1

Orthopaedic

Physical Therapy

Residency

Resident’s Handbook

2013-2014

General Residency Program Information

Estimated Number of Residents Per Year: 4

Duration of Program: 12-36 months

Start Date & Anticipated End Date: August 1st– July 31st

Tuition: $7,500. Continuing education benefits will be utilized by PTF employees to cover

the tuition cost.

PROGRAM FACULTY

ADMINISTRATORS – PHYSICAL THEAPY FIRST

John Baur, PT, DPT, OCS

RESIDENCY PROGRAM DIRECTOR

Ray Moore, PT, DPT, OCS

RESIDENCY PROGRAM COORDINATOR

Beth Glessner, Esq

CLINICAL FACULTY / MENTORS

Maureen Ambrose, PT, DPT, OCS

John Baur, PT, DPT, OCS

Ray Moore, PT, DPT, OCS

CLASSROOM / LAB INSTRUCTOR(S)

Kathleen Berglund, PT, DSc, FAAOMPT, COMT, OCS, ATC

CURRICULUM OUTLINE

Each resident receives a minimum of:

  • 370 Hours of Didactic Education
  • 200 Hours – Classroom/Lab Instruction, With Online Learning & Testing
  • 96 Hours - Lab Instruction
  • 104 Hours - Online Learning
  • 170 Hours – Independent Study Modules from APTA-Ortho Section (5 hours/module x 34 modules)
  • 150 Hours – 1:1 supervision while treating patients (3 hours per week, 50 weeks)
  • 1,100 Hours – Clinical Practice

Content of all didactic education (classroom, lab and online learning) encompass the following areas:

Online & Didactic/Lab Coursework

  • Module I: Biomechanical Assessment Treatment of the Lumbar Spine
  • Module II: Biomechanical Assessment Treatment of the Cervical Spine
  • Module III: Biomechanical Assessment Treatment of the Thoracic Spine
  • Module IV: Assessment, Treatment Manipulation of Peripheral Joints

Independent Study Modules – Orthopaedic Section of the APTA, Inc

  • Current Concepts of Orthopaedic Physical Therapy – 12 Modules
  • Postoperative Management of Orthopaedic Surgeries – 6 Modules
  • Pharmacology – 6 Modules
  • Diagnostic Imaging in Physical Therapy – 3 Modules
  • Clinical Applications for Orthopaedic Basic Science – 7 Modules

PROGRAM HOURS

Instruction / Method of Instruction
Online Hours / Laboratory Hours
CLASSROOM / LABORATORY INSTRUCTION
  • Module I: Biomechanical Assessment and Treatment of the Lumbar Spine
/ 26 / 24
  • Module II: Biomechanical Assessment and Treatment of the Cervical Spine
/ 26 / 24
  • Module III: Biomechanical Assessment and Treatment of the Thoracic Spine
/ 26 / 24
  • Module IV: Assessment, Treatment and Manipulation of the Peripheral Joints
/ 26 / 24
RESIDENT – DIRECTED STUDY
  • Basic Science & Tissue Healing
/ 15
  • Radiology
/ 12
  • Operative Procedures & Post-Operative Management
/ 40
  • Current Concepts of Orthopaedic Physical Therapy
/ 78
  • Pharmacology
/ 12
CLINICAL PRACTICE
  • 1:1 Clinical Mentoring / Instruction From Clinical Faculty While Treating Patients
/ 156 Hours
  • 1:1 Patient / Client Related Planning/Discussion/Review of Diagnostic Tests, Evaluations, Plan of Care, Etc….
  • Written Exam (Online)
  • Oral Skills Practical
  • Live Patient Examinations (Q & A in Clinic)
  • Skills Assessment (During Mentorship)
/ 6 Hours
30 Minutes / Skill
2 Hours
4 Hours
  • Clinical Review Session With Faculty
/ 20 Hours
  • Clinical Practice (Mentor Accessible)
/ 1,100 Hours

CURRICULUM Sequencing

Content is designed to progress residents through advanced orthopaedic treatment and differential diagnosis training during onsite lab intensives. Residents will simultaneously progress through online learning modules and testing platform related content as outlined by the most recent DSP publication for clinical content. Content will be designed to best fit the flow of the clinical lab material. The emphasis during clinical supervising and mentorship will focus on but not be limited to current topics in didactic program.

