Integrated Lower Spinal/Axial Applications Laboratory

Clock Hours: Fifteen and a half (15.5) contact hours

Audience:

This course is designed for licensed physical therapists (copy of physical therapy license required) who are intermediate learners in the field of orthopedic manual physical therapy.

Pre-requisites:

None

Course Description:

This Integrated Applications Laboratory FiT will incorporate didactic material from Ola Grimsby independent study material and clinical practice from educational block 3 to address orthopaedic injuries and diseases of the Lower Spinal/Axial. Learning experiences will include FiT case presentations with incorporate didactic and research material, simulated patient cases, laboratory sessions, and small group discussions that focus on clinically relevant examination and management techniques of persons throughout the lifespan. Upon completing of this integrated applications laboratory, the FiT should be able to critically examine, communicate, and effectively document the information gathered during the initial examination, as well as, appropriately manage persons with orthopedic injuries and diseases. Monthly laboratory sessions and case presentations/discussions, with incorporated evidence-based practice, will assist the FiT to understand the evidence supporting the concepts presented during the block and empower Fit to integrate these concepts into independent practice.

Teaching methods/learning experiences:

A variety of active learning methods will be incorporated into the case-based presentation of course material, including laboratory, independent problem assignments, group-based activities, and role-playing.

Overall Course Objectives:

Upon completion of this laboratory, the participant should be expected to:

1. Definitively select an initial patho-anatomical diagnosis to an orthopedic manual physical therapy patient/client presenting with lumbar/thoracic spine pathology.
2. Evaluate and manage the “whole” patient/client utilizing reason-based, individualized examination sequences, classification, and procedural interventions.
3. Discuss the unique assessment and disposition of the traumatic lumbar/thoracic spine patient.
4. Formulate an all-source evidence-informed management plan including education, manual therapy, and individually dosed neuromuscular rehabilitation techniques.

Specific Course Objectives:

Affective Domain:

Upon completion of this laboratory, participants should be expected to:

1. Accept that a strong understanding of the basic sciences of normal, abnormal and applied anatomy, physiology, biomechanics, and pathology are essential to the practice of orthopedic manual physical therapy.
2. Recognize the vital role that all-source evidence-informed clinical reasoning plays in the evaluation and management of orthopedic manual physical therapy patients/clients.
3. Realize that all orthopedic manual physical therapy patients/clients present with certain unique signs and symptoms that require an individualized approach to the evaluation.
4. Accept the concept of patho-anatomical diagnosis as the important goal in the evaluation of the orthopedic manual physical therapy patient/client.
5. Accept the importance of Selective Tissue Tension Testing (STTT) to the evaluation and management of the orthopedic manual physical therapy patient/client.
6. Identify patients who are more appropriately classified using other criteria (Clinical Prediction Rules, Symptom/Intervention based systems).
7. Internalize the importance of prognosis as a central factor in the evaluation and management of orthopedic manual physical therapy patients/clients.
8. Display the judgment required to make decisions that take into account, and are in the best interests of, the overall health and function of the individual.
9. Recognize the importance of all-source evidence-informed practice and balance all sources (clinical experience, literature, and patient preference) in search of best practices.

Cognitive Domain:

Upon completion of this laboratory, students should be expected to:

