NEUROMUSCULOSKELETAL 1

SHE Level 4
SCQF Credit Points 45.00
ECTS Credit Points 22.50
Module Code MHB123229
Module Leader Fiona Gough
School School of Health and Life Sciences
Subject Physiotherapy
Trimester
  • B (January start)

Summary of Content

This module will develop the ability of the student to assess and treat acute and chronic neuromusculoskeletal conditions of the appendicular skeleton. The module uses a principles approach, where theoretical knowledge, practical skills, and evaluation strategies are integrated to develop a comprehensive questioning approach to physiotherapy clinical practice. Emphasis is placed on understanding normal function of the neuromusculoskeletal area and the impact of dysfunction. This is facilitated by investigating anatomical, physiological, biomechanical, pathological and psychosocial aspects related to acute and chronic neuromusculoskeletal conditions across lifespan, multicultural society and an ageing population. Awareness of the changing nature of health care services and the impact on service delivery will be explored.

Syllabus

Pathophysiology: tissue response to cellular injury, the natural history of inflammation and presenting signs and symptoms. Fractures and the healing process of bone including contributing factors which may cause delayed healing or non union. Inflammatory and degenerative conditions including; Osteoarthritis, Rheumatoid arthritis, Ankylosing Spondylitis, aetiology, pathology, clinical features, management and education. The potential impact of age, gender, culture, behavioural issues and socio-economic status. Principles of management of soft tissue injuries including: pain control and restoration of normal function including motor learning, skill acquisition and movement analysis. Functional anatomy: osteology, arthrology, myology and neurology of the upper and lower limb. The relationship of structure to function; specific factors affecting movement at individual joints and the kinetic chain; the types of muscle contraction; analysis of joint movement; palpation skills. Psychomotor skills in relation to: assessment and treatment of neuromusculoskeletal (NMSK) dysfunction with theoretical underpinning using the Maitland approach, physiological and accessory movements, concept of end feel, neural testing. Relationship between habitual movement and postures and tissue adaption. Posture alignment, assessment, principles of re-education, principles of seating. Effects, applications, indications, contraindications, modifications and implementation of:-flexibility programmes; segmental control; muscle performance; strengthening, endurance training including FITT principles and mobilisation with movement. Biomechanical principles underpinning clinical practice e.g. the effect of loading, muscle activity, reduced loading and aging effects. Electrotherapy Modalities: effects, applications, indications, contraindications, modifications of: cryotherapy; ultrasound; thermal techniques; interferential therapy, Transcutaneous neuromuscular stimulation; and pulsed electromagnetic energy. Data gathering and interpretation of data. The evidence base of practice is emphasised with scientific critique in relation to validity/reliability/sensitivity/specificity/likelihood ratios. Undertake and evaluate methods used in practice in the assessment of clinical findings including: palpation; pain; swelling, joint range, muscle performance, gait, special tests and functional status. Relate International classification of function to pathologies and the impact impairment can have on health. Perform a subjective/objective examination, treatment of the peripheral joints of the upper and lower limbs involving explicit use of clinical reasoning and problem solving. Document assessment/treatment of NMSK conditions using POMR/SOAP principles, and conforming to HCPC and CSP professional guidelines. Key aspects of communication and the development of effective communication when interviewing/ assessing/treating patients and the development of shared goals.

Learning Outcomes

On successful completion of the module the student should be able to:-1. Identify relevant anatomical structures of the upper and lower limbs, and analyse these structures in relation to their functions within the neuromusculoskeletal system.2. Analyse the impact of neuromusculoskeletal pathologies, and dysfunction on normal neuromusculoskeletal function.3. Synthesise anatomical knowledge and psychomotor skills in competently demonstrating assessment procedures to differentiate anatomical structures in the upper and lower limbs .4. Explain and critically discuss clinical findings to the pathological processes in common acute/chronic neuromusculoskeletal conditions with consideration to age, gender and culture.5. Demonstrate and evaluate methods of data acquisition from patients with acute/chronic neuromusculoskeletal disorders (e.g., interview, physical examination, interpretation of tests).6. In simulated conditions, perform assessment and treatment techniques in a competent and safe manner, taking into account relevant dangers, safety precautions and contraindications in relation to patient and self.7. Justify the selection/modification of assessment/treatment techniques and approaches used in the management of common acute/chronic neuromusculoskeletal disorders of the upper and lower limb.8. Implement and evaluate methods used in clinical practice to assess pain, palpation, joint range, muscle performance, gait and functional status.9. Understand the importance of methods used to evaluate therapeutic effects of physiotherapy interventions in acute/chronic neuromusculoskeletal conditions across lifespan.10. Formulate shared treatment objectives from the analysis of examination data and place in order of priority.11. Discuss the impact of age, gender, culture, and socio-economic status in relation to neuromusculoskeletal conditions and their assessment and management.12. Critically appraise, interpret and apply relevant/current research evidence to underpin clinical reasoning, and decision making in relation to neuromusculoskeletal dysfunction.13. Demonstrate the application of ethical and legal issues relevant to physiotherapy practice.14. Demonstrate the ability to document physiotherapy findings in an agreed format (e.g., POMR/SOAP).

