PTAS 2110 - Neuromuscular Physical Therapy-Lecture

Credit Hours: 2.00

Objectives: The student will be able to:

1. Explain the general structure and divisions of the nervous system.
2. Describe the structure and function of the brain and spinal cord
3. Describe the structures of the peripheral nerve
4. Describe a reflex arc.
5. Describe the process of nerve innervation related to skeletal movement and sensory perception.

Outcome 2: Upon completion of this course, students will be able to discuss the relationship of developmental concepts to elements/principles of various neuromuscular approaches (PNF, Rood, Brunnstrom, Bobath, and Sensory Integration).

Objectives: The student will be able to:

1. Identify normal and abnormal reflexes.
2. Identify the stages of developmental sequence.
3. Relate stages of motor development to common neurological approaches
4. Describe common abnormal movement patterns.

Outcome 3: Upon completion of this course, students will be able to compare and contrast the basic principles of each neuromuscular technique including:

1. Proprioceptive Neuromuscular Facilitation (PNF).
2. Brunnstrom.
3. Neurodevelopmental Techniques (NDT).
4. Sensory Integration (SI).
5. Rood.

Objectives: The student will be able to:

1. Identify the basic principles and theory of NDT childhood.
2. Identify the purpose of NDT approach.
3. Given a treatment plan, design NDT treatment techniques for selected neurological disorders citing rationale.
4. Identify/discuss the basic principles and theory of SI.
5. Identify the purpose of the SI approach.
6. Given a treatment plan, design SI treatment techniques for selected neurological disorders citing rationale.
7. Identify/discuss the basic principles of Rood.
8. Identify the goals/purpose of Rood approach.
9. Given a treatment plan, design Rood treatment techniques for selected neurological disorders citing rationale.
10. Identify/discuss the basic principles of PNF.
11. Identify the goals/purpose of PNF approach.
12. Given a treatment plan, design PNF treatment techniques for selected neurological disorders citing rationale.
13. Identify/discuss the basic principles and theory of Brunnstrom.
14. Identify the goals/purpose of Brunnstrom approach.
15. Given a treatment plan, design Brunnstrom treatment techniques for selected neurological disorders citing rationale.

Outcome 4: Upon completion of this course, students will be able to given a treatment plan, identify and describe the applications of various neurological techniques for selected neurological disorders citing rationale.

Objectives: The student will be able to:

1. Compare and contrast the basic principles of each neurological approach.
2. Discuss the advantages and disadvantages of each neurological technique.

Outcome 5: Upon completion of this course, students will be able to describe the etiology, clinical manifestations and treatment of selected neurological conditions.

Objectives: The student will be able to:

1. Describe the etiology and clinical manifestations of central nervous system lesions.
2. Describe spasticity and pathological reflexes as it relates to neurological conditions.
3. Describe emergency and medical management of patients with acute neurological conditions.
4. Describe continuing medical and pharmacologcial management of patients with acute and progressive neuromuscular impairments
5. Discuss the purpose and value of the neurological examinations as performed by the physical therapist
6. Describe levels of arousal, mentation and common cognitive deficits in neurologically impaired patients.
7. Describe neurological examinations commonly performed by a physician for neurologically impaired patients.
8. Describe the physical therapy management of patients with commonly seen neuromuscular conditions including, but not limited to: CVA, acquired brain injury, spinal cord injury, Parkinson’s disease, multiple sclerosis, polyneuropathy, peripheral nerve injury.

Outcome 6: Upon completion of this course, students will be able to identify the role of the PTA in treating the neurologically impaired patient.

Objectives: The student will:

1. Discuss/identify the role of the PTA in treatment of neurologically impaired patients.
2. Discuss the role of the PTA in the application of techniques of neurological treatments.

Outcome 7: Upon completion of this course, students will be able to identify the role of the PTA in discharge planning and follow up care for patients with neurological disorders.

Objectives: The student will:

1. Discuss/identify the role of the PTA in discharge planning for patients with neurological disorders.
2. Discuss/identify the role of the PTA in follow up care for patients with neurological disorders.

Outcome 8: Upon completion of this course, students will be able to discuss the psychosocial aspects of neurological disorders and their impact on physical therapy treatment.

Objectives: The student will:

1. Discuss the psychosocial aspects of neurological disorders and their impact on physical therapy treatment.

• Communication: The graduate can communicate effectively for the intended purpose and audience.
• Critical Thinking: The graduate can make informed decisions after analyzing information or evidence related to the issue.
• Global Literacy: The graduate can analyze human behavior or experiences through cultural, social, political, or economic perspectives.
• Information Literacy: The graduate can responsibly use information gathered from a variety of formats in order to complete a task.
• Quantitative Reasoning: The graduate can apply quantitative methods or evidence to solve problems or make judgments.
• Scientific Literacy: The graduate can produce or interpret scientific information presented in a variety of formats.

