PROPOSED THREE- YEAR CURRICULUM · Web viewfor Physical Therapist Training in Afghanistan November 2006 Table of Contents Acknowledgements . 3 Background . 4 Physical Therapist Job

A THREE-YEAR CURRICULUMFOR PHYSICAL THERAPIST TRAINING

IN AFGHANISTAN

November 2006

TABLE OF CONTENTS

Acknowledgements …………………………………………………………………………. 3

Background …………………………………………………………………………………. 4

Physical Therapist Job Description ………………………………………………………….5

Graduate Competencies …………………………………………………………………….. 6

Educational Approach ……………………………………………………………………….8

Curriculum Overview ………………………………………………………………………. 9

Course Descriptions and Objectives ………………………………………………………. 10

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ACKNOWLEDGEMENTS

Many thanks to the following individuals who contributed significant time and expertise in the preparation of this curriculum:

Adbul Malik Halim, Swedish Committee for AfghanistanAziz Ahmad Adel, Physical Therapy Institute (Kabul)Björn Schranz, Handicap International (France)Chiara Retis, Handicap International (France)Esmatullah Naqshbandi, Afghan Physical Therapy AssociationJenny Wickford, Swedish Committee for AfghanistanRazikhan Hamdard, United Nations Development Program (Afghanistan)Ronald Chiu, International Assistance Mission (Afghanistan)Shah Mahmood, Sandy Gall’s Afghanistan AppealShukor Haqbeen, Physical Therapy Institute (Kabul)Shukrullah Zeerak, International Committee of the Red Cross (Kabul)Thierry Hergault, Handicap International (France)

The following organisations are gratefully recognised for providing technical and logistical assistance in the curriculum development process:

Afghan Physical Therapy AssociationDhulikhel Medical Institute (Nepal)Handicap International (France)Human Resource Department, Ministry of Public Health (Afghanistan)Institute of Health Sciences – KabulInternational Assistance Mission (Afghanistan)International Committee for the Red Cross (Afghanistan)Kabul Medical UniversityNational Program for Action on Disability, United Nations Development Program

(Afghanistan)Sandy Gall’s Afghanistan AppealSchool of Rehabilitation Therapy, Queen’s University (Canada)Swedish Committee for Afghanistan

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BACKGROUND

Physical therapist education in Afghanistan began with the Physical Therapy Institute (PTI, then known as the Physiotherapy School of Kabul), started by the International Assistance Mission (IAM) with cooperation from the Ministry of Public Health (MoPH). The first physical therapy training center, both professional and technical in form, began in 1984 with a 2-year diploma course. The curriculum for these early classes was developed along the guidelines of a World Confederation for Physical Therapy education document with an emphasis on the specific needs of Afghanistan.

In 1990, a curriculum revision was completed by IAM and approved by the MoPH. It included goals for each subject and emphasized the basic sciences required by physical therapists, as well as the special skills required for their work. Over the years since then, many modifications were made in order to fulfill felt needs and changing educational requirements at the time.

The current curriculum in use at PTI was last revised in 2002 through a review process that included the MoPH, World Health Organisation, International Medical Corps, PTI, International Committee of the Red Cross, and Sandy Gall’s Afghanistan Appeal. According to this 2-year physical therapy curriculum, 12th

grade graduates are introduced through the Institute of Intermediate Medical Education and required to pass a special physical therapy entrance examination before allowed to begin education towards becoming a physical therapist.

In 2003, all major rehabilitation stakeholders in Afghanistan agreed that a new educational program was required in order to improve the standards of patient care and to further the profession on the whole. Many thought that a four-year degree program would best serve the needs of Afghanistan, but after much discussion and debate, an agreement by all stakeholders was reached to implement a 3-year diploma program. It was felt that a 3-year curriculum would better suit the current state of the education and health care system in Afghanistan.

A longer-term goal is to further develop this 3-year program into a 4-year baccalaureate-level physical therapy education. With this in view, a four-year curriculum was developed initially in 2005 and then modified to the three-year program that is presented in this document. This modification is popularly referred to as a ‘three-plus-one’ curriculum in order to reflect the desire to add another year and become a university-level course as soon as it becomes feasible.

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PHYSICAL THERAPIST JOB DESCRIPTION

Physical therapists work with patients to plan and carry out individually designed treatment programs, based on careful assessment, towards restoring function and/or preventing disability from disease, trauma or injury. Physical therapists may be generalists or specialise their practice to specific clinical areas such as orthopaedics, paediatrics, cardio-respirology, or amputation rehabilitation. Physical therapists also work in the fields of consulting, education of individuals or groups, and research.

