Course Syllabus : Neurological Physical Therapy

School and Graduate Institute of Physical Therapy

National Taiwan University

Course Number: 408 32200 & 408 32210

Course Name: Neurological Physical Therapy

Course Credit: 3 units; Lecture 2 units, Laboratory 1 unit

Instructors: Ming-Hsia Hu, PT, PhD (principal instructor)

                Phone: 23123456 ext 7320

                E-mail: mhh@ntu.edu.tw

                Office: National Taiwan University Hospital, Four East Wing, Room 104

Kwan-Hwa Lin, PhD, PT

Pei-Fang Tang, PhD, PT

Jer Junn Luh, PhD, PT

Suh-Fang Jeng, ScD, PT

Class Level: third year PT undergraduate students

Class time: Wednesday 9:10 am-12:10 amFriday 1:20 pm-3:10 pm

Classroom:Four East Wing, Classroom II (practice room)

Course Description:

        This course integrates the basic principles of neurological science and the clinical practice of neurological physical therapy to prepare students for clinical practicum. The major areas conveyed in this course includes clinical decision making, neurological physical therapy models, task-analysis of neurological disorders, assessment and treatment techniques for neurological diseases such as stroke, spinal cord injury, traumatic brain injury, cerebella and vestibular, degenerative neurological diseases, peripheral neurological diseases. A brief introduction of physical therapy management principles for geriatric and long term care patients as well as a review of neonatal pediatric conditions is also included in this course.

 

General Course Objectives:

After completing this course, the students should be able to:

1. Apply appropriate physical therapy decision making process in handling neurological patients

2. Discuss and understand the essence of theories and models applied in neurological physical therapy

3. Perform and select appropriate assessment tools for patients receiving neurological physical therapy

4. Apply Safe and accurate physical therapeutic techniques for neurological and geriatric patients

5. Review the basic assessments and interventions in neonatal physical therapy.

 

Specific Objectives:

After completing the following topics, the students shouldd be able to

Week 1.

Topic

Orientation
Theoretical foundations for clinical practice
History taking and Chart Review

Ming-Hsia Hu

Goals

1.      Introduce ICF model and clinical decision-making for neurological patients

2.      Review motor control and motor learning theories

3.      Review Principles of history taking

practice history taking and chart review of neurological patients

Topic

PT for CVA (I)
Evaluation: JOMAC, language, vision, sensation, ROM, tone

M. H. Hu

Goals

1. Provide a review of epidemiology, physiology, and anatomy of stroke

2. Provide a review on the evaluation of mentality, language, vision, sensation, ROM and muscle tone of stroke patients appropriate for physical therapy

Week 2.

Topic

PT for CVA (II)
Evaluation: Brunnstrom stage, motor function, balance, gait

M. H. Hu

Goals

1. Understand Brunnstrom stage assessment

2. Describe the assessments for motor function of stroke patients, include PASS, Fugl-Meyer, Motor assessment tests

3. Describe assessments for balance of stroke patients, include NTUH balance grading system

4. Describe cadence, stride length, devices assessment for  stroke patients

Topic

PT for CVA (III)
Treatment: positioning, bed mobility

M. H. Hu

Goals

1. Understand positioning and placing techniques for stroke patients

2. Describe PROM techniques for stroke patients

3. Describe Briding and bed mobility for stroke patients

Week 3.

Topic

PT for CVA (IV)
Treatment: management of hemiplegic shoulder (sling, kinesiotape, facilitation, ES)

M. H. Hu

Goals

1. Understand epidemiology, physiology, anatomy, pathology of hemiplegic shoulder

2. Describe treatment techniques for hemiplegic shoulder: sling, kinesiotape, facilitation, ES, air splint

Topic

PT for CVA (V)
Brunnstrom & Bobath approaches

M. H. Hu

Goals

1. Introduce Brunnstrom approach for stroke patients

2. introduce Bobath approach for stroke patients

Week 4.

Topic

PT for CVA (VI)
Johnstone and motor relearning approaches

M. H. Hu

Goals

1. Introduce Johnstone approach for stroke patients

2. Introduce motor relearning approach for stroke patients

Topic

Advanced PNF (I)

K. H. Lin

Goals

1. Understand the principles of the PNF technique in the management of stroke patients

2. Apply the techniques based on the stages of recovery to stroke patients.

3. To be able to apply the techniques to stoke patients according to functional limitations

Week 5.

