Orthopedic Interventions in the Neurologic Patient

Faculty: Beth Fisher, PT, PhD; Rob Landel, PT, DPT, OCS

CEU credit: 1.575

Course Description

• What are the implications of musculoskeletal mobility restrictions on the movement patterns of neurological patients?
• How can you determine what musculoskeletal restraints your patient has?
• In what ways can these restrictions affect your patient’s function?
• How do you treat those problems?
• How can you incorporate newly gained mobility into more appropriate movement patterns?

This course is designed to address these questions. We start by proposing that many of the abnormal movement patterns demonstrated by the CNS-involved patient can be traced at least in part to dysfunctions in the musculoskeletal system. We examine the biomechanical principles upon which our hypothesis is based, and support it using videotaped patient examples. We then present a model for analyzing movement that incorporates the contributions of the musculoskeletal system. Lab sessions throughout the course allow for practice using the model, with the goal of being able to predict musculoskeletal dysfunctions based on alignment and movement. Methods of assessment to test these predictions are demonstrated and practiced, with special attention given to adaptations required for application to the neurologically impaired. Soft tissue and joint mobilization techniques that target the movement dysfunctions typically seen in this population are practiced. A thought process for integrating the newly gained range into functional movement patterns, using principles of movement re-education, is presented through lecture, discussion and lab sessions.

Our goal is that the participant will be able to use their new skills immediately upon returning to the clinic. Accordingly, the student-instructor ratio is kept low to allow for increased feedback and flexibility to meet the participants needs. The course is approximately 1/3 lecture format, with use of videotaped patients, and 2/3 hands-on lab sessions. Lab clothes are needed both days.

Level: Intermediate

Audience: Physical Therapists

Objectives

At the conclusion of this course, the participant will be able to:

1. Describe the movement analysis model.
2. Assess musculoskeletal movement restrictions in the neurologic patient.
3. Develop hypotheses of areas of musculoskeletal restrictions based on alignment and movement analysis.
4. Prioritize the importance of mobility restrictions based on biomechanical principles.
5. Identify the impact of musculoskeletal restrictions on functional tasks.
6. Develop manual treatment skills to address musculoskeletal restrictions to movement.
7. Apply movement re-education principles to utilize the newly gained mobility.

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Course Schedule

Saturday (Breaks given each half day)
8:00 10:15 10:45    11:30	Introduction LECTURE: Foundational Hypothesis. Patient Assessment based on hypothesis LECTURE: Predicting musculoskeletal dysfunctions based on alignment & movement; Thought process on prioritizing treatment approach LAB:   Alignment Analysis; Movement Analysis; Review of flexibility tests LECTURE: Soft tissue & joint restriction intervention fundamentals
12:00	LUNCH
1:00	LAB:   Impact of faulty alignment on function
3:15	LAB:   Interventions. Patient problem: Fixed flexed posture. Problem 1: Limited Hip Flexion
Sunday
8:00     10:15	LAB:   Intervention (cont.)             Problem 2: Limited Lumbar Flexion             Problem 3: Limited Lumbar Extension             Problem 4: Limited Thoracic Extension             Problem 5: Limited Scapular Adduction/Depression
12:00	LUNCH
1:00  2:00     3:30	LECTURE/LAB:         Functional context movement re-ed after gaining mobility, LECTURE/LAB:         Intervention (cont) Patient Problem: Asymmetrical sitting posture (CVA)           Problem 6: Limited Trunk Sidebend LECTURE/LAB:         Treatment (cont)             Problem 7: Limited Dorsiflexion             Weight-bearing joint mobilization and movement re-education
4:45	Summary & wrap-up