Curriculum | Bachelor of Physiotherapy | Physiotherapy in neurology | Paper Code – 03050403

Bachelor of Physiotherapy- IV year

Paper Code – 03050403

Physiotherapy in neurology

 

 TEACHING HOURS:300

Theory :200

Practical :100

THEORY-8O MARKS

Practical : 80marks

                                                                                                                          TIME: 3HOURS

Note: For Paper setters /Examiners

  • Paper setter is required to set eight questions from the entire syllabus out of which 5 questions is to be attempted, each carrying 16 marks.

 

Course Objective: -The objective of this course in that , the student will be able to identify disability due to neurological dysfunction, set treatment goals and apply their skill . In exercise therapy, electrotherapy and massage in clinical situation to restore neurological function In addition, the student will be able to fulfill with 75% accuracy (as measured by written, oral & practical internal evaluations) the following objectives of the course .

 

S. NO   TOPIC LEARNING

 OBJECTIVES (At the end of the session the student should be able to)

  TEACHING GUIDELINES Teaching

Learning Activities

Time
 

1

 

 

Basics of nervous system Describe the Basic Anatomy & Physiology of brain & spinal cord T cover, Review, the structure and function of

a ) neuron b) synapse c) supporting tissue,

Review the organization and function of a) cerebral hemispheres b) cerebellum c) spinal cord d) peripheral nerves e) pyramidal system f) extra pyramidal system.

Review the factors influencing alpha motor neuron activity.

Review the neurological basis of muscle tone and movement and demonstrate the following: a) hypertonia b) spasticity and rigidity c) ataxia d) athetosis e) chorea

Lecture discussion,

Students seminar

 

15 hrs
2 Principle of Assessment of nervous system Describe the  Principles of Assessment of sensory & motor system

 

To cover , a ) skill in history taking b) assessment of higher functions, cortical sensations, cranial nerves, dorsal column sensation and pain & temperature sensations c) assessment of motor function: grading of muscle power, assessment of range of movement, balance and coordination d) assessment of superficial and deep reflexes e) assessment of reflex maturation in terms of stimulus, position negative/positive reaction and their significance f) assessment of gait ­both normal and abnormal ( spastic, ataxic and paralytic patterns) Emphasis should be placed on teaching accurate assessment . Lecture discussion

Practical demonstration

Group discussion

 

15 hrs
2 Principles of Treatment Describe the basic techniques, modalities & splints used for rehabilitation To cover,  a)Sensory re -education

a)       Bobath’s / neuro developmental therapy,

b)      Motor re-education

c)      Strengthening exercise,

d)      coordination exercise,

e)      joint mobilization,

f)       PNF,

g)      Vojta techniques,

h)      biofeedback,

i)       Brunnstorm therapy,

j)       MRP,

k)      Sensory integeration therapy

l)       Treatment to improve function Free exercise, gait training with and without aids, activities of daily living, mat exercise

m)   Review the use of splints and braces in spastic upper motor neuron and in flaccid lower motor neuron lesions, in both upper and lower limbs

n)      Review the management of chronic pain in neurological conditions with respect to the type of pain treatment modalities available, selection criteria for each modality and possible complications

 

Lecture

discussion

Practical demonstration

Group discussion

Demonstration on patient

 

20 hrs
3 Cerebral palsy Describe the cerebral palsy, its different types , etiology ,its assessment and  rehabilitation To cover, Define cerebral palsy and describe the topographical classification, monoplegia, diplegia, paraplegia, hemiplegia & tetraplegiaDescribe types of cerebral palsy.

Assess reflex activity at different levels: Cortical, mid brain, brain stem, spinal Assess developmental milestones from birth to five years, Assess functional ability: Prone to supine (roiling) Coming to sitting, quadruped, crawling, kneeling, kneel­stand, stand with support and walking. Examine for contractures as follows: hip flexion, adduction, internal rotation: Knee flexion: ankle plantar flexion, inversion, eversion. Flexion contracture of elbow, wrist & fingers and spinal deformities.

Treatment – Describe and demonstrate the treatment motor dysfunction:

Passive movement, stretching of soft tissue tightness, use of ice to reduce spasticity, positioning the child to prevent soft tissue contractures, to inhibit abnormal reflexes and to facilitate’ volitional movement. Describe and demonstrate techniques of carrying of different type of CP children, encouraging bimanual activities in different starting positions like prone sitting and standing and activities across the midline. Describe appropriate home program for positioning the child, handling them and assisting improvement of function.

Lecture

discussion

 

Practical demonstration

Group discussion

Patient assessment

Vertcal and horizontal Integerated teaching

 

 

 

10 hrs
4 Peripheral Nerve Lesions Describe the Peripheral Nerve Lesions ,assessment and its pre and post operative rehabilitation To cover, Identify type of peripheral nerve lesions Assess the motor ‘system:

Specific muscles. Range of motion, active and passive ranges, muscle girth. Assess sensory system: touch, pain, temperature, par aesthesia, nerve reverberation. Assess autonomic function: sweating, skin condition, soft tissue atrophy Treatment: describe muscle reeducation techniques: electrical stimulation (selection of current): active, assisted, resisted movements: Passive and self assistive stretching and massage. Describe sensory reeducation and pain relief by various modalities; describe the common splints used peripheral nerve lesions. Static, dynamic and functional Isolating muscle contraction, specific muscle strengthening.

