PTAS 2120 - Neuromuscular Physical Therapy-Laboratory

Credit Hours: 1.50

Objectives: The student will:

1. Describe normal and abnormal tone including spasticity, flaccidity, and rigidity.
2. Describe and demonstrate methods of identifying and describing abnormal tone.
3. Identify components present and missing in various movement patterns.
4. Demonstrate techniques commonly used to inhibit and facilitate including Rood, Brunnstrom, and PNF.
5. Relate the development of normal movement patterns to functional outcomes and coordination.
6. Recognize and describe appropriate and inappropriate response to inhibition and facilitation techniques.
7. Utilize hand placement and verbal cues to obtain desired movement pattern.
8. Describe and discuss typical movement patterns in the patient with adult hemiplegia and the stages of recovery from abnormal movement patterns.
9. Describe the role of weight‐bearing activities in improving tone/weight‐bearing activities in the patient with adult hemiplegia.
10. Identify compensatory motor responses in abnormal movement patterns.

Outcome 2: Upon completion of this course, students will demonstrate activities related to the developmental sequence.

Objectives: The student will:

1. Describe the developmental stages.
2. Identify key features of each phase of the developmental sequence.
3. Relate developmental sequencing to stages of recovery in the patient with a neurological impairment.
4. Select and perform patient appropriate activities within each phase of the developmental sequence for selected diagnoses.

Outcome 3: Upon completion of this course, students will implement components of a treatment plan under the supervision of a physical therapist using problem solving when provided with a selected treatment plan for a patient with neuromuscular impairment.

Objectives: The student will:

1. Describe, discuss, and perform neuromuscular techniques appropriate for the patient’s diagnosis and impairments utilizing “mock” patient.
2. Discuss and describe indications, contraindications and precautions and safety risks for the patient with neuromuscular impairment including cues requiring termination of treatment.
3. Discuss the role of functional training and adaptive equipment for the patient with a neuromuscular impairment.
4. Demonstrate safe effective patient handling, draping and positioning for the patient with neuromuscular impairment.
5. Describe the role of family and caregiver in the management and education of the patient with neuromuscular impairment.
6. Write a daily progress note and home exercise for patient with neuromuscular impairment.
7. Discuss and describe how to modify a treatment program based on a patients symptoms and responses to treatment within the plan of care.
8. Describe appropriate PTA response to inappropriate behaviors commonly noted when treating a patient with a neurological impairment.
9. Demonstrate safe and effective motor function interventions for the neurologically impaired patient including gait and balance activities.

Outcome 4: Upon completion of this course, students will demonstrate and describe the appropriate role of the PTA in the management of the patient with neuromuscular impairment.

Objectives: The student will:

1. Perform data collection skills appropriate for the neurologically impaired patient that are necessary to implement and continue the plan of care, including balance, coordination, sensation and level of arousal, mentation and cognition
2. Describe participation in discharge planning appropriate to the PTA scope of practice.
3. Identify occurrences requiring consultation with a supervising physical therapist prior to implementing or continuing the plan of care.

Outcome 5: Upon completion of this course, students will demonstrate the ability to integrate issues of gender, culture, life span, and socioeconomic status into the treatment approach to the neurologically impaired patient.

Objectives: The student will:

1. Describe how a patient’s age, gender, culture, or socioeconomic status may alter the treatment of a patient with neurological impairment.
2. Describe methods to reduce the impact of cultural barriers on goal attainment.

Outcome 6: Upon completion of this course, students will demonstrate the ability to access research information regarding neuromuscular physical therapy via the Internet and paper based library resources.

Objectives: The student will:

1. Develop and complete an oral presentation on an assigned topic.
2. Provide a bibliography demonstrating use of library resources.

