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University of Maine at Presque Isle
181 Main St.
Presque Isle, ME 04769
COURSE SYLLABUS
NEUROLOGICAL INTERVENTIONS IN PHYSICAL THERAPY
CURRICULUM AND COURSE NUMBER: PTA 208
DEPARTMENT: Professional programs/PTA
CREDIT HOURS: 3
SEMESTER HOURS: CLASS: 2 LAB: 1
PREREQUISITES: Completion of all PTA general education requirements and first semester technical coursework
INSTRUCTOR: Vanessa Patenaude PT, MS
OFFICE: Wieden Hall 768-9678 [email protected]
OFFICE HOURS: By appointment-teaching schedule will be posted on door
COURSE DESCRIPTION
Course builds upon the student’s foundation in neuroscience and provides a greater breadth and depth of knowledge in neuroanatomy,
physiology, and pathology. The course emphasizes knowledge and skills needed to implement basic physical therapy interventions for the
neurologically impaired patient. Conditions discussed include CVA, TBI, SCI, Parkinson disease, MS, Vestibular disorders, and other neurologic
disorders.
REQUIRED TEXTS:
Umphred Darcy and Constance Carlson. (2006) Neurologic Intervention for Physical Therapist
Assistants. Thorofare, NJ. Slack.
O’Sullivan, Susan, and Thomas Schmitz. (2010) Improving Functional Outcomes in Physical Rehabilitation.
Philadelphia, PA. F.A. Davis.
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RECOMMENDED TEXTS:
O’Sullivan, Susan and Thomas Schmitz. (2007) Physical Rehabilitation 5th
Edition. Philadelphia, PA. F.A. Davis.
Brief Content Outline:
Introduction to class
Review clinical neuroanatomy/physiology
Review function of CNS
Dysfunction of CNS
Review function of PNS/ANS
Dysfunction of PNS/ANS
Data collection for neurological conditions
Motor learning/Neuromotor treatment theories
Intervention theories and principles
PT interventions for CVA/SCI/TBI/Parkinson’s/MS/Other
Interventions: neuromuscular control and re-education
Static/dynamic postural control and mobility
Functional interventions for: bed mobility, sitting, standing,
transfers, gait, ADL
COURSE OBJECTIVES
By the end of this course, the student will:
1. 3321: Demonstrate verbal and non-verbal communication with students, mock patients, instructors and
others in an effective, appropriate, and capable manner relative to course content in class and online.
a. demonstrate appropriate communication when given a case scenario for class discussion or lab practical
b. demonstrate satisfactory communication score on professionalism rubric
2. 3322: Recognize individual and cultural differences in class and responds appropriately in all aspects of
course content
a. demonstrates respect for individual and cultural differences when given a neurological case scenario for class discussion or lab practical
b. demonstrates satisfactory personal interaction score on professionalism rubric
3. 3323-4: Exhibit classroom and online conduct that reflects a commitment to meet the expectations of the
university, members of society receiving health care services, and members of the profession of
physical therapy.
a. demonstrate an overall satisfactory score on the course professionalism rubric.
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b. communicates to instructor/s strategy for improving any unsatisfactory professionalism scores
4. 3325: Demonstrate classroom and online conduct that reflects practice standards that are legal, ethical, and
safe relative to neurological physical therapy.
a. demonstrate a satisfactory score on any legal and ethical standard outlined in the course professionalism rubric.
b. utilizes gait belt and demonstrates appropriate safety awareness during all lab activities including practical exam case scenarios related to
therapeutic exercise.
5. 3326: Communicate an understanding of the plan of care developed by the physical therapist to achieve
short and long term goals and intended outcomes relative to neurological physical therapy.
a. demonstrates understanding of how neurological interventions will achieve goals and outcomes with accurate and appropriate assessment
and plan documentation.
b. chooses neurological intervention progression that is appropriate to accomplish POC goals and outcomes.
