by Marlene Suliteanu, OTR
In August, 2001, this article about HANDLE appeared in 2 editions of a national magazine for allied health professionals, ADVANCE for Occupational Therapists and ADVANCE for Speech-Language Pathologists and Audiologists. It is reprinted here with permission of the author, who has made minor revisions.
A few years ago therapists thought Outcome Studies would convince payers to “buy” professional recommendations. I didn’t detect any difference such studies made in the services payers bought. I think we defined “outcome” differently than payers do.
Recently I redefined “outcome,” “treatment” and “working” toward goals.
Idealized fantasy? No. That’s the reality of neuroscience translated into learning and behavior, as developed by The HANDLE Instituteâ. HANDLE is an acronym for: Holistic Approach to NeuroDevelopment and Learning Efficiency.
HANDLE defines outcomes in life, not in tasks. Therapy addresses the root causes of maladaptive or unsuccessful performance so with neurodevelopmental integration, the body, not the therapist, directs the individual to perform tasks optimally: effectively and efficiently.
So let’s look at some clinical examples.
First, in geriatrics:
I’ve seen how progressively declining activity levels as we age leave a by-product deficit with its own often-calamitous effect: less motor behavior seems to reduce input to the brain of the proprioceptive information basic to maintaining position in space. Not just the position of a limb, but of the whole body, with resultant distortion of vertical alignment (standing upright) and, from there, increased falls. How many geriatric clients are unable to give a reason when asked to describe the circumstance of the fall?
A concomitant result, also routinely heard in the halls of retirement buildings, is an increased fear of falls. It’s not just safety-prompted fear, but rather much deeper and more basic to self-image, namely fear of “Where am I?” A client verbalized this fear with visible panic when she found she couldn’t perform a finger-nose/finger-ear task. A program of direct, gentle, proprioceptive stimulation, plus vestibular stimulation in each axis of the semicircular canals, enabled this elderly woman very quickly to tolerate standing fully erect. She could not do that at all when I met her, was dependent on maximum assist to transfer and for essentially all dressing, and was non-ambulatory. She became able to walk with a walker and a stand-by assistant, including for bed and toilet transfers, and was independent with dressing. And her husband was taught how to implement the program for on-going follow-through.
An example unrelated to age or stage of life: pain.
Because this approach shifts the therapeutic paradigm off the traditional medical model – in which each diagnosis has a definitive “cause” to be treated, usually by covering up the offending behavior (including pain) – HANDLE can apply to many problems resistive to customary interventions. Once we let go of the idea that there is one “cause,” we allow for the possibility – implicit in the image of a single human organism comprised of interactive and interdependent systems – that multiple contributors “cause” the end diagnosed with a label. Take the example provided by Jill Maxwell, whose private practice – Max Well Physical Therapy and Massage, in Flint, Michigan – treats people with fibromyalgia and cervical and lumbar pain, among other diagnoses.
Jill became a HANDLE clinician in November, 1999. From her changed perspective, she has identified in fibromyalgia patients increased muscle tone and light or sound and tactile hypersensitivities. “I take a neurodevelopmental approach to fibromyalgia and see it as a condition in which various systems need to be integrated.” Jill also has correlated urinary frequency to sleep deprivation issues common among her back pain patients; so she has introduced them to a HANDLE activity that, among other benefits, strengthens the body’s sphincters.
Some pediatric examples:
Pediatrics begins at birth. Certified HANDLE Practitioner Barb Kaufman, PT, treats pre-term infants in the intensive care nursery as well as children through 18 years of age, in a Waterloo, Iowa, hospital-based pediatric setting.
Diagnoses include cerebral palsy, TBI, spinal cord injury, SI disorders, autism. Children with attention disorders and learning disorders are referred specifically for HANDLE assessments.
“I utilize HANDLE in some aspect with every child that I see,” says Kaufman. “Working on differentiation of movement helps children with central nervous system involvement to be more coordinated and to utilize less energy. The assessment of the visual system was a totally new area for me as a PT. It is essential to understand in order to know how the individual takes in visual information – how they see the world. HANDLE truly looks at the entire child and strengthens from the core. Families, excited about the results they see, have become our main referral source. The local physicians have been supportive after seeing the outcomes the children experience.”
Other problems for which HANDLE programs have achieved remarkable success include: hyperactivity, epilepsy, Obsessive Compulsive Disorder, Tourette’s, CHARGE Syndrome, traumatic brain damage and stroke, Asperger’s, and bipolar disorder.
Word of mouth, especially among families of clients and special-needs support groups, has attracted more demand around the world than the dozen or so Certified HANDLE Practitioners can satisfy. So at this date, Introductory and Advanced Training programs are slated for California, England and South Africa, besides at the Institute itself. Community Information presentations need only an invitation from a local group, to The HANDLE Institute in Seattle. Check the website – www.handle.org – for specifics.
I think this is the cusp of future rehab for all therapists. We need only to redefine the outcome of therapy as holistic and client engendered, instead of task specific and up to us. Then payers will want what we offer: lifestyle benefit.
Marlene Suliteanu, O.T.R., has worked in rehabilitation with all ages, in hospitals, out-patient clinics, home health agencies, nursing homes, and residential programs, over the course of a career that began at Ohio State University in 1963. This year she established GET ABLE – Gentle Enhancement Therapy for Any Body to Live Efficiently, in Oceanside, California.