NAIOMT Level II: C-616 Cervical Spine II

NAIOMT Level II: C-616 Cervical Spine II

NAIOMT Level II: C-616 Cervical Spine II
Faculty:

Kathleen Berglund, PT, DSc, FAAOMPT, COMT, OCS, ATC
Clock Hours:

Twenty-one (21) contact hours

Audience:
This course is designed for licensed physical therapists (copy of physical therapy therapy license required) who are intermediate learners in the field of orthopedic manual physical therapy.

Pre-requisites:
None, however, in order to receive the maximum benefit from this course, it is recommended that participants have completed C-516 course prior to taking this class.

Course Description:

This course will utilize case-based instruction to illustrate specific cervical spine conditions, and their detailed, specific biomechanical and neurophysiological assessment. Participants will assemble an all-source evidence-informed approach to evaluation and management through consideration of normal, abnormal and applied cervical spine anatomy, physiology, biomechanics, and pathology. Coursework will focus on reason-based development of individualized examination sequences aimed at patient/client classification into – management of an initial diagnosis, progression to a specific biomechanical and neurophysiological examination, including combined movements, symptom/intervention/rule -based classification groupings, or referral to another health-care provider. Traumatic cervical spine injury and the compromised vascular patient will be discussed in detail. Participants will compare the concepts of health, functioning, pain behaviors and their role in total patient/client management. Procedural interventions will include education, manual therapy techniques, and individualized neuromuscular rehabilitation prescription, with the goal of restoring normal function and preventing disability.; Specific cervical joint manipulation/mobilization of the upper cervical spine and uncovertebral joints will be introduced.

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 three 21-hour module, the participant should be expected to:

  1. Definitively select an initial patho-anatomical diagnosis to an orthopedic manual physical therapy patient/client presenting with cervical spine pathology.
  2. Evaluate and manage the "whole" patient/client utilizing reason-based, individualized examination sequences, classification, and procedural interventions.
  3. Discuss the unique assessment and disposition of the traumatic cervical spine patient.
  4. Formulate an all-source evidence-informed management plan including education, manual therapy, and individually dosed neuromuscular rehabilitation techniques.
  5. Demonstrate thrust joint manipulation/mobilization techniques for the upper, middle cervical and cervico-thoracic spine.
Specific Course Objectives:

Affective Domain:

Upon completion of this 21-hour 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. Realize that all orthopedic manual physical therapy patients/clients present with certain unique signs and symptoms that require an individualized approach to the evaluation.
  4. Accept the concept of patho-anatomical diagnosis as the important goal in the evaluation of the orthopedic manual physical therapy patient/client.
  5. Accept the importance of Selective Tissue Tension Testing (STTT) to the evaluation and management of the orthopedic manual physical therapy patient/client.
  6. Identify patients who are more appropriately classified using other criteria (Clinical Prediction Rules, Symptom/Intervention based systems).
  7. Internalize the importance of prognosis as a central factor in the evaluation and management of orthopedic manual physical therapy patients/clients.
  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.
  9. Recognize the importance of all-source evidence-informed practice and balance all sources (clinical experience, literature, and patient preference) in search of best practices.

Cognitive Domain:
Upon completion of this 21-hour module, students should be expected to:

  1. Analyze the current understanding of the normal, abnormal and applied anatomy, physiology, and biomechanics of the cervical spine.
  2. Recognize the unique specific biomechanical and neurophysiological examination and differentiate the relative worth of its components as applied to the cervical spine:
    • Passive Physiological Intervertebral Movements (PPIVM)
    • Passive Accessory Vertebral Movements (PAVM)
    • Tests of pain provocation (bone, nerve, ligament, soft tissue)
    • Joint stability testing
  3. Interpret the biomechanics of the cervical spine as they relate to the biomechanical and neurophysiological assessment of combined movements.
  4. Compare and contrast condition (illness) scripts based on patient age, gender and pain chart information, and definitively select an initial patho-anatomical hypothesis for the cervical spine from the following:
    • Systemic disease (cardiovascular, pulmonary, neurological, gastro-intestinal, endocrine, vascular, gynecological, musculoskeletal, integumentary, cancers)
    • Fracture/Dislocation
    • Arthritis (degenerative/systemic/traumatic)
    • Spondylolisthesis (congenital/acquired)
    • Disc pathology
    • Radiculopathy
    • Stenosis (central/lateral canal)
    • Segmental dysfunction (hypomobility, hypermobility, instability, uncovertebral)
    • Contractile tissue lesions
    • Non-Contractile tissue lesions (i.e. dizziness, headache and cervicogenic headaches)
  5. Question the initial hypothesis through targeted subjective questioning.
  6. Interpret red and yellow flag presentations, including central sensitization and neural mobility sensitivity, and discuss the decisions that need to be made about the management of these patients.
  7. Review the components of the cervical spine scan and biomechanical-neurophysiological examination.
  8. Identify individual all-source evidence-based tests and measures that are relevant to the diagnosis.
  9. Assemble all-source evidence-informed, reasoned, and individualized examination sequences specific to cervical spine conditions (illness) scripts.
  10. Modify individual examination sequences to take into consideration the traumatic cervical spine patient, and varying severity and irritability in patient/client presentations.
  11. Definitively select a patho-anatomical diagnosis.
  12. Formulate an accurate, individual prognosis for select patient/client presentation including those with poor health, low functioning and illness behaviors.
  13. Discuss specific indications and contraindications for orthopedic manual physical therapy intervention.
  14. Describe the principles of locking/localization techniques as they relate to specific segmental assessment and management of the cervical spine.
  15. Utilize case examples to formulate specific, all-source evidence-informed, individualized management plans, taking into account the overall health and function of the individual.

Psychomotor Domain
Upon completion of this 21-hour module, students should be expected to:

  1. Demonstrate a specific biomechanical and neurophysiological examination to the upper, middle and lower cervical spine.
    • Passive Physiological Intervertebral Movements (PPIVM)
    • Passive Accessory Vertebral Movements (PAVM)
    • Tests of pain provocation (bone, nerve, ligament, soft tissue)
    • Joint stability testing
  2. Demonstrate advanced components of a specific biomechanical-neurophysiological examination (C0-T1).
    • Combined Passive Physiological Intervertebral Movements (PPIVM)
    • Combined Passive Accessory Movements (PAVM) (including uncovertebral)
    • Locking techniques for the upper-lower cervical spine.
    • Upper cervical joint stability testing
  3. Demonstrate an acute scanning examination for the traumatic cervical spine patient.
  4. Demonstrate an appropriate physical therapy screening for causes of dizziness and headache, including cervicogenic headache.
  5. Demonstrate the ability to provide education to a patient/client, including prognosis, activity modification, and postural adaptation.
  6. Demonstrate orthopedic manual physical therapy intervention techniques:
    • Manual therapy techniques
      • Segmental traction in the upper and mid-lower cervical spine with focused locking.
      • Segmental flexion/extension mobilization in the upper, and mid-lower cervical spine with focused locking.
      • Segmental flexion/extension thrust joint manipulation in the upper and mid-lower cervical spine with focused locking.
    • Soft tissue techniques
    • Rehabilitation techniques
      • Neuromuscular rehabilitation of the cervical spine
      • Strength, mobility, and endurance training
    • Stabilization strategies (including external tape, body mechanics training)
    • Neurodynamic intervention
    • Neural de-sensitizing intervention
  7. Demonstrate modified variations of the interventions to take into consideration the varying levels of patient/client severity, irritability, and patient/client/therapist body type.