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"One of my earliest and happiest memories was watching my mother teach dance at a local nursery school in Portland, Oregon," recalls Deborah R. Brandt, PT, MS, CMA. "I was too young tobe in the class. I came along so she did not have to get a babysitter. At that time, I did not know that I was born with my mother's love of teaching and of dance. I figured it out along the way.

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"While I was watching those classes, I learned how to teach dance, what to teach and how to be supportive," she continues. "Throughout my professional life, I have worked to develop those skills from a passionate, but primitive and stumbling effort, into mature teaching with planning and refined knowledge guiding me. Every time I teach in a different environment, I have to re-think and re-work how to do it. This was the beginning of the triple themes of body movement, music, and teaching -- which have guided my spirit and my professional life."

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Ms. Brandt's blend of personal passion and clinical knowledge serves her well in her present career. "I now work as the senior physical therapist at the Lighthouse International Child Development Center (CDC) in New York City. The Center serves children ages two to five who need schooling and have a severe visual impairment and multiple other disabling conditions, and it also provides schooling for children without disabilities."

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Three years ago, Ms. Brandt initiated a contract with three PT programs to establish a clinical placement at the Lighthouse International CDC. Since that time, she has had the opportunity to mentor six physical therapy students and two PTs, in addition to treating her children.

"It has been my experience that my students have been very well prepared in terms of knowledge, treatment planning and problem-solving skills," she observes. "However, most of them have been completely overwhelmed when they actually began to treat children. Clinical placements serve the very important function of helping students turn knowledge into experience. I have discovered that one of the most difficult treatment skills I teach is how to be playful and authoritative with the child at the same time. Both are essential if PT goals are to be met."

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One fledgling PT in particular stands out in Ms. Brandt's memory. "I had a PT student for her internship. She had been with me three weeks. We had done weeks of co-treatment, had reviewed them, and she had learned good treatment skills. She had three weeks more to go, and even though we had worked on it, she was still at a loss about what to say to a child and how to say it during treatment. She was creative, smart and knowledgeable. The children liked her and she was very good with them. She could make up a treatment plan and goals, but when she had to carry out that treatment plan, she was so overwhelmed that most of the time, she looked at me helplessly.

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"'What was I to do?' I wondered to myself. After much consideration, I decided that after she knew what she wanted to do, and after we had reviewed how she would attempt to do it, I would sit across the room from her and tell her what to say and do, but I wouldn't do anything else."

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Ms. Brandt says that for about a week, she "did nothing but talk." She spoke to her student as if the student was in fact, the child, and then the student would speak the verbal cues to the child. "In addition," she says, "I could identify when she was losing the attention of the child before she could. She needed training to help her see it coming, so that she would not have to spend the next 10 minutes re-establishing the child's attention to the task. If the child was losing the thread of the treatment, I might tell her, 'Take his hand,' or 'Do something: you're going to lose him.'"

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The teaching strategy worked. "As she was able take over the job herself, my contribution became insignificant," Ms. Brandt recalls. "I was fascinated by this process. She kept trying, and over a short time, her confidence increased. She learned to make up an activity on the spot, and to adjust that activity as the capacity of the child was revealed. I watched my overwhelmed student, who once stumbled over words, become an excellent entry-level therapist.

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"Fortunately, my student was very motivated and able to tolerate frustration and keep trying. The little steps of success she experienced gave her the optimism and gratification to keep going."

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For her very young clients, Ms. Brandt says that learning must also occur incrementally, and in ways that allow the children to feel similarly encouraged and empowered. "School needs to be a place of fun, work and gratification," she states. "It needs to be a place where children can experience the satisfaction that learning can bring. Children should like that feeling. It should motivate them to continue to try to do activities even though they might be feeling frustrated. I think the learning process is the same, no matter how old you are.

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"The agreement that underlies my work with my PT students and my children," Ms. Brandt continues, "is that we will work together to approach the task at hand with the same goals. If we can like and respect each other to some degree, we have a baseline to build on. The treatment, or the coaching, becomes part of a trust based on this negotiation."

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This trust is the foundation of all future success. "In a manner of speaking, I put the child first and the physical therapy goal second. I work on developing a relationship with the child, and then continue to nurture the relationship -- while I continue to work on PT goals. In this atmosphere of trust and mutual understanding, I can communicate with my children in a way that makes me accessible to them. Ideally, this helps to make the therapy accessible to them."