Physical therapists are able to work as independent autonomous medical professionals, capable of seeing patients without being referred by a medical doctor. Physical therapists have enough professional knowledge to understand when to refer patients to medical doctors, or other health care professionals, for treatment. As such, physical therapists are capable of working with a participatory approach within a health-care team and/or community to provide complete holistic care.

Physical therapists work in a variety of settings including community health clinics, community-based rehabilitation programs, educational institutions, health centres, hospitals, rehabilitation centres, private clinics, or sports organisations.

Physical therapists perform some or all of the following activities and functions:

assess physical and functional abilities in order to identify physiotherapeutic problems develop a treatment plan to address the physical therapy problems give treatment which may include patient education, the use of exercises, mobilization, and

other physical modalities (for example: electrotherapy or hydrotherapy) maintain clinical and statistical records work in multidisciplinary teams and confer with other professionals as required develop and implement screening and preventative public health promotion programs conduct research in physical therapy other duties related to education, consultation, management or administration

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GRADUATE COMPETENCIES

At the end of the educational program, the graduates should be able to demonstrate the following knowledge, skills, and behaviours in fulfilling job requirements as a physical therapist:

EVALUATION:

1) Independent examination of a patient with confidence and proficiency in, but not limited to, the following areas:a) assistive and adaptive devices;b) community, social and work (job, school or play) integration;c) cranial nerve integrity;d) environmental, home, and work barriers (including accessibility barriers);e) ergonomics, posture and body mechanics;f) gait, assisted locomotion, and balance;g) integuementary integrity;h) mental and cognitive status;i) motor function;j) muscle performance (including strength, power, and endurance);k) neuro-motor development and sensory integration;l) orthotic, prosthetic, protective, and supportive device requirements;m) pain;n) range of motion (including muscle length, joint integrity / mobility);o) reflex and sensory integrity (including proprioception and kinesthesia);p) respiratory and circulatory status (including aerobic capacity and endurance);q) self-care and home management (including activities of daily living and instrumental

activities of daily living).

CLINICAL DECISION-MAKING:

2) Ability to combine and analyse all information collected in making a physical therapy diagnosis and determining a prognosis.

3) Demonstrate clinical decision making skill that includes effective clinical reasoning with an appreciation of evidence-based practice.

4) Ability to locate and evaluate information related to new physical therapy techniques and technologies related to patient care.

5) Understand the physical therapist’s role in the health care system, as well as one’s personal professional limitations, knowing when to refer to another physical therapist or other health-care provider for further examination.

6) Ability to prioritize patient goals in treatment planning and implementation.7) Be responsible for communicating or discussing relevant examination findings and/or

clinical impressions with other health-care providers.8) Co-operation with the patient, family or caregivers, and other health-care providers in

establishing realistic goals and treatment plans.9) Ability to adjust a treatment plan according to the patient’s status and/or response to

treatment.

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TREATMENT:

10) Provide direct physical therapy treatment including (but not limited to):a) airway clearance techniques;b) assisting in nursing management (including wound, bowel and bladder care);c) functional training in self-care, home management, community and work reintegration

(including activities of daily living);d) manual therapy techniques;e) patient and family instruction and encouragement;f) physical and electrotherapy modalities;g) prescription, application, and as appropriate, fabrication of adaptive, assistive, orthotic,

prosthetic, protective, and supportive devices;h) therapeutic exercise (including stretching, strengthening and aerobic conditioning).

11) Appropriate delegation and supervision of physical therapy assistants or other support staff in providing physical therapy treatment.

12) Appropriate assessment of the results of treatment given (adequate follow-up care / re-assessment).

PROFESSIONAL BEHAVIOURS:

13) Demonstrate professional behaviour in all interaction with patients, families, care givers, other health-care providers and students.

14) Demonstrate an understanding of disability issues (including current government legislation and policies) and a supportive attitude toward persons with disability.

15) Promote the multi-disciplinary team approach in the health care system, effectively communicating with medical, nursing and other health-care providers.

16) Practice physical therapy in accordance with the Afghan Physical Therapy Association’s Code of Conduct and the legal requirements of Ministry of Public Health.

17) Maintain patient records in accordance with government and employer standards.18) Demonstrate an interest in ongoing development of personal career goals and physical

therapy knowledge and skills.19) Ability to participate in educational and/or research activities (eg. case reports or

supervision of students).