c. describe rationale for selected interventions NM pg. 61
6. Identify and describe key structures and functions of the CNS including circulation a. Identify the lobes of the brain and their function
b. Identify the major parts of the brain and spinal cord and their function
c. Identify blood supply to the CNS
d. Identify spinal tracts and their function
7. Identify key structures and functions of the PNS a. Identify cranial nerves and their function
b. Identify function of the spinal nerves
8. Identify key structures and function of the ANS
9. Describe the clinical implications associated with lesions in the following areas:
a. UMN vs LMN
b. Lobes of the brain
c. Left vs right hemisphere
d. Cerebellum
e. Brainstem
f. Basal Ganglia
g. Spinal cord
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h. Various CNS arterial supply
i. Cranial nerves
j. UMN vs LMM
10. Identify and describe current theories of motor control, motor learning and recovery
a. Identify differences among motor learning, motor control and neuroplasticity
b. Identify stages of motor learning and strategies for intervention
c. Identify types of feedback and practice and strategies for intervention
d. Describe differences between recovery and compensation
11. Identify different types of frameworks for neuromotor intervention.
a. Identify different neurorehabilitation approaches including functional training, neurodevelopmental training, compensatory training
1. Identify basic concepts of each approach
2. Identify muscular facilitation and inhibitory techniques
12. 3327.1: Demonstrate competence in implementing functional training interventions and progressions for
ADLs according to a given neurological condition and POC.
a. administer functional activities for improved dynamic postural control when completing ADL for a patient with a given SCI/CVA/TBI
13. 3327.2: Demonstrate competence in implementing functional training interventions and progressions with
assistive/adaptive devices according to a given neurological condition and POC.
a. administer functional activities with cane, walker, forearm crutches, AFO etc. for pt. with TBI, CVA, or SCI
14. 3327.3: Demonstrate competence in implementing functional training interventions and progressions for
body mechanics according to a given neurological condition and POC.
a. administer functional activities for improved body mechanics during mobility activities for pt. with CVA/SCI or TBI and associated
spasticity
15. 3327.4: Demonstrate competence in implementing functional training interventions and progressions for
developmental activities according to a given neurological condition and POC.
a. administer functional activities for improved bed mobility and transfers for a given neuromuscular impairments
16. 3327.5: Demonstrate competence in implementing functional training interventions and progressions for
gait and locomotion according to a given neurological condition and POC.
a. administer functional activities to improve standing and gait for pt. with a given neurological condition.
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17. 3327.6: Demonstrate competence in implementing functional training interventions and progressions with a
given orthotic device, neurological condition and POC.
a. administer functional activities to improve community ambulation for pt. with a given neurological condition and orthotics.
b. Administer functional activities to improve donning/doffing orthotics as appropriate with pt. with a given neurological condition.
18. 3327.7: Demonstrate competence in implementing functional training interventions and progressions for
improved wheelchair management according to a given neurological condition and POC.
a. administer functional activities to improve wheelchair management for pt. with a given neurological conditional.
b. administer functional activities to improve household wheelchair maneuvering for pt. with a given neurological condition.
19. 3327.10: Demonstrate competence in implementing passive ROM for a given neurological condition and
POC.
a. identify and list indications and contraindications for various neurological conditions including spasticity, flaccidity, and sensory
impairments.
b. demonstrate manual PROM to pt. with CVA/TBI and spasticity.
c. Demonstrate appropriate inhibitory techniques for a pt. with CVA and spasticity.
20. 3327. 12-19: Discuss appropriate mechanical and physical agents for use in conjunction with given
neurological conditions when carrying out a PT plan of care.
a. identify, list, and discuss indications, contraindications and precautions for mechanical/physical agents for a given neurological case
scenario
b. identify the benefits of using a given mechanical or physical agent to enhance an intervention for neurological impairment for a given pt.
goal or outcome.
21. 3327. 20: Demonstrate competence in implementing aerobic conditioning exercise progressions for a given
neurological case scenario.
a. implement aerobic conditioning for pt. with CVA/SCI/TBI and a goal to participate in functional wheelchair activities
22. 3327. 21: Demonstrate competence in implementing balance and coordination exercise progressions for a
given acute neurological case scenario.
a. implement static/dynamic balance and coordination activities in sitting/standing for pt. with neurological impairments from
CVA/TBI/SCI.
