"appraising physiotherapy practice 2007 2008"
University of the West of England Faculty of Health and Life Sciences BSc (Hons) Physiotherapy Neurology Syllabus Year 1 Neurology Sensory/motor system overview To locate anatomically the meninges and explain their function to include function of cerebro-spinal fluid To locate anatomically the 4 lobes of the brain, the cerebrum (cerebral hemispheres and basal ganglia) , thalamus and hypothalamus To locate anatomically key landmarks including central gyrus and longitudinal fissure for purposes of future orientation To locate anatomically the cerebellum To locate anatomically the basal ganglia To locate anatomically the pons, medulla and mid-brain To locate anatomically the spinal cord To distinguish between central nervous system (CNS) and peripheral nervous system (PNS) To distinguish between divisions of PNS i.e. sensory- motor and autonomic To distinguish between divisions of autonomic nervous system To be familiar with the meaning of the following terms; afferent, efferent, effector, ascending tracts, descending tracts. Histology of Nerve tissue Describe the structure of a neuron. Draw a neat labelled diagram Briefly highlight the functional significance of axon, axon hillock, dendrite, and cell body. Explain the functional significance of the Myelin Sheath Define the following terms Node of Ranvier, Terminal Boutons, Pre-synaptic terminals, Unipolar, Bipolar, Multipolar, Sensory neuron, motor neuron, interneuron. 1 Name the 3 connective tissues around the nerve and briefly explain how the histological structure relates to their function Briefly explain how the histological structure of the following nerve fibre types relates to their function Type A nerve, Type B and Type C Identify and briefly explain the functions of the Neuroglia in PNS and CNS Electrical Activity in the Nervous System Define the following terms Open channels, Voltage-gated channels, Ligand-gated channels, Resting membrane potential, Graded potential , Synapse, Synaptic transmission, Neurotransmitters, Spatial summation, Temporal summation, Pre-synaptic facilitation, Pre-synaptic inhibition, Chemical synapse , Electrical synapse Briefly explain the relevance of Sodium – Potassium Pump (NA+ - K). Identify the structures where the following neurotransmitters are found Acetylcholine, Dopamine, Epinephrine, Histamine, Endorphins, Substance P Enkephalins. Explain the stages of event occurring as a result of Action Potential Define and briefly explain the significance of neuromuscular junction (NMJ) Explain the significance of spatial and temporal summation Sensory System To identify the range of sensory modalities experienced as part of everyday life To identify the range of sensory receptors needed to gather respective sensory stimuli To understand that stimuli (mechanical, thermal, chemical etc.) are transduced to give rise to a graded potential To understand the term graded potential and understand the relationship between graded potential and action potential To understand the concept of adaptation in the context of sensory receptors To broadly outline the neuro anatomy involved in the transmission of sensory information (receptors, sensory neurones, dorsal root ganglion, dorsal horn spinal cord, ascending tracts, key central nervous system centres) 2 To detail the following; o Spinothalamic tract o Dorsal column medial lemniscus pathway To identify and understand the function of Spino cerebellar tract To locate the primary sensory cortex anatomically and introduce its structure and function To introduce the sensory homunculus To locate the sensory association area and introduce its function Spinal Cord Describe the gross structure of the spinal cord (should be familiar with the following) Extension of the spinal cord – Vertebral level, spinal level Spinal enlargements and reasons for these Coverings of the spinal cord including the Meninges Sub-arachnoid space and its significance Filum terminale Define the term cauda Equina and briefly explain its significance Describe the internal structure of the spinal cord (student should be able to identify the following in the transverse section of the spinal cord) Grey matter – the reason it is grey White matter – the reason it is white Anterior horn cell – (Cell body of motor neuron (Final common-pathway) Posterior horn cell (Sensory neuron) Lateral horn cell – (Autonomic neurons) Posterior ganglion – (Cell body of the sensory neuron) Define the term stretch reflex (proprioceptive) and briefly explain the mechanism of the stretch reflex. Illustrate a simple reflex arc with a diagram Define the terms Upper motor neuron and lower motor neuron. Briefly explain the differences between these two types of neurons Briefly explain the term Common Final Pathway Define the terms Alpha Motor neuron, Gamma motor