Post- Operative management: Pressure bandaging reeducation after transfer. Describe a home programm.

Lecture

discussion

Practical demonstration

Group discussion

Patient assessment

 

Horizontal Integerated teaching

 

15 hrs
6 Neuro Muscular Diseases & its physiotherapy management Describe the

A)Amyotrophic Lateral sclerosis

 

 

 

 

B)Demyelinating inflammatory poly radiculoneuropathies

 

 

 

 

 

 

C)Muscular Dystrophy

 To cover, introduction, etio pathology, clinical sign & symptoms, impairments, disabilities evaluation Procedure, physiotherapy management.

Definition of De myelinating inflammatory poly radiculoneuropathies: Introduction, etio pathology, clinical sign & symptoms, impairments, disabilities. evaluation procedure & physiotherapy management

Definition of Muscular Dystrophy Describe stages of the disease ambulatory .wheelchair and bed stages. Describe significance of exercise resisted. active and free. Identify and assess common contractures and deformities. Assess range of motion and muscle power. Assess functional ability.

Demonstrate treatment program for strengthening weak muscles: Active movements and hydrotherapy Increase range of motion by suspension therapy, powder board, passive stretching positioning etc.

Demonstrate gait training with appropriate orthosis, Describe management of chest complication: breathing exercises chest percussion, drainage of secretions and assisted coughing.

Lecture

discussion

 

Role model

 

Practical demonstration

 

Group discussion

 

Patient assessment

 

10 hrs
7 Basal ganglionic disorders Describe the basal ganglionic disorders in relation to posture and movement, its assessment and rehabilitation in detail

Parkinsonism

 

 

Huntington

Wilsons Diseases

Tardive Dyskinesia.

Dystonias.

 

 

 To cover, Review the natural history, course and prognosis of the disease. Identify and assess problems in posture sitting, kneeling and standing balance, voluntary and automatic movements rigidity. Tremor and gait. Assess also hearing, speech and finger dexterity. Describe disability grading according to Yulu. Demonstrate treatment: postural awareness and relaxation training. Gait training techniques: associated reactions, heel-toe gait, overcoming obstacles, start and stop on command, turning and walking backwards, forwards and sideward. Describe an appropriate home exercise programme.

Introduction to Huntingtons Diseases

Introduction to  Wilsons Diseases

Introduction to Tardive Dyskinesia.

Introduction to Dystonias

Lecture

discussion

 

Practical demonstration

Group discussion

 

11 hrs
8 Spinal Cord Lesions

 

Describe the Spinal Cord Lesions, its assessment and

Rehabilitation in detail.

 

To cover , Describe types of spinal cord lesions Describe sign of tract and root Interruptions, Describe positioning of the patient in acute spinal cord injury. Describe assessment of the motor system tone, power of specific muscle range of motion and limbs girth. Describe assessment of sensory system and reflexes.

Describe assessment of functional ability and balance reactions in appropriate cases. Describe assessment of respiratory function Muscles of respiration, coughing ability and vital capacity Describe how the level of lesion is ascertained.

Treatment- Describe the stages of immobilization & stage when weight bearing is allowed, Describe spinal orthosis. Demonstrate motor reeducation program and program for respiratory care In high level paraplegics and quadriplegics Demonstrate progressive ambulation, mat exercises, various strengthening program , methods of decreasing spasticity and improving sitting balance

Demonstrate paraplegic gaits and reeducation in functional activities transfer and protective falling. Describe common ambulatory aids used in paraplegics and common splints used in tetraplegics.

Describe the use of Hydrotherapy in paraplegics. Describe the concept of team approach in rehabilitation of these patients

Lecture

discussion

Practical demonstration

Group discussion

 

20 hrs
9 Stroke Describe the Hemiplegia, its syndromes, assessment and physiotherapy management  To cover, hemiplegia and identify the following. Sensory disturbance, alterations in tone, loss of selective movement, loss of balance reactions and communications problems

Treatment Describe the unilateral and bilateral approaches to treatment.

Describe positioning in the supine position, on the affected and on the unaffected sides. Demonstrate activities in the recumbent position arm mobilization. Trunk elongation-scapular movement, arm elevation, activities for a recovering arm activities for the lower limb.i.e. hip and knee flexion over the side of the bed, knee extension with dorsi flexion, hip control, and isolated knee extension

Mat activities demonstrate rolling on to affected and unaffected sides, sitting and kneeling. Describe the technique of making a patient sit passively and active assisted in sitting: Demonstrate Transfer Technique Describe activities in sitting equal weight transference on buttocks, shuffling on buttocks. weight transfer through arms balance reaction on trunk & head.