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EDUCATIONAL APPROACH

Understanding that the goal of any educational process is to affect positive changes in the learner’s knowledge, attitudes, and psycho-motor skills, this curriculum incorporates the following principles:

applied; all material is taught towards practical clinical application autonomy; encouraging learners in their individual critical-thinking and problem-solving

skills dignity and respect; an environment that values individuals from all ethnic groups and

cultures evidence-based; appreciating the scientific basis for what is taught learner-centered; encouraging the learner to actively participate in the educational process life-long learning; instilling the idea that learning extends beyond the formal educational

program itself multiple teacher roles; seeing the teacher as a fellow learner, the facilitator in the learning

process, as well as a professional role-model.

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CURRICULUM OVERVIEW

The academic year is made up of 17 weeks, each with 36 hours of classroom, laboratory, or clinical instruction. The total hours (not including examination periods) is 3672. According to current Afghan standards, each hour consists of 45 minutes of actual teaching time.

SEMESTER ONE WEEKLY HOURS Human Anatomy* ……………………………………………………………………………………….. 6Human Physiology* ……………………………………………………………………………………... 6Principles of Psychology ………………………………………………………………………………… 3Introduction to Kinesiology and Biomechanics ………………………………………………………. 3Introduction to Physical Therapy* ……………………………………………………………………... 10Professional Issues in Physical Therapy* ……………………………………………………………….. 2English …………………………………………………………………………………………………... 3Islamic Studies* …………………………………………………………………………………………. 2Information Technology* ……………………………………………………………………………….. 1

SEMESTER TWO Human Anatomy* ……………………………………………………………………………………….. 6Human Physiology* ……………………………………………………………………………………... 6Introduction to General Medical Sciences ………………………………………………………………. 6Introduction to Mental Health …………………………………………………………………………… 1Introduction to Physical Therapy* ……………………………………………………………………... 10Professional Issues in Physical Therapy* ……………………………………………………………….. 2English …………………………………………………………………………………………………... 2Islamic Studies* …………………………………………………………………………………………. 2Information Technology* ……………………………………………………………………………….. 1

SEMESTER THREE Neuroanatomy and Neurophysiology ………..…………………………………………………….……. 8Human Development in Relation to Physical Therapy Practice ………………………………………… 5Medical Sciences I (Musculo-Skeletal and Cardio-Respiratory) ……………………………………….. 4Physical Modalities and Electrotherapy …………………………………………………………………. 5Orthopaedic Physical Therapy …………………………………………………………………………... 8Cardio-Respiratory Physical Therapy …………………………………………………………………… 4English ……………………………………………………………………………………………………2

SEMESTER FOUR Clinical Rotations …………………………… FOUR placements of FOUR weeks each – 16 weeks totalSeminars / Independent Study ………………………………………………………………… ONE week

SEMESTER FIVE Medical Sciences II (Neurological and Psychological) ………………………………...……………….. 4Exercise Physiology……………………………………………………………………...……………..... 2Advanced Orthopaedic Physical Therapy ……………………………………………………………….. 6Neurological Physical Therapy ………………………………………………………………….……... 15Special Topics in Physical Therapy (Ob-Gyn, Burns, and Amputees) ………………………………….. 5Community-Based Rehabilitation ……………………………………………………………………….. 2English ……………………………………………………………………………………………………2

SEMESTER SIX Clinical Rotations ……………………………. FIVE placements of FOUR weeks each – 20 weeks totalSeminars / Independent Study ………………………………………………………………… ONE week

* Full year courses

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COURSE DESCRIPTIONS AND OBJECTIVES

HUMAN ANATOMY ‡ ‡

A study of gross and functional anatomy, covering upper extremity, lower extremity, and trunk regions. This course focuses on locomotor systems and their controls, including osteology, arthrology, myology and surface anatomy. This gives the anatomical foundation for further physical therapy study.

At the conclusion of this course, the student will:

1. Know the common terminology used in anatomy.2. Understand the general structure of the human body, its parts and their relationships together.3. Know the structure, classification and anatomical function of bones, joints, muscles, nerves,

ligaments and other soft tissues.4. Know the surface anatomy of the important structures of the human body.

HUMAN PHYSIOLOGY ‡

A study of the function of human organs and body systems. This gives the physiological foundation for further physical therapy study.


1. Know the physiological function and interrelationships of the nervous, muscular, circulatory, respiratory, immune, genito-urinal, reproductive, endocrine and digestive systems.