1. Introduction to class
   1. Neuro mind set
2. Cerebral Vascular Accidents
   1. Definition
   2. Demographics
   3. Risk Factors of Stroke
   4. Prevention of Stroke
   5. Etiology
   6. Transient Ischemic Attack
   7. CVA / Medical Intervention
   8. Recovery from Stroke
   9. Stroke Syndromes
   10. Clinical Findings
   11. Complications of Stroke
3. Facilitation / Inhibition Techniques
   1. Proprioceptive Facilitation
   2. Exteroceptive Stimulation Techniques
   3. Vestibular Stimulation Techniques
   4. Other facilitatory techniques
4. Brunnstroms Movement Therapy in Hemiplegia
   1. Signe Brunnstrom
   2. Basic tenets of Brunnstrom’s Theory
   3. Brunnstrom’s stages of recovery
   4. Treatment principles using Brunnstrom approach
5. Motor Development a Motor Control
   1. Motor Control
   2. Stages of Motor Control
   3. Directional concepts of development
   4. Gross motor milestones
   5. Fine motor milestones
   6. Motor development, chronologically speaking
   7. Motor development necessary for Neuro?
   8. Review of primitive reflexes
   9. Review of Righting Reactions
   10. Review of Equilibrium Reactions
6. Motor Control and Motor Learning
   1. Review of motor control
   2. Postural control
   3. Development of postural control
   4. Righting reactions
   5. Protective reactions
   6. Equilibrium reactions
   7. Postural Control
   8. Nashner’s Model of Postural Control
   9. Motor learning
   10. Open vs. Closed tasks
   11. Effects of practice
7. Neurodevelopmental Treatment (NDT)
   1. Berta and Karl Bobath
   2. About NDT
   3. 4 objectives of NDT for the child with cerebral palsy
   4. Goal of physical therapy treatment with NDT
   5. NDT approach
   6. Key points of control
   7. Dynamic Trunk
   8. Principles of Handling
   9. Reflex inhibiting postures
8. Neuro Anatomy
   1. Overview of nervous system
   2. Foundation of nervous system
   3. Structures and functions of the central nervous system
   4. Deep structures of cerebral cortex
   5. Cerebellum
   6. Brain stem
   7. Spinal Cord
   8. Components of the spinal cord
   9. Peripheral nervous system
   10. Cranial Nerves
   11. Spinal Nerves
   12. Muscle spindle
   13. Golgi Tendon Organ
   14. Autonomic Nervous System
   15. Cerebral Circulation
   16. Reaction to Injury
9. Cerebral Palsy
   1. Definition
   2. Incidence
   3. Etiology
   4. Prenatal causes
   5. Perinatal causes
   6. Post natal causes
   7. Classification
   8. Diagnosis
   9. Impairments associated with cerebral palsy
   10. Treatment of cerebral palsy
10. TBI
    1. Statistics
    2. Causes
    3. Classification of brain injuries
    4. Secondary problems associated with traumatic brain injuries
    5. Evaluation
    6. Glasgow Coma Scale
    7. Patient problem areas
    8. PT intervention
    9. Rancho scales of cognitive function
    10. PT during inpatient rehabilitation
    11. Treatment strategies
    12. Discharge strategies
11. Proprioceptive Neuromuscular Facilitation (PNF)
    1. Definition
    2. PNF in general
    3. Principles of PNF
    4. Contraindications to PNF
    5. Basic procedures for facilitation
    6. PNF techniques
    7. PNF techniques used to achieve a particular goal
    8. Patterns of facilitation
12. Multiple Sclerosis
    1. Definition
    2. Statistics
    3. Etiology
    4. Pathophysiology
    5. Clinical symptoms of MS
    6. Patterns of symptoms
    7. Clinical manifestations
    8. Types of MS
    9. Exacerbating factors
    10. Diagnosis
    11. Prognosis
    12. Medical management
    13. Physical therapy management
13. Parkinson’s Disease
    1. Definition
    2. Statistics
    3. Etiology
    4. Primary Parkinson’s
    5. Secondary Parkinson’s
    6. Post infectious Parkinson’s
    7. Toxic Parkinson’s
    8. Pharmaceutical Parkinson’s
    9. Metabolic causes
    10. Parkinsonian Syndrome
    11. Pathophysiology
    12. Clinical manifestations
    13. Functional manifestations
    14. Direct impairments
    15. Diagnosis
    16. Disease course
    17. Medical management
    18. Surgical management
    19. Rehabilitative management
14. Spinal Cord Injury (SCI)
    1. Statistics
    2. Causes of SCI
    3. Life expectancy
    4. Spinal anatomy review
    5. Areas of spinal cord most commonly injured
    6. Naming the level of injury
    7. Classification of injury
    8. Neurological level
    9. Mechanism of injury
    10. Medical intervention
    11. Recovery
    12. Pathological changes following SCI
    13. Types of lesions
    14. Signs and symptoms of spinal cord injury
    15. Complications of SCI
    16. Functional potential in SCI
15. Sensory Integration Therapy (SI)
    1. Definition
    2. Application to adults
    3. Adaptive response
    4. SI therapy
    5. Purposes of SI system
    6. Sensory system and problems associated with them
    7. Characteristics of SI dysfunction
16. Neuroevaluation
    1. Role of PTA in neuroevaluation: Data collection
    2. Vital signs
    3. Sensory
    4. ROM
    5. Strength
    6. Righting reactions
    7. Balance
    8. Gait
    9. Functional skills
    10. Tips for data collection