UNIVERSITY OF COLORADO PHYSICAL THERAPY PROGRAM

Transcription

1 UNIVERSITY OF COLORADO PHYSICAL THERAPY PROGRAM Course Title: Credit Hours: Clinical Skills: Examination and Evaluation I 2 Contact hours: Lecture: 6 Lab: 19 Self-directed: Goniometry and Palpation modules Course Number: DPTR 5201 Semester: (Summer 1) Year: 2014 Course Coordinator: Amy Wallace PT, DPT, OCS, FAAOMPT Phone number: address: amy.mcdevitt@ucdenver.edu Office hours: Requested, non-posted hours availe by Course Lab Instructors: David James, PT, DPT, OCS, SCS, CSCS address: david.james@ucdenver.edu Dana Judd DPT address: dana.judd@ucdenver.edu Betti Krapfl PT address: betti.krapfl@ucdenver.edu Meghan Bawn DPT address: Meghan.Bawn@ucdenver.edu Phone number: Catherine Bilyeu PT address: catherine.bilyeu@ucdenver.edu 1

2 Rebecca Downey DPT address: Jason Delavan DPT address: Alyssa Arms DPT address: Lara Canham DPT address: Bryan Crouch DPT, OCS, CSCS address: Dan Malone PT, PhD, CCS address: Course Communication Announcements of course information and other communication within this course will be sent using the address designated by the student. It is the student s responsibility to check on a regular basis. Non- communication: The Canvas format will be used for this class. Method of Making Appointments for Office Hours: office hours requests should be ed to instructor Vocabulary and Terminology (abbreviations): only standard abbreviations should be used in this course. *Course Description Introduction to a structure for analyzing patient encounters (patient/family centered care, basics of patient management from Guide to PT Practice, Enablement/Disablement Models: WHO-ICF). Introduction to the process of obtaining information from a general health questionnaire, patient history and systems review; selecting-administering tests and measures to gather data about the patient. The process of examination begins with an overview of the patient s ability to participate and function in their daily lives. 2

3 Course Objectives: Terminal Course Objectives: At the completion of this course, the student will be able to: 1. Cite the elements of patient/client management outlined in the Guide to Practice. 2. Demonstrate basic subjective and objective patient examinations appropriate to the practice of Physical Therapy including practice in: a. Measuring joint range of motion with goniometry b. Measuring strength with specific manual muscle testing (Kendall) c. Measuring strength functionally from a wheelchair/bedside d. Measuring gross motor strength with an upper/lower quarter motor screen by spinal segments e. Examining static standing, sitting, and sleeping posture f. Palpating anatomic structures. 3. Apply knowledge of anatomy and applied anatomy to reinforce the examination and evaluation. 4. Identify questions regarding the reliability, validity, sensitivity and specificity of the various tests and measures described and performed in this course. 5. Compare performance-based vs self-report outcome surveys. 6. Utilize a process of hypothesis/speculation guided by knowledge of the International Classification ICF to direct your reasoning for conducting a given test. 7. Behave in a professional manner with verbal and nonverbal communication when interacting with peers and faculty. 8. Assess effectiveness of her/his own communication and modifies when appropriate. Instructional Course Objectives Palpation 1) Identify, describe and discuss anatomical structures and relationships utilizing proper terminology and spelling 2) Identify specific bony landmarks, muscle, ligament, and capsular attachments of the extremities, thorax, and head and neck 3) Identify and palpate surface anatomical structures and landmarks related to the extremities, spine, skull, head and neck. 4) Demonstrate clinical competency in palpating, from the surface of the body, structures of relevance to physical therapy. 5) Develop a basis for utilizing knowledge of bony landmarks, muscle action and joint motion to aid in palpating specific landmarks and structures. 6) Schedule your self-directed learning at an appropriate pace. 3

