Caroline Havard, MOVE Trainer, reflects on her recent visit to Russia with the MOVE Programme. Here, she shares her blog about her experiences and thoughts on another international development for MOVE.

“An exciting training opportunity!” This was the subject heading of an email I almost deleted as I trawled through my inbox at the end of a working day in May 2018.

I thought it was likely to be a generic ‘round robin’ about a mandatory update but it turned out to be a proposal from Charlotte Peck, the MOVE Programme Manager, asking me to consider travelling to Russia to deliver MOVE training for a team of rehabilitation professionals at the Ilizarov Centre in Kurgan.

Charlotte presented the plan in true MOVE style; it was motivating (she said it would be exciting), it’s an opportunity (MOVE is all about creating opportunities) and it will involve learning (as one would hope as a result of our training).

I am neither adventurous nor particularly well-travelled and I was immediately out of my comfort zone. However, I knew this was an unusual chance to do something interesting and out of the routine. Up to now, my experience with the MOVE Programme, albeit extremely positive, was confined to educational settings within the UK, and mainly at Crownbridge School which became a MOVE Centre of Excellence in 2012.

Charlotte’s request came as a direct result of a similar trip in October 2017 to train a rehabilitation team in Yekaterinburg. The feedback was positive, and another centre was keen to come on board with this excellent concept.

I read Charlotte’s email several times. She had helpfully included a map which showed that the distance from Moscow to Kurgan was similar to the distance from the UK to Moscow. I was going to Siberia. I began to worry that I might not enjoy the food, and would there be a decent cup of coffee when I needed one? And how on earth do I pronounce even simple phrases like “Good morning”?!

Arriving in Russia

With Siberia in mind I packed my winter woollies and we were off. We were greeted in Moscow by our exceptionally able interpreter Nastye, and Natalia, one of the directors of Rehab & Medical (the sole distributers of Rifton equipment in Russia along with other disability products). This company were the sponsors for the trip.

MOVE training does not endorse any specific equipment. However, Rifton products were designed to specifically work with the principles of MOVE, i.e. to provide as much support as is required with the facility to remove support as an individual gains ability.

The next day we flew from Moscow to Tyumen, a city in Siberia, where we were greeted by Ludmilla, a member of the educational staff from the Centre. A minibus from the centre transported us at speed through the flat Siberian countryside which was in contrast to the opulence of central Moscow.

The Ilizarov Centre

The Move team outside of the Ilizarov Centre in Russia

I had heard of Ilizarov, or rather the frame (an external fixator mainly used in limb-lengthening orthopaedic surgery). The Centre is world-famous, its founder being a pioneer of surgery for limb reconstruction after fractures, bone lengthening and treatment of severe bone infection (osteomyelitis). However, in the UK, the MOVE Programme is mainly used in schools and my experience as a physiotherapist is mainly with people who have complex neurodisability. It would be a challenge to deliver MOVE Training to such a different setting!

On our first day at the Centre, we met the team who were to learn and work with us for the next five days. Without exception, people were gentle, courteous and interested. Charlotte and I were soon aware that this group was quick on the uptake, although we still had our doubts about how applicable the MOVE Programme would be for them. They were a mixture of physiotherapists, physiotherapy assistants, neurologists, a rehabilitation consultant and an orthopaedic surgeon. We would not normally have a group of doctors attending MOVE training in the UK.

The language barrier is significant. We were fortunate to have an able translator; however, I was not prepared for the delay involved in imparting information in this manner. I learned to be as concise as possible, speaking in short phrases and waiting for the responses and questions which inevitably came back via the translator.

Initially, five days seemed too long for delivering what is usually a two-day course, however the team still had to see their patients each day, so we worked from 1pm until 5pm on most days. We included a session with a real case patient which stimulated useful discussion for the group.

Meeting patients

Patients come to the Ilizarov Centre for surgery. Some of these patients have cerebral palsy or other brain injuries; many of them undergo soft tissue lengthening for contractures and/or bony surgery or osteotomies for improving alignment.

Many children and young people with achodroplasia (dwarfism) are treated at the centre. We observed around fifteen children with this condition working on their individual exercise programmes in a therapy gym. Many had one leg significantly longer than the other and had been provided with a platform slipper for the short leg. They were all sporting the famous Ilizarov frame which looks like a piece of metal scaffolding with pins which go through the middle of the limb to provide stability.

