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LIH Healthcare Hosts Pre-Conference Workshops at ISPRMDC

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The International Society of Physical and Rehabilitation Medicine for Developing Countries (ISPRMDC) held its third annual conference from July 28 – 31 in Kunming, China. This year, the conference featured a special pre-conference workshop series hosted by LIH Healthcare, conference corporate sponsor. The workshop series was led by a group of internationally renowned rehabilitation experts, who are also members of LIH Healthcare’s Consultant Advisory Board. They discussed 3 trending rehabilitation topics, “Spasticity Management,” “Cardiac Rehabilitation,” and “Motor Control and Learning.” The workshops introduced cutting-edge concepts and included on-site demonstration with the most advanced technology in the field. Focusing on enhancing awareness on how to promote patients’ functional ability and quality of life, the workshop series gained attention from international and local rehabilitation communities.

Audience ISPRMDCThe first workshop, Spasticity Management, was led by Dr. Gerard Francisco and Dr. Heakyung Kim. Both are well known rehabilitation professionals. Two breakout sessions included “Contemporary Strategies for Post-Stroke Spasticity Management” and “Strategies of Spasticity Control in Cerebral Palsy Children.” Dr. Francisco is the current Director of the American Board of Physical Medicine and Rehabilitation and Chief Medical Officer of TIRR Memorial Hermann. He is also a clinical professor and Chairman of the Department of Physical Medicine and Rehabilitation at the University of Texas Health Science Center at Houston Medical School. Dr. Kim is the Fellowship Program Director of Pediatric Rehabilitation Medicine and Director of Pediatric Physical Medicine & Rehabilitation Medicine at Morgan Stanley Children’s Hospital of New York Presbyterian Hospital in New York City; she also serves as A. David Gurewitsch Professor of Rehabilitation and Regenerative Medicine and Professor of Pediatrics at Columbia University Medical Center and Weill Cornell Medical Center.

”Cardiac Rehabilitation” workshop sessions were led by Dr. Matthew Bartels and Professor Alice Jones, also two very renown rehabilitation experts. The two breakout sessions included “Physical Medicine and Rehabilitation Medicine Physician in Cardiac Rehabilitation: Restoration of Function and Health” and “The role of a Physiotherapist in Cardiac Rehabilitation.” Dr. Bartels is the current Chairman of the Department of Rehabilitation Medicine at Montefiore Medical Center/Albert Einstein College of Medicine in New York. He has also been prominently engaged in the American Board of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, Association of American Physicians, and the International Society for Heart & Lung Transplantation. Professor Jones is an international expert in cardiorespiratory physical therapy; she is currently an Honorary Professor at the University of Sydney.

The “Motor Control and Learning” workshop session was led by Professor Fengyi Kuo and Therapist Ching-Chun Lin. The session was rolled out with a deep dive from theoretical lecture to practical experience. Professor Kuo is currently an occupational therapy clinician at LIH Olivia’s Place, Shanghai, and a visiting professor at Indiana University/IU School of Health and Rehabilitation Sciences in Indianpolis, Indiana, United States. She also serves on the American Occupational Therapy Association (AOTA)’s Childhood Obesity Prevention and Health Promotion Work Group. Ching-Chun Lin is an experienced physical therapist with extensive clinical and research experience in neurology, pediatrics, orthopedics, geriatrics, and neurocognitive fields. She has previously served as Physical Therapist Lead of the Rehabilitation Medicine Department at Zhonghe Memorial Hospital of Kaohsiung Medical School.

ISPRMDC Pre-Conference Presenters and LIH Healthcare Executives

ISPRMDC Pre-Conference Presenters and LIH Healthcare Executives

The sponsor of the the pre-conference series, LIH Healthcare, is a leading rehabilitation provider in China, with multiple clinics in major cities including Beijing and Shanghai. In 2016, LIH Healthcare will open Shenzhen LIH Olivia’s Place, followed by Kunming SkyCity Rehablitation Hospital, the first large-scale rehabilitation hospital in southwestern China. LIH Healthcare’s mission to bring best high quality rehabilitation services and reputation for clinical and management best practices has gained the technical support of many national and international experts including the clinical experts represented on the company’s Consulting Advisory Board and Technical Advisory Board, as well as partner organizations including Children’s Specialized Hospital (New Jersey, US) and Montefiore Medical Center, (New York, US).