4 Goniometry 1) Schedule your self-directed learning at an appropriate pace. 2) State normal range of motion for each movement at each joint according to American Academy of Orthopaedic Surgeons (AAOS) standards. 3) Describe appropriate test positions, endfeels and alignment in relation to anatomical landmarks. 4) Select active or passive motion appropriately. 5) Note factors affecting performance (ie pain, etc.). 6) Describe alternative methods for measuring joint motions. 7) Perform passive goniometric measurements at all joints in the upper extremity. Muscle Testing 8) Describe appropriate sites for palpation of specific muscles and tendons. 9) Identify principles of stabilization, pressure and support as described by Florence Kendall. 10) List criteria for grading muscle strength. 11) Identify populations in which specific muscle testing is essential. 12) Differentiate between specific and functional muscle testing. 13) Match appropriate form of muscle testing to patient presentation. 14) Recognize substitution. 15) Discuss causes of identified substitutions. 16) Perform specific manual muscle tests as described by Kendall. 17) Perform functional muscle testing from bedside and chair. Posture static 18) Discuss the historical perspective of examining posture / alignment. 19) Describe the ideal posture as described by Kendall. 20) Identify anatomical landmarks that coincide with the line of reference. 21) Identify deviations from the plumb line. 22) Identify typical faulty postures including kypholordosis, sway back, flat back, military posture, and associated musculoskeletal changes as described by F. Kendall. 23) Demonstrate skill in observation of static posture 24) Apply principles of ideal posture to the sitting and sleeping positions. Functional assessment 25) Discuss the importance of assessing function in the home, work, and community environments. Tests and measures 26) Appreciate the skill of careful measurement and how error in measurement affects treatment. 27) Apply measurement categories to Physical Therapy variables. 28) Define reliability and validity. 29) Compare types of reliability and validity. 30) Define objective and subjective measurements. 31) Discuss the relationship between reliability and validity. 32) Define sensitivity and specificity as they relate to tests and measures. 4

5 Required Reading: 1. Kendall FP, McCreary EK, Provance PG, Rodgers MM, Romani WA. Muscles: Testing and Function: With Posture and Pain. 5 th edition. Williams and Wilkins; 2005 (MMT pages 4-24 and all upper quarter muscle tests; Posture pages 51-95) 2. Norkin CC, White DJ. Measurement of Joint Motion: 4th edition. Philadelphia. FA Davis; 2009 (3-53) 3. Guide to Physical Therapist Practice. APTA Second edition. You can access copies in the PT library Ed 2 South-3 rd floor. You can also access this through the Health Sciences Library either in hard copy or on the student computers: Hard copy: Guide to Physical Therapist Practice. APTA Second edition Computer : Interactive Guide to Physical Therapist Practice (HSL Info Commons PCs) The following sections: Understanding Physical Therapy Practice: only the overview of disablement. (pages 27-33) Basics of Patient Client Management (pages 39-50) 4. Also read the description of International Classification of Functioning description found in the course materials section of Canvas (1 page) On Canvas, under course materials or sylus: 1. International Classification of Functioning (1 page) 2. Abstract: MacDermid JC, et al. Intratester and intertester reliability of goniometric measurement of passive lateral shoulder rotation Full text: Landers MR, et al. An Analysis of 2 Sitting Postures and Their Effect on Pulmonary Function Full text: Kibler BW, et al. Evaluation of Apparent and Absolute Supraspinatus Strength in Patients With Shoulder Injury Using Scapular Retraction Test Full text: Frese E, et al. Blood Pressure Measurement Guidelines for Physical Therapists AW. Clinical Skills: Examination and Evaluation I Sylus Recommended Reading: 1. Daniels L, Worthingham C. Muscle Testing: Techniques of Manual Examination. WB Saunders Co; Biel A. Trail Guide to the Body. Books of Discovery;4 th edition. (Palpation) 3. International Classification of Functioning, Disability and Health. World Health Organization. Geneva Curricular threads: The Physical Therapy program emphasizes several content areas. These content areas are called curricular threads because they span the curriculum rather than being contained in one or two courses. The curricular threads addressed in this course include (may include all or some of listed threads): Patient Centered Care Application of Movement Science 5