Topic

Advanced PNF (II)

K. H. Lin

Goals

1. Understand the principle of the PNF technique in the management of spinal cord injured and other neurological patients

2. Apply the techniques to spinal cord injured and other neurological patients based on functional limitations

Topic

Sit to stand evaluation and training (includes outcome measures)

K. H. Lin

Goals

1. Understand the basic strategies of sit-to-stand in healthy subjects and patients

2. Evaluate the subjects and set the goals of treatment

3. Apply the techniques to teach the patients

Week 6.

Topic

Constraint-induced movement therapy (includes outcome measures)

P. F. Tang

Goals

1. Introduce CIMT as a neurorehabilitation treatment approach grounded in basic neurosciences

2. Understand the development of CIMT

3. Discuss the application of CIMT to patients with stroke

4. Understand the limitations of CIMT

5. Understand modifications of CIMT and their effects

6. Introduce ongoing clinical trials of CIMT

Topic

Balance evaluation and training (includes outcome measures)

M. H. Hu

Goals

1. Describe the systems approach for balance assessment and training

2. Describe balance assessment tools, include Romberg, one-leg stance, Berg Balance Scale, Functional reach, Smart Balance Master system, etc.

3. Describe balance training techniques: multi-sensory balance training, weight-shifting, etc.

4. Describe evidences of balance management in neurological patients

Week 7.

Topic

Gait evaluation and training (I) (includes outcome measures)

P. F. Tang

Goals

1. Describe the human gait cycle

2. Understand subtasks of human walking

3. Understand functional tasks in different phases of the human gait cycle

4. Understand biomechanical analysis of human gait

5. Understand the types of neurologic/geriatric gait

Topic

Gait evaluation and training (II) (includes outcome measures)

P. F. Tang

Goals

1. Understand the purposes of gait training for patients with stroke

2. Understand the factors underlying gait disorders in patients with stroke

3. Understand different gait training therapies for patients with stroke

4. Practice gait training

Week 8.

Topic

PT for cerebellar lesions, coordination exercises

M. H. Hu

Goals

1. Provide a review of cerebellar disorders

2. Describe physical therapy assessment tools for cerebellar disorders

3. Describe physical therapy training techniques for cerebellar patients, includes Frenkel exercise

Topic

PT for vestibular dysfunction

M. H. Hu

Goals

1. Provide a review of vestibular dysfunction

2. Describe physical therapy assessment tools for vestibular dysfunction

3. Describe physical therapy treatment techniques for vestibular dysfunction

4. Provide evidence for vestibular rehabilitation

Week 9.

Topic

Midterm exam (Hu: 64%, Lin: 18%, Tang: 18%)

M. H. Hu

K. H. Lin
P. F. Tang

Topic

PT for SCI (I), Evaluation

K. H. Lin

Goals

1. Understand the major characteristics of SCI patients

2. Understand the evaluation form for impairment assessment: (ASIA)

3. Understand the evaluation form for functional assessment: (FIM)

Week 10.

Topic

PT for SCI (II), positioning, skin care and chest care

K. H. Lin

Goals

1. Understand the major problems of skin and respiration in SCI patients

2. Understand the principles for skin care and chest care

3. Able to apply the techniques to SCI patients

Topic

PT for SCI (III), functional mat exercise

K. H. Lin

Goals

1. Understand the principles of mat exercise

2. Apply the techniques to SCI patients based on the level of injury

Week 11.

Topic

PT for SCI (IV), gait training and wheelchair activity training

K. H. Lin

Goals

1. Understand the principles of gait pattern and wheelchair activity in SCI patients

2. Train the SCI patients based on the level of injury

Topic

PT for multiple sclerosis, ALS, and MND

K. H. Lin

Goals

1. Understand the major problems with multiple sclerosis, ALS, and MND patients

          2. Understand the principles of evaluation and management of multiple sclerosis, ALS, and MND patients

3. Train the patients based on the severity of patient

Week 12.

Topic

PT for post polio and Guillain-Barre syndromes

J. J. Luh

Goals

1. Describe the pathological lesion occurring in poliomyelitis and Guillain-Barre syndrome

2. State the goals for clinical management of the postpolio syndrome and GBS

3. Plan the intervention process to meet the need of the client

Topic

PT for Neurovascular entrapment syndromes & PNS lesions

J. J. Luh

Goals

1. Understand the anatomy and function of PNS

2. Understand the changes occurring with PNS lesion

3. Describe the basic evaluation methods for neurovascular entrapment syndrome and PNS lesions

4. Discuss the goals and methods of interventions

Week 13.

