Modulation of sensory input to help inform and direct motor output thereby improving performance of movement and function, remains a key component of the Bobath Concept. Therapists achieve this through different means including altering alignment, improving efficiency of muscle activity recruited and working to improve the patients acceptance of the base of support, to mention a few. This sensory input is utilised at all levels in the CNS from the spinal cord to the cerebellum and sensory cortex.
As therapists we rely on what we can see and feel to inform our clinical decision making and in turn provide a rich sensory input for the patient. So far so good, that is until we all started to wear PPE. Of course, it is essential and a crucial component of Infection prevention, to allow us to work safely in this current pandemic, however, it’s caused havoc with my ability to provide a rich sensory input to both my patients and also, very interestingly, to myself.
Masks and visors are cumbersome to wear and even with the best efforts, visors tend to get misted up, especially at the end of a long session. This obviously impacts on my vision; with focus I can look at one particular body part but using wider vision to observe the impact and alignment in other areas is difficult. This has slowed down my processing and specificity of what I am seeing and has made my clinical reasoning feel less precise and accurate.
In addition, perceptually I was not always aware of the position of my mask and I have, on several occasions, found my self bumping into patients. It has also made me realise how I sometimes use my head as a stable reference point against the patient, to assist their stability.
Verbal input is also an important part of facilitation and guidance of activity, which again has been slowed down and sometimes muffled by the use of a mask. I also hadn’t realised how much information I get from a patients face regarding feedback from different interventions - I have become much better at reading eyes only!
Gloves are used at all times; the first point is to get the right size. Too big and everything moves under my hands, too small and my hands feel squeezed. Trying to gain specific input through my gloved hands feels clumsy and lacks specificity. This impacts on what information I receive and also on the patient’s experience.
Patients also sometimes experience gloves pulling their hairs and skin, which can be noxious and produce undesired effects.
Initially I found these changes to my practise very challenging, I felt treatments did not flow as smoothly and everything took longer to complete, which was both frustrating and tiring. Over time this has become the ‘new normal’ and has in turn lead to a speeding up and increased precision of my clinical reasoning to the point where I feel I’m back up to my normal level of skill!
Patient feedback has also reflected that they are adapting too, and now sessions are feeling very much back to the pre-Covid level, which is great for both therapist and patients alike.
How much longer this will continue I don’t know, but one positive thought is that perhaps, when we can be PPE free, we may have new improved facilitation skills, with the sudden enhanced level of sensory information!
BBTA are teaching courses in covid-secure environments and will help you develop your facilitation skills to improve your patient outcomes. If you would like to book into any of our courses have a look at our website or get in touch with us. www.bbtaorg.uk