SAN DIEGO STATE UNIVERSITY DOCTOR OF PHYSICAL THERAPY PROGRAM DPT 835: NEUROPHYSIOLOGICAL THERAPEUTICS I Fall 2013 Lecture: Wednesday 2:00-4:40 pm Lab: Thursday 9:00 am - 2:40 pm INSTRUCTORS Laila, PT, PhD Office: DPT 126 Email: lalibiglou@mail.sdsu.edu Office Phone: (619) 594-5553 and - 0940 Office Hours: Thursday 3:00-4:00 pm Annie Burke- Doe PT, MPT, PhD Office: TBD Email: aburkedoe@mail.sdsu.edu Office Hours: Thursday 2:45-3:45 pm PURPOSE/COURSE OVERVIEW This course addresses the physical therapy examination, evaluation, diagnosis, prognosis and plan of care (including interventions) for adults with movement problems stemming from dysfunction of the supra- spinal central nervous system. Emphasis will be on Stroke, Parkinson s disease, and Other Basal Ganglia Disorders or Movement Disorders. Laboratory sessions are taught in parallel with the materials of the course, and will be used to provide students with an opportunity to practice and refine skills related to the evaluation and treatment of neurologic patients. Case studies and small group discussions will be used to encourage integration of the various treatment approaches used in the management of the people with neurological disorders. COURSE PREREQUISITES DPT 726: Clinical Anatomy II DPT 760: Neuroscience DPT 883: Seminar in Normal Human Gait COURSE MATERIALS Required Textbooks: 1. O Sullivan SB, & Schmitz TJ. Physical Rehabilitation. 6th ed. F.A. Davis 2013 2. Blumenfeld, H. Neuroanatomy though Clinical Cases. 2nd ed. Sunderland, MA: Sinauer Associates, Inc 2010 Recommnded Textbook: Umphred DA, et al. Umphred s Neurological Rehabilitation, 6th ed. Mosby 2012 Optional Books: Leiber, RL. Skeletal Muscle Structure, Function, and Plasticity. 3rd ed. LLW 2009 Kandel ER, et al. Principles of Neural Science, 5th Edition. McGraw- Hill 2012 Schmidt RA & Lee TD. Motor Control and Learning: A Behavioral Emphasis. 5th ed. Human Kinetics 2011 Required Journal Readings To be announced during class or on the course blackboard website. STUDENT LEARNING OUTCOMES Given: An adult with a movement problem All examination and intervention competencies acquired to date relevant to physical therapy. A variety of treatment venues At the completion of DPT 835 NEUROPHYSIOLOGICAL THERAPEUTICS I, each student will be able to: Describe the pathophysiological effects of lesions to the supra- spinal central nervous system and the major sensory and motor pathways within the central nervous system, explain and related these effects to movement dysfunction. Describe medical and pharmacological management of various diagnoses associated with central nervous system and the major sensory and motor pathways within the central nervous system involvement. 1
Describe patient s movement dysfunction, associated activity and participation limitations and relevant personal and environmental contextual factors by gathering information from medical chart, patient or significant other interview or observation. Communicate effectively and professionally with the patient, family, caregiver and other individuals involved with the patient s care. Modify the communication based on the patient s abilities to receive or express language. Hypothesize potential components of movement (body structure and function) that are interfering with movement. Identify the stage(s) of movement most affected. Hypothesize the neural, mechanical, physiological and behavioral factors underlying component(s) of movement (and their interaction) in order to develop the initial hypotheses about the cause of the movement dysfunction. Perform a screening examination of sensory and motor systems. Continually assess and determine whether it is advisable to proceed with examination or intervention or identify the need to refer to or consult with another health care practitioner Design and implement a comprehensive physical therapy examination that includes examination of peripheral sensory (light touch, sharp dull, vibration, proprioception) function, motor function, and deep tendon reflex integrity, - Select, prioritize and perform