NEUROMUSCULOSKELETAL 2

SHE Level 5
SCQF Credit Points 15.00
ECTS Credit Points 7.50
Module Code MMB122703
Module Leader Emma-Jane Murchie
School School of Health and Life Sciences
Subject Physiotherapy
Trimesters
  • A (September start)
  • B (January start)

Summary of Content

This module aims to develop knowledge and understanding of function and dysfunction of the neuromusculoskeletal system within the vertebral spine, lumbopelvic and temperomandibular regions. The structural, physiological and psychosocial impact of dysfunction will be explored with particular consideration to pain mechanisms in acute and chronic presentations in a range of groups and individuals. A variety of physiotherapeutic approaches to assessment and management for dysfunction of the neuromusculoskeletal system within the vertebral spine, lumbopelvic and temperomandibular regions will be considered with critique of their theoretical and evidence based underpinning . The module theme addresses the three components of theory, skills and evaluation using constructivist teaching, learning and assessment strategies. The theory component includes the pathophysiology, clinical features, therapeutic intervention and management of patients with spinal disorders such as intervertebral disc lesions, whiplash associated disorders, headache and spondylosis/spondylolisthesis. The skills component will utilise this theoretical underpinning, enabling the student to plan and evaluate assessment and management approaches for a range of patient populations and practice settings whilst developing psychomotor and clinical reasoning skills. The evaluation component will specifically focus on the analysis and evaluation of the psychosocial and economic impact of the work environment in relation to assessment and management of neuromusculoskeletal dysfunction within the vertebral spine, lumbopelvic and temperomandibular regions .

Syllabus

Applied functional anatomy of the vertebral spine, lumbopelvic and temperomandibular joint regions (including osteology, arthrology, myology and neurology). The anatomical and physiological basis of pain classification (including peripheral nociceptive, peripheral neurogenic, central sensitization) with consideration to clinical indicators on examination and possible management strategies. Pathophysiology and age related changes of the intervertebral disc, facet joints, vertebral bodies and neural tissues. Diagnostic imaging of the spine. Clinical features and therapeutic management of neuromusculoskeletal disorders of the vertebral spine, lumbopelvic and temperomandibular joint regions in a range of different groups and individuals (including spondylosis/spondylolisthesis, degenerative joints, intervertebral disc lesions, vertebra-basilar insufficiency, headaches, whiplash associated disorders, cervical instability, thoracic outlet syndrome, spinal nerve/nerve root, cauda equina and spinal cord lesions, neural tissue dysfunction, myofascial pain). Concepts and issues in prophylactic back care education and the management of chronic low back within physiotherapy and from multidisciplinary team perspective. Systematic subjective and objective examination skills and procedures of the vertebral column (cervical, thoracic and lumbar spine), lumbopelvic and temperomandibular regions (including identification and implications of red, yellow, blue and black flag markers). Theoretical and practical application of a range of neuromusculoskeletal assessment and treatment approaches (including Maitland, Mackenzie, Mulligan, Edwards, Lee, Butler, Shacklock, O'Sullivan, Travell and Simmons, Chaitow; Comerford) to address dysfunction within joint, muscle and neural systems (including documentation in compliance with professional and regulatory requirements) UK welfare and benefits system. AHP Advisory Fitness for Work Report. Systems Approach to workplace assessment. Work-related psychosocial obstacles to recovery and return to work (blue and black flags). Principles of ergonomics and anthropometrics. Work-based ergonomic assessment instruments.

Learning Outcomes

Upon Successful completion of the module the student should be able to:-1) Identify relevant anatomical structures of the vertebral spine, lumbopelvic and temperomandibular regions, and analyse these structures in relation to their functions within the neuromusculoskeletal system.2) Critically discuss the impact of age related, pathological and activity-related changes on the normal function of the vertebral spine, lumbopelvic and temperomandibular regions, and their relationship to clinical signs and symptoms3) In simulated conditions, perform assessment and treatment techniques in a competent and safe manner, taking into account relevant dangers, safety precautions and contra-indications in relation to 'patient' and self.4) Critically discuss and justify the assessment, diagnosis and management of simulated patients with neuromusculoskeletal dysfunction of the vertebral spine, lumbopelvic and temperomandibular regions with consideration to various underlying pain mechanisms5) Critically appraise, interpret and apply a broad range of research evidence to underpin clinical reasoning and decision making in relating to neuromusculoskeletal dysfunction of the vertebral spine, lumbopelvic and temperomandibular regions6) Critically discuss the impact of age, gender, culture, ethnicity, socioeconomic status and spiritual/religious beliefs in relation to assessment and management of neuromusculoskeletal function and dysfunction of the vertebral spine, lumbopelvic and temperomandibular regions7) Critically discuss the psychosocial and economic impact of neuromusculoskeletal dysfunction of the vertebral spine, lumbopelvic and temperomandibular regions (including chronic pain) upon the patient, their family & carers, their workplace, the community and society8) Within a simulated environment, perform a workplace evaluation of a single worker (applying the Systems Approach to Ergonomics) and propose an appropriate ergonomic intervention for the management of neuromusculoskeletal dysfunction of the vertebral spine, lumbopelvic and temperomandibular regions9) Demonstrate the application of ethical and legal issues relevant to physiotherapy practice 10) Demonstrate the ability to record physiotherapy findings and interventions in an agreed format (e.g. POMR/SOAP) taking credence of professional and legal requirements