neurons , Motor unit, Motor unit recruitment, Dermatomes, Myotomes, Reciprocal innervation , Monosynaptic / Polysynaptic, Ipsilateral / Contralateral, Intersegmental, Plantar reflex or Babinski’s sign. 3 Define and briefly explain the functional significance of Flexor withdrawal reflex &crossed extensor reflex Briefly discuss the functions of Spinal cord Brainstem Identify the location of the brainstem Name the structures which constitute the brainstem (from top to bottom) Name the 12 pairs of cranial nerves Identify the location of midbrain Identify the following structures in the midbrain and briefly explain their significance Superior Colliculus, Raphe Nucleus , Periaqueductal Gray matter, Red nucleus, Substantia Nigra Identify the origin, pathway, termination of the Tectospinal tracts. Briefly explain the functional significance of Tectospinal tracts. Draw a labelled diagram to illustrate the pathway Identify the origin, pathway, termination of the Rubrospinal tracts. Briefly explain the functional significance of Rubrospinal tracts. Draw a labelled diagram to illustrate the pathway Name the cranial nerves whose cell bodies are located in the Midbrain Identify the location of Pons Identify the following structures in the Pons and briefly explain their functional significance Respiratory centres, Reticular Formation Explain in detail the origin, pathway, termination and function of the Medial Reticulospinal tracts. Draw a labelled diagram to illustrate the pathway Name the cranial nerves whose cell bodies are located in the Pons Identify the location of Medulla Oblongata Identify the following structures in the Medulla and briefly explain their functional significance 4 Pyramid, Cardiovascular centre, Medullary rhythmicity centre, Reticular Formation Explain in detail the origin, pathway, termination and function of the Lateral Reticulospinal tracts. Draw a labelled diagram to illustrate the pathway Name the cranial nerves whose cell bodies are located in the Medulla Name the tract that originates from the VIII cranial nerve nuclei Explain in detail the role of Reticulospinal tracts in the maintenance of normal muscle tone Cerebrum Identify the location of cerebrum Define the following terms Cerebral hemisphere, Longitudinal fissure , Cerebral cortex, Gyrus, Sulcus, Central Sulcus, Lateral Sulcus, Lobes, Association fibres, Projection fibres, Corpus Callosum , sensory cortex, Motor cortex . Name the lobes of the brain and briefly highlight their functions Identify the following structures in the brain and explain their functional significance Primary somatosensory area, Somatosensory association area, Primary Motor area, Supplementary motor area, Pre-motor area, ,Pre-frontal cortex, Broca’s area, Wernicke’s area, Auditory area, Visual area, , Internal Capsule, Thalamus, Hypothalamus . Explain in detail the origin, pathway, termination and function of the Cortico- spinal tracts. Draw a labelled diagram to illustrate the pathway Briefly explain the origin, pathway, termination and function of the Cortico- bulbar tracts. Draw a labelled diagram to illustrate the pathway Identify the connections cortex makes with the other parts of the central nervous system. Briefly explain the functional significance of these connections Cerebellum To locate the cerebellum on relation to other CNS structures 5 To identify the functional lobes of the cerebellum and explain their function To develop an understanding of the functional relationship which the cerebellum has with other parts of the PNS and CNS in terms of inputs to and outputs from the respective functional lobes of the cerebellum To develop an understanding of and explain in detail the role of the cerebellum as a ‘comparator’ in producing coordinated movement To develop an understanding of and explain in detail the role of the cerebellum in maintaining postural tone and balance Given that the cerebellum has no direct access to spinal motor neuron pools, to explain in detail how the cerebellum exerts its influence Vestibular System To identify, locate anatomically and explain the role of vestibular sensory receptors To explain the mechanisms involved in detecting rotary and linear movements of the head To be aware of the role of the ocular-motor reflex in relation to stabilising an image on the retina Explain the pathways involved in conducting vestibular information centrally Identify the CNS centres to which vestibular information is conveyed Identify and broadly locate the vestibular nuclei To identify the vestibulo-spinal tracts in terms of their origin and termination and understand their function To understand the functional relationship between the vestibular system and the cerebellum To explain the function of the vestibular system in regulating movement and posture Basal Ganglia To identify and locate (broadly) the 5 nuclei which make up the basal ganglia To develop an understanding of the functional relationship which the basal ganglia have with other parts of the CNS in terms of inputs to and outputs from the nuclei (i.e. identify input and output nuclei and their connections) To understand the effect which the output nuclei have on the thalamus, thus ultimately effecting movement via indirect influence on cortical motor areas To explain the role of the basal ganglia in maintaining postural tone and to briefly outline the pathways involved. 