LIH HealthCare Brings Train the Trainer Model to Chinese Cardiopulmonary Rehabilitation

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“It exceeds far beyond my expectation; it is truly a training program that separates from most of the so called ‘training’ offered in the market these days.”

                                                      – Mr. Qian, training participant

 

The first Cardiopulmonary Rehabilitation Theory and Clinical Procedure Training Program came to a close on 30 July 2016 in Beijing. Instructed by a team of 14 highly distinguished trainers including Dr. Matthew Bartels, Chairman of the Department of Rehabilitation Medicine at Montefiore Medical Center/Albert Einstein College of Medicine, Professor Dayi Hu, Chairman of China Heart Federation, and Professor Leming Wang, Managing Director of Chinese Association of Rehabilitation Medicine, the 7-day program has received record attention from the cardiopulmonary rehabilitation professional community and a well-established reputation since the first day of the training.

Training participants were the 61 national finalists selected from 200 applicants to join the first pilot program. All of them are current clinicians such as physicians, nurses, and therapists, as well as hospital administrators. By the end of the training, qualified graduates were awarded with the joint graduation certificate to become certified trainers recognized by LIH Healthcare, China Heart Federation, Montefiore Medical Center, and Chinese Association of Rehabilitation Medicine.

 

Dr. Matthew Bartels, Member of the LIH Healthcare Consulting Advisory Board, teaching on the first day of the training program.

Dr. Matthew Bartels, Member of the LIH Healthcare Consulting Advisory Board, teaching on the first day of the training program.

High-Ranking Trainer Brings Quality and Perfection

“Dr. Matthew Bartels attracted crowds of training participants after the class,” said Dr. Jie Zhang, Executive Vice President of Strategy & Corporate Development and Director of Clinical Liaison Leadership at LIH Healthcare. Cultural differences are commonly seen as a challenge for many western rehabilitation trainers in the larger context of China’s medical environment. Dr. Bartels is well aware of the challenge and capable of bringing effective learning to Chinese audiences by collaborating with prestigious healthcare organizations in the local market. “Dr. Bartels is highly engaged with Chinese training participants, and is also well-guided thanks to the successful collaboration with our professional training team”, remarked Dr. Zhang.

Training participants expressed their opinion of the course on the post-training satisfaction survey. The training sessions led by Dr. Bartels claimed 100.00% satisfaction rate from 51 out of 61 training participants on almost all teaching topics.

 

Dr. Bartels conducting an Incremental Shuttle Walk Test with a training participant

Dr. Bartels conducting an Incremental Shuttle Walk Test with a training participant

Strong Emphasis on Practical Experience

As the key architect and instructor of this training program, Dr. Bartels is well recognized in the world of cardiopulmonary rehabilitation.  His teaching format stretched from lecture presentations to practical learning through case discussion and demonstration. Training participants gained a wealth of knowledge by having intense case discussion with their team members with a side selection of scenarios varying from hospital-based outpatient programs to home-based cardiac programs. In the session of Basic Exercise Physiology for Cardiac Rehabilitation, training participants were instructed by Dr. Bartels on the Incremental Shuttle Walk Test to strengthen their knowledge of aerobic training.

 

Participants discuss analysis of a 6-minute walking test provided to an 80-year-old patient.

Participants discuss analysis of a 6-minute walking test provided to an 80-year-old patient.

“It is actually a far better result than attending professional conferences overseas, the training has been a very effective learning experience in many different ways.”

-Ms. Liu, training participant

Due to the practical theme of the training, many participants found it extremely beneficial to have frequent opportunities to exchange ideas between instructors and fellow students, which consisted of experienced healthcare professionals from diverse disciplines, departments and backgrounds. Most of the practical experiences were closely integrated with clinical scenarios with specific and detailed explanations to demonstrate the mapping process of clinical reasoning and diagnosis.

 

The Future of Cardiopulmonary Rehabilitation Training in China

Through examining the situation of limited highly qualified cardiopulmonary rehabilitation training resources in China, LIH Healthcare recognizes that the future of cardiopulmonary rehabilitation here will be realized through the delivery of high quality training services that offer participants the opportunity to gain professional skill and hone their expertise. LIH Healthcare believes in the value of investing in the development of China’s rehabilitation healthcare professionals and will continue its strong commitment to increase professionalism in the rehabilitation community in China.