Teaching / Learning Strategy

It is expected that students will take responsibility for knowledge and skill acquisition by actively participating in the learning process, with tutors primarily taking the role of facilitators and advisors. Directed reading and tutor-led tutorials will initially introduce new theoretical concepts but the emphasis in this module is on experiential and shared learning through student-led seminar presentations, group discussion and case study material. GCU Learn (Blackboard Virtual Learning Environment) will be used as an interactive teaching resource to facilitate and deepen learning throughout the module. Critical evaluation of physiotherapeutic approaches to assessment and management of spinal disorders in current clinical practice will be encouraged through group work and discussion of the research evidence and its application. Psychomotor skills will be demonstrated and practiced utilising the application of theoretical concepts in practical skills workshops. Tutor support will be available during these sessions to provide formative feedback however students are encouraged to practice independently using peer review and self-appraisal. Audio-visual material of assessment and treatment techniques will further enable such practice. Students' learning will be enhanced by participating in case study/clinical reasoning panels. These panels will provide a forum for the student to critically explore their knowledge, understanding and application of theoretical concepts. They will also enable the development of the communication skills required to competently express their cognitive processes relating to patient assessment and management with experienced therapists and their peers.

Indicative Reading

Adams, M., Bogduk, N., Burton, K. & Dolan, P. 2013. The Biomechanics of Back Pain. 3 rd edition. Edinburgh: Churchill Livingstone. Banks, K. & Hengeveld, E. 2010. Maitland's Clinical Companion. An Essential Guide for Students. Edinburgh: Churchill Livingstone/Elsevier. Black, C. 2008. Working for a Healthier Tomorrow: A Review of the Health of Britain's Working Age Population. London: The Stationery Office. Bogduk, N. 2005. Clinical Anatomy of the Lumbar Spine and Sacrum. 4th edition. Edinburgh: Churchill Livingstone. Boyling, JD. & Jull, GA. 2004. Grieve's Modern Manual Therapy: the Vertebral Column. 3rd edition. Edinburgh: Churchill Livingstone. Bullock, MI. (Ed) 1990. Ergonomics: The Physiotherapist in the Workplace. International Perspectives in Physical Therapy (6). Edinburgh: Churchill Livingstone. Butler, D. 2000. The Sensitive Nervous System. Edinburgh: Churchill Livingstone. Butler, D. & Moseley, L. 2013. Explain Pain. 2 nd edition. Adelaide: NOI Publications. 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]. Chartered Society of Physiotherapy , 2013b. Practice Education: guidance, Support and Information. CSP London [Online], Available at <https://v3.pebblepad.co.uk/v3portfolio/csp/Asset/View/6jqbh3H5jdtc49hjMZs576jZWZ/6jqbh3H5jdtc5hmGbm5rkr9H3y> . [Accessed 11 th October 2013]. Comerford, M. & Mottram, S. 2012, Kinetic Control. The Management of Uncontrolled Movement , Churchill Livingstone/Elsevier, Edinburgh. Cook, CE. & Hegedus, EJ. 2008. Orthopedic Physical Examination Tests. An Evidence-based Approach. Upper Saddle River, New Jersey: Pearson Prentice Hall. Day, R., Fox, J. & Paul-Taylor, G. 2009. Neuromusculoskeletal Clinical Tests. A Clinician's Guide. Edinburgh: Churchill Livingstone Elsevier Dul, J. & Weerdmeester, B. 2008 Ergonomics for Beginners. Oxford: CRC Press Inc., Taylor & Francis Ltd. Ferguson, F. 2009. Managing Lower Back Pain. Edinburgh: Churchill Livingstone/ Elsevier. Greenhalgh, S. & Selfe, J. 2010. Red Flags II. A Guide to Solving Serious Pathology of the Spine. Edinburgh: Churchill Livingstone/Elsevier. Greenhalgh, S. & Selfe, J. 2006. Red Flags. A Guide to Identifying Serious Pathology of the Spine. Edinburgh: Churchill Livingstone/Elsevier. 