Making an Impact Early
Imprints program aims to boost the numbers of PTs who can improve the lives of very young children with disabilities
Unlike most kids his age, two-year-old Andrew Murphy can't walk unaided. Still, his grandmother is cheered by the brown-haired, blue-eyed boy's most recent feat-fearlessly careening throughout her house and yard with his walker. Noting his gleeful grin, Sylvia Meisenheimer says such moments make her both proud and grateful: Proud because Andrew has started to overcome the many physical problems that began to plague him a few months after his birth; and grateful for an in-home early intervention program that she feels has helped him do so.
Parents Jessica and Stephen Murphy noticed several months after he was born that their son's eyes were crossing and that he was vomiting and gagging during feedings. Soon he virtually became unable to swallow food or move his bowels. His pediatrician said that he was suffering from ataxia, incoordination of the muscles.
Although Andrew's doctor couldn't pinpoint the cause, he believed that the condition was not progressive and that it might be helped by physical therapy. He referred the Murphys to the Brazoria Association of Children with Handicaps, a state-funded, county-based early intervention program that provides physical and occupational therapy services to children and families. The program serves as a training site for the UTMB Imprints program (Improved Training of Physical Therapists in Early Intervention Settings), an undertaking funded by the Office of Special Education Programs, U.S. Department of Education. Imprints provides additional training to those who wish to work with children with disabilities up to three years old. It is offered to UTMB physical therapy students thanks to a $1.4 million, five-year grant awarded to UTMB's School of Allied Health Sciences' Physical Therapy Department.
For UTMB physical therapy students, Imprints amounts to an additional semester beyond the seven semesters required to complete the Master of Physical Therapy degree. It consists of three courses, counting for three credits each, and a six-week, hands-on internship. Each course focuses on providing therapy to infants and young children with disabilities and their families, and each
explores subjects including neonatal intensive care and fam ily-centered and community-based practice. Students are financially assisted for the last two semesters of their regular physical therapy studies and for the additional Imprints semester. Total support for the three semesters is approximately $16,000 per student. That pays for tuition and fees, a monthly housing allowance, books, reimbursement for professional dues, a travel stipend for professional conferences, a stipend for the clinical internship, and a laptop computer.
Kara Price, who graduated in February with a master's degree in physical therapy and completed the Imprints program in June, says the certification program helped her realize her dream of working with children with medical problems-"something I never thought I'd be able to do without going to medical school and becoming a pediatrician."
According to Christine Baker, UTMB associate professor and project director of the Imprints program, the principal purpose of the program is to increase the number and quality of physical therapists trained to provide services to infants and toddlers with disabilities.
Baker says a second goal of the program is to boost the number of physical therapists from underrepresented groups and from among those with physical disabilities who want to work with these young "special needs" children, including children with conditions ranging from Down syndrome and cerebral palsy to premature babies in neonatal intensive care units. (In the spring 2003 semester, three of the nine Imprints students were from underrepresented groups.)
"Because this area is so specialized, training students to work in the neonatal intensive care unit and in other early intervention settings is important," Baker says. These areas, she adds, are "very, very different, and not everyone feels comfortable going into them right out of school."
"There is a big difference between hospital care and home-based care," Baker notes. "In clinical care or hospital-based care, the focus is the patient; but in the home-based program, emphasis is on the whole family, its needs, and what can be done to help it."
Andrew Murphy gets weekly visits from Dana Wild, a physical therapist and clinical instructor to various Imprints students as part of their full-time, six-week clinical rotations. Wild, who is co-project director for Imprints, supervises UTMB physical therapy students enrolled in the program as they help provide in-home treatment each week to about fourteen young patients from the Brazoria County area.
When possible, these sessions are presented as play. Later, therapists give families ideas on activities to do at home. For example, therapists may ask families to focus on particular groups of muscles by putting a toy up on a table just out of reach, requiring the child to stretch certain muscles. Meisenheimer, who watches Andrew while his parents work and has seen the dramatic results of the program, is enthusiastic.
"It has been a pretty big chore to get him where he is from where he's been," Meisenheimer says. "I think back now to how hard he used to struggle and how we wouldn't have known what to do without Dana and the interns to help us."
Wild stresses that the program is designed to involve both therapist and family. If a particular method for an exercise doesn't work, families are encouraged to come up with their own solutions. Andrew's family, for instance, took him on an Easter egg hunt around the yard, which required him to bend down and pick up eggs and put them in the basket. The hunts continued over the weekend, and Andrew had fun while exercising the prescribed muscle groups. Andrew's big sister Danielle, age eight, was used to helping him and had to learn to let him do things for himself.
Imprints student Leslie Turlington says the program helped her find her calling as a physical therapist in the neonatal intensive care unit. "When I first started," she says, "I was actually afraid of these babies because they were so fragile." The hands-on internship and the reassuring presence of a supervisor gave her the confidence she needed to do the job. She explains, "It's so important to have someone watching over you while you handle the babies and get used to all the lines and tubes and the alarms going off."
Turlington continues: "What's amazing is that even though these babies have so many problems, they already have such distinct personalities. I've watched people in other medical disciplines who come in to see these babies, but they really don't interact. But by the nature of our jobs, PTs must do so." And that's how the Imprints program sold Turlington on working in the NICU: "I can look at a baby and know that I can have an impact."