Olivia’s Foundation Focus: Bethel

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Some of the most rewarding work we do is through the pro-bono efforts of Olivia’s Foundation. Olivia’s Foundation is the non-profit foundation arm of LIH Olivia’s Place. Our mission is to provide pro-bono and subsidized therapy for special needs children with financial challenges, provide training to caregivers and parents of children with special needs, and promote awareness about special needs children and persons with disabilities. The Foundation works with numerous welfare centers, foster care homes, and non-profit organizations.  We are very proud to have partnered and worked with Bethel, a home for children with visual impairments.

Bethel has four centers for blind children, each with a different focus, including early intervention, primary school, high school, and long-term care. Children come to Bethel from over 35 welfare centers across the country to receive individual care and education with a focus on visual impairment.

Many of Bethel’s preschool children have multiple needs or have developmental delays due to lack of early intervention. When the children arrive at Bethel, each gets an IEP (Individualized Education Program).  LIH Olivia’s Place has teamed up with Bethel to provide assessments in physical therapy, occupational therapy, and speech-language therapy to develop goals for the children.

Bethel started a relationship with LIH Olivia’s Place in 2012. At that time, the pro-bono effort was more focused on assessments and training Bethel staff since Bethel had more children with multiple needs (mostly autism). In the last couple of years, Bethel has had many successful adoptions of these children.  Having clinical reports from LIH Olivia’s Place therapists for adoptive families to review has been very helpful in the adoption process.

DongQiang with his new wheelchair.

DongQiang with his new wheelchair.

However, because of the complexity of the needs of many of the Bethel children, many are still waiting to be adopted. To help these children and their caregivers, LIH Olivia’s Place therapists have provided individual occupational and speech therapy sessions since 2015. The children typically attend six or more sessions along with their Bethel caregivers and teachers so they can learn how to help the children make progress at home. Between 2015 and 2016, 11 children have benefited from occupational, speech, and physical therapy from LIH Olivia’s Place. A couple stories are shared below.

Dong Qiang is a Bethel boy who has cerebral palsy in addition to visual impairment. An LIH Olivia’s Place occupational therapist created a postural management report, which helped Bethel determine which wheelchair would be the best fit for him.  She also connected Bethel with the wheelchair’s manufacturer. DongQiang’s quality of life has improved dramatically by having a wheelchair that supports him and is a better fit for his needs.

TWenYanghis year, Wen Yang attended both speech and occupational therapy at LIH Olivia’s Place. Wen Yang has a condition called cortical visual impairment. Children with this condition are visually impaired because the brain has trouble interpreting the information the eyes perceive, and Wen Yang presented with delays often associated with this condition. When he started therapy at LIH Olivia’s Place, he showed very little interest in toys and could only move by scooting across the room. By the third session, he surprised everyone by walking away from the room. During therapy, he also learned to play with toys and is now a much more engaged and happier child. LIH Olivia’s Place therapists were so encouraged by his progress that they continued to work with him for a few additional weeks. Wen Yang is now attending preschool at Bethel and is able to play with other boys his age.

These two stories are just a highlight of some of the progress and success that therapy has brought to the children at Bethel. At Olivia’s Foundation, we aim to help more children at Bethel and other organizations such as Bethel to make strides in their development and live happier and more fulfilling lives.


SMA Patients Get a Boost in China

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6P5A4178To honor Spinal Muscular Atrophy (SMA) Awareness Month this August, the first China SMA conference was held successfully in Beijing on August 6, 2016. Organized by Beijing Meier Advocacy & Support Center for SMA, nearly 200 SMA patients and their families attended the conference to gain important knowledge about the condition as well as treatment and therapy options. The speakers included leading experts in clinical SMA, genetics, genetic screening, prenatal diagnosis, rehabilitation therapy, and drug research areas from the USA, Taiwan, Hong Kong and the mainland. LIH Olivia’s Place was proud have Eva Ma, Occupational Therapist at our Beijing Clinic, as a speaker during the conference.

Spinal muscular atrophy (SMA) is a disease that robs people of physical strength by affecting the motor nerve cells in the spinal cord, taking away the ability to walk, eat, or breathe. It is the number one genetic cause of death for infants. SMA is caused by a mutation in the survival motor neuron gene 1 (SMN1). In a healthy person, this gene produces a protein that is critical to the function of the nerves that control our muscles. Without it, those nerve cells cannot properly function and eventually die, leading to debilitating and often fatal muscle weakness. SMA affects approximately 1 in 10,000 babies, and about 1 in every 50 people is a genetic carrier. SMA can affect any race or gender.