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]. Hodges, P. Cholewicki, J. & Van Dieen, J. 2013. Spinal Control: The Rehabilitation of Back Pain. Edinburgh: Churchill Livingstone/Elsevier. Irnich, D. 2013. Myofascial Trigger Points. Comprehensive Diagnosis and Treatment. Edinburgh: Churchill Livingstone/Elsevier. Jones, MA. & Rivett, DA. 2003. Clinical Reasoning for Manual Therapists. London: Butterworth Heinemann. Jull, G. Sterling, M. Falla, D., Treleaven, J. & O'Leary, S. 2008. Whiplash, Headache and Neck Pain. Research-based directions for physical therapies. Edinburgh: Churchill Livingstone. Kendall, N & Burton K. 2009. Tackling Musculoskeletal Problems - A Guide for the Clinic and Workplace. London: The Stationery Office (TSO) Lee, D. 2011, The Pelvic Girdle: an Integration of Clinical Expertise and Research, 4th edition, Churchill Livingstone, Edinburgh. Maitland, GD., Hengeveld, E., Banks, K. & English, K. 2013. Maitland's Vertebral Manipulation. 8th edition. London: Butterworth Heinemann. Main, CJ., Sullivan, MJ. & Watson, PJ. 2007. Pain Management: practical applications of the biopsychosocial perspective in clinical and occupational settings. 2nd edition. London: Churchill Livingstone. McCarthy, C. 2010. Combined Movement Theory. Rational Mobilization and Manipulation of the Vertebral Column. Edinburgh: Churchill Livingstone/Elsevier. McGill, S. 2007. Low Back Disorders. Evidence-based Prevention and Rehabilitation. 2nd edition. Champain IL: Human Kinetics. McKenzie, R. & May, S. 2003. The Lumbar Spine. Mechanical Diagnosis and Therapy. 2nd edition. New Zealand: Spinal Publications. McKenzie, R. & May, S. 2006 The Cervical and Thoracic Spine. Mechanical Diagnosis and Therapy. 2nd edition. New Zealand: Spinal Publications. Mulligan, BR. 2010. Manual Therapy. Nags, Snags. MWM etc. 6th edition. Wellington: Plane View Services. Palastanga, N. & Soames, R. 2011. Anatomy and human movement: structure and function. 6th edn. Oxford: Butterworth Heinemann. Petty, N. & Moore, A. 2011. Neuromusculoskeletal Examination and Assessment. 4th edition. Edinburgh: Churchill Livingstone. Petty, N. 2012. Principles of Neuromusculoskeletal Treatment and Management. A Guide for Therapists. 2nd edition. Edinburgh: Churchill Livingstone. Shacklock, M. 2005 Clinical Neurodynamics. A New System of Neuromusculoskeletal Treatment. London: Butterworth Heinemann. Swain, J., & Bush, KW. 2009. Diagnostic Imaging for Physical Therapists. St Louis: Saunders/ Elsevier. Van Griensven, H. Strong, J. & Unruh, A. 2013. Pain. 2 nd edition. Edinburgh: Churchill Livingstone Vincenzo, B. Hing, W. Rivett, D. & Hall, T. 2011. Mobilisation with Movement. The Art and the Science. Edinburgh: Churchill Livingstone Waddell, G. & Burton, AK. 2006. Is work good for your health and well-being? The Stationery Office, London. Waddell, G., Burton, AK. & Kendall, NAS. 2008. Vocational Rehabilitation: what works, for whom, and when? London: The Stationery Office.

Transferrable Skills

In undertaking this module students will develop and consolidate skills in the following areas: critical enquiry, communication, psychomotor, moving and handling, health & safety, hand hygiene, risk assessment, clinical reasoning, analytical problem solving, reflective practice, clinical debate, teaching, organization, planning, time management, utilization of technology and equipment, accessing information sources, independent study, critical reading and appraisal of literature, presentation and dissemination of knowledge, peer learning and group work, personal/professional development planning, data collection and recording

Module Structure

Activity Total Hours
Assessment (FT) 15.00
Tutorials (FT) 36.00
Independent Learning (FT) 69.00
Practicals (FT) 30.00

Assessment Methods

Component Duration Weighting Threshold Description
Exam (Dept) 01 0.50 30.00 45% Practical Viva - 30 mins
Course Work 01 0.00 70.00 45% Case Study Analysis - 2500 Words