2. Know the normal bodily response to tissue injury.

PRINCIPLES OF PSYCHOLOGY ‡

An introductory course to the study of psychology; the student will gain a greater understanding of human behavior including: perception, cognition, learning and motivation.


1. Understand the biological basis of behaviour, learning and motivation.2. Understand human perception and cognition.3. Understand basic human psychological development and personality.

INTRODUCTION TO KINESIOLOGY AND BIOMECHANICS

The basic facts, concepts and techniques of analysis of human movement. Students will understand the physics of posture and movement as the basis of physical therapy treatment.


1. Have a basic understanding of kinematics and kinetics as applied to posture and movement.2. Have an adequate knowledge base to apply biomechanical principles to normal and pathological

conditions.

‡ Expected that a non-physical therapist will be involved teaching this course.

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INTRODUCTION TO PHYSICAL THERAPY

The entire field of physical therapy is surveyed. Included in this course are the principles of therapeutic exercise (massage, stretching, strengthening, physical education, group therapy), basic patient handling and care (transfers, lifts, and positioning), communication and evaluation skills (interview, ROM, goniometry, MMT), the basics of clinical reasoning, assistive devices and orthotics, as well as record keeping.


1. Understand the scientific basis and effectiveness of physical therapy evaluation and treatment procedures.

2. Obtain pertinent history and identify patient problems through interview and other evaluation procedures. Document relevant aspects of history, examination, assessment, planning and treatment.

3. Select and perform appropriate examination and interpretation of results including:a. body composition;b. posture;c. joint integrity and mobility;d. joint range of motion;e. endurance;f. strength;g. functional status;h. gait and balance;i. physiological response to exercise;j. basic pulmonary and cardio-vascular functions.

4. Discuss and implement basic therapeutic procedures such as: range of motion, exercise, strength training, mobilisation, and massage.

5. Understand functional training, orthotic and assistive devices as part of physical therapy.6. Demonstrate effective, safe and appropriate patient handling skills including sterile techniques,

environment awareness and proper body mechanics.

PROFESSIONAL ISSUES IN PHYSICAL THERAPY

An introduction to the profession of physical therapy. This includes the place of the profession in the health care system, legal issues, government regulation, medical ethics, communication and education in physical therapy, as well as the role of the professional association.


1. Understand the present state of physical therapy as it relates to the scope of practice and its place within the Afghan health care system.

2. Know the World Health Organization’s international classification of function (ICF)3. Understands the importance of ethics in physical therapy such as respecting the code of conduct. 4. Gain an appreciation for the caring nature of physical therapy and its scope of practice in

relation to patient care providers and other health care professions.5. Demonstrate effective and professional oral, non-verbal and written communication skills in

relation to the patient, family, health care providers and others with appropriate interviewing techniques and medical recording.

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6. Have basic knowledge and skills in advising and instructing patients based on educational theory.

7. Understand the issues related to legal regulation including the roles of the government and the professional association.

ENGLISH ‡ ‡

Basic conversational English and medical terminology related to physical therapy, to assist in working in an international environment and accessing physical therapy resources in English.


1. Know basic medical terminology in English.2. Be able to understand physical therapy resources written in English.3. Be able to actively participate in a basic medical conversation in English.

ISLAMIC STUDIES ‡

This course is to be administered in accordance to the academic requirements and teaching objectives of the department responsible for Islamic Studies.

INFORMATION TECHNOLOGY ‡

Basic computer skills are taught as a foundation for administration, record keeping, statistics, and research.


1. Be able to use properly word processing and spreadsheet computer software.2. Be able to find and use information from Internet resources.

INTRODUCTION TO GENERAL MEDICAL SCIENCES ‡

This course covers: first aid skills, nursing care, public health, medical laboratory and microbiology investigations, pharmacology, and radiology. This course provides basic medical knowledge and health care skills that affect physical therapy treatment.


1. Be able to give basic first aid, including cardiopulmonary resuscitation.2. Know general nursing skills such as infection control, general patient care, patient hygiene and

bowel and bladder care. 3. Understand the importance of physical therapy in public health practice, specifically in the areas

of general wellness, health promotion and disease prevention.4. Be able to effectively instruct patient and family how to prevent complications such as pressure

sores, deformation and contractures.5. Be able to interpret basic medical laboratory results and their effect on physical therapy

treatment.6. Understand the most common microbiological organisms and their effects.


