Northern Connections: May 12-13, 2023

Description:

• FIREFLY is Ontario’s newest Children’s Treatment Centre (CTC). Having received designation as a CTC in January 2021, FIREFLY began the work of developing our specialty rehabilitation services and continues to be on this journey. In the interest of building connections and sharing expertise in the pursuit of further service expansion in our region, FIREFLY invites you to join us for a light breakfast to network and connect around the following specialized rehabilitation topics: Seating & Mobility, Complex Feeding & Swallowing, and Augmentative & Alternative Communication. Any clinician who practices in these areas is encouraged to attend.

Presenters:

• Brock Chisholm (Physiotherapist, NOSM University – Clinical Learning Liaison)
• Jamie Trusler (Physiotherapist, NOSM University – Clinical Learning Liaison)
• Cara Green (Dietician, NOSM University – Manager, Northern Ontario Dietetic Internship Program)
• Mike Ravenek (Occupational Therapist, NOSM University – Manager, Health Sciences)

Abstract:

• Although most learners complete their education without significant difficulties, a small percentage will experience challenges during their program. Challenges on placements might relate to their knowledge, skills, attitude, or professionalism and are often interconnected with other issues (personal life, environment); understanding these issues can help identify and address them. This discussion based workshop will focus on how preceptors can support learners – and be supported themselves – when challenges arise with a learner on a placement. The way the COVID-19 pandemic has increased certain types of challenges seen in the development of some learners will also be discussed.

Learning Objectives:

1. Describe the importance of addressing performance issues with learners.
2. Using participant examples, identify strategies to accurately identify and best support a struggling learner.
3. Develop a plan to manage learner performance issues and/or professional issues if they were to occur.
4. Reflect on the content discussed in relation to case scenarios and one’s own practice.

Presenters:

• Cindy Davis-Maille (Speech-Language Pathologist, NOSM University – Clinical Learning Liaison)
• Sarah Tinkler-Josephi (Speech-Language Pathologist, NOSM University – Clinical Learning Liaison)
• Erica Ogilvie (Occupational Therapist, NOSM University – Clinical Learning Liaison)

Abstract:

• Clinical reasoning is the way clinicians and learners think about the problems they see in practice and is the basis for clinical decision making. This type of reasoning is one of the most difficult competencies for a learner to develop. It is the foundation for the implementation of evidence-based practice and high-quality clinical care. This discussion based workshop will focus on how preceptors can support the development of this competency in learners on placements. How the COVID-19 pandemic has created additional challenges related to the development of this competency will also be discussed.

Learning Objectives:

1. Discuss the development of clinical reasoning in learners
2. Review the clinical reasoning cycle and how it could be used to evaluate learners.
3. Share ideas around strategies for the development of clinical reasoning
4. Reflect on the content discussed in relation to case scenarios and one’s own practice.

Presenter:

• Michael Belcamino (Physiotherapist, Walser & Associates Physiotherapists, Thunder Bay – Clinical Education Lead)

Abstract: 

• The frequent use of thinking and reasoning is required in physiotherapy practice. Physiotherapists use clinical reasoning, which is the thinking and decision-making processes in the clinical setting (Jones, 2019). Furthermore, clinical reasoning involves cognitive and psychomotor processes, and patient collaboration in managing impairments (Elvén et al., 2022). Physiotherapists integrate the biopsychosocial approach in clinical reasoning assessment and management (Elvén et al., 2022; Elvén & Dean, 2017; Elvén et al., 2018). Clinical reasoning has been studied in physiotherapy for many years (Christensen et al., 2019 Doody & McAteer, 2002; Edwards et al., 2004); however, research on its application to enhance low back pain management is limited (McKenzie & May, 2003; Noll et al.,, 2001). The presentation will provide strategies to enhance physiotherapists’ (novice or experienced) clinical reasoning skills in lumbar assessment. Other clinicians (physicians) may also benefit from this information.

Learning Objectives:

1. Apply Clinical Reasoning strategies in assessment of low back pain.
2. How to use cues from patient history and examination to enhance Clinical Reasoning.
3. Identify sources of Clinic Reasoning errors that could influence patient assessment and management.

