would be most beneficial for the therapists in Guatemala. Since I have never been to Las Obras or Guatemala, I needed a lot of guidance regarding the appropriate level of complexity with which to present and the resources that would and would not be available to the therapists in Guatemala. I also completed a Health Literacy Assignment to ensure that my presentation was at the appropriate level of comprehension and to ensure that my Spanish language skills were adequate enough to give the presentation.
Since I am unable to give the presentation in Guatemala prior to graduation, I gave the presentation to my capstone committee in English. All three of my committee members are physical therapists. In addition, Dana is a Certified Pediatric Specialist who went on the service trip to Guatemala last year, Lisa Johnston is the coordinator of the Guatemala trip and is very familiar with the patient population and the way in which the physical therapists at Las Obras operate, and Julia is a pediatric physical therapist at UNC Children’s Hospital who has gone on many mission trips to countries with few resources to perform physical therapy. I carefully chose each of these therapists to serve on my capstone committee because I truly value their input and feedback, and I know that I have a lot to learn from them.
During my presentation, I asked for specific feedback regarding logistics, presentation style, positioning using resources that would be available in Guatemala, and any other tips that the therapists thought would be helpful. The presentation was very much a learning experience for me as my committee members provided tips and additional feedback throughout the presentation. The nature of the presentation is very interactive with a designated lab portion at the end. Following the presentation, each committee member was given a Capstone Feedback Form to fill out regarding the clarity of the presentation and any additional feedback they would like to share.
Acknowledgements:
First and foremost, I would like to thank my advisor, Dana McCarty, and my committee members, Lisa Johnston and Julia King for their valuable input and feedback throughout this entire process. This project could not have been done without their feedback and support throughout this process. Molly Miller was very helpful serving as a proof-reader and model during my presentation to my committee members. Sarah Van der Horst and Jayson Garmizo assisted with editing the Spanish translations. Dan Owen helped improve the clarity of the presentation by assisting me in the process of adding arrows to the pictures used in the presentation and handout. Finally, I would like to thank my classmates for becoming like a family to me. You all made this process much more enjoyable.
References:
1. Massery M. Screening and treating musculoskeletal restrictions related to breathing and/or postural impairments. [DVD]. Glenview, IL. Rehabilitation Institute of Chicago.
8 Responses to “Techniques to Improve Respiratory Function in Patients with Neuromotor Delay”
Chloe Smith
Hey Megan-
Thank you so much! This is certainly an area of PT in which more research is desperately needed. I do not currently plan on conducting any research regarding respiratory function in this patient population in the next few years, but it’s certainly something I will keep looking for information on throughout my career as a PT! I am definitely excited to see how these techniques improve function in the patients in Guatemala, and in my future patients as well.
Thanks for reviewing my project 🙂 Good luck in your upcoming clinical!
-Chloe
Megan Schilter
Hi, Chloe!
You did an excellent job on such an interesting project. I’m sorry that you have not yet had the chance to go to Guatemala, but when you do finally make the trip, it is clear that this project will impact and help a large number of people.
I also appreciate the work that went into a topic that is fairly under-studied in the world of physical therapy. Have you considered further research on respiratory function in this particular population in your own professional practice?
Best of luck on the upcoming rotation! I hope you have a chance to practice Spanish-speaking skills prior to your trip–your translation skills are impressive and give you the opportunity to help many more patients 🙂
Megan
Chloe Smith
Molly-
Thank you so much for being a large part of my presentation and my project! I am lucky to have such awesome and genuinely caring classmates like yourself! I know that the physical therapy profession will be a better place with you in it. Good luck with the final few months of the program!
-Chloe
Chloe Smith
Hi Carla-
Thanks for reviewing my presentation! I think one of the biggest barriers to the therapists in Guatemala to utilize these techniques on the patients at Las Obras is the short amount of time they have to spend with each patient. From what I understand, the hospital is pretty short-staffed, so the patients do not get much individualized attention. Therefore, when the patients do receive therapy, it is pertinent that the interventions used are the ones that will be the most beneficial for the patients. As a new graduate, I know that I will be one of the least experienced therapists there, so I think it will be very important for me to get to know the other therapists and the way physical therapy works in that particular facility before I give my presentation and suggest alternative treatment interventions. I am planning on spending multiple weeks at Las Obras, so I think that will assist in breaking down some of the barriers I will face. Having the ability to spend a few weeks getting to know the therapists and co-treating patients with these therapists will give us the opportunity to teach each other different techniques. I hope to give my presentation towards the end of my visit so that I have already built a rapport with the therapists and they have been able to see the improvements in the patients from these techniques firsthand. The more they can see how beneficial these techniques can be, the more likely I think they will be to use them. Thanks again for your comment!
-Chloe
Chloe Smith
Hey Elizabeth-
Thanks for your encouragement! I have uploaded the powerpoint version of my presentation now so that you can read the speaker’s notes and, hopefully, understand the pictures a little better. In the technique you are referring to, the goal is to increase the accessory muscle use of the upper chest. In order to do that, the therapist provides a series of quick stretches to the top of ribcage, adjusting the angle of the quick stretch provided as the patient continues to inhale. The hope is that the tactile cues will assist the patient in expanding the upper chest while inhaling, rather than breathing into the diaphragm/stomach area. Hope this explanation helps! Thanks for reviewing my presentation!
-Chloe
Molly Miller
Chloe! I am honored to have been a part of your capstone presentation. You presented your materials very clearly and succinctly with good use of pictures and descriptions. I liked that your presentation was so applicable to clinical practice and that your committee members got to practice the techniques immediately with feedback. I hope that you receive good feedback from our professional peers in Guatemala. I am impressed with your translation of materials to Spanish. Speaking proficiently in Spanish will really serve you well in your future and I’m glad that you have still decided to pursue service in Guatemala despite the trip being cancelled. I wish you the best of luck and great job on your capstone!
Molly
Carla Hill
Chloe,
Great job with your Capstone. Sorry you didn’t have the chance to go to Guatemala yet, but very excited for you to have arranged the opportunity to do so after graduation. Your handout is a very helpful reference for clinicians wanting to practice/implement a technique. What do you anticipate will be the biggest barrier with getting therapists in Guatemala to utilize these techniques and how will you try to address it proactively?
Elizabeth Lynch
Hi Chloe,
What a neat project! I really admire the work you’ve put into improving your Spanish communication over the past year, especially the time you spent translating at the Children’s Specialty Clinic. This skill will be such a blessing to your patients and their families in the future. I also think that your powerpoint and handout are very well done, and I learned a lot of new information by reviewing them. I particularly liked the slide you included on “positioning after the respiratory techniques,” as I feel like it’s easy to forget these details once the formal therapy session is over, and all caregivers should be instructed in the importance of positioning for improved respiratory function as well. Lastly, I really benefitted from the pictures you included in order to help describe the specific techniques in your presentation and handout. This would be a much harder topic to comprehend without the use of visual aids. I wanted to ask if you could explain the arrows you used on the picture of the accessory muscle activation technique. I wasn’t sure how to interpret the four arrows pointing away from the patient’s body. Thank you again for sharing such practical information on a very important topic, and I hope you will have the opportunity to present in Guatemala after graduation.
Congratulations!
Elizabeth