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7. Knows the common medicines used in orthopaedic, neurological and respiratory diseases, their effects as well as proper dosage levels.

8. Understand the different diagnostic imaging methods, their effect on the human body as well as their benefits and limitations in physical therapy management.

INTRODUCTION TO MENTAL HEALTH ‡

An introduction to common mental disorders and their effect on physical therapy management. These include: psychosis, depression, anxiety disorders (including post-traumatic stress disorder), epilepsy, mental retardation and substance abuse.


1. Understand the importance of mental health as a primary health concern.2. Be able to describe some common psychological disorders: their causes, signs and management.3. Be able to identify persons with potential mental health problems, knowing when to refer to

other health care practitioners for patient problems outside the field of physical therapy and how to work with them in overall patient care.

NEUROANATOMY AND NEUROPHYSIOLOGY ‡

The detailed study of the central nervous system and the normal physiology of sensori-motor function. Common neurological conditions will be introduced, as well as the physiology of pain.


1. Be able to describe the anatomy of the central and peripheral nervous systems including the brain, spinal cord and peripheral nerves.

2. Be able to identify and describe the neural mechanisms associated with motor control, motor function, and pain.

3. Be able to identify how disruptions of these mechanisms result in impaired movement.4. Be able to identify the underlying principles and/or mechanisms for certain treatment strategies.5. Be able to discuss the implications for treatment of some motor control theories.

HUMAN DEVELOPMENT IN RELATION TO PHYSICAL THERAPY PRACTICE

The study of normal and abnormal development throughout the life cycle: from conception, fetal and child development to changes in the geriatric population. It includes an introduction to the particular aspects of physical therapy required for pediatric and geriatric patients. This course reinforces the holistic approach necessary for effective physical therapy management in these populations.


1. Understand human development and its implications about healthy functioning in all areas of life.

2. Be able to screen individuals to determine the need for physical therapy examination or referral to other health professionals.


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3. Be able to examine and interpret the result of examination of functional status, growth and life span development, gait and balance, motor control, posture, reflexes, righting and equilibrium reactions in childhood and old age.

4. Understand the unique needs in the physical therapy assessment and treatment in pediatric and geriatric populations.

5. Understand the total development of the person in her/his environment and the need to use an interdisciplinary approach (including family education) in providing physical therapy care.

MEDICAL SCIENCES I (MUSCULO-SKELETAL AND CARDIO-RESPIRATORY) ‡

The study of cause, nature and behavior of disease processes with special emphasis on musculo-skeletal and cardio-respiratory conditions. Normal bodily response to tissue injury will be introduced. This course deals with the medical and surgical management of disease and disability, not the physical therapy management.


1. Have knowledge of pathology, diagnosis and treatment of diseases commonly encountered by physical therapists in rheumatology and orthopaedics, vascular diseases, amputations, cardio-respirology, burns, endocrinology, metabolic disorders and nutrition.

2. Be able to explain the scope of medical and surgical practice by physicians, roles of other selected health professionals and their relationship to physical therapy.

3. Have a knowledge base for decision making regarding referral of problems of disease and disability, which are not within the scope of practice of physical therapy.

4. Have knowledge of causes of disease and disability as well as concepts of disease prevention and health promotion.

PHYSICAL MODALITIES AND ELECTROTHERAPY

The study of the physiological effects, indications and contraindications for heat, cold, electrotherapy, ultrasound, laser and vibration applications. Emphasis will be on the integration of modalities into the larger scheme of physical therapy management.


1. Be able to describe, safely operate and maintain the equipment used in applying:a. superficial heat and cold;b. ultrasound;c. short-wave diathermy;d. laser;e. pneumatic compression;f. electrical currents;g. electromyographic biofeedback.

2. Be able to explain, based on the research literature, the effects of physical agents and electrical modalities used in physical therapy practice.

3. Be able to explain normal and abnormal physical responses to treatment.4. Be able to select appropriate modalities for the management of pain, musculo-skeletal

dysfunction, problems of motor control, inflammation, edema, tissue healing and skin conditions with consideration of the indications and contraindications in each case.


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5. Be able to adapt physical agent or electrical modality treatment according to the clinical reasoning process.

6. Be able to record physical agent or electrical modality treatment and assess its outcome.7. Understand the use and limits of physical agent and electrical modality treatment in overall

physical therapy care.8. Perform selected electrical testing of peripheral nerve function and have a knowledge of other

electrophysiological tests for nerve and muscle function.