23. 3327. 23: Demonstrate competence in implementing conditioning and reconditioning exercise progressions
for a given neurological case scenario.
a. implement ADL reconditioning exercises for pt. with CVA/TBI and SCI
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24. 3327. 24: Demonstrate competence in implementing posture awareness exercise progressions for a given
neurological case scenario.
a. implement posture awareness exercises for pt. with a given neurological condition.
25. 3327. 27: Demonstrate competence in implementing strengthening exercise progressions for a given
neurological case scenario.
a. implement LE strength exercises for pt. with a given neurological condition.
b. demonstrate facilitory techniques for pt. with flaccidity.
26. 3327. 25-26: Demonstrate competence in implementing ROM and flexibility exercise progressions for a
given neurological case scenario.
a. implement appropriate stretching exercises for pt. with SCI/SCI/TBI
27. Identify and describe data collection skills for neurological impairment
a. 3328.10: Recognizes absent or altered sensation
i. identifies the importance of collecting subjective information from subject regarding any known sensory deficits
ii. demonstrates appropriate sensory screening as appropriate prior to neurological interventions
b. identify and describe techniques for assessment of motor impairment
c. identify and describe special tests for UMN and LMN dysfunction
28. 3328.1: Demonstrates competence in performing vital sign measurements in the neurologically impaired
population
a. identifies expected vital sign changes in pt. with neuromuscular impairments
b. demonstrates and discusses changes to technique in vital sign data collection in pt. with cognitive, sensory, or neuromuscular impairment
29. 3328.5: Demonstrates competence in data collection skills for arousal, mentation, and cognition in
neurologically impaired population
a. discusses appropriate cognitive screening tool for pt. with various neurological impairments due to stroke or TBI
30. 3328.9: Demonstrates competence in describing the safety, status, and progression of patients with
neurological conditions while engaged in gait, locomotion, balance, wheelchair management and
mobility.
a. identifies potential safety issues including neglect, sensory, neuromuscular, balance and cognitive deficits and identifies the appropriate
screening tool i.e. Berg balance, FIM, etc., for documentation of progress.
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31. 3328.15: Demonstrates competence in measuring muscle strength by manual muscle testing
a. demonstrates competence to adjust muscle strength test to accommodate for cognitive or sensory deficits due to neurological condition
32. 3328.22-23, .31: Demonstrates competence in collecting data related to pt. pain level or functional capacity at home or work, and recognizes
activities, positions, or postures that alleviate or aggravate pain
a. demonstrates competence in clinical case scenario to adjust method of ascertaining pain level or functional status from pt. with cognitive,
sensory, communication or other deficit due to neurological condition
b. demonstrates competence in clinical case scenario to identify activities, positions, or postures that will likely alleviate or aggravate pain
when pt. is unable to communicate due to neurological impairment.
33. 3329: Adjusts interventions within the plan of care established by the physical therapist in response to
patient clinical indications and reports this to the supervising physical therapist.
a. observes, identifies, and communicates to supervising PT changes in fatigue levels, functional capacity, or other clinical indicators due to
neurological condition that warrants reduction in pt. activity level or stress.
b. take vital signs before, during, and after intervention and continuously monitor for signs of activity intolerance
34. 33210: Recognizes when intervention should not be provided due to changes in the patient’s status and
reports this to the supervising physical therapist.
a. reviews documentation in given neurological scenario for changes in physician orders.
b. identifies and describes signs and sxs of autonomic dysreflexia for pt. case scenario with SCI
c. monitors vital signs and other indicators of a patient’s intolerance to activity including blood pressure, HR, RR, pulse oximetry, rating of
perceived exertion, diaphoresis, skin color etc. for a given neurological condition and plan of care
33211: Reports any changes to the patient’s status to the supervising physical therapist.
d. demonstrates appropriate and accurate documentation regarding changes to patient status in stroke, TBI, or SCI case scenario
e. demonstrates appropriate and accurate verbal report to supervising PT in stroke, TBI, or SCI case scenario
35. 33212: Recognize when the direction to perform an exercise is beyond that which is appropriate for a
physical therapist assistant and initiates clarification with the physical therapist.
a. identifies interventions in a given case scenario that are inappropriate for the PTA relative to neurological intervention
b. recognizes when intervention should not be provided due to changes in pt. status and re-evaluation may be indicated
36. 33213: Participates in educating patients and caregivers as directed by the supervising physical therapist in
a given case scenario
a. utilizes written and verbal communication that is non-technical and understandable to patient and caregivers
b. adjusts communication style to accommodate communication deficits including aphasia, visual or auditory impairments due to
neurological impairment.