Though there is not yet an effective pharmaceutical treatment for SMA, various nursing services and therapies can delay progression of the disease, improve life quality, and earn more time for drug research. With the current progress in genetics research, SMA has been identified by the US National Institute of Health (NIH), as one of the neuromuscular diseases which will likely yield promising breakthroughs. However, in China, therapy and rehabilitation services available to SMA patients in China are underdeveloped and a lot of work remains on increasing clinical research and therapy, rehabilitation and education. SMA patients and their families lack the knowledge, access to resources and treatment/therapy options that are the standard for SMA patients in the rest of the world.

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Eva Ma, Occupational Therapist, offered a dynamic presentation, demonstrating key concepts to conference participants

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LIH Olivia’s Place aims to help to close the gap when it comes to providing high-quality rehabilitation services to pediatric SMA patients in China. Eva Ma’s 90-minute presentation was titled “Positioning Children and Teenagers for Function,” and included valuable information about how to effectively position children with SMA for effective skeletal and muscular development and to maintain the most efficient respiratory (breathing) functions and feeding and nutritional status. Eva emphasized the importance of regularly changing a child’s position, which is critical for developing gross and fine motor skills, maintaining functional use of their hands, and preventing further deformities. It is critical to provide solid support for a child with SMA in all different positions so that they have the stability needed in order to maintain proper body alignment throughout the day.

ThiIMG_2416s functional presentation was very well-received by conference participants, and the Q&A session spilled over its allotted time, as many parents sought out Eva’s expertise on specific challenges their children are facing.

With the large demand of SMA patients needing access to high-quality rehabilitation services in China, LIH Olivia’s Place and Olivia’s Foundation are now partnering with Beijing Meier Advocacy Group to assist these children and their families. We look forward to making a difference in the lives of children with SMA!

Meier Advocacy & Support Center for SMA was founded by actress Feng Jiamei and SMA Type III patient Ma Bin. It is a non-profit organization dedicated to helping people with SMA and supports families through networking, information, and services and sponsorships. The organization maintains the Chinese SMA Patient Registry and collects clinical and genetic information of individuals affected by Spinal Muscular Atrophy to promote clinical trials in China.


Clinician Profile: Zhang Yan (Irene Zhang), Occupational Therapist

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Irene Zhang

Irene Zhang, Occupational Therapist, LIH Olivia’s Place Shanghai

Zhang Yan (Irene Zhang)

Irene is a Hong Kong-registered occupational therapist. She has a Bachelor of Science in Occupational Therapy from Hong Kong Polytechnic University and a diploma in Rehabilitation Science from West China Center of Medical Sciences, Sichuan University. She has worked with adults and children in rehabilitation center, hospital, and school settings. Her clinical interests are in working with children with a variety of special needs, including sensory processing difficulties, handwriting difficulties, ADHD, ASD, dyslexia, Down syndrome and cerebral palsy.Languages: English, Mandarin, Cantonese

 

Why did you choose to work at LIH Olivia’s Place?

LIH Olivia’s Place is the pioneering service provider in China that offers world class, multidisciplinary pediatric therapy services. In addition, I was attracted by the mission to make high standard therapy universally available in China.

 

Why did you choose your field?

After having worked with adults with disabilities, disaster victims, and children with special needs. I found I was really enjoying teaching children new skills while playing with them. Pediatric occupational therapy offers me the opportunity to enjoy every minute of my life and meanwhile fulfill my career aspirations.

 

What are some of the most rewarding experiences you have had in your chose profession?

After regular visits to a welfare center for a year, all bed-bound children now have adaptive chairs and a daily routine to access these chairs. The quality of life for these children has changed and the staff at the center have started to understand how important a positive attitude and praise are for teaching and training children.

 

What’s your favorite thing about living in China and working at LIH Olivia’s Place?

The not very fast-not very slow pace of living in Shanghai and the international environment and culture compatibility at LIH Olivia’s Place.

 

What would you like to be doing in 5 years’ time?

Besides personal professional development, as a pediatric OT working mainly with expatriate families in Shanghai currently, I would like to contribute as much as I can to promote a holistic occupational therapy service to children with special needs all over China. This would include visiting more local schools and extend OT service in local schools and establishing long-term relationships and regularly visiting two more welfare centers.