Teaching / Learning Strategy

This module will undertake a constructivist approach. Theoretical concepts will be explored through key note lectures, tutorials, seminars, clinical reasoning panels, group work, and self directed learning. Tutor and student led tutorial sessions; seminars and workshops with group discussion coupled with the use the of the GCULearn learning environment will be ultilised to facilitate and deepen learning in a blended fashion. Practical skills will be demonstrated and developed over the course of the module using a variety of methods. Simulation will be used to help students contextualise and apply clinical knowledge and skills as well as to develop clinical reasoning. A variety of other methods will be used to help develop students understanding and application of knowledge and psychomotor skills. Clinical reasoning panels, case studies, practical skill sessions, peer learning, self assessment, audio video material, clinical simulation and interaction will be undertaken. Peer and self assessment will be strongly encouraged to promote student learning. Interviewing and listening skills will be developed and discussions with patients and carers will enable students to understand the impact of the rehabilitation process. Critical evaluation of strategies and interventions in current clinical practice will be encouraged through group work and discussion of the evidence base. The above approach will be instrumental in facilicating the movement to M level following completion of this module.

Indicative Reading

Essential Reading Butler, D. & Moseley, L. 2003, Explain pain, Noigroup Publications, Adelaide. Hamill, J.H. & Knutzen, K.M. 2009, Biomechanical basis of human movement, 3rd edn, Lippincott, Williams & Wilkins, Philadelphia. Hattam, P. & Smeatham, A. 2010, Special tests in musculoskeletal examination, Churchill Livingstone, Oxford. Palastanga, N. & Soames, R. 2011, Anatomy and human movement: structure and function, 6th edn, Butterworth Heinemann, Oxford. Petty, N.J. 2011, Neuromusculoskeletal examination & assessment, 4th edn, Churchill Livingstone, Edinburgh. Petty, N.J. 2011, Principles of neuromusculoskeletal treatment and management, 2nd edn, Churchill Livingstone Edinburgh. Watson, T. 2008, Electrotherapy: evidence-based practice 12 th Ed, Churchill Livingstone, Edinburgh Recommended Abernethy, B., et al. 2013, Biophysical foundations of human movement, 3rd edn, Human Kinetics, Leeds. Atkinson, K., Coutts, F. & Hassenkamp, A.M. 2005, Physiotherapy in orthopaedics, 2nd edn, Churchill Livingstone, Edinburgh. Butler, D. 1991, Mobilisation of the nervous system, Churchill Livingstone, Edinburgh. Clark, M.A. & Lucett, M.A. 2011, NMSM essentials of corrective exercise training, Lippincott, Williams & Wilkins, Baltimore. Chartered Society of Physiotherapy, 2011. Code of Members' Professional Values and Behaviour. CSP: London, [Online]. Available at: <http://www.csp.org.uk/publications/code-members-professional-values-behaviour> [Accessed 26th June 2013]. Chartered Society of Physiotherapy, 2012 Information paper: Record Keeping guidance PD061, CSP London,[Online], Available at <http://www.csp.org.uk/publications/record-keeping-guidance> . [Accessed 26th June 2013]. Chartered Society of Physiotherapy, 2013a. Quality Assurance Standards for Physiotherapy Service Delivery. CSP London [Online], Available at <http://www.csp.org.uk/publications/quality-assurance- standards> . [Accessed 11 th October 2013]. Clarkson, H.M. 2013, Musculoskeletal assessment: joint motion and muscle testing, 3rd edn, Lippincott Williams & Wilkins, Baltimore. Dziedic, K. & Hammond, A. 2010, Rheumatology Churchill Livingstone. Edinburgh Eustace, S., Johnston, C. & O'Neill, P. 2007, Sports injuries examination, imaging & management, Churchill Livingstone, Edinburgh. Field, A. 2013, Discovering statistics using IBM SPSS, 4th edn, Sage, London Field, D. 2013, Anatomy palpation & surface markings, 5th edn, Butterworth Heinemann, Oxford. Hengeveld, E. & Banks, K. Eds. 2005, Maitland's peripheral manipulation, 4th edn, Butterworth Heinemann, Oxford. Health and Care Professions