6 Use of Evidence and Critical Thinking in Clinical Decision-Making Teaching Methods: Lecture and oratory sessions (demonstration and practice), independent learning modules. Evaluation Methods: 1. This course will use online self-study process, final written and practical exams. Additionally your professional behaviors will be a weighted in your final grade. 2. Grades and grading policies: Self study 10% Professional Behaviors 5% Simulated quiz 20% Practical Exam 45% Final Exam 20% Total 100% Grading Scale: The UCD Grading Scale found in the Policies and Procedures manual will be followed in this class. Assignments/Exams: 1. Complete independent goniometry and palpation videos/modules before practical exam. (worth 10% of your total grade) 2. Simulated quiz (worth 20% of your total grade) There will be one graded quiz. The quiz will be done in the following manner: An examination will be conducted on a simulated patient as you observe. You will answer questions based on what you observe. The purpose of this quiz is twofold: first to provide you with an opportunity to observe the flow of a sequenced exam and second, to have you begin to recognize impairments, limitations, or dysfunctions as you see them occurring. 3. Practical examinations (Graded and worth 45% of your total grade) * Each student will perform as the patient and the therapist. The student/ patient will be instructed by a faculty member on how to perform with a deficit, dysfunction or limitation and the student/physical therapist will perform and be asked questions about the performance of the skill and the results if appropriate. * Examples: 1) You as the student/physical therapist draw a goniometry card saying elbow flexion ; upon completion of the skill your faculty examiner may ask you the following with the limitation in active elbow flexion range of motion, 6

7 can you conclude a deficit in muscle strength? As the student you will respond yes or no and why. 2) You as the student/physical therapist draw a MMT card saying hip flexors ; upon completion of the MMT you determine your patient has a muscle grade of 3-; your faculty examiner may ask you the following would it be necessary to examine the passive hip range of motion? As the student you will respond yes or no and why. 3) You will assess static posture from either the anterior, posterior, or side view, beginning with plumb line alignment (Kendall) and then report to the examiner what it is you see on your partner and what it might mean. 4) You will perform a BP exam using the dual head-set stethoscope. * In addition, you will be asked to self assess your performance, (including the psychomotor performance and your ability to articulate to the instructor). Your professional presentation will also be part of the grading scheme. * You will be scheduled in groups and assigned a partner at the time of the exam. The exam will take approximately 2 hours. 1) MMT with palpation 2) Goniometry with palpation 3) Static posture with palpation 4) Blood pressure with palpation * This is a graded examination and the criteria for grading the exam will be provided for you as we progress through the quarter. * You must pass with a 73% and if on the first attempt you do not pass you will be offered another attempt. In the event that you must take a portion of the exam again, a grade of C is the highest you can obtain. 3. Final examination (graded and worth 20% of your total grade): * This will be comprehensive take home, short answer examination. * Exam will be availe on August 4 and due on August 10th by 5:00 or anytime during that week. Placed in folder in Amy Mcdevitt s mailbox. 4. Professional Behaviors (observed and worth 5% of your total grade): Each student enrolled in this course is expected to conduct her/himself in a respectful and professional manner. This includes, but is not limited to, being punctual and prepared for every lecture and oratory session, respecting her/his classmates and the faculty during class discussions and oratories; working independent of classmates when asked to do so; working in a positive and productive manner with classmates during ; respecting oneself by presenting her/his own ideas and opinions in a positive and thoughtful manner that promotes the attention and respect of classmates and faculty; being committed to a positive learning experience. Please review the academic honor code policy. Course Policies: 7

8 Policy Regarding Assignment Requirements from P & P manual Faculty use a variety of formats for course assignments ranging from situations in which students work entirely on their own to situations in which students work coloratively in pairs or in small groups, with a range of options in between. Students operate under the UCD Honor Code in all courses and for all assignments. Students should carefully review course expectations with regard to each specific assignment and the work requirements. Students are responsible for paying close attention to the guidelines given by the Course Coordinator(s). In the event of uncertainty, students should err on the side of working independently and ask for clarification. Review the following in the P&P: Honor code Copyright/article posting Professional Behaviors students are expected to follow all professional behaviors as detailed in the P&P Retake policy Grounds for not passing course Mandatory classes and requirement that any absence requests must be processed through the Student Absences Committee. *Class Schedule and Format: Class Schedule Clinical Skills: Examination and Evaluation I Date Topic Presenter Applicable readings/references June 3 Lecture Ed2N 2106 Intro to examination: Information from Guide to Practice; ICF International Classification of Function; Systems review 1) Guide to Physical Therapist Practice.APTA Second edition. (see required readings above) The following sections: Understanding Physical Therapy Practice: only the overview of disablement. (pages 27-33) Basics of Patient Client Management (pages 39-50) 2)Description of International Classification of Functioning (Canvas: course materials) (1 page) 8