Radio Show “Rehabilitation Classroom” Improves Awareness

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The Rehabilitation Classroom, a public benefit broadcasting program co-created by Kunming LIH SkyCity Rehabilitation Hospital and Yunnan News Radio Station, has been broadcast over FM105.8 since 1 July 2016. The program has been well-received, with excellent audience ratings.

 

Nelson Chow, CEO of LIH Healthcare, broadcasts at Yunnan News Radio Station.

Nelson Chow, CEO of LIH Healthcare, broadcasts at Yunnan News Radio Station.

The first guest of Rehabilitation Classroom was Nelson Chow, CEO of LIH Healthcare. In telling the story of his young daughter Olivia, who has Down syndrome, Nelson emphasized the important role that therapy has played in Olivia’s development. In another broadcast, Professor and Occupational Therapist Fengyi Gou (Taiwan), also with LIH Healthcare, introduced geriatric disease rehabilitation and shared experiences in how to live healthily and happily in one’s senior years. So far, seven experienced clinicians have been invited to this program to impart rehabilitation knowledge to listeners. By using plain language and related stories, the experts have made this program easy to understand and enjoyable to listen. Topics in July and August have included:

  • Olivia’s Story (presented in two parts)
  • Cervical Spondylosis Rehabilitation
  • Early Rehabilitation of Fracture
  • Give Yourself a Chance of Recovery
  • Healthy and Happy Old Age
  • To know CPR, To Improve Life Quality

 

Yunnan News Radio Station has an audience of 6.5 million throughout Kunming, many of whom are seniors. This program helps listeners learn more about rehabilitation and contributes to improve national awareness. The partnership between Kunming LIH SkyCity Rehabilitation Hospital and Yunnan News Radio Station will continue to invite rehabilitation medicine experts to provide community-based education to our audience, especially on topics that positively impact the lives of seniors, in the near future.


LIH Olivia’s Place Moves to Digital Assessments

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The Speech-Language and Psychology teams at LIH Olivia’s Place Shanghai have recently made the exciting transition to digital assessment administration for many formal assessments.  Since LIH Olivia’s Place opened in 2010, we have been committed to using leading industry standard assessments and to safeguarding the intellectual property of the assessment authors and publishers. This has always meant dealing with a number of challenges to ensure that test materials from international assessment publishers could be readily and consistently available. The opportunity to explore another way of maintaining our high standards while we continue to grow in China, while protecting the integrity of the assessments themselves, was exciting to us.

 

kid hands ipadThe decision to change from paper-and-pencil test formats to the use of iPad and computer-based testing was no easy task. Our teams had to consider the ease of use for children and parents, comfort levels with necessary technology, and the learning curve of new administration techniques. However, after trials by our speech and psychology staff, it was clear that these formats would be of significant benefit to the families we serve and our clinicians. Once a struggle because most assessments must be purchased outside of China, digital assessment platforms will allow LIH Olivia’s Place clinicians to immediately access the most up-to-date versions of some of our most widely used tools. They will also allow us to stay immediately informed of any changes or improvements in the tests we use.

 

Digital administration is now offered through several assessment publishers and LIH Olivia’s Place will migrate to digital platforms as they become available and well-tested. One of these platforms is Q-Interactive, offered by Pearson, the publisher of many of the most reputable and evidence-based tests. It can be used to both administer and score tests that are traditionally given by examiners in a paper-and-pencil format. Using the digital version of the assessment, testing takes place on two iPads using an app called Assess. The first iPad is used by the examiner to access the test administration instructions, score and record responses, and control visual stimuli. The person who completing the assessment uses the other iPad to view and respond to stimuli. Q-interactive can also generate summary information for assessments administered on the iPads.

 

Pearson has conducted substantial research to ensure that the use of its digital system does not detract from the quality of assessments administered. Prior to inclusion in the Q-interactive library, each new type of subtest underwent an equivalency study to evaluate whether scores from digital testing were interchangeable with those scored from paper-and-pencil testing. Results of these studies support the validity of Q-Interactive as a method of administration for all tests included.

 

The transition to digital assessment is an intensive process. While familiar with the paper and pencil versions of these tools, our clinicians have undertaken additional training to solidify their competency in each assessment they will be administering with the new systems.  Clinicians and families at LIH Olivia’s Place Shanghai will be the first to use these advanced digital platforms, other LIH Healthcare clinics and hospitals can anticipate having access to this technology and specialized training in the near future.


