NAIOMT Level III: C-715 Advanced Upper Quadrant Integration

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NAIOMT Level III: C-715 Advanced Upper Quadrant Integration

Faculty: All credentialed faculty
Clock Hours: Forty-Two (42) contact hours



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



None. However, in order to receive the maximum benefit from this course, it is recommended that participants have completed all 500 and 600 level courses prior to taking this class.


Course Description:

This course will utilize case-based instruction to illustrate specific conditions of the integrated upper quadrant and the decision making process inherent to their total management. Designed to develop intermediate to advanced clinical reasoning skills in the field of orthopedic manual physical therapy, participants will develop the skills necessary to move beyond an initial patho-anatomical diagnostic hypothesis towards a detailed exploration of the etiology behind the diagnosis. Complex, multi-region patient/client problems of the neuromusculoskeletal system will be analyzed in an instructor specific methodology, based on the various biomechanical and neuromusculoskeletal models available, including original, and novel, thoughts and theory. Management will focus on a multi-faceted approach encompassing manual therapy, neurophysiological techniques, and various other treatment approaches.


Teaching methods/learning experiences:

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


Overall Course Objectives:

Upon completion of this four (4) day module, participants should be expected to:

  1. Recognize that all pathoanatomical diagnoses and disease states have an etiology behind them that is often complex, multi-faceted, and remote from the sign of the symptoms.
  2. Describe the concept of interdependence as it applies to orthopedic manual physical therapy
  3. Perform individualized assessment sequences, including subjective and objective tests and measures, as applied to the complex neuromusculoskeletal patient/client.
  4. Perform advanced, specific, localized mobilization and joint thrust manipulation techniques with and without segmental locking.
  5. Evaluate the clinical, literature, and patient driven evidence for specific conditions encountered.


Specific Course Objectives:

Affective Domain:

Upon completion of this 4-day module, 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. Accept the concept of patho-anatomical diagnosis as the important goal in the evaluation of the orthopedic manual physical therapy patient/client.
  4. Accept the importance of Selective Tissue Tension Testing (STTT) to the evaluation and management of the orthopedic manual physical therapy patient/client.
  5. Recognize that patients with neuromusculoskeletal problems present with multi-faceted, multi-region signs and symptoms that require an interdependent approach to their evaluation and management.
  6. Internalize the contention that advanced clinical reasoning, evaluation, and management are not conducive to standardization and will reflect a thoughtful, individual and eclectic approach.
  7. Recognize that simple theories do not general fit complex problems; they require original constructs, and a thoughtful approach to their solution.
  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.


Cognitive Domain:

Upon completion of this 4-day module, participants should be expected to:

  1. Analyze the clusters of symptoms and signs to formulate hypotheses of relationships within the upper quadrant, and the effect of dysfunction (culprits) on the etiology of common upper quadrant syndromes.
  2. Assess the postulated local and remote effects of abnormal posture on the tissues and biomechanics of the head, neck, TMJ, thorax, rib cage, shoulder girdle complex and upper extremity joints.
  3. Apply principles of axoplasmic flow compromise, segmental facilitation, and double crush syndrome to the assessment and intervention of the head, cervical, thoracic and upper extremity units
  4. Evaluate the mechanisms of interdependent normal and pathological biomechanics between the upper thoracic, lower, mid and upper cervical, TMJ, shoulder girdle and all upper extremity joints
  5. Identify the indications and contraindications for OMPT intervention to the temporo-mandibular joint, upper, middle and lower cervical and upper thoracic spine, upper ribs and upper extremities
  6. Plan and perform combined movement end range examination and intervention techniques (quadrant tests and interventions) where appropriate for the upper limb joints.
  7. Synthesize the examination findings into a comprehensive diagnostic statement based on the principles of interdependence.
  8. Develop a logical, sequential management plan that addresses each area of regional dysfunction.
  9. Develop a detailed prognostic statement about each patient scenario.


Psychomotor Domain

Upon completion of this 4-day module, participants should be expected to:

  1. Utilize special tests and screening measures to minimize the potential risks of orthopedic manual physical therapy assessment and intervention to the patient/client.
  2. Perform an efficient screening and detailed biomechanical examination of the upper and middle cervical spine and perform specific gliding and traction mobilization techniques utilizing combined motions and locking/focusing maneuvers.
  3. Perform an efficient screening and detailed biomechanical examination of the lower cervical, upper thoracic and ribs and perform specific gliding and traction mobilization/manipulation (including high velocity low amplitude/thrust) techniques utilizing combined motions and locking/focusing.
  4. Perform an efficient and detailed selective tissue tension and biomechanical examination of the temporomandibular joints and perform appropriate biomechanical and non‑biomechanical intervention techniques for temporomandibular joint dysfunction.
  5. Demonstrate an effective education sequence for the complex, multifaceted patient.
  6. Safely and effectively perform joint thrust manipulation techniques to the upper quadrant joints, including the cervical spine, cervico-thoracic joint, and the upper quadrant peripheral joints.
  7. Integrate joint mobilization/manipulation with other manual and non-manual interventions

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