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37. 33214: Provides patient-related instruction in given case scenarios regarding neurological condition to
patients, family members, and caregivers to achieve outcomes for given interventions identified in
the plan of care established by the physical therapist.
a. demonstrates appropriate verbal cuing when instructing patients with given neurological impairment
b. demonstrates appropriate tactile feedback when instructing pt. with given neurological impairment
38. 33215: Take appropriate action to manage patient falls and other potential emergency situations while
implementing neurological interventions.
a. identify appropriate emergency actions in a given scenario
b. describe and demonstrate appropriate technique to assist falling patient with neurological deficit to floor in a given scenario
c. identify potential harmful/emergency situations that may arise relative to neurological condition i.e. autonomic dysreflexia, increased ICP
etc.
39. 33216: Complete thorough, accurate, logical, concise, timely, and legible documentation relative to
neurological interventions that follows guidelines and specific documentation formats required by
state practice acts, the practice setting, and other regulatory agencies.
a. demonstrate accurate use of medical terminology and abbreviations relative to neurological interventions
b. accurately document the procedural interventions and related data collection for a given case example related to neurological interventions
c. describe how documentation requirements relative to neurological intervention vary depending upon practice setting (eg. skilled nursing,
outpatient, home health etc.)
40. 33218: Read and accurately interpret health care literature related to course content.
a. complete accurate article critiques related to neurological intervention
b. identify and discuss relevant information from research presented in class
41. 33219: under the direction and supervision of the physical therapist, instructs other members of the health
care team using established techniques, programs, and instructional materials commensurate with the
learning characteristics of the audience.
a. educate nursing, PT aide or other staff regarding proper spasticity-inhibiting technique for given case scenario
42. 33226: Identify examples of social responsibility, citizenship and advocacy in PT within the context of
course content.
a. identify examples of social responsibility and citizenship i.e. raise stroke awareness and prevention with local representatives
b. discuss benefits of volunteering time to participate in balance screening
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General Information:
1) Office Hours:
The instructor is available by appointment or by chance via phone, email, or in person. Students are strongly encouraged to make an appointment
in order to ensure instructor’s availability.
2) Syllabus, course outline, assignment list, lecture outlines and other classroom related information will be on blackboard.
3) Students are encouraged to make appointments to meet with the instructor during office hours if you are having difficulty with class.
Instructional Methods: Lecture, class discussion, instructor demonstrations, laboratory practice sessions, small group work, role playing, mock
patients, guest speakers and possibly guest patients.
Evaluation Methods: Written exams, written quizzes, lab exams, skills assessments, rubrics for attendance and professionalism, article review
Grading:
1. Exams 3 @ 16% =48%
2. Quizzes 2 @ 7% =14%
3. Practical Exams 2 @ 8% =16%
4. Written Assignments =12%
5. Attendance =05%
6. Professionalism =05%
100%
Grading Scale: A 10 point scale will be used for grading as follows:
94-100 % A 74-76% C
90-93 A- 70-73 C-
87-89 B+ 67-69 D+
84-86 B 64-66 D
80-83 B- 60-63 D-
77-79 C+ 0-59 F
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Communication:
Emails and phone calls will be responded to within 24 hours on weekdays and no later than noon on Monday for communication received on
weekends. We will post an announcement on Blackboard if we will be out of the office for longer than 1 day. Students are expected to check their
student generated emails and blackboard announcements on a weekly basis for class related updates.
Class Cancellation:
If I need to cancel class for any reason I will make every attempt to post a Blackboard announcement and send an email within 24 hours of class,
generally by 8:00 pm the evening prior.
Assignments:
Assignments will be collected at the beginning of class on the due date. Late assignments may be submitted in person or emailed. Late assignments
will receive a 5 point penalty per day.