Keeping Our Own Team Healthy: Staff Physical Therapy Workshop

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Physical therapists ZiLi Wang and Ilija Dimitrovski gave staff at LIH Olivia’s Place Shanghai a workshop on managing workplace postures, including short assessments for staff with work or sports related pain. The health of our clinicians and support staff is very important, as having a pain-free body allows us to perform at our best.

Staff learned about the basics of core muscle strengthening to help maintain proper posture, and how to manage their works pace. Specific problems, such as neck, back, and shoulder pain were individually addressed, with the physical therapists showing their assessment flow – from asking subjective questions to the actual physical examination. Suggestions for exercises to relieve neck stress and stretch the neck and shoulder muscles were also given and demonstrated.

Here are a few of the exercises that were included:

 

Neck Extension: This exercise helps relieve pain from the neck after too much time spent looking down at laptops or paperwork.

Neck Extension

 

Tuck your chin in and slide your whole head backward. Slowly extend your neck as you look up. Slowly right your head, then repeat the movement 10 times. Do not repeat this exercise if it worsens your pain!

 

Neck Muscle Stretches: These exercises help stretch out the neck muscles on both sides.

 

Neck Stretch

 

Look down and turn the head slightly (45 degrees) to either side. Take the arm on the side turned to, and gently pull the head down. Maintain the stretch for 30 seconds.

 

Core and Back Exercise: This is a general exercise that can be used to improve core strength and back stability. If it is too difficult to maintain, do only the legs or arms component.

Superman

Kneel down so that your back is flat and your knees and shoulders are flexed to 90 degrees. Slowly raise up one leg and at the same time raise the opposing arm, keeping your back flat. Hold the posture for up to 1 minute. Repeat using the opposite limbs.

 

 


LIH Announces Technical Advisory Board Members

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LIH Olivia’s Place is thrilled to announce the addition of Dr. David Cifu and Dr. Denise Challis to our Techinical Advisory Board, joining our standing members who have recently committed to continued service: Dr. Ao Lijuan, Professor Jean Deitz, Professor Sharon DeMuth, and Dr. Henry L. Lew.

We warmly welcome our new Technical Advisory Board members and thank each of our continuing members who have renewed their commitment to our organization. Each shares the vision, mission, and values of LIH Healthcare and brings the kind of creativity, energy, and commitment that LIH Olivia’s Place needs to build on what we have accomplished together over the last several years. Their distinctive knowledge, experience, and expertise in rehabilitation will support our efforts in increasing our impact on China’s rehabilitation services.

 

Dr. Ao 1Ao Lijuan, MD

Dr. Ao is the Department Chairperson of Kunming Medical University’s Rehabilitation Medicine Department. She is also the Vice Chairperson of the China Association of Rehabilitation Medicine, the Secretary General of the Yunnan Provincial Association of Rehabilitation Medicine, the Chief Physician in the Rehabilitation Department of the Second Affiliated Hospital of Kunming Medical University, the Chief Medical Officer of the Yunnan Disabled People’s Federation Rehabilitation Hospital, and on the editorial boards of multiple medical journals. Dr. Ao has made very significant contributions to the development of rehabilitation medicine, physical therapy, occupational therapy and speech and language pathology in China. Among other things she has been instrumental in starting the first degree programs in these three latter fields. Dr. Ao has a passionate commitment to the development of pediatric therapy in China, assessment of children with cerebral palsy, and methodology for treatment.

 

DCHALLISDenise Challis, MA., MB., Bchir., Msc., DCH., FRCPCH

Dr Challis has specialized in neuro-pediatrics over the past 44 years, having trained in the Universities of Cambridge and London. She consulted at The Portland Hospital, London, England, until autumn 2015. Her specialism was in the assessment and treatment of children from all over the world with neurological conditions, including autism, cerebral palsy, epilepsy, neurodegenerative diseases, and a wide range of congenital disorders. Her continued special interests include the holistic management of the care of children with complex, chronic disorders from initial assessment, particularly using the Griffiths Mental Development Scales (GMDS). She lectures regularly in the UK and abroad, particularly in China, partly to facilitate the growing use of assessment in diagnosis and provision of therapy for children with disabilities Dr. Challis is presently a Consultant Pediatrician specializing in Neurodevelopment and Neurodisability. She is the Past President of the Association for Research in Infant and Child Development. She is also a member of the Member of the British Paediatric Neurology Association and the British and European Academies of Childhood Disability.