ORTHOPAEDIC PHYSICAL THERAPY

A study of basic principles of musculo-skeletal assessment and the physical therapy management of musculo-skeletal disorders. This includes the basic principles of interpreting radiographs as part of physical therapy assessment as well as the theoretical and practical principles of using assistive and orthotic devices.


1. Be able to apply knowledge of anatomy and physiology of the musculo-skeletal system to assessment and treatment of musculo-skeletal conditions.

2. Be able to describe the pathology, causes and prognosis of musculo-skeletal conditions.3. Understand the principles of musculo-skeletal assessment and demonstrate competence in:

a. Taking and recording an appropriate history from a patient (subjective examination);b. Selecting appropriate physical examination procedures and applying them accurately

and safely (objective examination); c. Interpreting the results of the examination, including radiological findings, and

making a physical therapy diagnosis (analysis).4. Recognize and identify, through a screening examination, conditions of systemic or serious

nature requiring referral to a physician.5. Recognize the scope of physical therapy in the management of musculo-skeletal conditions,

knowing when to refer to other health care practitioners for patient problems outside the field of physical therapy and how to work with them in overall patient care.

6. Be able to design, implement, and modify as indicated by re-assessment, a physical therapy treatment plan for musculo-skeletal conditions, using appropriate treatment techniques, including, but not limited to:

a. active exercise;b. application of physical agents or electrical modalities;c. education of patient and family / care giver;d. environmental modification;e. ergonomics;f. functional activities;g. gait and posture training;h. muscle strengthening;i. orthotic and assistive devices (taping, ambulatory aids);j. passive movement;k. soft tissue manipulation (stretching, massage);l. traction.

7. Be able to describe the medical and surgical management of musculo-skeletal conditions and the role of physical therapy in the management of the patient undergoing orthopedic surgery.

8. Be able to recognize indications, precautions and contraindications for physical therapy treatments and practice safe techniques at all times.

9. Record in writing the assessment findings, treatment plan, its implementation, re-assessment findings, and treatment plan changes.

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CARDIO-RESPIRATORY PHYSICAL THERAPY

Assessment and treatment techniques for respiratory and cardiovascular conditions will be studied. Although pathological status will be discussed the emphasis of the course will be on clinical application of cardio-respiratory physical therapy.


1. Recognize the scope of physical therapy in the management of cardiovascular and respiratory conditions, knowing when to refer to other health care practitioners for patient problems outside the field of physical therapy and how to work with them in overall patient care.

2. Be able to competently:a. assess and establish a physical therapy diagnosis for an individual with a suspected

respiratory and/or cardiovascular condition;b. plan a treatment program based on assessment findings and relevant diagnostic test

results (including, but not necessarily limited to radiology, blood gas analysis, oxymetry, electrocardiograms, pulmonary function testing, exercise tolerance testing);

c. apply appropriate physical therapy techniques in respiratory and cardiovascular care, including, but limited to:

i. active breathing exercises; ii. basic exercise programs;

iii. education of patient and family / care-giver;iv. inhalation therapy;v. manual and mechanical vibrations / percussions;

vi. postural drainage.3. Have a working knowledge of equipment used in the Intensive Care Unit (ICU) including

oxygen delivery systems, monitors, ventilators and suctioning apparatus.4. Understand the team approach to pulmonary and cardiac rehabilitation.5. Be introduced to current research in cardio-respiratory studies with an emphasis on the scientific

basis of cardio-respiratory physical therapy.

CLINICAL PLACEMENTS – YEAR TWO

This course consists of 16 weeks (4 placements of 4 weeks each) of clinical practice in rehabilitation centers, clinics and hospitals (in-patients and out-patients).

The students will integrate and apply the knowledge previously acquired from theoretical lessons and practical laboratories primarily related to orthopaedic and cardio-respiratory conditions, both in adults and children.

The student should have the opportunity to observe all aspects of physical therapy. It is expected that the student will mainly be involved with assessment and supervised treatment. The primary goal is to reinforce the framework for effective clinical practice.

At the conclusion of these placements the student must be able to perform the following according to the skills and knowledge learned to this point:

1. Assess the patient 2. Combine and analyse all information collected3. Plan the treatment and prioritize patient goals

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4. Provide direct physical therapy treatment 5. Evaluate results and adjust the treatment plan 6. Demonstrate professional behavior with patients, care-givers and other health-care providers7. Understand the multi-disciplinary approach in the health care system and effectively

communicate with medical, nursing and other health care providers8. Maintain patient records

MEDICAL SCIENCES II (NEUROLOGICAL AND PSYCHOLOGICAL) ‡ ‡

The study of cause, nature and behaviour of disease processes with special emphasis on neurological and psychological conditions. The course deals with the medical and surgical management of disease, physical and mental disability, not the physical therapy management.