appropriate examination procedures safely, effectively and efficiently. - Discuss reliability and validity of selected tests and measures - Modify the examination plan a) if indicated by information gathered during the examination b) based on time constraints c) based on patient response. - Accurately summarize examination findings verbally. - Accurately document examination findings in writing. Based on a synthesis of examination findings, develop and document in writing an evaluation or working hypothesis(es) regarding the patient s movement that - identifies the location and extent of lesion in the central nervous system - describes the underlying reasons for the central nervous system dysfunction Establish a physical therapy diagnosis Establish a prognosis based on evidence based practice principles - prioritize realistic outcomes and short- term goals based on prognosis and personal and environmental contextual factors. - determine appropriate recommendations for patient disposition or follow- up Design and implement a physical therapy plan of care based on evidence based principles that is congruent with medical and pharmacologic management - Discuss the purpose, theoretical rationale, expected response of any intervention in relation to hypotheses - Summarize any existing support in literature for the efficacy of any intervention. - Select appropriate interventions. - Perform intervention(s) safely, effectively and efficiently. COURSE EVALUATION Grading for this course is on a grade basis (A- F). The course grade will be based on the accumulated score from practical, oral and written exams, and presentation there is no extra credit available. For the exams, use the student learning outcomes/objectives. There are four exams: practical exam 1 and 2, Mid- term exam (oral and written), and final written exam. The topics for each exam will be announced in the class. Assessment Percentage Grading Scale Practical Exam 1 25% A >92.0% Practical Exam 2 15% A- 90.0 91.9% Mid-term Oral Exam 10% B+ 88.0 89.9% Mid-term Written Exam Final Written Exam 15% 25% B B- 82.0 87.9% 80.0 81.9% Presentation 10% C+ 78.0 79.9% C 72.0 77.9% Total (Overall) 100% F < 71.9% Evaluation criteria for each exam will be posted on the course blackboard site. 2
PURPOSE OF THE EVALUATION METHODS Practical examinations The practical examinations provide opportunities for students to demonstrate safe and effective performance of neurological examination and intervention skills for patients with central nervous system involvement. Presentation The 10- minute presentation will provide an opportunity for students to review a specific topic related to the course materials, summarize the main information related to it, and present it to their classmates. Oral examination The oral examinations provide students with opportunities to expansively demonstrate their knowledge of and ability to apply neuroscience and clinical knowledge to the examination, evaluation, diagnosis, prognosis and intervention of patients with neurological conditions. Written examination The written exam will provide an opportunity for students to demonstrate their knowledge of the pathophysiology, etiology, diagnosis, prognosis, medical, pharmacologic and rehabilitation intervention, and typical course of various clinical conditions associated with central nervous system involvement. COURSE SCHEDULE WEEK 1 TIME TOPIC FACULTY READINGS W 8/28/2013 2:00-3:15 Course Introduction Integrating the Motor Control Framework and the International Classification of Disability and Function (ICF) Framework W 8/28/2013 3:30-4:40 Motor Learning TH 8/29/2013 9:00 11:40 (A) Guide to Physical Therapy Practice Burke- Doe TH 8/29/2013 12:00-2:40 (B) Guide to Physical Therapy Practice Burke- Doe WEEK 2 W 9/4/2013 2:00-3:15 Motor Examination W 9/4/2013 3:30-4:40 Motor Examination TH 9/5/2013 9:00 11:40 (B) Motor Examination Lab Burke- Doe TH 9/5/2013 12:00-2:40 (A) Motor Examination Lab Burke- Doe WEEK 3 W 9/11/2013 2:00-3:15 Sensory Examination W 9/11/2013 3:30-4:40 Sensory Examination TH 9/12/2013 9:00 11:40 (A) Sensory Examination Lab Burke- Doe TH 9/12/2013 12:00-2:40 (B) Sensory Examination Lab Burke- Doe WEEK 4 W 9/18/2013 2:00-3:15 Cortical Structures, Functions and Pathways W 9/18/2013 3:30-4:40 Reflexes NCV/EMG TH 9/19/2013 9:00 11:40 (B) Case Evaluations and Discussions Burke- Doe TH 9/19/2013 12:00-2:40 (A) Case Evaluations and Discussions Burke- Doe WEEK 5 W 9/25/2013 2:00-3:15 Stroke Pathophysiology W 9/25/2013 3:30-4:40 Sensorimotor Abnormalities Post- Stroke Stiffness and Spasticity TH 9/26/2013 9:00 11:40 (A) Spasticity, Stiffness and Contracture Assessment Lab Burke- Doe TH 9/26/2013 12:00-2:40 (B) Spasticity, Stiffness and Contracture Assessment Lab Burke- Doe 3
WEEK 6 W 10/2/2013 2:00-3:15 Postural Control and Balance Abnormalities Post- Stroke W 10/2/2013 3:30-4:40 Gait Abnormalities Post- Stroke TH 10/3/2013 9:00 11:40 (B) Gait and Balance Assessment Lab Burke- Doe This session will be held at Dr. s laboratory. TH 10/3/2013 12:00-2:40 (A) Gait and Balance Assessment lab Burke- Doe WEEK 7 W 10/9/2013 2:00-3:15 Interventions Principles W 10/9/2013 3:30-4:40 Lower Extremity, Gait and Balance Interventions TH 10/10/2013 9:00 11:40 (A) LE Intervention Lab Burke- Doe TH 10/10/2013 12:00-2:40 (B) LE Intervention Lab Burke- Doe WEEK 8 W 10/16/2013 2:00-3:15 Upper Extremity Interventions W 10/16/2013 3:30-4:40 Orthotics - Principles and Applications to Adults TH 10/17/2013 9:00 11:40 (B) UE Intervention Lab Burke- Doe TH 10/17/2013 12:00-2:40 (A) UE Intervention Lab Burke- Doe WEEK 9 W 10/23/2013 2:00-3:15 Medical Management of Stroke W 10/23/2013 3:30-4:40 Speech and Language Therapy for Stroke TH 10/24/2013 9:00 11:40 (A) Case Evaluations and Discussions Burke- Doe TH 10/24/2013 12:00-2:40 (B) Case Evaluations and Discussions Burke- Doe WEEK 10 W 10/30/2013 2:00 4:40 Mid- term Written and Oral Exam TBA TH 10/31/2013 9:00 11:40 (B) Practical Exam 1 Burke- Doe TBA TH 10/31/2013 12:00-2:40 (A) Practical Exam 1 Burke- Doe TBA WEEK 11 W 11/6/2013 2:00-3:15 Basal Ganglia Structure, Function and Pathways W 11/6/2013 3:30-4:40 Parkinson s Disease, and Non- motor Symptoms of PD TH 11/7/2013 9:00 11:40 (A) PD Evaluation Lab (UPDRS, etc.) Burke- Doe TH 11/7/2013 12:00-2:40 (B) PD Evaluation Lab (UPDRS, etc.) Burke- Doe WEEK 12 W 11/13/2013 2:00-3:15 Motor Symptoms of PD: Gait, Postural Control Abnormalities, Rigidity, Akinesia, and Bradykinesia W 11/13/2013 3:30-4:40 Interventions Principles TH 11/14/2013 9:00 11:40 (B) PD Evaluation Lab Burke- Doe TH 11/14/2013 12:00-2:40 (A) PD Evaluation Lab Burke- Doe WEEK 13 W 11/20/2013 2:00-3:15 Upper Extremity Interventions - PD W 11/20/2013 3:30-4:40 Lower Extremity, Gait and Balance Interventions in PD TH 11/21/2013 9:00 11:40 (A) PD Intervention Lab Burke- Doe TH 11/21/2013 12:00-2:40 (B) PD Intervention Lab Burke- Doe 4
WEEK 14 W 11/27/2013 2:00-3:15 Medical Management of PD W 11/27/2013 3:30-4:40 Speech and Language Therapy for PD TH 11/28/2013 No Classes - Thanksgiving Day Burke- Doe WEEK 15 W 12/4/2013 2:00-3:15 Dystonia - Hemiballismus Huntington's Disease W 12/4/2013 3:30-4:40 Multiple Sclerosis (MS) Amyotrophic lateral sclerosis (ALS) TH 12/5/2013 9:00 11:40 (B) Case Discussions and Practice Burke- Doe TH 12/5/2013 12:00-2:40 (A) Case Discussions and Practice Burke- Doe WEEK 16 W 12/11/2013 2:00 4:00 Final Written Exam TBA TH 12/12/2013 9:00 11:40 (A) Practical Exam 2 Burke- Doe TBA TH 12/12/2013 12:00-2:40 (B) Practical Exam 2 Burke- Doe TBA WEEK 17 W 12/18/2013 2:00 4:40 Review and Scoring of Presentations CLASS ATTENDANCE One of the professional responsibilities of a physical therapist student is to attend every scheduled class. Learning experiences in the curriculum are arranged sequentially, to ensure that new information, knowledge, and skills are integrated with previously introduced material. In addition, the DPT curriculum includes significant opportunities for collaborative learning, where interaction between and among students and faculty are critical components of the students learning. Therefore, these learning experiences cannot be repeated and your attendance