 

DCIFUDavid Cifu, MD

Dr, Cifu is Chairman and the Herman J. Flax, MD Endowed Professor (tenured) of the Department of PM&R at the Virginia Commonwealth University (VCU) School of Medicine in Richmond, Virginia. He is also Chief of PM&R Services of the VCU Health System and Founding Director of the VCU-Center for Rehabilitation Sciences and Engineering (CERSE). He is the Senior Traumatic Brain Injury Specialist for the U.S. Department of Veterans Affairs. He has been funded on 39 research grants of over $130 million, including currently serving as Principal Investigator of the VA/DoD $62.2 million Chronic Effects of Neurotrauma Consortium (CENC). In his more than 25 years as an academic physiatrist, he has delivered more than 500 regional, national, and international lectures, published more than 200 scientific articles and 65 abstracts, and co-authored or edited 31 books and book chapters. He is also the Past President of the American Academy of PM&R (2007-8) and Editor-in-Chief of the 5th Edition of Braddom’s Physical Medicine and Rehabilitation textbook (2015).

 

JDEITZJean Deitz, PhD, OTR/L, FAOTA

Dr. Deitz was a professor in the Department of Rehabilitation Medicine, School of Medicine, University of Washington (UW) for 30 years. During her tenure at the University, she was involved in curriculum design, development, implementation, and evaluation; taught undergraduate, masters, and doctoral level courses; served as Graduate Program Coordinator for the Department; mentored graduate students in occupational therapy, physical therapy, prosthetics and orthotics, and education; chaired the committee that developed the UW interdisciplinary PhD program in Rehabilitation Science; was the principal investigator or project coordinator for numerous federally funded grants related to either program development or research; and was elected to the UW Graduate School Council.

She has published extensively with a focus on pediatrics, measurement, and assistive technology. She has 80 research publications in peer-reviewed journals and has contributed chapters to major textbooks in her field. Nationally, she served as an American Occupational Therapy Foundation (AOTF) Regional Research Consultant and chaired the AOTF Research Advisory Council;served on the National Advisory Board for Medical Rehabilitation Research (National Institutes of Health); and was on the editorial boards of peer-reviewed journals appropriate to her field.   Her primary awards include American Occupational Therapy Foundation Academy of Research; Fellow of the American Occupational Therapy Association; Lifetime Honorary Membership in the American Academy of Orthotists and Prosthetists (in recognition of her leadership in helping them move their educational programs to the master’s level); and two American Occupational Therapy Foundation Meritorious Service Awards (2003 and 2008).  The latter was for being an “effective and articulate advocate for the relationship among occupation, participation, and health”; and for sharing a “wealth of knowledge” and an “interdisciplinary perspective, as both a scholar and teacher.”

 

SMDEMUTHSharon DeMuth, PT, MS, DPT

 Dr. DeMuth developed the clinical pediatric physical therapy curriculum in the Doctor of Physical Therapy program at the University of Southern California (USC) where she taught for 16 years until she retired in 2013. Her contributions to the Division of Biokinesiology and Physical Therapy were recognized with the Division Tribute Award in 2014. Dr. DeMuth especially enjoyed supervising students in providing care for children and families in Fit Families (the pro bono clinic at USC) and at volunteer sites in Mexico. She has continued volunteering as a clinician and teacher of physical therapists and orthotists caring for patients with cerebral palsy and polio internationally. Prior to teaching at USC she served as a clinician, and supervising therapist at Boston Children’s Hospital and Children’s Hospital of Los Angeles as well as acting director of physical therapy at the Children’s Hospital of Philadelphia. Dr. DeMuth directed the Los Angeles collection of normative data for the Test of Infant Motor Performance, a multi-center NIH funded research project with Suzann Campbell, PT, PhD, to develop a new test for evaluating motor performance in infants born prematurely. She was also co-lead investigator on the Pediatric Endurance and Limb Strengthening Study (PEDALS) that evaluated the effect of a stationary bicycling intervention on strength and endurance in children with the spastic diplegic form of cerebral palsy. She has served as the co-chair of the education committee and as the chair of the nominating committee of the Pediatric Section of the American Physical Therapy Association. She was recognized for her service to the Pediatric Section with the G E “Bud” DeHaven service award, one of the sections highest honors. Dr. DeMuth was an article reviewer for the journal of Pediatric Physical Therapy. She has written chapters on orthopedic pediatric physical therapy in two texts and has published abstracts and articles in peer reviewed journals on idiopathic scoliosis, cerebral palsy, orthotic practice and wound healing using electrical stimulation.

