University of Maine at Presque Isle 181 Main St. Presque Isle, ME COURSE SYLLABUS NEUROLOGICAL INTERVENTIONS IN PHYSICAL THERAPY

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1 University of Maine at Presque Isle 181 Main St. Presque Isle, ME COURSE SYLLABUS NEUROLOGICAL INTERVENTIONS IN PHYSICAL THERAPY CURRICULUM AND COURSE NUMBER: PTA 208 DEPARTMENT: Professional programs/pta CREDIT HOURS: 3 SEMESTER HOURS: CLASS: 2 LAB: 1 PREREQUISITES: Completion of all PTA general education requirements and first semester technical coursework INSTRUCTOR: Vanessa Patenaude PT, MS OFFICE: Wieden Hall vanessa.patenaude@umpi.edu OFFICE HOURS: By appointment-teaching schedule will be posted on door COURSE DESCRIPTION Course builds upon the student s foundation in neuroscience and provides a greater breadth and depth of knowledge in neuroanatomy, physiology, and pathology. The course emphasizes knowledge and skills needed to implement basic physical therapy interventions for the neurologically impaired patient. Conditions discussed include CVA, TBI, SCI, Parkinson disease, MS, Vestibular disorders, and other neurologic disorders. REQUIRED TEXTS: Umphred Darcy and Constance Carlson. (2006) Neurologic Intervention for Physical Therapist Assistants. Thorofare, NJ. Slack. O Sullivan, Susan, and Thomas Schmitz. (2010) Improving Functional Outcomes in Physical Rehabilitation. Philadelphia, PA. F.A. Davis. 1

2 RECOMMENDED TEXTS: O Sullivan, Susan and Thomas Schmitz. (2007) Physical Rehabilitation 5 th Edition. Philadelphia, PA. F.A. Davis. Brief Content Outline: Introduction to class Review clinical neuroanatomy/physiology Review function of CNS Dysfunction of CNS Review function of PNS/ANS Dysfunction of PNS/ANS Data collection for neurological conditions Motor learning/neuromotor treatment theories Intervention theories and principles PT interventions for CVA/SCI/TBI/Parkinson s/ms/other Interventions: neuromuscular control and re-education Static/dynamic postural control and mobility Functional interventions for: bed mobility, sitting, standing, transfers, gait, ADL COURSE OBJECTIVES By the end of this course, the student will: : Demonstrate verbal and non-verbal communication with students, mock patients, instructors and others in an effective, appropriate, and capable manner relative to course content in class and online. a. demonstrate appropriate communication when given a case scenario for class discussion or lab practical b. demonstrate satisfactory communication score on professionalism rubric : Recognize individual and cultural differences in class and responds appropriately in all aspects of course content a. demonstrates respect for individual and cultural differences when given a neurological case scenario for class discussion or lab practical b. demonstrates satisfactory personal interaction score on professionalism rubric : Exhibit classroom and online conduct that reflects a commitment to meet the expectations of the university, members of society receiving health care services, and members of the profession of physical therapy. a. demonstrate an overall satisfactory score on the course professionalism rubric. 2

3 b. communicates to instructor/s strategy for improving any unsatisfactory professionalism scores : Demonstrate classroom and online conduct that reflects practice standards that are legal, ethical, and safe relative to neurological physical therapy. a. demonstrate a satisfactory score on any legal and ethical standard outlined in the course professionalism rubric. b. utilizes gait belt and demonstrates appropriate safety awareness during all lab activities including practical exam case scenarios related to therapeutic exercise : Communicate an understanding of the plan of care developed by the physical therapist to achieve short and long term goals and intended outcomes relative to neurological physical therapy. a. demonstrates understanding of how neurological interventions will achieve goals and outcomes with accurate and appropriate assessment and plan documentation. b. chooses neurological intervention progression that is appropriate to accomplish POC goals and outcomes. c. describe rationale for selected interventions NM pg Identify and describe key structures and functions of the CNS including circulation a. Identify the lobes of the brain and their function b. Identify the major parts of the brain and spinal cord and their function c. Identify blood supply to the CNS d. Identify spinal tracts and their function 7. Identify key structures and functions of the PNS a. Identify cranial nerves and their function b. Identify function of the spinal nerves 8. Identify key structures and function of the ANS 9. Describe the clinical implications associated with lesions in the following areas: a. UMN vs. LMN b. Lobes of the brain c. Left vs right hemisphere d. Cerebellum e. Brainstem f. Basal Ganglia g. Spinal cord 3