9 June 6 Lecture Ed2N 2106 Continuation of June 3 rd ; Evidence based practice using abstracts; case examples SCAN: Abstract: MacDermid JC, et al. Intratester and intertester reliability of goniometric measurement of passive lateral shoulder rotation (Canvas: course materials) 4)SCAN: Full text: Landers MR, et al. An Analysis of 2 Sitting Postures and Their Effect on Pulmonary Function (Canvas: course materials) 5) SCAN: Full text: Kibler BW, et al. Evaluation of Apparent and Absolute Supraspinatus Strength in Patients With Shoulder Injury Using Scapular Retraction Test (Canvas: course materials) June 10 th Lecture Ed2N 2106 Continuation of June 6 and examination information related to goniometry, MMT, posture and palpation To be read throughout the semester: 1)Kendall FP, McCreary EK, Provance PG, Rodgers MM, Romani WA. Muscles: Testing and Function: With Posture and Pain. 5 th edition. Williams and Wilkins; 2005 (MMT pages 4-24 and all upper quarter muscle tests; Posture pages 51-95) 2)Norkin CC, White DJ. Measurement of Joint Motion: 4th edition. Philadelphia. FA Davis; 2009 (3-53) June 13 June 17 June 20 Palpation start-up Goniometry start - up Static Posture James and various Norkin and White self study manual 1)Kendall FP, McCreary EK, Provance PG, Rodgers MM, Romani WA. Muscles: Testing and Function: With Posture and Pain. 5 th edition. Williams and Wilkins; 2005 (View the diagrams: Posture pages 51-95) 9

10 June 24 Posture Cont. 1)Kendall FP, McCreary EK, Provance PG, Rodgers MM, Romani WA. Muscles: Testing and Function: With Posture and Pain. 5 th edition. Williams and Wilkins; 2005 (View the diagrams: Posture pages 51-95) June 27 MMT 1 Shoulder Keep up with Kendall Text July 1 MMT 2 Elbow/Wrist Keep up with Kendall Text Thursday July 3 MMT 3 Scapula Keep up with Kendall Text July 8 MMT 3 Scapula Upper Motor Screen Kendall text Upper quarter motor screening form Wednesday July 9th MMT 4 Hip Kendall text 10

11 July 15 MMT 5 Hip/Knee Kendall text July 18 In class quiz Judd and various In class quiz on a simulated patient examination July 22 Vital Signs HR/BP/RR Malone and various Frese E, et al. Blood Pressure Measurement Guidelines for Physical Therapists (Canvas: required readings) July 25 MMT 6 Foot/Ankle Kendall text July 29 MMT 7 Foot/Ankle Lower Motor Screen Kendall text Lower quarter motor screening form Aug 1 MMT 8 Abdominals James and various Kendall text Sahrmann abdominal testing form (Canvas: module-pelvis/abdomen) 11

12 Aug 8 Functional muscle testing Sitting/Bedside Aug Review and Practical Simulation Tues 8/ Lab Group Ed1 3200/3400 Practical Exams All items for practical examination testing will be in Canvas: modules Wed 8/ Lab Group Ed1 3200/3400 Lab Attire: Shorts and jog bras (when conducting MMT of the scapular muscles, must wear something other than a jog bra in order to expose the interscapular muscles) Class Schedule: Readings for goniometry are self driven. Palpation learning is self driven and through modules. MMT readings from Kendall correspond to the muscles being tested in each. The muscle tests being presented depend on the pace of class and will be announced at the end of each. 12