6 Year 2 Neurology September 2008 – November 2008 Paediatrics, Adult Neurology, Care of the Elderly, Mental Health, Learning Disability Lectures Seminar / Practical 1. Neurological Assessment 1. Rehabilitation – what is it? Setting 2. Gullian Barre Syndrome GBS the scene 3. ICF 2. Introduction to Neurological 4. Neuroplasticity 1 Assessment 5. National Service Framework 3. Guillain Barre/Lesions of Peripheral 6. Stroke - Cortex Nervous System Rehabilitation 7. Stroke – patient perspective principles 8. Stroke- Perception 4. Central Nervous System/Stroke - 9. Multiple Sclerosis – patient Rehabilitation principles perspective 5. Rehabilitation of the Acute Patient – 10. Multiple Sclerosis – Research E.g. GBS, Acute Stroke 11. Imaging Techniques 6. Outcome measures – ICF, SMART 12. Neuro Community Practitioner goals, few OM practiced – Gross 13. Neuroplasticity ll motor function, Timed Up and Go, 14. Outcome Measures Motor Assessment Scale, Quality of 15. Parkinson’s disease - Basal Life Questionnaire - Application Ganglia 7. Gait – Practical 16. Gait Analysis – normal and Rehabilitation principles abnormal 17. Muscle tone / Hypertonicity – Eclectic / Tool kit approach is taken. A wide range of therapeutic options Hypotonicity (Spasticity, Spastic dystonia) . are discussed and put into practice – E.g. Exercise therapy, Facilitation of movement, functional tasks etc. Spinal Cord Injury Study Day – Salisbury District Hospital January 2008 – February 2008 Lectures Seminar / Practical 1. Normal development / Normal 1. Working with Altered Tone Postural Control Mechanism 2. Paediatric Seminar – Spasticity 2. Cerebral Palsy - Abnormal 3. Athetosis /Ataxia seminar Postural Control Mechanism 4. Student led presentations - Bobath / 3. Paediatric Assessment Conductive education, Sensory 4. Paediatric OT Integration 7 5. Traumatic Brain Injury 5. Postural management 6. TBI Practitioner 6. Play 7. Postural management 7. Mental Health 1, 2 8. Music Therapy 8. Group work 9. Psychology 1, 2, 3, 4 9. Care of the elderly 10. Premature birth 10. Treatment approaches – Bobath, 11. Paediatric Rheumatology Movement Science 12. Working with Children and 11. Peripheral Nerve Injuries Families 12. PNF 13. Mental Health 1, 2, 3 13. Balance 14. Paediatric Orthotics 15. Paediatric orthopaedics 16. Paediatric orthopaedics Surgery 17. Laughter Therapy 18. Elderly care 19. Effects of ageing 20. Mental Health Practitioner 21. Mental Health – patient 22. Communication 23. Learning difficulties – Practitioner 24. Learning difficulties 1, 2 April 2009 – May 2009 Lectures Seminar / Practical 1. Therapeutic Handling Year 3 Neurology November 2008- December 2008 Lectures: 1. DART Lecture – VL 2. Neurophysiotherapy – changing practice 3. Paediatric patients on the ICU Seminar / Practical 8 Seminar 1: To discuss dilemmas facing neurology physiotherapists in relation to evidence- based practice Discussion of 1. Pomeroy, V. and Tallis, R. (2002) Neurological rehabilitation: a science struggling to come of age. Physiotherapy Research International 7(2) pp76-89. 2. Pomeroy, V.M. and Tallis, R.C. (2003) Avoiding the Menace of Evidence- tinged Neuro-rehabilitation. Physiotherapy. 89 (10) pp595-601 3. Wade DT (2001) Research into the black box of rehabilitation: the risks of a Type III error. Clinical Rehabilitation 15 pp1 – 4. Seminar / Practical 2 Discussion of : Mudge, S. and Stott, S.N. (2007) Outcome measures to assess walking ability following stroke: a systematic review of the literature. Physiotherapy. 93(3) pp189-200. Practical: Practice physiotherapy intervention and use of outcome measures for problems associated with upper motor neuron disruption. Outcome Measure [Rivermead Visual Gait, and Wisconsin Gait Scale] Case study – CVE Seminar / Practical 3 Critically appraise the article Hunter et al (2006) Development of treatment schedules for research: a structured review to identify methodologies used and a worked example of ‘mobilisation and tactile stimulation’ for stroke patients. Physiotherapy 92 (4) pp195-207 Practical: Case study Discuss the importance of utilising an eclectic approach to the management of neurological disorders. Demonstrate a range of practical skills relating to the physiotherapeutic management of neurological disorders affecting the upper limb. 9 10