Students submitting work by email should expect to receive a receipt confirmation within 24 hours during the week and by 12:00 pm on Monday
for work submitted on weekends. Students who do not receive receipt confirmation from the instructor should assume failure of transmission
occurred and re-submit in order to avoid late penalties or a zero.
Faxed assignments are not acceptable.
Written Assignments:
Article Review:
Students will choose a scientific article to review and submit near the end of the semester. The student may choose any research article that meets
the following criteria:
1. The article must be from a peer reviewed, scientific journal
2. The topic must be related to physical therapy and neurological conditions, examination, interventions.
3. The article should be no older than 2006 unless the instructor gives clearance.
Completed assignments should meet the following criteria:
1. All work should be clean and typed.
2. The journal article should be attached to the written review.
Written Soap Notes:
Students will work in pair with mock patient scenarios. Students will be responsible for writing soap notes on these “mock patients”.
Soap notes will be passed in the same day as the “mock patient scenarios”
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Written Exams: 1. There will be three written exams.
2. There will be two quizzes.
3. Missed exams/quizzes must be made up within one week of the original test date. Arrangements to make up an exam are the responsibility of the
student and should be done your first day back to campus. A grade of zero will be issued for missed make up exams. Make up exams may be
modified from the original.
Practical Exams:
1. There will be two practical exams. If a patient is needed, a classmate or faculty member will serve as the model. Prior to your exams you will be
given the score sheet as well as possible scenarios and/or techniques you will be asked to demonstrate. Sign-up sheets will be posted on the lab
door.
2. The minimum passing grade for practical exams is 80% and includes passing of all essential/critical skill standards outline therein. Failed exams
must be repeated within one week for an average grade of not more than 80% including passing of all essential/critical skill standards. Students
will be allowed to repeat a failed lab exam once.
3. Missed exams must be made up within one week of the original test date. Arrangements to make up an exam are the responsibility of the student
and should be done your first day back to campus. A grade of zero will be issued for missed make up exams. Make up practicals may be
modified from the original.
4. Students are expected to be appropriately dressed for each practical exam including hair, fingernails, clothing, shoes, and hygiene.
Skill Assessments: 1. Prior to completing this course, students will need to demonstrate competency in learned skills which will be verified by program core faculty,
course instructor, or an approved teaching assistant. In the event a student needs remediation for any skills, an individualized learning plan will be
developed by the student and instructor.
2. Students may repeat a skills assessment once to prove competency prior to the corresponding practical exam.
Attendance
Students should make every attempt to attend all classes and submit all assignments. Since there are constant learning opportunities between students
and between faculty and students, it is expected that students will attend each class meeting. Students missing 25% of classes (lecture and/or lab)
prior to the mid-point of the semester may be withdrawn from the course. Students are also expected to arrive for class on time and remain in class
until dismissed by the instructor. Please notify the instructor of all delays or absences as soon as possible.
For grading purposes the following will also be considered an absence:
4 episodes of late arrivals or early departures
Arriving after the mid-point of the class
Departing before the mid-point of the class
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Attendance grade is based on the percentage of classes attended
Professionalism
Professional behavior is an important attribute that all successful clinicians possess. Developing your professionalism as student clinicians will give
you the interpersonal tools necessary to interact with patients, coworkers and other professionals from a wide range of cultural and educational
backgrounds. Remember that you are representatives of the University of Maine at Presque Isle, the College of Professional Programs, and your
state and national professional affiliation. All students should strive to meet all criteria as outlined on the professional behavior assessment rubric
and remain respectful of the faculty, staff and classmates.