1. Normal Movement Lab
   1. Objective‐‐ the student will be able to:
      1. identify components of normal movement during functional activities
      2. identify what omponent is missing during abnormal movement
      3. demonstrate and describe any abnormal compensatory responses when an essential component of normal movement is missing
   2. Special Topics covered:
      1. Motor control analysis
      2. Observation of normal/abnormal movements
         1. Sitting
         2. Supine to sit
         3. Sit to stand
         4. Standing
2. Abnormal Movement
   1. Objective‐‐ the student will be able to:
      1. observe neurological clients performing functional skills on a videotape and identify gross abnormal movement patterns being utilized by the neurological client
      2. experience a simulation of how a client with abnormal movement patterns may feel during functional activities
      3. accurately describe the patterns of hypertonicity
   2. Specific topics covered:
      1. Videotapes of neurological clients with abnormal tone
      2. Simulation of pathological reflex patterns and abnormal tone
      3. Typical abnormal tone in adult hemiplegia
3. Positioning and Bed Mobility
   1. Objective‐ the student will be able to:
      1. discuss goals of positioning in acute stages and its impact on potential recovery
      2. identify the appropriate postures for the neurological client when supine, side‐lying, and sitting in a chair
      3. describe the position of dynamic alignment in sitting
      4. using correct technique, demonstrate positioning the neurological client in supine, side‐lying or sitting position
      5. demonstrate techniques for bed mobility activities
   2. Specific topics covered:
      1. Typical abnormal posture in adult hemiplegia
      2. Dynamic alignment in sitting
      3. Positioning of neurologic client
         1. Goals of positioning
         2. Supine
         3. Side‐lying
         4. Sitting
      4. Bed mobility
         1. Bridging activities
         2. Rolling to side‐lying, supine
         3. Moving up in bed
         4. Lying to sitting
4. Facilitation and Inhibition of Tone and Movement
   1. Objective‐‐ the student will be able to:
      1. identify and accurately apply various neuromuscular techniques to facilitate and inhibit abnormal tone.
      2. discuss the rate of stimulation as it applies to four rules of sensory stimulation and motor output
   2. Specific topics covered:
      1. Facilitation techniques
         1. Exteroceptive
         2. Proprioceptive
         3. Vestibular
      2. Inhibitory techniques
         1. General - neutral warmth, slow stroking, slow gentle shaking, slow vestibular rocking, tonic labyrinthine inverted
         2. Specific - pressure, joint compression, traction, prolong icing
      3. Rules of sensory input and motor output
5. Mat Activities: Trunk Control and Mobility
   1. Objective‐‐the student will be able to:
      1. demonstrate neruomuscular techniques to improve trunk mobility and stability during sitting
      2. relate the importance of trunk and limb alignment
      3. discuss the goals of performing activities of bridging and lower trunk rotation
      4. demonstrate how mobility and stability can be developed during bridging and lower trunk rotation
      5. demonstrate one activity to improve controlled mobility during bridging
   2. Special topics covered:
      1. Bridging
         1. Goals
         2. Techniques - mobility, stability, controlled mobility
      2. Lower trunk rotation
         1. Goals
         2. Techniques
      3. Rolling
         1. Goals
         2. Technique
6. Upper Extremity Activities
   1. Objective‐‐the student will be able to:
      1. discuss the importance of upper extremity treatment in the neurological client
      2. discuss the complications of painful and/or subluxation of the shoulder and reflex sympathy dystrophy that are often seen in the client with neurological dysfunctions
      3. demonstrate/discuss precautions in handling the upper extremity of the client with a neurological problem.
      4. demonstrate neuromuscular techniques to mobilize the neurological client’s scapula
      5. demonstrate proper way to hold a client’s hand to inhibit tone or avoid increasing tone
      6. demonstrate/describe the position of dynamic alignment when the neurologic client is sitting
      7. demonstrate/describe the sequence of activities when treating the upper extremity
      8. demonstrate various neuromuscular techniques/activities to improve mobility
   2. Specific topics covered:
      1. Upper extremity complications in the neurologically impaired patient
      2. Upper extremity neuromuscular activities/techniques
         1. Purposes
         2. Mobilization of scapula
         3. Mobilization of the hand
      3. Treatment: basic components of normal movement and dynamic sitting posture
         1. Body on limb
         2. Body and limb together
         3. Limb on body
         4. Functional activity
7. Neuromuscular Techniques for Transfers
   1. Objective‐‐ the student will be able to:
      1. discuss why going supine to sit is more therapeutic when it is performed on the involved side
      2. discuss why a modified pivot transfer is preferred over a standing pivot transfer with neurologically impaired client
      3. demonstrate techniques to assist a neurologic client to achieve normal components of movement during the following transitional movements:
         1. supine to sit
         2. scooting while sitting
         3. modified pivot transfer
         4. sit to stand
      4. demonstrate techniques to facilitate and mobilize the trunk of neurologic client in order to improve anterior/posterior tilts and lateral weight shift
      5. demonstrate various techniques to improve trunk control in sitting
      6. discuss components of movement necessary for an effective and safe transfer
   2. Specific topics covered:
      1. Trunk mobilization
         1. Purposes
         2. Anterior/posterior mobilization technique
         3. Lateral mobilization technique
      2. Facilitation techniques for pelvis
      3. Transitional sit to stand technique
      4. Neuromuscular transfer techniques
         1. Patient preparation
         2. Scooting
         3. Sit to stand
         4. Modified transfer
8. Neuromuscular Techniques for Standing and Gait
   1. Objective‐‐ the student will be able to:
      1. discuss/identify the components of movement necessary for normal sit to stand, balanced standing, weight shifting during standing and ambulation
      2. discuss how “missing” components will affect the neurologically impaired client’s ability to perform sit to stand, balanced standing, weight shifting during standing and ambulation
      3. Demonstrate various neuromuscular techniques to facilitate normal sit to stand, balanced standing, weight shifting during standing and ambulation
   2. Specific topics covered:
      1. Sit to stand
         1. Essential normal components
         2. Common problems
         3. Neuromuscular techniques
      2. Balanced standing
         1. Essential normal components
         2. Common problems
         3. Neuromuscular techniques
      3. Weight shifting
         1. Essential normal components
         2. Common problems
         3. Neuromuscular techniques
      4. Stance, phase of ambulation
         1. Essential normal components
         2. Common problems
         3. Neuromuscular techniques
      5. Swing phase of ambulation
         1. Essential normal components
         2. Common problems
         3. Neuromuscular techniques