1. Have knowledge of pathological factors, clinical signs and symptoms, secondary complications, prognosis and treatment of diseases commonly encountered by physical therapists in neurology including upper and lower motor neuron lesions, neuromuscular diseases and pediatrics.

2. Be able to explain the scope of medical and surgical practice by physicians, roles of other selected health professionals and their relationship to physical therapy.

3. Have a knowledge base for decision making regarding referral of problems of disease and disability, which are not within the scope of physical therapy practice.

4. Have knowledge of causes of disease and disability as well as concepts of disease prevention and health promotion.

EXERCISE PHYSIOLOGY

This course is concerned with the effects of physical activity at the cellular level as well as the physiological basis for specificity of training, exercise and aerobic and anaerobic energy production. The influences of growth, aging and health on exercise responses will also be examined.


1. Understand the concepts and mechanisms of the physiology effects of physical exercise in healthy individuals.

2. Understand how various diseases affect normal exercise physiology and change the ability to perform exercise.

3. Understand the limiting factors to exercise performance in both healthy and clinical populations.4. Be aware of the possible ways to improve exercise performance in both normal and clinical

populations.5. Have knowledge of a variety of “field” measures of exercise performance.

ADVANCED ORTHOPEDIC PHYSICAL THERAPY

Functional anatomy and pathomechanics of selected regions of the neuro-musculo-skeletal system will be studied in detail. Then, more in-depth techniques of manual therapy assessment and treatment of neuro-musculo-skeletal disorders will be introduced.

At the conclusion of this course, the student will:‡ Expected that a non-physical therapist will be involved teaching this course.

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1. Be familiar with the functional anatomy, normal and pathological mechanics of spinal and peripheral joints, as well as the associated neural connections.

2. Be able to choose, perform and adapt selected objective tests including active and passive physiological movements, accessory movements and other special tests for spinal and peripheral joints and soft tissues.

3. Be able to use knowledge of functional anatomy, biomechanics, pathomechanics, assessment principles with clinical findings to establish a physical therapy diagnosis for different types of dysfunction.

4. Understand and apply the Cyriax, Maitland and Kaltenborn approaches in the comprehensive assessment and treatment of spinal / peripheral joint and soft tissue dysfunctions.

5. Understand the concepts of neurogenic pain and be able to apply them in nerve tension testing and nerve mobilization.

6. Be able to identify the indications and contraindications for, as well as explain the effects of manual therapy.

7. Be able to develop a comprehensive and integrated approach to the management of neuro-musculo-skeletal disorders.

NEUROLOGICAL PHYSICAL THERAPY

Basic principles and application of physical therapy in the management of neurological disorders, including assessment, theory and physiological basis will be introduced. Practical experience is provided with the most commonly seen conditions (cerebral vascular accident, spinal cord injury, peripheral nerve injury, polio, cerebral palsy, spina bifida, and others).


1. Be able to apply knowledge of anatomy and physiology of the nervous system to assessment and treatment of neurological conditions.

2. Understand the principles of neurological assessment and demonstrate competence in:a. Taking and recording an appropriate history from a patient or family member

(subjective examination);b. Selecting appropriate physical examination procedures and applying them accurately

and safely (objective examination); c. Interpreting the results of the examination (analysis)

3. Recognize and identify, through a screening examination, conditions of systemic or serious nature requiring referral to a physician.

4. Recognize the scope of physical therapy in the management of neurological conditions, knowing when to refer to other health care practitioners for patient problems outside the field of physical therapy and how to work with them in overall patient care.

5. Be able to design, implement, and modify as indicated by re-assessment, a physical therapy treatment plan for common neurological conditions, using appropriate treatment techniques.

6. Be able to describe the medical and surgical management of neurological conditions and the role of physical therapy in the management of the patient undergoing neurological surgery.

7. Be able to recognize indications, precautions and contraindications for physical therapy treatments and practice safe techniques at all times.

8. Record in writing the assessment findings, treatment plan, its implementation, re-assessment findings, and treatment plan changes.