References:

• Christensen, N., et al. (2019). Chapter 31: Strategies to facilitate clinical reasoning development. In M.A. Jones & D.A. Rivett (Eds.), Clinical Reasoning In Musculoskeletal Practice (pp. 562-582). Elsevier.
• Doody, C., & McAteer, M. (2002). Clinical reasoning of expert and novice physiotherapists in outpatient orthopeadic setting. Physiotherapy, 88(5), 258-268.
• Elvén, M., et al. (2022). Assessing clinical reasoning in physical therapy: Discriminative validity of Reasoning 4 Change instrument. Physiotherapy, 117, 8-15.
• Elvén, M., & Dean, E. (2017). Factors influencing physical therapists’ clinical reasoning: qualitative systematic review and meta-synthesis. Physical Therapy Reviews, 22(1-2), 60-75.
• Elvén, M. et al. (2018). Criterion scores, construct validity and reliability of a web-based instrument to assess physiotherapists’ clinical reasoning focused on behaviour change: “Reasoning 4 Change”. AIMS Public Health, 5(3), 235-259.
• Jones, M.A. (2019). Chapter 1: Clinical Reasoning: Fast and slow thinking in musculoskeletal practice. In M.A. Jones & D.A. Rivett (Eds.), Clinical Reasoning In Musculoskeletal Practice (pp. 2-31). Elsevier.
• McKenzie, R. & May, S. (2003). Chapter 20: Clinical reasoning, In The Lumbar Spine: Mechanical Diagnosis and Therapy (pp. 521-529). Spinal Publications.
• Noll, E et al. (2001). Clinical reasoning of an experienced physiotherapist: Insight into clinical decision-making regarding low back pain. Physiotherapy Research International, 6(1), 40-51

Presenter:

• Halle Demchuk (Speech-Language Pathologist, Keewaytinook Okimakanak Board of Education & Self-Employed, Thunder Bay)

Abstract:

• From doctor’s offices to speech pathology clinics, language acquisition milestones look the same; children learn individual words that they later combine into phrases and sentences. But what does that mean for our Autistic children who can script full TV shows, yet don’t use individual words? Is this just jargon or stimming? Should it be ignored? Research from Rydell & Prizant (1984) and Marge Blanc (2012) has indicated that there are two distinct ways to process and develop language – analytic language development and gestalt language development – though the latter is not taught in graduate programs. Although analytic development is viewed as “standard”, many allistic (non-Autistic) and Autistic children are gestalt language processors. These children develop language following a process known as Natural Language Acquisition (NLA), and many children move through the NLA stages independently. However, Autistic children often get “stuck” in the process, and have a much more difficult time achieving self-generated language. This presentation aims to explain the difference between gestalt and analytic language processors and provide an overview of how to assist Autistic children in moving through the stages of NLA. Halle Demchuk is a registered Speech-Language Pathologist (SLP) and the first SLP in Northwestern Ontario to be trained in working with gestalt language processors.

Learning objectives:

1. Participants will differentiate between analytic language processing and gestalt language processing
2. Participants will be able to summarize Stages 1-4 of the Natural Language Acquisition framework

References:

• Blanc, M. (2012). Natural language acquisition on the autism spectrum: The journey from echolalia to self-generated language. Madison, WI: Communication Development Center.
• Prizant, B. M., & Rydell, P. J. (1984). Analysis of functions of delayed echolalia in autistic children. Journal of Speech, Language, and Hearing Research, 27(2), 183-192.

Presenters: 

• Denise Taylor (Physiotherapist, St. Joseph’s Care Group, Thunder Bay – Manager Regional Rehabilitative Care Program)
• Alison Denton (Sociologist, St. Joseph’s Care Group, Thunder Bay – Manager Regional Seniors’ Care Program)
• Gabrielle Sadler (Physiotherapist, Rehabilitative Care Alliance, Toronto – Project Manager)

Abstract: 

• Purpose: To provide secondary fall prevention by embedding the Rehab Care Alliance post-fall rehabilitation pathway into practice. In the North West, falls among older adults account for 40% of hospitalizations and 24% of Thunder Bay ED visits. Thunder Bay is well above the provincial benchmark for repeat ED visits for falls. Rehabilitative care reduces the risk of falls and functional decline in older adults. Methods and Analysis: Using a Quality Improvement approach, the post-fall pathway was piloted for older adults presenting to ED or reporting a fall in a retirement home. Patient referrals, progress, pre-post self-reported health status (EQ-5D-5L) and experience (EQ-VAS) was tracked. Regional partners met at the end of each cycle to review the data and develop an action plan. Findings: The majority of patients reported improved function (82.4%) and health-related quality of life (mean change=9.7) and were likely to recommend the services (average 6.2/7). Process improvements included consistent assessment of fall risk factors and rehabilitation follow-up. Noted barriers included rehabilitation wait times and patient refusal. Conclusion: Embedding an actionable rehabilitation post-fall pathway in practice contributed to an improvement in patients’ function.

Learning Objectives:

1. Discuss rationale for and strategies used to embed a secondary fall prevention rehabilitation pathway into practice in the City of Thunder Bay.
2. Identify process improvements, barriers and suggestions to the implementation of the pathway.
3. Describe the impact of the Post-Falls Rehabilitation Pathway for patients and the system.