This was a thought-provoking moment as I understand that it is not routine practice in the UK to treat this condition in this way. People of small stature generally choose not to have surgery and expect to be accepted as they are. After all they are not clinically unwell.

I discussed this with Alexander Gubin, the Centre Director. I asked him about the attitudes and reasons why so many children choose to undergo limb lengthening. He said that the culture is different in Russia and Asia and that sadly, often it is almost impossible for families to accept such significant abnormality and disability for their children.

On the morning of the second day, Ludmilla gave us a tour of the Centre museum. The founder, Gavriil Ilizarov is omnipresent. Statues of him greet all who approach, both outside and inside the main entrance to the centre. Photographs abound, and one has the feeling that he is everywhere and sees everything.

The museum is a mixture of history and quirky memorabilia with a little entertainment added to the experience. Ilizarov was born in Poland. He published extensively and enjoyed celebrity status both in and outside Russia.

The staff are clearly proud of the Centre’s heritage. Doctors come from many countries including the former Soviet countries and China and Asia to learn the techniques and work with the surgeons here.

Equipment

Child using equipment to assist with standing

As the week progressed and we had more opportunity for discussion, it became evident to me that the availability of equipment such as standing frames and walking frames which we take for granted here in the UK is simply not the case in most of Russia.

Although MOVE does not actively endorse any specific brands of equipment, it assumes that children, young people and adults will have access to some kind of supportive rehabilitation equipment to assist them with learning physical tasks. The Ilizarov team had recently taken delivery of some Rifton equipment with which most of them had yet to become familiarised.

This kit will help them with devising MOVE Programmes, however their patients stay for a limited period and will not have access to this equipment after they are discharged home. It was also my impression that they were unlikely to have much in the way of regular contact with a physiotherapist either.

Developing a MOVE action plan

Charlotte and I felt that it was important for this team to consider what the Move Programme could add to their existing provision and also to think about how they can use the MOVE ethos within the centre. This would involve creating awareness amongst the wider staff groups including care and nursing teams as well as the patients and their families so that everyone understands the idea of enabling the individual and encouraging independence at every opportunity, not just in therapy sessions.

We discussed that the MOVE Programme should offer the team ideas for better discharge plans for the patients to take home with them to their daily settings. Some of the patients make more than one visit to the Ilizarov centre so there is the opportunity for follow up in some cases.

The final part of the training course involves a session where the participants consider how they will take the programme forwards and what needs to happen to allow them to do this. Time will tell regarding its value here, but the feedback was unanimously positive.

The MOVE organisation offers to provide as much support as possible. Already, there has been an exchange of emails between Russia and the UK office since our visit. The clinical team are looking at ways to apply the MOVE 'ethos' which is really the most important bit.

We also spoke about the topic of moving and handling which is such a big subject in our country. Clearly, the issues of staff time lost from the workplace due to back injuries is not confined to the UK. The Russian team were interested to know how we deal with such problems.

Despite the apparent geographical remoteness, we had the impression that this was a vibrant working environment and these people were open to new ideas and keen to be in touch with the wider world. This is not always the case within many of our own settings here in the UK.

They were extremely courteous and gracious about our work and teaching. On the final day, they provided a delicious sit-down lunch before we started the final session. They presented us with gifts and I wondered if visiting Russians would be treated so well in the UK.

I hope that the twenty Russian rehabilitation professionals feel they have learned and benefitted from our visit. However, it is important to say that I have also learned from this trip. It is good to move outside one’s comfort zone once in a while and I am grateful for the opportunity to do just that.

With thanks to: 

Alexander Gubin, Centre Director of the Ilizarov Centre

Natalia and Pankaj, Rehab Medical

Andrey Kalachev also from Rehab Medical, who kindly demonstrated the Rifton equipment

Charlotte Peck, Move Programme Manager

Aneurin Bevan University Health Board Physiotherapy Service, for supporting me to make the trip.

Crownbridge School where I have worked with the MOVE Programme for many years

The families and children who have allowed us to use their photographs and videos in our presentations.

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