Recoveryinterventions.com

History of the Development of Our Approach to Handling and Time line for our Personal Development

To begin it is important to acknowledge the major influences impacting the development of our philosophy and treatment.  It began in the 70’s when we both trained with the Bobaths.  The Bobath philosophy was a belief in the Recovery of Motor control in brain injured children and adults.  In their management strategies, the Bobaths’s created conditions of practice in which the client was required to use the involved Body segments.  Through her handling Mrs Bobath was able to reinstate more normal force parameters in skeletal muscle. Concurrently Jan Utley was teaching neuroscience at Chicago Medical University, Chicago, Illinois.  Through her studies  and teaching it became increasingly obvious to Jan that accessing neuroplasticity in the lesioned Brain could result in the recovery of motor control.  It was clear that the client must practice in conditions that would force the brain to engage in processing resulting in motor recovery.  This was the beginning of the quest for the creation of handling strategies that would enable the client to achieve more complete motor recovery.  Finally working with the Bobaths and the research in Neuroscience were the two major influences on our teaching and practice as clinicians.

Jan  taught both anatomy and neuroscience from 1970-1979 in Chicago Medical University.  During these years she developed a wealth of knowledge in the area of neuroscience.  This experience motivated her in clinical practice to create and explore applications based on the research in neural plasticity.  Many of Jan’s early influences were Dr. Paul Bach y Rita, Dr. Josephine Moore, Dr. Stanley Finger, and Dr. Donald Stein.  Later she was strongly influenced by Kendall, Schwarz and Jessell’s findings in their compilation(“Principles of Neuroscience”) of the research  in neural plasticity and recovery .  After completing her studies with the Bobaths’s in 1977 + 1978, Jan studied further with them to become an instructor in the Bobath approach.   In the 1990’s the influence of Dr Carolee Winstein, Dr. Steven Wolff,and Dr Eduard Taub  provided a continued motivation to connect the research findings to the clinical application with brain injured clients.  This resulted in the creation of management strategies utilizing Forced use for optimizing motor recovery.

As a student and later as a clinician in the 1970’s  Susan  Woll was confronted with her inablility to access the recovery that she had learned about in her university studies.  She  was so frustrated by the  lack of results with neurologically involved clients that she decided to travel to Europe to work.  In Switzerland she experienced exactly the same frustrations that she had experienced in the United States.   Clients  were surviving Stroke and Head Injury but no handling strategies  were effective in achieving what the literature in neuroscience was beginning to describe as the Potential for  neural plasticity and recovery of motor control.  In 1973 , she was able to attend a  new course given by Berta and Karl Bobath in the Treatment of Adults with Hemiplegia.   This was  the second course of its kind given by the Bobath’s who  until that time had primarily worked with Children with Cerebral Palsy.  The course took place in Basel, Switzerland at the Felix Platter Spital.  For Susan it was a turning point.  She experienced in Mrs Bobath, a teacher and therapist who not only believed in the potential for the recovery of motor control but also a teacher who promoted the creation of more effective handling strategies that forced the client to engage the affected body segments in function.  This learning experience has continued to be a life long influence in her efforts to solve motor control problems. Eager to learn more she  followed the Bobaths  to take as many courses as possible as a basis for her own clinical application of what she  was learning. In 1981 she participated in an advanced handling course with Jan Utley and Isabelle Bohman, in Toronto , Canada.  There she found  teachers who were following the literature in Neuroscience and believed in creating new handling strategies based on current  research in regard to the recovery of motor control .  In 1983 she traveled to London and participated in the Bobath  Pediatric course for the treatment of children with Cerebral Palsy. It was only a short time afterward (1983) that she began her training to become a Bobath Instructor with Jan and Boh.

1983-1990. Susan became an instructor in1986 and not long thereafter she and Jan began working together.  This became a life long relationship for Susan and Jan   in which they stimulated  each other to continue learning about the newest neuroscience research and as a result,  create the handling strategies that would optimize the recovery of motor control.  Together they began making revolutionary changes in the therapeutic interventions in Bobath courses and clinical practice.  The   interventions became more extreme in terms of utilizing  forced use paradigms.  They also recognized that the clients had Orthopedic constraints and that Orthopedic management in the form of mobilization would be necessary for increased range of motion and accessing  skeletal muscle control.    They also recognized that the management strategies needed to be in more functional postures like sitting , standing and walking.  At this point training in supine was eliminated from the handling in courses with the exception of clients with more severe disability.    They created management strategies directed more toward regaining  the functions required for daily life.  Their investigation of motor learning principles and research led them  to acknowledge that massed practice ( repetition) would be a requirement for motor recovery.  In 2002 they conducted a research project in the clinical application of forced use including both treatment and massed practice.  In this research project the clients all had more severe motor dysfunction than those who had participated  in past research  in CIMT.  The results of their study demonstrated that more severely involved clients could achieve motor recovery in the involved body segments.  This experience substantiated their belief that the only strategies leading to recovery must involve Forced Use Paradigms in both treatment and massed practice.  The client’s progress  exceeded any level that they had in experienced in the past.  This reinforced their belief in the potential for recovery through Forced Use handling strategies.  Since that time, while being continually involved with managing clients in this way, the progress that has been achieved has deepened Susan and Jan’s belief in the potential for recovery through these handling principles.  For this reason in 2006, they  developed a course of study for highly trained therapists to become Forced Use Specialists.   In 2012, the International Forced Use Specialist Association (IFUSA)was formed  with the aim of furthering this form of handling for clients’s with Neurological dysfunction.