 

HLEWHenry L. Lew, MD, PhD

Dr. Lew is a board-certified physician in Physical Medicine and Rehabilitation (PM&R) in the USA. He completed his PM&R residency training and Traumatic Brain Injury (TBI) fellowship at the University of Washington in Seattle, Washington. Dr. Lew served as Clinical Assistant Professor of PM&R at Stanford University School of Medicine, Associate Professor at Harvard Medical School, and currently holds two Professor appointments, one at the University of Hawaii School of Medicine, and the other at Virginia Commonwealth University School of Medicine.Dr. Lew has been awarded multiple federal and state grants to study the diagnosis and rehabilitation of brain injury, with emphasis on promoting evidence-based clinical practice. He has published more than 120 scientific articles, 10 book chapters, and authored 3 textbooks (Electromyography, Polytrauma Rehabilitation, and Braddom’s Textbook of PM&R, as Associate Editor, with Dr. David Cifu as the Editor).  He has been recently appointed as Chair of the Education Committee for the International Society of Physical and Rehabilitation Medicine (ISPRM).

 

For inquiries about our Technical Advisory Board, please contact Dr. Jie Zhang., Director, LIH Healthcare Training Division


What is the Role of Medications in ADHD?

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by Susan Cadzow, MD, Director Developmental-Behavioral Pediatrics, LIH Olivia's Place

by Susan Cadzow, MD, Director Developmental-Behavioral Pediatrics, LIH Olivia’s Place

Children and adults with severe attentional difficulties are sometimes prescribed medications. This is generally only when their symptoms are having a significant impact on learning and general function.

Medications should only be considered after other non-pharmacological supports and strategies have been implemented and there are still major concerns that the child is functioning well below their ability level due to concentration deficits.

Before considering medications, a pediatrician will do a thorough medical history and examination. Co-existing medical conditions that might be affecting the child’s performance can be identified and treated if necessary. The evaluation will also focus on assessing the nature and the severity of the problem. Information will be gathered from parents, the child’s school, and the child him/herself if they are old enough. In some cases, another referral may be made during this process, for example, to a psychologist to undertake formal assessment of the child’s learning profile and abilities).

Regarding ADHD medications, it’s important to recognize that they are aimed at reducing specific “target symptoms,” namely hyperactivity, impulsivity, and distractibility. They generally do not have specific action in terms of behaviours such as defiance and aggression. However, there can be some positive benefits for behavior and social skills if the problems are resulting from impulsivity or poor self-regulation.

If everyone agrees that a trial of medications may be helpful and is appropriate for the individual child, generally a 1 to 2 month trial of a stimulant medication will be started as the “first line” treatment. If stimulant medications are prescribed appropriately, approximately 70-80 % of people show a beneficial response (that is, significant reduction in the target symptoms).

In general stimulant medications are very safe and have been in use since the 1980s for treating children with ADHD. Reduction in appetite during the day is a common side effect of stimulant treatment. Children must be monitored carefully to ensure intake is adequate and growth is not affected. The pediatrician will follow up on a regular basis to assess dose adequacy, ongoing effects, and side effects. ADHD medications do act on chemical transmitter levels in the brain so there are many other possible side effects involving the neurological system but fortunately these are very rare and normally immediately reversible when the medications are stopped.

Since the main time that the medication effects (improved concentration, planning, and focus) are needed is the school day many families choose to not give the medication on weekends and school holidays. If for any reason stimulant medication is not effective or not well tolerated there are some alternate medications that can be tried. For example, Strattera (atomoxetine), is one that is often used and which is also available in China. Occasionally this may be tried first, particularly in children with significant anxiety symptoms as it also has an anti-anxiety effect.

Key Points

1. ADHD medications should normally be considered only in children with severe symptoms who have already tried non-medication therapies.
2. Medications are only part of the treatment plan for children with ADHD. Behaviour management, school support, classroom strategies, and counselling are also very important.
3. Children need to be assessed thoroughly before a trial of medications and monitored closely during treatment.
4. The main aim of medication is to reduce specific target symptoms in order to allow the child to reach their learning potential. Improvements in social skills and relationships may be seen if impulsivity and self-regulation have been a problem.
5. Approximately 70-80% of people with a diagnosis of ADHD respond positively to treatment with stimulants.
6. Stimulant medications have been used in ADHD since the 1980s and are well-researched and generally very safe.


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