Week # / Supervised Mentorship / 1:1 Direct Mentorship / Structured Adjunct Learning / Weekend Clinical Intensives
1
2 / 21 Hours / 3 Hours / Basic Orthopaedic Science
(5 weeks) / Module I Lab: Biomechanical Assessment and Treatment of the Lumbar Spine
(3 days, 24 hours)
3 / 21 Hours / 3 Hours / Module I - Online Learning
(26 hours)
4 / 21 Hours / 3 Hours
5 / 21 Hours / 3 Hours
6 / 21 Hours / 3 Hours
7 / 21 Hours / 3 Hours
8 / 21 Hours / 3 Hours / Radiology (3 weeks)
9 / 21 Hours / 3 Hours
10 / 21 Hours / 3 Hours / Module II Lab: Biomechanical Assessment and Treatment of the Cervical Spine
(3 days, 24 hours)
11 / 21 Hours / 3 Hours / Orthopaedic Rehabilitation and Surgical Procedures
(10 weeks) / Module II - Online Learning
(26 hours)
12 / 21 Hours / 3 Hours
13 / 21 Hours / 3 Hours
14 / 21 Hours / 3 Hours
15 / 21 Hours / 3 Hours
16 / 21 Hours / 3 Hours
17 / 21 Hours / 3 Hours
18 / 21 Hours / 3 Hours / Module III: Biomechanical Assessment and Treatment of the Thoracic Spine
(3 days, 24 hours)
19 / 21 Hours / 3 Hours / Module III - Online Learning
(26 hours)
20 / 21 Hours / 3 Hours
21 / 21 Hours / 3 Hours / Current Topics in Orthopaedic Rehabilitation
(26 weeks)
22 / 21 Hours / 3 Hours
23 / 21 Hours / 3 Hours
24 / 21 Hours / 3 Hours
25 / 21 Hours / 3 Hours
Module IV: Assessment, Treatment and Manipulation of the Peripheral Joints
(3 days, 24 hours)
26 / 21 Hours / 3 Hours / Module IV - Online Learning (26 hours)
27 / 21 Hours / 3 Hours
28 / 21 Hours / 3 Hours
29 / 21 Hours / 3 Hours
30 / 21 Hours / 3 Hours
31 / 21 Hours / 3 Hours
32 / 21 Hours / 3 Hours
33 / 21 Hours / 3 Hours
34 / 21 Hours / 3 Hours
35 / 21 Hours / 3 Hours
36 / 21 Hours / 3 Hours
37 / 21 Hours / 3 Hours
38 / 21 Hours / 3 Hours
39 / 21 Hours / 3 Hours
40 / 21 Hours / 3 Hours
41 / 21 Hours / 3 Hours
42 / 21 Hours / 3 Hours
43 / 21 Hours / 3 Hours
44 / 21 Hours / 3 Hours
45 / 21 Hours / 3 Hours
46 / 21 Hours / 3 Hours
47 / 21 Hours / 3 Hours / Pharmacology (4 weeks)
48 / 21 Hours / 3 Hours
49 / 21 Hours / 3 Hours
50 / 21 Hours / 3 Hours
51 / 21 Hours / 3 Hours
52 / 21 Hours / 3 Hours
53 / 21 Hours / 3 Hours

Course Descriptions

Module I: Biomechanical Assessment and Treatment of the Lumbar Spine.

Format: 3 day onsite seminar/laboratory, online discussion board, videos of technique, Power point Presentations of related material and anatomy, course manual, descriptive anatomy test.

Moderator: Josh Renzi, PT, MSPT, lecturer

Contact: Beth Glessner, Tel: 410-662-7977,

Duration: 8 weeks

Course syllabi, course description, educational objectives, requirements for successful completion, and teaching methods.

Description: This course is designed prepare the therapist with an essential background in examination and selection of evidence based interventions for lumbar spine. Attention will be given to selected manual therapy interventions, indications and contraindications.

Education methods will include: 24 hours classroom didactic training and lab, review and online testing of course material, course manual, supplemental videos and 26 hours of online guided learning.

Onsite Seminar: 24 hours didactic/laboratory. 26 hours online course preparation hours

Objectives and Requirements for Completion: Upon completion of the course the therapist will be able to identify the common condition scripts for lumbar spine and pelvis, pass a clinical skills evaluation, and online testing covering the didactic and course manual material.

Syllabi:

Module I Manual:

  1. Clinical Reasoning in Pathoanatomical Diagnosis and Treatment
  2. Illness (Condition) Scripts
  3. Making the Diagnosis
  4. Cognitive Bias and Errors
  5. Reducing Bias and Error
  6. Clinical Reasoning Methods
  7. Condition Scripts,
  8. Algorithms
  9. The Objective Examination
  10. Positive and Negative Examinations .
  11. Basis of the Cyriax Examination
  12. Inappropriate Conditions
  13. Systems Examination
  14. General Neuro‐musculoskeletal Examination Outline
  15. The Scan Examination
  16. The Subjective Examination

Module I: Lumbar Spine *in class / Topics
Anatomy , biomechanics and pathomechanics
  • Descriptive
  • Surface*
  • Applied*
/
  • lumbar vertebrae
  • pelvis
  • hip