1959-1963  Jan Utley studied for her BA at David Lipscomb University

1963-1965  Jan Studied Physical Therapy at Baylor University

1972    Jan took the 2 week  Bobath Course: Introduction to Treatment of Children wit Cerebral Palsy

1974    Jan attended   Bobath: Pediatric Course in Treatment of  Children with CP

1976    Jan attended Bobath Basic Course in the Treatment of Adult Hemiplegia

1977-1978  Jan trained with Dr Karl and Berta Bobath to become an Instructor

1977-1979  Jan was employed as Anatomy and Neuroscience Instructor at Chicago Medical University

1979-2002  Jan was Adjunct Professor in the Department of Physical Therapy at Texas Women’s University

1966-1970  Susan Woll studied for her BS in Physical Therapy at Northeastern University, Boston, Massachusetts

1970-1973 Moss Rehabilitation Hospital, Philadelphia, PA

1973  Bobath Basic Course in the Treatment of Adult Hemiplegia

Felix Platter Spital, Basel , Switzerland

1973-1974 Stadtspital Waid, Zürich, Switzerland

                        Capacity: Staff Physical Therapist

1975             St. Vincent's Hospital, New York City, NY

1975  Studied  Psychology at New School for Social Research, New York City-ABD

1975-1976 Rheuma- und Rehabilitations-Zentrum Valens, Valens, Switzerland

                        Capacity: Staff Physical Therapist

1977-1980 Spital Limmattal, Zürich, Switzerland

                        Capacity: Staff Physical Therapist, 1977    Capacity: Assistant Chief, 1978-1980

 1980-1986  Santa Clara Valley Rehabilitation Hospital

                        Capacity: Sr PT: General Rehabilitation, Sr. PT, Pediatrics Department

1983   Susan attended the Bobath Pediatric course: Treatment of Children with Cerebral Palsy, London, England

1989-2003 Self Employed As Physical Therapy Consultant and NDT Adult Hemiplegia  Instructor/IBITA Advanced Instructor For Adults with Neurological Dysfunction – 1997                       

2000-2002    Adjunct Faculty, Texas Women’s University, School of Physical Therapy, Dallas, Texas

 Time Line of Historical Influences:

1989  Steven Wolff published  Forced Use Study using Constraint and no control group -  home activity suggestions.

1993   Eduard Taub published first Forced Use Study with Constraint with Clients that also included a control group and some handling as well as massed practice.

1994 First course in Bad Ragaz at the Hermitage

1999 . 28-29.May Carolee Winstein course in Rheinburg Clinic – showed Carolee the results of Andrea Heinrichsohn’s forced use interventions and the pre and post WMFT  in Bad Ragaz.

2000, July29-30  Attended Forced Use Course—application taught by David Morris in San Francisco

2001 Article in NDTA Network/ Journal comparing and contrasting Bobath Strategies with the Application of the Strategies for Intervention created out of the influences of Forced Use Research and Research in Recovery of Function….

2002  Research Project,” Clinical Application of Forced Use Handling Strategies to Recovery Motor Control,” in Los Angeles ,funded by the Tartikoff Foundation

2002  Created the Forced Use Handling Course.  The first two courses were given At St. David’s Medical Center in Austin,Texas and Schule v. Physio und Ergo Therapie, Gera, Deustchland.  

2003    First course for Forced Use Handling  was given  at the Fortbildungszentrum Zurzach, Zurzach, Switzerland .

2006   The curriculum for becoming a Specialist in the Area of the Clinical Application of Forced Use was developed and tested for the first time at the Zentrum for Rehabilitation in Pforzheim, Deutschland.  This two year course of study was only completed by one Ergo Therapist. 

2010 + 2011 The  more developed Curriculum for becoming a Forced Use Therapist was  started and completed by a group of 9 Physio and Ergo therapists.  This curriculum and its content was accepted by the EDUQUA for quality assurance.

IFUSA    had its first General Versammlung and Officially became the Official Organization of Forced use Specialists.  28-29.April.2012  Statuten accepted and finalized – written in the Handelskammer -05.2012

2012+2013  A group of 6 more highly qualified Physio and Ergo therapists embarked on the course of study to become Forced Use Specialists.



Another facet of our professional activities is the handling of clients using forced use management strategies to promote more complete and more rapid recovery of motor control.  Our clients participate in an intensive regime of mobilisation of areas of orthopedic stiffness, strengthening and activation of muscular control as well as recovering functional use of the involved body segments.  Clients participate for up to 6 hours per day in blocks of  one to three weeks.  All of the current neuroscience research proves that it is never too late to activate the processes that promote recovery of motor control.

Please feel free to contact us at any time about  your potential for recovery and discuss scheduling a consultation.