Having inherited her mother's love of movement, Ms. Brandt was drawn toward a career in dance, and earned a B.F.A. in Dance Theatre from New York University's School of the Arts. "After that, I taught dance and exercise to people of all ages, and choreographed, performed in and produced my own concerts," she says. "Then I apprenticed to a movement therapist and studied many of the somatotherapies and worked in the office of a developmental optometrist. I became a movement therapist with my own private practice.

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"Eventually, I wanted to broaden my knowledge and skills, and earn a more stable income," continues Brandt. "With the hope that a career in physical therapy would make it possible for me to achieve many goals, I returned to school."

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Her decision has yielded many rewards. "Physical therapy has promoted my continued learning and allowed me to use my love of movement to help people. I feel that my work is valuable, and I am very happy that I made the career choice that I did," she says.

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"Working at the CDC has given me the opportunity to try to understand people whose perceptions of the world are very different from mine," Ms. Brandt observes. "I am fascinated with how they make sense of their world. I continually seek to understand their experience of the world, and to learn how to build bridges between our worlds.

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"My most important treatment tool is myself," she states. "While it is important to know a wide variety of techniques and how and when to apply them, it is the therapist who is the bridge between the treatment technique and the child."

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Ms. Brandt cites a quote attributed to Ernest Hemingway: "Never confuse movement with action," she says. "I want to teach my children to translate their movement into action, so they learn to use themselves to solve problems, to communicate, to meet their needs themselves or to get others to meet their needs."

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Building bridges to self-sufficiency for children is seldom simple or straightforward, but it has afforded her some of her most triumphant moments. One little boy, with whom Brandt began to work when he was about three years old is the central character in one of her favorite memories.

 

"He was a nonverbal child who had learned to communicate with his incredibly charming smile, and who was used to being carried because he could not walk. He had no interest in walking because he had no need to walk," she shares. "However, I trained him to use a walker, and insisted that he use the walker to get himself from his bus into the school. Sometimes it took him an hour, but day after day -- with the help of a very special teacher assistant -- he did this.

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"Even though this child had no interest in walking for its own sake, he loved the attention he would get as he walked around the school with his walker. The whole staff cooperated and would give him positive feedback as he traveled from room to room.

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"For more than a year, praise was what motivated him. He was eventually able to graduate to Loftstrand crutches," recalls Ms. Brandt. "One day, as he was walking down the hall with me, he stopped. With complete command, he looked me in the face, took off one crutch and handed it to me, and then took off the other and handed it to me.

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"I put the crutches in the closet and never took them out," she says. "I knew he was communicating to me that he wanted to walk on his own.

We both knew eventually that he would, even though at that time, his gait was unsteady. He frequently fell or almost fell, and he would veer from one side of the hall to the other.

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"I was thrilled," she remembers. "Here was the motivating power of mastery, and how it could generate the feeling of the value of 'my' independence, or of 'I did it!' In that moment, he set his own PT goals -- instead of my setting them for him."

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For Ms. Brandt, moments like these reinforce her fascination with movement, an inborn passion inherited from her mother.

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"Many years after observing and attending the nursery-school dance class, my mother and I were walking along the beach. She pointed out a toddler jumping while looking at the ocean, and commented that his joy and excitement at observing the waves had become jumping.

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"As I explore the meaning of movement, I marvel at the unity of feeling and expression that this toddler was able to experience at that moment," she concludes. "And I was so excited to be present when my CDC child also experienced it. Often, the reason we have someone on our caseload is that they are unable to experience this unity, or may experience it within a very limited range. For example, they may feel the joy and excitement, but may be unable to 'jump for joy.'

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"I am grateful that my life's work has been to help people develop the harmony of feeling and expression in movement that I first discovered in my mother's dance class."

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Deborah R. Brandt, PT, MS, CMA, presents in-services and continuing education courses on gross motor intervention for children who have a visual impairment and other disabling conditions. 

Esther Martin is a freelance writer based in the Philadelphia, PA, area. She is on the editorial staff of NEWS-Line for Physical Therapists and PTAs.

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