Council, 2012. Standards of conduct, performance and ethics. HCPC: London, [Online]. Available at: <http://www.hpc-uk.org/aboutregistration/standards/standardsofconductperformanceandethics/>. [Accessed 26 th June 2013]. Health and Care Professions Council, 2013. Standards of Proficiency - Physiotherapists. HCPC London [Online], Available at http://www.hpc-uk.org/publications/index.asp?id=49#publicationSearchResults <http://www.hpc-uk.org/publications/index.asp?id=49> . [Accessed 11 th October 2013]. Hertling, D. & Kessler, R.M. 2006, Management of common musculoskeletal disorders, 4th edn, Lippincott Williams & Wilkins, Baltimore. Hicks, C. 2004, Research methods for clinical therapists, 4th edn, Churchill Livingstone, Edinburgh. Holey, E. & Cook, E. 2003, Evidence-based therapeutic massage: a practical guide for therapists, Churchill Livingstone, Edinburgh. Jones, M.A. & Rivett, D.A. 2004, Clinical reasoning for manual therapists, Butterworth Heinemann, Oxford. Kendall, F.P., McCreary, E.K., Provance, P.G., Rodgers, M. & Romani, W.A. 2005, Muscles: testing and function, 5th edn, Lippincott Williams & Wilkins, Baltimore. Kerr, A. 2010, Introductory biomechanics, Churchill Livingstone, Edinburgh. Lederman, E. 2005, The science and practice of manual therapy, 2nd edn, Churchill Livingstone, Edinburgh. Kolt, G.S. & Snyder-Mackler, L. Eds. 2003, Physical therapies in sport and exercise, Churchill Livingstone, Edinburgh. Lieber, R.L. 2010, Skeletal muscle structure, function and plasticity: the physiological basis of rehabilitation, 3rd edn, Lippincott Williams & Wilkins, Baltimore. Mulligan, B.R., 2010, Manual Therapy: Nags, snags, 6th edn, Plane View Services, Wellington. Nordin, M. & Frankel, V.H. 2012, Basic biomechanics of the musculoskeletal system, 4th edn, Lippincott Williams & Wilkins, Baltimore. Norkin, C.C. & Levangie, P.K. 2005, Joint structure and function: a comprehensive analysis, 4th edn, FA Davis, Philadelphia. Perry, J. & Burnfield, J.M. 2010, Gait analysis: normal & pathological function, 2nd edn, Slack Incorporated, Thorofare, New Jersey. Robertson, V., Ward, A., Low, J. & Reed, A. 2006, Electrotherapy explained: principles & practice, 4th edn, Butterworth Heinemann, Oxford. Shamley, D. 2005, Pathophysiology: an essential text for the allied health professions, Butterworth Heinemann, Oxford. Thein-Brody, L. & Hall, C.M. 2011, Therapeutic exercise: moving toward function, 3rd edn, Lippincott, Williams & Wilkins, Baltimore. Tiildus, P.M. 2008, Skeletal muscle damage and repair, Human Kinetics, Leeds. Van Griensven, H. Strong, J. & Unruh, A. 2013 Pain 2 nd edn. Churchill Livingstone. Edinburgh Vicenzino, W., Hing, W., Rivett, D. & Hall, D. 2011, Mobilisation with movement, the art and the science, Churchill Livingstone, Edinburgh. Whittle, M. 2012, Gait analysis, 5th edn, Butterworth Heinemann, Oxford.

Transferrable Skills

In undertaking the module students will develop and consolidate skills in the following areas:-communication, clinical reasoning/reflection, reflective writing, accessing databases and other information sources. Utilisation of equipment, time management, independent study, teamwork, analytical problem solving, clinical reasoning and reflection, reflective writing, presentation and decision making. Knowledge and understanding of working with patients with acute/chronic neuromusculoskeletal conditions within a physiotherapy specific/multi-disciplinary framework. Assessment and management of neuromusculoskeletal conditions within a multi-cultural society and across lifespan. Research skills: literature searching/critiquue, evidence based practice, outcome measures/continuing professional development, resource management, organisation and planning. Role of governing/professional bodies (HCPC/CSP) in relation to clinical practice.

Module Structure

Activity Total Hours
Tutorials (FT) 24.00
Assessment (FT) 45.00
Practicals (FT) 120.00
Seminars (FT) 24.00
Independent Learning (FT) 237.00

Assessment Methods

Component Duration Weighting Threshold Description
Coursework 1 0.00 40.00 35% Coursework - 2,500 words
Exam (Dept) 01 1.00 60.00 35% OSPE