Conditions
(incidence/ prevalence, and presentation* /
  • Lumbar disc herniation
  • Lateral stenosis
  • Central stenosis
  • Acute cauda equine syndrome
  • Spondylolisthesis
  • Claudication
  • Segmental dysfunction
  • Systemic arthropathies (AKS, RA, reactive arthritis)
  • Sacroiliitis (systemic, traumatic, microtraumatic)
  • Neoplastic disease
  • Radiculopathy
  • Peripheral neuropathy
  • Myelopathy
  • osteoporosis
  • Whiplash

Clinical reasoning* /
  • Pattern recognition
  • Hypothetic-deduction
  • Illness scripts
  • SFD
  • Bias correction
  • DDx,
  • Diagnosis specific treatment
  • Prognosis

Assessment techniques
Medical diagnostic *
Segmental* /
  • Scan examination
  • Neurophysiological (multifidus, quadrants)
  • Biomechanical (PPIVMs, translation)

Treatment and management techniques* /
  • Specific exercise prescription for above conditions
  • Mechanical and manual traction
  • Pain modulation treatments
  • Low grade mobilizations
  • Electrical stimulation
  • Exercises
  • Cryo-thermal
  • Rest and back supports
  • Referral out for medical treatment and investigation
  • Lumbar regional manipulation
  • Rotational specific manipulation
  • Hip manipulation
  • Stabilization therapy
  • Movement rehabilitation therapy

Medical management and investigations for above conditions /
  • X-ray
  • MRI
  • CAT
  • Radio-uptake scans
  • Blood work
  • EEG and nerve conduction studies
  • EKG

SPECIFIC COURSE OBJECTIVES:

Module I objectives:

  1. Clinical applications and interpretation of Cyriax clinical exam.
  2. Interpreting active passive, and resistive testing
  3. Performing and interpreting Passive physiological intervertrebral motion testing
  4. Stability testing of the spine
  5. Neurologic testing
  6. Red and yellow flag recognitions and interpretation.
  7. Selected intervention for Condition scripts.
  8. Condition Scripts
  9. Identification of typical presentation of selected pathology for the Lumbar Spine and Pelvis.
  10. Hypothesis testing for specific illness scripts
  11. Spinal stenosis
  12. Spondylolisthesis
  13. HNP
  14. Segmental dysfunction
  15. Spinal instability
  16. Visceral, cancers
  17. Selected Interventions based on clinical evidence:
  18. Appropriate application of Stabilization techniques
  19. Appropriate application of Therapeutic exercise and PNF
  20. Selected manipulation
  21. Lumbar
  22. Pelvis
  23. Online Course Learning Objectives
  24. Understand the application of selective tissue tension testing system to the spine and extremity joints and recognize, interpret and appraise the test results of the following:
  1. contractile and inert tissues lesions
  2. dural and neural mobility problems
  3. spinal cord, spinal nerve and nerve root compression/compromise signs and symptoms
  4. normal and abnormal end feels to motion
  5. capsular and non-capsular patterns of restriction
  6. tendonitis, tendonosis, tenosynovitis and bursitis
  7. resisted/resistive tests
  8. Scanning examinations of the lumbo/sacral spine
  9. A complete and detailed history and systems review
  10. Active, passive & resisted (resistive) tests to determine status of tissues
  11. Routine neuromeningeal tension/mobility tests
  12. Neurological tests of function spinal nerve, nerve root, peripheral nerve
  13. Neurological tests for function of CNS including dynamic stretch reflexes (deep tendon, clonus), nociceptive reflexes (Babinski, Hoffman etc.)
  14. General stress tests (including compression, traction, postero/anterior pressures, general lumbar torsion, sacroiliac, peripheral ligamentous)
  15. Special tests: vertebral artery insufficiency screening, neuromeningeal tests etc.
  16. Recognize the presence of serious or worsening neurological signs
  17. Recognize red and yellow flags
  18. Develop a provisional hypothesis/diagnosis and apply deductive reasoning to rule in or out the hypothesis
  19. Identify and categorize the musculoskeletal structures or functions that require intervention or further examination, including: posture, articular & soft tissue, neurological, dural, vascular and adjacent joints
  20. Apply theories of inflammation and wound repair/healing to deep transverse friction application
  21. Apply the principles of the effect and application of basic spinal exercise principles.

Module II: Biomechanical Assessment and Treatment of the Cervical Spine.

Format: 3 day onsite lecture/laboratory days,8 week online learning material presented pre and post intensive,online discussion board, videos of technique, Power point Presentations of related material and anatomy, course manual, descriptive anatomy text and online testing for competency.

Moderators: Josh Renzi, PT, MSPT, lecturer

Contact: Beth Glessner, Tel: 410-662-7977,

Grading: Module testing will be conducted thought online learning and testing platform. Completion of the program online testing with a grade ≥80% is required for passing. Clinical skills practical will be used to evaluate performance and clinical reasoning. Passing is a grade of ≥70%.