Demonstrate activities in the standing position: standing from plinth, from chair ( assisted and independent), weight bearing an affected leg, knee, control in stand weight transfers forward, backward and side wards, Gait training and stair climbing. Describe tilt board activities in the lying and sitting positions Describe additional methods of stimulation using verbal cues, ice, pressure & tapping. Describe management of shoulder pain and shoulder hand syndrome Identify ‘and describe hemiplegics gait, identify synergy, Components and abnormal reflex activities. Demonstrate reeducation of gait, motor relearning techniques functional approach and use of orthosis.

Lecture

discussion

 

Practical demonstration

 

Group discussion

 

Visit to OPD/IPD

 

20 hrs
10 cerebral lesion. Describe & the Explain the Incoordination and its physiotherapy management including assessment.

 

To cover, Identify and assess abnormal tone, decomposition of movement Rapid alternate movements, proprioception, dysmetria. posture and gait.

Treatment Demonstrate exercises for In coordination- Frenkel’s and weighted exercises. Demonstrate techniques for reeducation of balance and equilibrium reactions by visual compensation Describe use of appropriate aids far ambulation depending in the severity of affection – walker, elbow crutches, quadruped, walking sticks, etc.

Lecture

discussion

 

Practical demonstration

Group discussion

 

10 hrs
11 Poliomyelitis Describe its stages & post Polio syndromes: describe the assessment and its rehabilitation To cover, Define poliomyelitis and review the stages in the disease -acute, recovery and residual paralysis.

Describe treatment in the acute stage, chest care, positioning. Describe the assessment of a patient in the recovery stage: active and passive range of motion, soft tissue tightness, muscle power & spinal deformities

Demonstrate treatment in the recovery stage: muscle strengthening- progress resistive exercises. Describe the role of suspension and hydrotherapy

Describe the treatment of soft tissue tightness by passive stretching, auto-stretching, pre-operative assessment of contractures: hip flexion, TA contracture, knee flexion and foot deformities.

Review orthotic aids commonly used the management of polio. Describe tendon transfer operations commonly performed, Describe functional retraining for self care, gait training and posture correction.

Teachers seminar

Practical demonstration

Group discussion

 

12 hrs
12 Multiple Sclerosis Describe Multiple Sclerosis, its assessment and management To cover, Define Multiple Sclerosis, etiopathology, sign & symptoms, stages, examination procedure,     physiotherapy treatment goals and treatment techniques. Lecture

discussion

Practical demonstration

Group discussion

10 hrs
13 Vestibular Disorders, Balance & Vestibular Disorders, its assessment and its technique.  To cover ,basic physiology and balance control, common vestibular disorder, assessment, therapeutic goals and treatment techniques

 

Lecture

discussion

Practical demonstration

Group discussion

12 hrs
 

 

 

 

14

 Neuro surgery

 

 

Review the principle of pre and post operative management by physiotherapy

To cover,

1.      Common surgeries of the cranium &. brain.

2.      Common surgeries of vertebral column & spinal cord

3.      Common surgeries of peripheral nerves

4.      Surgical interventions in traumatic head injuries

Lecture

discussion

Role model

Practical demonstration

Group discussion

 

 

 

 

20 hrs


PRACTICAL
Hrs :100

Case presentation 40

Spotting     : 20

Viva voce :   40

 

  1. Practical demonstration of Physical assessment in Neurologoical conditions.
  2. Practical demonstration of various Physiotherapy techniques used in management of Neurologoical conditions.
  3. Practical demonstration of basic principles of Physiotherapy assessment, functional assessment and application of Physiotherapy in Various Neurological conditions.
  4. Practical demonstration of basic principles of Physiotherapy assessment, functional assessment and application of Physiotherapy in various Cranial & Spinal surgeries.
  5. Student must maintain a logbook. The duly completed logbook should be submitted during practical examination.

Books Recommended:

  1. Cash’s textbook of neurology for, physiotherapists – Dowani – J P Brothers.
  2. Adult Hemiplegia – Evaluation & treatment – Bobath – Oxford ButterworthHeinm an
  3. Neurological Rehabilitation – Carr&Shepherd – ButterworthHeinrnan
  4. Tetraplegia and paraplegia – A guide for physiotherapist- Bromley­Churchill Livingstone.
  5. Neurological physiotherapy – A, Problem solving approach – Susan Edwards- Churchill Linvigstone.
  6. Neurological Rehabilitation – Urmpherd – Mosby.
  7. Geriatric physical therapy- Gucciona- Mosby
  8. Motor assessment of Developing Infant – Piper &Darrah – W B. Saunders.
  9. Pediatric phySical therapy- Teckling Lippincott
  10. Treatment of cerebral Palsy and motor Delay – Levitts- Blackwell Scientific Publications, London.
  11. Aging the Health care Challenge – Levis- FA Davis.

Physiotherapy in Pediatrics – Shepherd – Butterworth Heinrnan