4 h. Various CNS arterial supply i. Cranial nerves j. UMN vs LMM 10. Identify and describe current theories of motor control, motor learning and recovery a. Identify differences among motor learning, motor control and neuroplasticity b. Identify stages of motor learning and strategies for intervention c. Identify types of feedback and practice and strategies for intervention d. Describe differences between recovery and compensation 11. Identify different types of frameworks for neuromotor intervention. a. Identify different neurorehabilitation approaches including functional training, neurodevelopmental training, compensatory training 1. Identify basic concepts of each approach 2. Identify muscular facilitation and inhibitory techniques : Demonstrate competence in implementing functional training interventions and progressions for ADLs according to a given neurological condition and POC. a. administer functional activities for improved dynamic postural control when completing ADL for a patient with a given SCI/CVA/TBI : Demonstrate competence in implementing functional training interventions and progressions with assistive/adaptive devices according to a given neurological condition and POC. a. administer functional activities with cane, walker, forearm crutches, AFO etc. for pt. with TBI, CVA, or SCI : Demonstrate competence in implementing functional training interventions and progressions for body mechanics according to a given neurological condition and POC. a. administer functional activities for improved body mechanics during mobility activities for pt. with CVA/SCI or TBI and associated spasticity : Demonstrate competence in implementing functional training interventions and progressions for developmental activities according to a given neurological condition and POC. a. administer functional activities for improved bed mobility and transfers for a given neuromuscular impairments : Demonstrate competence in implementing functional training interventions and progressions for gait and locomotion according to a given neurological condition and POC. a. administer functional activities to improve standing and gait for pt. with a given neurological condition. 4

5 : Demonstrate competence in implementing functional training interventions and progressions with a given orthotic device, neurological condition and POC. a. administer functional activities to improve community ambulation for pt. with a given neurological condition and orthotics. b. Administer functional activities to improve donning/doffing orthotics as appropriate with pt. with a given neurological condition : Demonstrate competence in implementing functional training interventions and progressions for improved wheelchair management according to a given neurological condition and POC. a. administer functional activities to improve wheelchair management for pt. with a given neurological conditional. b. administer functional activities to improve household wheelchair maneuvering for pt. with a given neurological condition : Demonstrate competence in implementing passive ROM for a given neurological condition and POC. a. identify and list indications and contraindications for various neurological conditions including spasticity, flaccidity, and sensory impairments. b. demonstrate manual PROM to pt. with CVA/TBI and spasticity. c. Demonstrate appropriate inhibitory techniques for a pt. with CVA and spasticity : Discuss appropriate mechanical and physical agents for use in conjunction with given neurological conditions when carrying out a PT plan of care. a. identify, list, and discuss indications, contraindications and precautions for mechanical/physical agents for a given neurological case scenario b. identify the benefits of using a given mechanical or physical agent to enhance an intervention for neurological impairment for a given pt. goal or outcome : Demonstrate competence in implementing aerobic conditioning exercise progressions for a given neurological case scenario. a. implement aerobic conditioning for pt. with CVA/SCI/TBI and a goal to participate in functional wheelchair activities : Demonstrate competence in implementing balance and coordination exercise progressions for a given acute neurological case scenario. a. implement static/dynamic balance and coordination activities in sitting/standing for pt. with neurological impairments from CVA/TBI/SCI : Demonstrate competence in implementing conditioning and reconditioning exercise progressions for a given neurological case scenario. a. implement ADL reconditioning exercises for pt. with CVA/TBI and SCI 5

6 : Demonstrate competence in implementing posture awareness exercise progressions for a given neurological case scenario. a. implement posture awareness exercises for pt. with a given neurological condition : Demonstrate competence in implementing strengthening exercise progressions for a given neurological case scenario. a. implement LE strength exercises for pt. with a given neurological condition. b. demonstrate facilitory techniques for pt. with flaccidity : Demonstrate competence in implementing ROM and flexibility exercise progressions for a given neurological case scenario. a. implement appropriate stretching exercises for pt. with SCI/SCI/TBI 27. Identify and describe data collection skills for neurological impairment a : Recognizes absent or altered sensation i. identifies the importance of collecting subjective information from subject regarding any known sensory deficits ii. demonstrates appropriate sensory screening as appropriate prior to neurological interventions b. identify and describe techniques for assessment of motor impairment c. identify and describe special tests for UMN and LMN dysfunction : Demonstrates competence in performing vital sign measurements in the neurologically impaired population a. identifies expected vital sign changes in pt. with neuromuscular impairments b. demonstrates and discusses changes to technique in vital sign data collection in pt. with cognitive, sensory, or neuromuscular impairment : Demonstrates competence in data collection skills for arousal, mentation, and cognition in neurologically impaired population a. discusses appropriate cognitive screening tool for pt. with various neurological impairments due to stroke or TBI : Demonstrates competence in describing the safety, status, and progression of patients with neurological conditions while engaged in gait, locomotion, balance, wheelchair management and mobility. a. identifies potential safety issues including neglect, sensory, neuromuscular, balance and cognitive deficits and identifies the appropriate screening tool i.e. Berg balance, FIM, etc., for documentation of progress. 6

