Mindy is a paediatric physiotherapist who is completing her PhD through the University of Otago Medical School Research, Teaching and Rehabilitation Unit, with a focus on using available technology to support parents in managing home therapy programmes for their children with cerebral palsy. She obtained her masters in child health and neurodevelopment in South Africa in 2010 focusing on the early detection of developmental delay in at-risk infants.
Mindy ran her own large paediatric rehabilitation centre in South Africa up until 2010 when she moved to New Zealand. In New Zealand she has had various roles at the Nelson-Marlborough District Health Boards, both clinically as a paediatric therapist and in management as team-leader for Child Development Service. She serves on the Guidelines and Consensus Committee of the Physiotherapy New Zealand Paediatric Special Interest Group, The Clinical Reference Group for Cerebral Palsy in the New Zealand Child and Youth Clinical Network and runs an international community of practice for pediatric physio and occupational therapists online.
Her passion, and the central theme in both her masters dissertation and current research, is the value of partnering with parents in paediatric rehabilitation and research.
In her spare time, Mindy hosts a podcast that showcases clinical excellence in pediatric neuromotor rehabilitation with the aim of capturing the voice and experience of expert clinicians in the field.
Note: You should consult with your doctor or physical therapist for recommendations on treatment. The views and opinions expressed in this article are those of Mindy and do not necessarily reflect the official policy or position of OnlinePhysicalTherapyPrograms.com
What inspired the start of Wired On Development?
I come from a big city in South Africa where I had easy access to ongoing professional development with amazing clinicians. When I moved to New Zealand several years ago I found myself in a beautiful coastal town with snow-capped mountains, seas and forests, which I love, but I noticed that I started to feel like I was in a rut professionally. I didn’t even miss it at first. I just drifted on in my new job working for a government child development service for a few years and then fell into a management position as team leader for the service across two districts. I landed up spending all my time and energy trying to keep kids out of getting services so I could manage wait-lists. Working long hours with lots of stress, ticking boxes rather than providing meaningful services that actually improve lives.
About a year into the management role, I had the opportunity to interview Beverley Cusick for our Paediatric Special Interest Group and it was as if a light had been switched on. I realised that management was not my thing and I needed to be working with kids and families and connecting with people and conversations that drive my passion. I love podcasts and I was surprised that there were none from expert clinicians and thought leaders in our field so, I thought I would start doing them to share knowledge, get inspired, and stay accountable to the kids and parents I’m meant to be helping. I quit the team leader role and learned about websites and podcasts. About hosting and editing audio and about email managers, CRMs, domains, and social media and started Wired On Development. It’s been quite a learning curve, but so much fun.
What do you hope your readers get out of the information you share with them?
I hope for 3 things: that they are inspired to try new things and get creative and innovative in their clinical work, that they are informed about the different approaches, options and ideas that makes our profession so rich, and that the ideas and insights they get from the podcasts help them to be more effective and confident clinicians. There is a lot of information from academics and research publications, but physical therapy is a practical profession and it’s harder to gain practical knowledge. I hope to strengthen the voice of the experienced clinician and give it a platform. It’s an equally important leg of EBP.
What are some of the most important things we have learned about neuromotor development in recent years?
That is a difficult question to answer. I think there is a growing recognition in the academic research around how sensory processing and integration impacts neuromotor output, however it’s not a new concept. Similarly, neuroplasticity and the impact of repetition, novelty, task specific training within meaningfully function tasks and intrinsic motivation would be something to pay attention too, but it’s not new. The field is much more aware of whole of life issues for children with disabilities and looking more at participation as an important concept that requires awareness of both environmental interventions as well as therapeutic interventions, rather than an activity level focus that addresses the typical milestones of sitting, crawling, walking etc. There is much more emphasis on what we can help the child to do, rather than how the child is able to do something, however there is also a growing body of research on 24 hour postural management and preventing long-term orthopedic complications and other related health issues by paying attention to alignment and quality of movement. Honestly, I think the most significant thing we’ve learned about neuromotor development, is that randomized control trials and current approaches to research are not adequate to fully understand how we as therapists impact and influence the kids in our care in the real world. We are only scratching the surface of how we can start to really research what we do.
What are the challenges to ensuring that children get the physical therapy care they need as soon as possible?
The biggest challenge is probably funding and capacity. There are reliable and sensitive tools that are excellent at identifying early neuromotor risks, but there is often a delay in access to services due to late referrals or long waitlists.
How can healthcare professionals (PTs, OTs, SLPs, and more) work together in a way that maximizes patient outcomes?
Being aware of the roles and strengths of each profession helps therapists know what is and isn’t possible and when to refer. Shared learning helps with this, as does good communication. Taking time to sit down as a team and discuss shared clients and putting the child at the center of any decisions is essential. Having clear, shared goals with the family and the whole team that link important developmental aspects and enable everyone to focus on specific activities without feeling overwhelmed or disconnected is a good way to go.
How can new PTs stay up to date on the latest evidence?
Well, they can join the Wired On Development Facebook group. We share and discuss a lot of the research in the group and how it relates to our clinical work. There is also plenty of free content available on the internet these days. Signing up for newsletters from organizations like cerebralpalsy.org is useful in getting some regular curated content sent straight to your inbox and a lot of the publishers (like Science Direct from Elsevier) will also let you put in your topics of interest and send you the latest research based on your keywords. Some of the journal management platforms like Mendeley are also useful for this. It’s a real issue losing access to full text journals once you are no longer a student, but a lot of the professional organizations like the American Academy of pediatrics will bridge this gap. Our Physical Therapy Society has an agreement with the university libraries where they are able to access articles for members, but the best way really is to keep studying – it’s partly why I’m doing my PhD – just so I can have articles on tap
Do you have any advice for PT students?
Embrace not knowing. It’s only when you can identify gaps in your knowledge that you’re actually starting to learn something that will take you to the next level of clinical expertise. I talk to advanced clinicians all the time and they are still learning, still having aha moments and still making mistakes – that’s what makes them good clinicians.
Don’t be a tick-box therapist – Standardized forms and measures are useful for funding and management, but they won’t improve your clinical skills or your ability to analyze and problem solve the more complex clients – and that’s where the fun is. Video your treatments, take lots of photos and take time to analyze these and share them with your colleagues. It’s hard to develop these skills when you’ve got a wriggly, wiggly child that you’re working with in a treatment session. Videos and photos allow you to slow movement down or compare side-by-side, and more importantly to share with colleagues and get a different perspective or see things with different eyes.