1. Analyze the current understanding of the normal, abnormal and applied anatomy, physiology, and biomechanics of the lumbar/thoracic spine and pelvis.
2. Recognize the unique specific biomechanical and neurophysiological examination and differentiate the relative worth of its components as applied to the cervical spine:
   • Passive Physiological Intervertebral Movements (PPIVM)
   • Passive Accessory Vertebral Movements (PAVM)
   • Tests of pain provocation (bone, nerve, ligament, soft tissue)
   • Joint stability testing
3. Interpret the biomechanics of the cervical spine as they relate to the biomechanical and neurophysiological assessment of combined movements.
4. Compare and contrast condition (illness) scripts based on patient age, gender and pain chart information, and definitively select an initial patho-anatomical hypothesis for the lumbar/thoracic spine and pelvis from the following:
   • Systemic disease (cardiovascular, pulmonary, neurological, gastro-intestinal, endocrine, vascular, gynecological, musculoskeletal, integumentary, cancers)
   • Fracture/Dislocation
   • Arthritis (degenerative/systemic/traumatic)
   • Spondylolisthesis (congenital/acquired)
   • Disc pathology
   • Radiculopathy
   • Stenosis (central/lateral canal)
   • Segmental dysfunction (hypomobility, hypermobility, instability, uncovertebral)
   • Contractile tissue lesions
   • Non-Contractile tissue lesions (i.e. dizziness, headache and cervicogenic headaches)
5. Question the initial hypothesis through targeted subjective questioning.
6. Interpret red and yellow flag presentations, including central sensitization and neural mobility sensitivity, and discuss the decisions that need to be made about the management of these patients.
7. Review the components of the cervical spine scan and biomechanical-neurophysiological examination.
8. Identify individual all-source evidence-based tests and measures that are relevant to the diagnosis.
9. Assemble all-source evidence-informed, reasoned, and individualized examination sequences specific to lumbar/thoracic spine and pelvis conditions (illness) scripts.
10. Modify individual examination sequences to take into consideration the traumatic lumbar/thoracic spine and pelvis patient, and varying severity and irritability in patient/client presentations.
11. Definitively select a patho-anatomical diagnosis.
12. Formulate an accurate, individual prognosis for select patient/client presentation including those with poor health, low functioning and illness behaviors.
13. Discuss specific indications and contraindications for orthopedic manual physical therapy intervention.
14. Describe the principles of locking/localization techniques as they relate to specific segmental assessment and management of the lumbar/thoracic spine.
15. Utilize case examples to formulate specific, all-source evidence-informed, individualized management plans, taking into account the overall health and function of the individual.

Psychomotor Domain

Upon completion of this laboratory, participants should be expected to:

1. Demonstrate a specific biomechanical and neurophysiological examination to the lumbar/thoracic spine and pelvis.
   • Passive Physiological Intervertebral Movements (PPIVM)
   • Passive Accessory Vertebral Movements (PAVM)
   • Tests of pain provocation (bone, nerve, ligament, soft tissue)
   • Joint stability testing
2. Demonstrate advanced components of a specific biomechanical-neurophysiological examination (T2-sacrum).
   • Combined Passive Physiological Intervertebral Movements (PPIVM)
   • Combined Passive Accessory Movements (PAVM) (including uncovertebral)
   • Locking techniques for the lumbar/thoracic spine.
   • Lumbar spine and pelvic joint stability testing
3. Demonstrate an acute scanning examination for the traumatic lumbar/thoracic spine and pelvis patient.
4. Demonstrate the ability to provide education to a patient/client, including prognosis, activity modification, and postural adaptation.
5. Demonstrate orthopedic manual physical therapy intervention techniques:
   • Manual therapy techniques
     • Segmental traction in the lumbar/thoracic spine with focused locking.
     • Segmental flexion/extension mobilization in the lumbar/thoracic spine with focused locking.
     • Segmental flexion/extension thrust joint manipulation in the lumbar/thoracic spine with focused locking.
   • Soft tissue techniques
   • Rehabilitation techniques
     • Neuromuscular rehabilitation of the lumbar/thoracic spine and pelvis
     • Strength, mobility, and endurance training
   • Stabilization strategies (including external tape, body mechanics training)
   • Neurodynamic intervention
   • Neural de-sensitizing intervention
6. Demonstrate modified variations of the interventions to take into consideration the varying levels of patient/client severity, irritability, and patient/client/therapist body type.

Requirements for successful completion

1. Attend and participate in laboratory sessions
2. Complete presentation with score >80%

Instructional methods

1. 1. laboratory, independent problem assignments, group-based activities, and role-playing