7 : Demonstrates competence in measuring muscle strength by manual muscle testing a. demonstrates competence to adjust muscle strength test to accommodate for cognitive or sensory deficits due to neurological condition ,.31: Demonstrates competence in collecting data related to pt. pain level or functional capacity at home or work, and recognizes activities, positions, or postures that alleviate or aggravate pain a. demonstrates competence in clinical case scenario to adjust method of ascertaining pain level or functional status from pt. with cognitive, sensory, communication or other deficit due to neurological condition b. demonstrates competence in clinical case scenario to identify activities, positions, or postures that will likely alleviate or aggravate pain when pt. is unable to communicate due to neurological impairment : Adjusts interventions within the plan of care established by the physical therapist in response to patient clinical indications and reports this to the supervising physical therapist. a. observes, identifies, and communicates to supervising PT changes in fatigue levels, functional capacity, or other clinical indicators due to neurological condition that warrants reduction in pt. activity level or stress. b. take vital signs before, during, and after intervention and continuously monitor for signs of activity intolerance : Recognizes when intervention should not be provided due to changes in the patient s status and reports this to the supervising physical therapist. a. reviews documentation in given neurological scenario for changes in physician orders. b. identifies and describes signs and sxs of autonomic dysreflexia for pt. case scenario with SCI c. monitors vital signs and other indicators of a patient s intolerance to activity including blood pressure, HR, RR, pulse oximetry, rating of perceived exertion, diaphoresis, skin color etc. for a given neurological condition and plan of care 33211: Reports any changes to the patient s status to the supervising physical therapist. d. demonstrates appropriate and accurate documentation regarding changes to patient status in stroke, TBI, or SCI case scenario e. demonstrates appropriate and accurate verbal report to supervising PT in stroke, TBI, or SCI case scenario : Recognize when the direction to perform an exercise is beyond that which is appropriate for a physical therapist assistant and initiates clarification with the physical therapist. a. identifies interventions in a given case scenario that are inappropriate for the PTA relative to neurological intervention b. recognizes when intervention should not be provided due to changes in pt. status and re-evaluation may be indicated : Participates in educating patients and caregivers as directed by the supervising physical therapist in a given case scenario a. utilizes written and verbal communication that is non-technical and understandable to patient and caregivers b. adjusts communication style to accommodate communication deficits including aphasia, visual or auditory impairments due to neurological impairment. 7

8 : Provides patient-related instruction in given case scenarios regarding neurological condition to patients, family members, and caregivers to achieve outcomes for given interventions identified in the plan of care established by the physical therapist. a. demonstrates appropriate verbal cuing when instructing patients with given neurological impairment b. demonstrates appropriate tactile feedback when instructing pt. with given neurological impairment : Take appropriate action to manage patient falls and other potential emergency situations while implementing neurological interventions. a. identify appropriate emergency actions in a given scenario b. describe and demonstrate appropriate technique to assist falling patient with neurological deficit to floor in a given scenario c. identify potential harmful/emergency situations that may arise relative to neurological condition i.e. autonomic dysreflexia, increased ICP etc : Complete thorough, accurate, logical, concise, timely, and legible documentation relative to neurological interventions that follows guidelines and specific documentation formats required by state practice acts, the practice setting, and other regulatory agencies. a. demonstrate accurate use of medical terminology and abbreviations relative to neurological interventions b. accurately document the procedural interventions and related data collection for a given case example related to neurological interventions c. describe how documentation requirements relative to neurological intervention vary depending upon practice setting (eg. skilled nursing, outpatient, home health etc.) : Read and accurately interpret health care literature related to course content. a. complete accurate article critiques related to neurological intervention b. identify and discuss relevant information from research presented in class : under the direction and supervision of the physical therapist, instructs other members of the health care team using established techniques, programs, and instructional materials commensurate with the learning characteristics of the audience. a. educate nursing, PT aide or other staff regarding proper spasticity-inhibiting technique for given case scenario : Identify examples of social responsibility, citizenship and advocacy in PT within the context of course content. a. identify examples of social responsibility and citizenship i.e. raise stroke awareness and prevention with local representatives b. discuss benefits of volunteering time to participate in balance screening 8

