Ghent, Belgium

Physical Therapy - Winter 2018

International Experience

● Name: Seth Conway, SPT

● Colleague: Jordan Bosch, SPT

● Countries Visited During Experience: ○ Belgium, France, Netherlands, Spain,

Luxembourg, England, Germany

● Languages Exposed To:

○ Dutch, French, English, Spanish, German

BelgiumPopulation Belgium ~ 11.35 million

Population Ghent ~ 253,000

Languages: Dutch, French, English

Flag:

http://www.freeworldmaps.net/europe/belgium/map.html

https://wall.alphacoders.com/by_sub_category.php?id=210408&name=Flag+of+Belgiu

m+Wallpapers

Belgian Government & Healthcare● Government

○ Member of European Union (28 countries)○ Government Type: Constitutional Monarchy - Federal Parliamentary Democracy○ Civil Law System

■ Continually updated to conform to European Union

● Healthcare○ Bismarck Model

■ Covers Everybody■ Everyone pays via social security for national welfare benefits

https://en.wikipedia.org/wiki/Federal_Governme

nt_of_Belgium

Specific Learning Objectives1. Demonstrate and exemplify a professional level of cultural competence (observable by the

university) working with patients internationally in Ghent, Belgium.

2. Effectively and efficiently navigate international language barriers (with min assist or less) to

provide effective physical therapy treatment.

3. Incorporate at least 3-5 new techniques specific to your clinic into my physical therapy skill-set

4. Demonstrate positive evolution (growth in PT knowledge and skill) over period of 3 week

international clinical rotations observable by CI.

Clinical Experience - UZ GentRotations

● Pediatrics - K7 (3 weeks)● Geriatrics - K1 (3 weeks)

https://www.gaf.eu/projecten/campusader-uz-gent

http://www.m4architecten.be/projects/revalidatiecentrum-uz-gent/

How’s my Dutch? - Language barriers were

more apparent during my rotations than they

would typically be due to the specific patient

populations I worked with. Many of the

children had not yet learned English, and

many of the geriatric patients were growing

up before English was more heavily

emphasized in local schools.

Pediatrics Experience● Equipment and Resources - bioness units, LED sensor discs, sensory room...● Holistic Approach - Interdisciplinary Team Integration● PT often scheduled 1-2x times/day: 30 min sessions● Exposure: Genetic Diseases, TBI, Amputee, Conversion Disorder, Post-Operative...

Pediatrics ExperienceEach patient would rotate daily through PT, OT, Psychology, School

Daily Chart: Each child was

represented as an animal logo.The

children could find their “animal”

and see a visual representation of

their daily schedule.

Sensory Room

(snoezelruimte): Used to

stimulate in efforts to facilitate

improved sensory processing

and sensory integration in

children and infants.

Kitchen/Break Room: Each day, the

children would come together for a 30

minute break for socialization - a way

to simulate a typical Belgian school

day. Children would also cook with

adult helpers as an integrated part of

PT/OT therapy.

PT - Kine

OT - Ergo

Special Therapy Activity● The Dolphin Project

○ Pediatrics patients learned to give physical commands to dolphins as a form of therapy and got to perform their learned skills in front of there friends and family.

○ I was allowed to observe as an audience member during the final show with friends and family of the patients.

http://www.kinderrevalidatie.be/site/

http://www.kinderrevalidatie.be/site/media1#dolfijnenproject

Geriatrics Experience● Similar to SNF setting in U.S. ● Group Therapy Approach: Indirect & Direct

○ Up to 15 patients worked in the gym at one time under supervision by PT/OT

○ Indirect Therapy: Patients would rotate on available gym equipment every 20 minutes under supervision of PT/OT.

○ Direct Therapy: Each patient would have 10-30 minutes of individualized therapy time with PT to work on specific needs such as therapeutic exercises or mobilizations (PROM). ■ Therapy was heavy on “Belgian mobilizations (PROM

in U.S.)”

● Patients seen during physician rounds daily

● Exposure: Post-Operative, Trauma, Burns, General Weakness http://bulletin.facs.org/2016/11/the-acs-leads-efforts-to-improve-

quality-of-care-for-older-surgical-patients/

Summary of Techniques Practiced/Learned

1. Incorporating games with a skilled therapy objective during pediatrics sessions

2. Stimulating pediatrics patients during therapy through use of manual therapy and

visual/audial stimulation

3. Multi-joint LE Mobilizations (PROM)

a. hip, knee

b. Flexion, extension, abduction, adduction (when applicable)

4. Gait training without use of gait belt https://www.flintrehab.com/2018/gait-training-stroke-

rehabilitation/

Cultural Differences in PT● No Gait Belts● Forearm crutches used over axillary crutches (even for non-WB)● Daily documentation less involved● Obesity less common - active culture, biking culture (even in winter)● Patients often seen multiple times a day for treatment (eg. peds)

http://queenmathilde.blogspot.com/2

015/03/european-money-week.html

http://www.copenhagenize.com/2018/04/ghent-

changing-whole-circulation-plan.html

Cultural & Geographical Differences - Europe vs. U.S.● Water:

○ Many Europeans prefer to drink bottled water instead of tap water. In many places tap water is not even served/given. Free filtered water fountains are a rarity.

● Central Air / Heating○ Buildings normally heated by steam radiators. Central air is not common, especially in older

buildings. Lack of air circulation inside buildings (outside the research hospital) did not go unnoticed.

● Transportation○ Bikes: most common mode of transportation in Ghent.○ Efficient Public Transportation: Train, tram, and bus are highly developed

and easy ways to travel around Belgium as well as neighboring European countries.

● Weather○ Cloudy and rainy during most of our stay in Europe during winter…. think

Seattle, WA.

https://www.google.com/url?sa=i&source=imag

es&cd=&ved=2ahUKEwia8fn3q9nfAhUwja0KH

Q1pCH0Qjhx6BAgBEAM&url=https%3A%2F%

2Fhiveminer.com%2FTags%2Fbus%2Cgent&p

sig=AOvVaw05QJ-

RVWFOulR3YlIA73iA&ust=1546870525083341

European Travel● Traveling between countries is easy due to European Union● Advantage of proximity to other countries and cultures

Referenceshttps://www.cia.gov/library/publications/the-world-factbook/geos/be.html

https://www.expatica.com/be/

http://www.pnhp.org/single_payer_resources/health_care_systems_four_basic_models.php

http://www.kinderrevalidatie.be/site/