is a professional responsibility. Corrective action for unexcused absences: Attending class is expected during the entire DPT curriculum. Missing class adversely affects the learning experience and contributes to poor performance. Two unexcused absences in a course will result in a grade of failure for that course. Please see your student handbook for complete details on policies for attendance and absences. CLASSROOM TARDINESS Being on time to classes is expected. Missing class adversely affects the learning experience and contributes to poor performance. Tardiness also disrupts the class, your peers and instructor. Like unexcused absences, tardiness is considered irresponsible, disrespectful and unprofessional. Corrective action for tardiness: Students in violation of the tardiness requirement will first receive a verbal warning with corrective instruction for the first unexcused tardiness. If the same student breaks the tardiness policy a second time, the violation will result in the student not being allowed in the class and will receive an unexcused absence for that day. This may result in a reduced letter grade at the discretion of the instructor. A third unexcused tardiness violation will be considered a second unexcused absence and will result in a grade of failure for that course. Please see your student handbook for complete details on policies for classroom tardiness. ATTIRE Students are required to wear attire which conforms to the image of the professional physical therapist. The DPT program is a setting where students, faculty, guests, patients, other professionals, and the general public form an impression of us, based on our appearance and conduct. Casual and faddish clothing are not permitted in the classroom, library, or laboratories. Corrective Action for attire: Students in violation of the dress requirements will first receive a verbal warning with corrective instruction. If the same student breaks the dress code a second time, the violation will result in the student being sent home to change clothes and will receive an unexcused absence for that class. Please see your student handbook for complete details on policies for attire in lectures and laboratories. STATEMENT ON CHEATING AND PLAGIARISM Cheating is the actual or attempted practice of fraudulent or deceptive acts for the purpose of improving one s grade or obtaining course credit; such acts also include assisting another student to do so. Typically, such acts occur in relation to examinations. However, it is the intent of this definition that the term cheating not be limited to examination situations only, but that it include any and all actions by a student that are intended to gain an unearned academic advantage by fraudulent or deceptive means. 5
Plagiarism is a specific form of cheating which consists of the misuse of the published and/or unpublished works of others by misrepresenting the material (i.e., their intellectual property) so used as one s own work. Penalties for cheating and plagiarism range from a 0 or F on a particular assignment, through an F for the course, to expulsion from the University. For more information on the University s policy regarding cheating and plagiarism, refer to the Schedule of Courses ( Legal Notices on Cheating and Plagiarism ) or the University Catalog ( Policies and Regulations ). STUDENTS WITH DISABILITIES The University is committed to providing reasonable academic accommodation to students with disabilities. The Student Disability Services Office provides university academic support services and specialized assistance to students with disabilities. Individuals with physical, perceptual, or learning disabilities as addressed by the Americans with Disabilities Act should contact Student Disability Services office for information regarding accommodations at (619) 594-6473 (http://www.sa.sdsu.edu/dss/dss_home.html). Moreover, you should notify me so that reasonable efforts can be made to accommodate you. This syllabus and schedule are subject to change in the event of extenuating circumstances. 6