9 General Information: 1) Office Hours: The instructor is available by appointment or by chance via phone, , or in person. Students are strongly encouraged to make an appointment in order to ensure instructor s availability. 2) Syllabus, course outline, assignment list, lecture outlines and other classroom related information will be on blackboard. 3) Students are encouraged to make appointments to meet with the instructor during office hours if you are having difficulty with class. Instructional Methods: Lecture, class discussion, instructor demonstrations, laboratory practice sessions, small group work, role playing, mock patients, guest speakers and possibly guest patients. Evaluation Methods: Written exams, written quizzes, lab exams, skills assessments, rubrics for attendance and professionalism, article review Grading: 1. Exams 16% =48% 2. Quizzes 7% =14% 3. Practical Exams 8% =16% 4. Written Assignments =12% 5. Attendance =05% 6. Professionalism =05% 100% Grading Scale: A seven point scale will be used for grading as follows: % A 80-82% C 93-95% A C B D B D B D C F 9

10 Communication: s and phone calls will be responded to within 24 hours on weekdays and no later than noon on Monday for communication received on weekends. We will post an announcement on Blackboard if we will be out of the office for longer than 1 day. Students are expected to check their student generated s and blackboard announcements on a weekly basis for class related updates. Class Cancellation: If I need to cancel class for any reason I will make every attempt to post a Blackboard announcement and send an within 24 hours of class, generally by 8:00 pm the evening prior. Assignments: Assignments will be collected at the beginning of class on the due date. Late assignments may be submitted in person or ed. Late assignments will receive a 5 point penalty per day. Students submitting work by should expect to receive a receipt confirmation within 24 hours during the week and by 12:00 pm on Monday for work submitted on weekends. Students who do not receive receipt confirmation from the instructor should assume failure of transmission occurred and re-submit in order to avoid late penalties or a zero. Faxed assignments are not acceptable. Written Assignments: Article Review: Students will choose a scientific article to review and submit near the end of the semester. The student may choose any research article that meets the following criteria: 1. The article must be from a peer reviewed, scientific journal 2. The topic must be related to physical therapy and neurological conditions, examination, interventions. 3. The article should be no older than 2006 unless the instructor gives clearance. Completed assignments should meet the following criteria: 1. All work should be clean and typed. 2. The journal article should be attached to the written review. Written Soap Notes: Students will work in pair with mock patient scenarios. Students will be responsible for writing soap notes on these mock patients. Soap notes will be passed in the same day as the mock patient scenarios Written Exams: 1. There will be three written exams. 2. There will be two quizzes. 10

11 3. Missed exams/quizzes must be made up within one week of the original test date. Arrangements to make up an exam are the responsibility of the student and should be done your first day back to campus. A grade of zero will be issued for missed make up exams. Make up exams may be modified from the original. Practical Exams: 1. There will be two practical exams. If a patient is needed, a classmate or faculty member will serve as the model. Prior to your exams you will be given the score sheet as well as possible scenarios and/or techniques you will be asked to demonstrate. Sign-up sheets will be posted on the lab door. 2. The minimum passing grade for practical exams is 80% and includes passing of all essential/critical skill standards outline therein. Failed exams must be repeated within one week for an average grade of not more than 80% including passing of all essential/critical skill standards. Students will be allowed to repeat a failed lab exam once. 3. Missed exams must be made up within one week of the original test date. Arrangements to make up an exam are the responsibility of the student and should be done your first day back to campus. A grade of zero will be issued for missed make up exams. Make up practicals may be modified from the original. 4. Students are expected to be appropriately dressed for each practical exam including hair, fingernails, clothing, shoes, and hygiene. Skill Assessments: 1. Prior to completing this course, students will need to demonstrate competency in learned skills which will be verified by program core faculty, course instructor, or an approved teaching assistant. In the event a student needs remediation for any skills, an individualized learning plan will be developed by the student and instructor. 2. Students may repeat a skills assessment once to prove competency prior to the corresponding practical exam. Attendance Students should make every attempt to attend all classes and submit all assignments. Since there are constant learning opportunities between students and between faculty and students, it is expected that students will attend each class meeting. Students missing 25% of classes (lecture and/or lab) prior to the mid-point of the semester may be withdrawn from the course. Students are also expected to arrive for class on time and remain in class until dismissed by the instructor. Please notify the instructor of all delays or absences as soon as possible. For grading purposes the following will also be considered an absence: 4 episodes of late arrivals or early departures Arriving after the mid-point of the class Departing before the mid-point of the class Attendance grade is based on the percentage of classes attended 11