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SPECIAL TOPICS (OBGYN, BURNS, AMPUTEES)

The obstetrics and gynaecology section of this course covers reproductive endocrinology, normal pregnancy and delivery, as well as etiology, pathology, as well as the medical and physical therapy management of common disorders. In the burns section, causes and prognosis as well as techniques such as mobilization, casting and positioning of those patients will be introduced. The third part of the course will study the in-depth management of clients with limb amputations.


1. Have knowledge of the functional anatomy of the pelvic floor and reproductive endocrinology2. Have knowledge of normal pregnancy, labor and delivery, maternal and fetal complications, and

diseases complicating pregnancy.3. Understand the role of physical therapy in obstetrics and gynecology.4. Be able to:

a. perform a subjective and objective physical therapy assessment for pregnant and postpartum populations;

b. plan and implement an appropriate physical therapy treatment program for these populations (including, but not necessarily limited to exercise prescription, relaxation and pain-relieving techniques ).

5. Have knowledge of the functional anatomy of the skin.6. Understand classification of burn injuries, concepts of wound healing and scarring, principles of

wound care, and the implications for physical therapy.7. Understand the role of physical therapy in the prevention of disability and management of

burns.8. Be able to:

a. perform a subjective and objective physical therapy assessment of a burn patient;b. plan and implement an appropriate physical therapy treatment program for a burn

patient.9. Have knowledge of the causes of extremity amputation, the levels at which amputations are

performed, and the available prosthetic replacement of amputated limbs.10. Understand the social and psychological effects of limb amputation.11. Understand the role of physical therapy in the management amputations and the social re-

integration of the affected individual.12. Be able to:

a. perform a subjective and objective physical therapy assessment of a patient with an amputation;

b. plan and implement an appropriate physical therapy treatment program of a patient with an amputation (including, but not necessarily limited to strengthening and stretching exercises, residual limb management, and mobility, gait, balance and functional retraining).

COMMUNITY-BASED REHABILITATION

The course examines current models of community practice and focuses on knowledge needed to provide rehabilitation services based on the social-community model.

At the end of this course, the student will:

1. Be able to describe the current situation of disability in Afghanistan.2. Be able to identify the social, political, governmental, economic, cultural, and religious factors

that affect attitudes towards and the general treatment of people with disabilities and handicaps.

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3. Understand the basic principles of community development, and how they relate to rehabilitation in the community.

4. Understand the situations from which many patients come from and to which they will return.5. Be able to effectively participate in a local survey of disability with community-health workers.6. Demonstrate the ability to use the home environment and locally available materials to

perform/teach physiotherapy to patients/family members and be provide adequate follow-up care.

7. Be able to conduct a community meeting in a participatory fashion to promote disability awareness and to teach health promotion, disability prevention and integration.

8. Demonstrate an awareness of home/family/community priorities in planning treatment intervention as indicated by appropriate questions in the evaluation process and the choice of appropriate treatment goals and methods.

9. Be able to work with/train medical staff and community-health workers to provide rehabilitation services.

10. Be able to describe in detail the disability related resources available in Afghanistan, and be aware how to access these resources appropriately. (WHO’s “Training in the community for people with disabilities”)

CLINICAL PLACEMENTS – YEAR THREE

This course consists of 20 weeks (5 placements of 4 weeks each) of clinical practice in rehabilitation centers, clinics and hospitals (in-patients and out-patients) as well as community-based rehabilitation services.

The students will integrate and apply the knowledge previously acquired from theoretical lessons and practical laboratories related to all conditions including orthopaedic, cardio-respiratory and neurological, both in adults and children.

It is expected that the student will mainly be involved with all aspects of physical therapy practice including assessment and treatment. The primary goal is to progress the student to becoming an independent professional.

At the end of these placements the student must be able to perform the following according to the skills and knowledge learned to this point:

1. Assess the patient.2. Combine and analyze all information collected.3. Plan the treatment and prioritize patient goals.4. Provide direct physical therapy treatment.5. Evaluate results and adjust the treatment plan.6. Give effective health care advice, prevention information and train care-givers when

required (families, other health professionals, community workers).7. Demonstrate professional behavior in all interaction with patients, care-givers and other

health-care providers.8. Understand the multi-disciplinary approach in the health care system and effectively

communicate with medical, nursing and other health care providers.9. Maintain patient records.10. Work as independent, safe and effective professional physiotherapist.

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Documents

PROPOSED THREE- YEAR CURRICULUM · Web viewfor Physical Therapist Training in Afghanistan November 2006 Table of Contents Acknowledgements . 3 Background . 4 Physical Therapist Job