Topic

PT for geriatric patients

M. H. Hu

Goals

1. Review epidemiology and theories of aging

2. Introduce cognitive impairment with aging

3. Describe physical therapy assessment of geriatric patients, include MMSE

4. Describe exercise principles for geriatric patients

5. Evidence for geriatric physical therapy

6. Understand long term care concepts

Topic

PT for inflammatory and infectious brain disorders (includes HIV infection)

J. J. Luh

Goals

1. Understand the different type of inflammatory and infectious disorders within the brain

2. Understand the neuropathology with chronic HIV disease

3. Structure the evaluation process and intervention process

Week 14.

Topic

PT for basal ganglia disorders, group exercise

J. J. Luh

Goals

1. Describe the circuitry of the basal ganglia and its roles in sensorimotor process.

2. Explain the signs and symptoms in common basal ganglia disorders

3. State the evaluation process for patients with basal ganglia disorder

4. Plan and perform treatment programs for the patients with basal ganglia

Topic

PT for brain tumors

P. F. Tang

Goals

1. Provide a review of brain tumors

2. Introduce the incidence and etiology of brain tumors

3. Understand the classifications of brain tumors

4. Describe signs and symptoms of brain tumors

5. Introduce diagnosis of brain tumors

6. Understand medical and surgical management of brain tumors

7. Discuss rehabilitation management of brain tumors

Week 15.

Topic

PT for traumatic brain injury, memory and cognitive training

 

P. F. Tang

Goals

1. Understand definitions of relevant terms

2. Introduce the epidemiology of TBI

3. Describe the etiology/mechanisms of brain injury and pathology

4. Introduce diagnostic criteria of TBI

5. Understand the classifications of TBI

6. Describe clinical manifestations of TBI

7. Understand acute medical management of TBI

8. Discuss rehabilitative and physical therapy management of TBI

9. Discuss prevention of TBI

Topic

Review of neonatal and pediatric physical therapy

S. F. Jeng

Goals

Describe the basic assessment and intervention in neonatal physical therapy

Week 16.

Topic

Comparison of Various Approaches

M. H. Hu

Goals

1. Integrate theories and models for neurological physical therapy

2. Review decision-making process for neurological patients with case samples

3. Review commonly used assessment tools and treatment techniques

Topic

Review of neonatal and pediatric physical therapy

S. F. Jeng

Goals

Describe the basic assessments and interventions in neonatal physical therapy

Week 17.

Topic

Practice exam (3 hours) (Hu: 30%, Lin: 30%, Tang: 20%, Luh: 20%)

M. H. Hu
K. H. Lin
P. F. Tang
J. J. Luh

Topic

Review of neonatal and pediatric physical therapy

S. F. Jeng

Goals

Describe the basic assessments and interventions in neonatal physical therapy

Week 18.

Topic

Final exam week (Lin: 36%, Tang: 16%, Hu: 18%, Luh: 30%)

M. H. Hu
K. H. Lin
P. F. Tang
J. J. Luh

Goals

 

 

Textbooks and References

1. Umphred DA. Neurological rehabilitation, 4th ed. St. Louis: Mosby, 2001.

2. O'Sullivan SB, Schmitz TJ (eds). 2001. Physical Rehabilitation Assessment and Treatment. 4th ed. FA Davis:Philadelphia.

3. Somers FM. Spinal cord injury-functional rehabilitation, 2nd ed. New Jersy: Prentice Hall, 2001.

4. Carr J and Shepherd RB. Neurologic Rehabilitation: Optimizing Motor Performance. Butterworth-Heinemann, 1998 (reprinted 1999, 2000.

5. Shumway-Cook A, Woollacott MH. Motor Control : Theory and Practical Applications. Lippincott Williams & Wilkins, 2001.

6. Davies PM: Right in the middle. Berlin Heidelberg: Springer-Verlag, 1993.

7. Sawner K, Lavigne J. Brunnstroum’s Movement Therapy in Hemiplegia: A Neurophysiological Approach. 2nd ed. New York: JB Lippincott company, 1992.

8. Sullivan PE, Markos PD. Clinical Procedures in Therapeutic Exercise. 2nd ed, Connecticut: Appleton & Lange, 1996.

9. American Physical Therapy Association. Guide to Physical Therapist Practice, 2nd ed. Alexandria: APTA, 2001.

10.   Bromley I. 1991. Tetraplegia and paraplegia: a guide for physiotherapists. 4th ed. Churchill Livingstone: London.

11.   胡名霞。動作控制與動作學習。第15章。台北:金名,2001

 

Grading System:

Lecture: Mid-tern exam 50%Final exam 50%

Practice: final exam 90%, in-class performance 10%