12 Professionalism Professional behavior is an important attribute that all successful clinicians possess. Developing your professionalism as student clinicians will give you the interpersonal tools necessary to interact with patients, coworkers and other professionals from a wide range of cultural and educational backgrounds. Remember that you are representatives of the University of Maine at Presque Isle, the College of Professional Programs, and your state and national professional affiliation. All students should strive to meet all criteria as outlined on the professional behavior assessment rubric and remain respectful of the faculty, staff and classmates. Please see other important information, and UMPI policies and procedures at the following link: 12

13 Resources 1 ( Jan. 24) 2 (Jan. 31) Introduction to PTA 208 -Class expectations -assignments -Attendance and grading policies -professionalism rubric Introduction to Neurorehabilitation: Review CNS PNS ANS Clinical implications associated with lesions in the following areas: a) UMN vs. LMN b) Lobes of the brain c) Left vs right hemisphere d) Cerebellum e) Brain stem f) Basal Ganglia g) Spinal cord h) Various CNS arterial supply i) Cranial nerves j) UMN vs LMM Assignments/Reading Assignments Chapter 1 Umphred s Neurorehabilitation for the PTA It is advised to start reviewing Chapters 3-10 in O Sullivan s Improving Functional Outcomes to prepare for labs that start approx. week # 4 Chapter 7 and Pages 151, , O Sullivan s Physical Rehabilitation Lab Activities Exams/Lab Practicals/Assignments Due Quiz # 1 (Take Home) (Neuroanatomy and clinical implications) 3 (Feb. 7) Principles of Interventions: Concepts/Terminology Motor Learning Intervention Theories Chapter 1, 3 & 5 Umphred s Neurorehab for the PTA Part I O Sullivan s Improving Functional Outcomes (Suggested Reading) Take home quiz # 1 Due 13

14 4 (Feb. 14) Quiz # 2 CVA Rehab Pathology-brief review Data collection Intervention Chapter 13 O Sullivan s Physical Rehabilitation Chapter 4 & 11 Umphred s Neurorehab for the PTA (Suggested Reading: Chapters 5-8, 18 O Sullivan s Physical Rehabilitation) CVA: Data collection procedures Quiz # 2 (Principles of Intervention) Winter Break (Feb 18-22) 5 (Feb. 28) 6 (Mar 7) 7 (Mar 14) CVA Rehab continued: data collection continued as needed. Intervention: CVA Rehab intervention continued Mock CVA Patients Exam I Lab Exam I(CVA) Chapter 5 Umphred s Neurorehab for the PTA Chapters 3-10 in O Sullivan s Improving Functional Outcomes CVA: continued CVA: Intervention Exam I (CVA) Lab Exam I (CVA) Mock CVA soap notes due 14

15 8 (Mar 21) 9 (Mar 28) 10 (Apr 11) TBI Rehab Pathology-brief review Data collection Intervention Intervention: TBI TBI Rehab continued Mock TBI patients Spring Break (Apr 1-4) SCI Rehab Pathology-brief review Data collection Intervention Intervention: SCI: Chapter 10 Umphred s Neurorehab for the PTA Review Chapter 5 Umphred s Neurorehab and Chapters 3-10 in O Sullivan s Improving Functional Outcomes (Suggested Reading: Chap. 22 O Sullivan s Phys Rehab) Chapter 9 Umphred s Neurorehab for the PTA Review as per # 8 (Suggested Reading: Chap. 23 O Sullivan s Physical Rehabilitation) TBI: Data collection procedures TBI: Intervention SCI: Data collection procedures SCI: Intervention Mock TBI soap notes due 15

16 11 (Apr 19) 12 (Apr 26) SCI Rehab continued Mock SCI patients Written Exam II Parkinson s/ms/vestibular/other Dx Rehab Pathology-brief review Data collection Intervention Chapter 12 Umphred s Neurorehab for the PTA Review as per s 8 & 9 (Suggested Reading: Chaps O Sullivan s Phys Rehab) Data collection procedures Intervention Written Exam II (TBI/SCI) Mock SCI soap notes due 13 (May 2) 14 (May 9) 15 (May 16) Parkinson s/ms/other Dx Rehab continued Mock patients Lab Exam II-depending on schedule and timing this lab exam may need to be scheduled outside of class time****** Written Exam III Finals Neuro Article Review Due Lab Exam II (SCI,TBI,Other) Mock patient soap notes due Written Exam III 16