Presenter:

• Sheila Renton (Occupational Therapist & Health Sciences Section Chair, NOSM University)

Abstract:

• Designed for Health Sciences Preceptors interested in learning more about becoming a NOSM University faculty member, this session will include a brief overview of the division structure of the Faculty Affairs portfolio, with specific focus on the Division of Clinical Sciences. Participants will consider frequently asked questions about the benefits and opportunities available to NOSM U clinical faculty members and familiarize themselves with the processes involved in the submission and review of applications for faculty appointment.

Learning Objectives:

1. Describe NOSM U’s processes for the submission and review of applications for faculty appointments within the Division of Clinical Sciences.
2. Identify relevant information and resources.

Presenters:

• Nicole Pajala (Speech-Language Pathologist, Nicole Pajala-Speech Language Pathologist, Thunder Bay)
• Lindsay Knutson Smith (Speech-Language Pathologist, SPOT Speech Pathology & Orofacial Myofunctional Therapy, Winnipeg)

Abstract:

• For those of us who move from professionals into parenthood, we often cross into a unique and personal area where our two worlds collide. For some of us, we start to embark on an all too common, yet very under-serviced area of pediatric feeding issues. This was part of each of our stories and how we have decided to specialize further. Availability of services in the North continue to be an issue with reaching client demands; furthermore, subspecialty services are nearly non-existent. What constitutes as a pediatric feeding disorder? Through each of our personal journeys we both started to research to understand more. Pediatric feeding disorder (PFD) is defined as “impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction” (Goday et al., 2019). We often hear ‘it takes a village to raise a child’ and as professionals that includes focusing on a holistic view of the patient including, but not limited to: lactation, myofunctional considerations, cognitive ability, physical strength, sensory development, respiration and in each of these – knowing when to refer. Our most vulnerable; infants and children require the functional use of our oral structures to facilitate our respiration, safe feeding, nutritional needs, and our ability to communicate and yet, the area of oral structures are often overlooked and underrated. Let’s start the discussion and build the village.

Learning Objectives:

1. Looking back at history, questioning myths, and focusing on research
2. The Holistic Village: describing who might be included on the multi disciplinary team and when to refer.
3. Providing education about the role of the SLP. Specifically, focusing on the ages 0-3 with regards to feeding and development. In addition, focusing from the ages 3 plus with regards to the role of myofunctional therapy.

References:

• Goday, P. S., Huh, S. Y., Silverman, A., Lukens, C. T., Dodrill, P., Cohen, S. S., … Phalen, J. A. (2019). Pediatric Feeding Disorder. Journal of Pediatric Gastroenterology and Nutrition, 68(1), 124–129

Presenters:

• Denise Taylor (Physiotherapist, St. Joseph’s Care Group, Thunder Bay – Manager Regional Rehabilitative Care Program)
• Taryn Klarner (Kinesiologist, Lakehead University, Thunder Bay – Assistant Professor School of Kinesiology, Faculty of Health and Behavioural Sciences)

Abstract:

• Background: Essential rehabilitation services are not available in most remote, Indigenous communities requiring elders to leave their community to receive care. Thus, a Community Rehabilitation Worker (CRW) program was developed to train local community members to support elders and Home and Community Care (HCC) clients. The goal of the CRW program/role is to improve equity in access to quality, culturally-safe care and build capacity as called for by the Truth and Reconciliation Committee. Methods: A highly collaborative partnership between First Nations, academic institutions, health care organizations and an advisory committee, thematically analyzed the implementation of the program and role through interviews, focus groups, CRW submissions, and HCC Community of Practice meeting minutes. Results: The program content and delivery was appropriate. The program and role is essential for equity in access to care, health and wellbeing of Indigenous elders. However, increased communication and CRW role clarification is required. The lack of health human resources results in CRWs performing tasks outside their job description. Conclusion: In order for community-based rehabilitative service programs to be successfully implemented, increased communication about the program and role, and improvement in recruitment and retention of community care providers is imperative.

Learning Objectives:

1. Discuss strategies used to collaboratively develop the Community Rehabilitation Worker (CRW) training program in response to community identified needs.
2. Identify facilitators, challenges and suggestions to improve the implementation of a CRW training program and role in the community.
3. Describe the impact of the CRW role on stakeholders (clients, staff, CRW learners, community).