Please see other important information, and UMPI policies and procedures at the following link: www.umpi.edu/syllabus-policies
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Resources
Assignments/Reading
Assignments Lab Activities Exams/Lab
Practicals/Assignments Due
Week 1
( Jan. 24)
Introduction to PTA 208 -Class expectations -assignments -Attendance and grading policies -professionalism rubric Introduction to Neurorehabilitation: Review CNS PNS ANS
Chapter 1 Umphred’s
Neurorehabilitation for the PTA
It is advised to start
reviewing Chapters 3-10 in O’Sullivan’s
Improving Functional Outcomes to prepare
for labs that start approx. week # 4
Week 2
(Jan. 31)
Clinical implications associated with lesions in the following areas:
a) UMN vs LMN
b) Lobes of the brain
c) Left vs right hemisphere
d) Cerebellum
e) Brain stem
f) Basal Ganglia
g) Spinal cord
h) Various CNS arterial supply
i) Cranial nerves
j) UMN vs LMM
Chapter 7 and Pages 151, 246-247, 709-
716 O’Sullivan’s Physical
Rehabilitation
Quiz # 1 (Take Home)
(Neuroanatomy and clinical implications)
Week 3
(Feb. 7)
Principles of Interventions:
Concepts/Terminology
Motor Learning
Intervention Theories
Chapter 1, 3 & 5 Umphred’s
Neurorehab for the PTA
Part I O’Sullivan’s Improving Functional
Outcomes (Suggested Reading)
Take home quiz # 1 Due
14
Chapter 13 O’Sullivan’s Physical
Rehabilitation
Week 4
(Feb. 14)
Quiz # 2
CVA Rehab
Pathology-brief review
Data collection
Intervention
Chapter 4 & 11 Umphred’s
Neurorehab for the PTA
(Suggested Reading: Chapters 5-8, 18
O’Sullivan’s Physical Rehabilitation)
Lab Activities: CVA:
Data collection procedures Skills checks
Quiz # 2 (Principles of Intervention)
Winter Break (Feb 18-22)
Week 5
(Feb. 28)
CVA Rehab continued: data collection continued as needed.
Intervention:
Chapter 5 Umphred’s
Neurorehab for the PTA
Chapters 3-10 in
O’Sullivan’s Improving Functional
Outcomes
Lab Activities: CVA: continued
Lab Activities: CVA:
Intervention Skills checks
Week 6
(Mar 7)
CVA Rehab intervention continued
Mock CVA Patients
Skills checks
Week 7
(Mar 14)
Exam I
Lab Exam I(CVA)
Exam I (CVA)
Lab Exam I
(CVA)
Mock CVA soap notes due
15
Week 8
(Mar 21)
TBI Rehab Pathology-brief review
Data collection
Intervention
Intervention: TBI
Chapter 10 Umphred’s
Neurorehab for the PTA
Review Chapter 5 Umphred’s
Neurorehab and Chapters 3-10 in
O’Sullivan’s Improving Functional
Outcomes (Suggested Reading: Chp. 22 O’Sullivan’s
Phys Rehab)
Lab Activities: TBI:
Data collection procedures Skills checks Lab Activities:
TBI: Intervention
Skills checks
Week 9
(Mar 28)
TBI Rehab continued
Mock TBI patients
Skills checks
Spring Break (Apr 1-4)
Week 10
(Apr 11)
SCI Rehab
Pathology-brief review
Data collection
Intervention
Intervention: SCI:
Chapter 9 Umphred’s
Neurorehab for the PTA
Review as per Week # 8
(Suggested Reading: Chp. 23 O’Sullivan’s
Physical Rehabilitation)
Lab Activities: SCI:
Data collection procedures
Skills checks
Lab Activities: SCI:
Intervention Skills checks
Mock TBI soap notes due
16
Week 11
(Apr 19)
SCI Rehab continued
Mock SCI patients
Skills checks
Week 12
(Apr 26)
Written Exam II
Parkinson’s/MS/Vestibular/Other Dx Rehab
Pathology-brief review
Data collection
Intervention
Chapter 12 Umphred’s
Neurorehab for the PTA
Review as per Weeks 8 & 9
(Suggested Reading: Chps. 19-24
O’Sullivan’s Phys Rehab)
Lab Activities: Data collection procedures Skills checks Lab Activities: Intervention
Skills checks
Written Exam II (TBI/SCI)
Mock SCI soap notes
due
Week 13
(May 2)
Parkinson’s/MS/other Dx Rehab continued
Mock patients
Skills checks Neuro Article Review Due
Week 14
(May 9)
Lab Exam II-depending on schedule and timing this lab exam
may need to be scheduled outside of class time******
Lab Exam II (SCI,TBI,Other)
Mock patient soap
notes due
Week 15
(May 16)
Written Exam III
Finals Week
Written Exam III