Additional Authors/Contributors:

• Helle Møller Department of Health Sciences, Lakehead University;
• Joan Rae, Health and Social Services; Sandy Lake First Nation;
• Robert Baxter, Health and Social Services, Eabametoong First Nation;
• Wes Nothing, Health, Michikan (Bearskin) First Nation;
• Nancy Sakchekapo, Health, North Caribou Lake First Nation;
• Mary Ellen Hill,Centre for Rural & Northern Health Research – Lakehead University;
• Shane Strickland, Confederation College-School of Health, Negahneewin & Community Services;
• Tim Larocque, Confederation College- Applied Research
• Esmé French, NWO Regional Stroke Network-Thunder Bay Regional Health Sciences Centre;
• Hannah Melchiorre, Queen’s University- Master of Public Health, St. Joseph’s Care Group;
• Nicole Lee, Department of Health Sciences, Lakehead University
• Marinna Read, Indigenous Services, St. Joseph’s Care Group

Presenters:

• Brock Chisholm (Physiotherapist, NOSM University – Clinical Learning Liaison)
• Jamie Trusler (Physiotherapist, NOSM University – Clinical Learning Liaison)
• Cara Green (Dietician, NOSM University – Manager, Northern Ontario Dietetic Internship Program)
• Mike Ravenek (Occupational Therapist, NOSM University – Manager, Health Sciences)

Abstract:

• Broadly defined, feedback is information provided to a person about their performance in an attempt to help that person improve. Feedback can help set a path for students, directing their attention to areas for growth, and connecting them with future learning opportunities. Feedback is also important for preceptors to receive from learners, in helping to develop and refine their teaching skills. This discussion based workshop will focus on strategies to support the feedback process with learners on placements. The COVID-19 pandemic has created additional challenges related to giving and receiving feedback that will also be discussed.

Learning Objectives:

1. Share ideas around strategies for delivering and obtaining feedback with learners
2. Discuss how to adapt feedback according to the needs of the learner.
3. List potential strategies to navigate communication breakdown while delivering or receiving feedback.
4. Reflect on the content discussed in relation to case scenarios and one’s own practice.

Presenters:

• Cindy Davis-Maille (Speech-Language Pathologist, NOSM University – Clinical Learning Liaison)
• Sarah Tinkler-Josephi (Speech-Language Pathologist, NOSM University – Clinical Learning Liaison)
• Erica Ogilvie (Occupational Therapist, NOSM University – Clinical Learning Liaison)

Abstract:

• Preceptorship is premised on a trusting relationship between preceptor and learner, where the preceptor strives to create a safe and meaningful learning environment. Clear communication is essential to this relationship. Although the words we use to communicate with learners are important, they make up a small part of our overall message in communicating with learners. This can sometimes lead to a breakdown in communication and impact the relationship. This discussion based workshop will focus on how preceptors can support effective communication in the learner-preceptor relationship on placements. The way the COVID-19 pandemic has impacted communication on placements and building relationships with learners will also be discussed.

Learning Objectives:

1. Identify factors to discuss with the learner at the beginning of the placement to build effective communication.
2. Review the components of human communication.
3. Discuss effective communication strategies and how to repair a breakdown in communication.
4. Reflect on the content discussed in relation to case scenarios and one’s own practice.

• Denise Taylor (Physiotherapist, St. Joseph’s Care Group, Thunder Bay – Manager Regional Rehabilitative Care Program)
• Linda Sanzo (Occupational Therapist, St Joseph’s Care Group, Thunder Bay – Regional Rehab Care Outreach Program)

Abstract:

• Purpose: Current rehabilitation vacancy rates in rural Northwestern Ontario climbed to 18%. The Regional Rehabilitative Care Outreach Program (RRCOP) model was developed to address the regional gaps in service and persistent vacancies. Methods: RRCOP provides Physiotherapy and Occupational Therapy, in-person and virtually, throughout Northwestern Ontario, supported by local rehabilitation assistants as required. Shared care provides assistance for more complicated patients. The evaluation includes process measurements, outpatient wait times, and quantitative and qualitative patient and staff experience. Findings: Rehab access is preserved with wait-time reductions. Patient experiences indicate convenience and ability to access rehabilitation services. Local providers are appreciative and the RRCOP team finds it valuable to understand the role of community providers. Discussion: The RRCOP model provides improved access to rehabilitation close to home at a higher standard of care. Hospitals are able to provide rehabilitation services locally for inpatients and outpatients and ongoing support for novice practitioners. Conclusion: RRCOP provides coordination, monitoring, and ability to address the health human resource challenges at a regional level. Improved access to care, reduced wait times and improved patient and staff satisfaction confirm the need for this service.

Learning Objectives:

1. Discuss the rationale for the Regional Rehabilitative Care Outreach Program (RRCOP).
2. Describe the model of the Outreach Program for both direct service provision and Shared Care.
3. Describe the impact of the RRCOP on access to rehabilitative care, client and provider experience across the region.