Duration: 8 weeks

Course syllabi, course description, educational objectives, requirements for successful completion, and teaching methods.

Description: This course is designed to prepare the Physical Therapist in advanced differential diagnosis, biomechanical assessment and treatment of the Cervical Spine. Online learning will portion will provide a background in descriptive anatomy, Differential diagnosis relevant to the cervical spine and introduce assessment and treatment techniques. Attention will be given to selected manual therapy interventions, indications and contraindications. The 3 day clinical intensive will focus on clinical evaluation and treatment skill covered in the online module.

Education methods will include: 24 hours classroom didactic training and lab. 26 additional hours will be required to review power point material, course manual, videos, and descriptive anatomy material. Online testing and clinical skills assessment will also be performed.

Onsite Seminar: 24 hours didactic/laboratory. 26 hours online course preparation hours.

Objectives and requirements for completion: On completion of the course the therapist will be able to identify the common condition scripts for Cervical Spine, pass a clinical skills evaluation, and online test covering the didactic and course manual material with a grade of 80% or better.

Course materials

  • Power point and anatomy manual review: Elbow, Ankle and Wrist.
  • Online learning Platform: videos, PPT presentation on biomechanics and treatment.
  • Manual: Cervical Spine course manual
  • Discussion board

Module II Cervical *in-class / Topics
Anatomy , biomechanics and pathomechanics
  • Descriptive
  • Surface*
  • Applied *
/
  • Craniovertebral
  • Cervical
  • Brain stem
  • Neurovascular supply head, neck and spinal cord

Conditions
(incidence/ prevalence, and presentation* /
  • Cervical disc herniation
  • Lateral stenosis
  • Central stenosis
  • Segmental dysfunction
  • Systemic arthropathies (AKS, RA, reactive arthritis)
  • Vertebral artery ischemia
  • Craniovertebral instability
  • Down’s
  • Grisel’s
  • Arthropathy
  • Headache
  • Spondylogenic
  • Vertebral artery
  • Migraine
  • Intracranial bleed
  • tension
  • Dizziness
  • Neoplastic disease
  • Radiculopathy
  • Peripheral neuropathy
  • Myelopathy
  • Osteoporosis
  • TMJ arthritis
  • Systemic
  • Traumatic
  • Infective

Clinical reasoning* /
  • Pattern recognition
  • Hypothetic-deduction
  • Illness scripts
  • SFD
  • Bias correction
  • DDx,
  • Diagnosis specific treatment
  • Prognosis

Assessment techniques
Medical diagnostic *
Segmental* /
  • Scan examination
  • Neurophysiological (multifidus, quadrants)
  • Biomechanical (PPIVMs, position tests, PAIVMs)

Treatment and management techniques* /
  • Specific exercise prescription for above conditions
  • Mechanical and manual traction
  • Pain modulation treatments
  • Low grade mobilizations
  • Electrical stimulation
  • Exercises
  • Cryo-thermal
  • Rest
  • Referral out for medical treatment and investigation
  • Traction manipulation
  • Direction specific manipulation
  • Facet distraction manipulation
  • Costotransverse distraction manipulation
  • Stabilization therapy
  • Movement rehabilitation therapy

Medical management and investigations for above conditions /
  • X-ray
  • MRI
  • CAT scan
  • Radio-uptake scans
  • Blood work
  • EEG and nerve conduction studies
  • EKG

SPECIFIC COURSE OBJECTIVES:

Module II objectives

  1. Perform and interpret results of the biomechanical assessment for the Cervical spine.
  2. Interpreting active passive, and resistive testing
  3. Performing and interpreting Passive physiological motion testing
  4. Stability testing of the Thoracic spine.
  5. Neurologic testing
  6. Red and yellow flag recognitions and interpretation.
  7. Selected intervention for condition scripts.
  8. Condition Scripts
  9. Identification of typical presentation of selected pathology and subluxations
  10. Apply Hypothesis testing for illness scripts as part of the differential diagnosis
  11. Select and perform appropriate manual therapy intervention based on subjective and objective data.
  12. Select appropriate Interventions: Ther ex, Neuromuscular Re-education, modalities and Home exercise program for illness scripts.
  13. Manual therapy interventions
  14. Apply appropriate manual therapy intervention based on clinical exams
  15. Demonstrate proper technique with manipulation taking into account:
  16. Proper treatment selection
  17. Integrate proper neuromuscular reeducation and therapeutic exercise prescription.
  18. Appropriate force for selected treatment
  19. Evaluation of response to treatment

Module III: Biomechanical Assessment and Treatment of the Thoracic Spine

Format: 3 day onsite lecture/lab,online discussion board, videos of technique, Power point Presentations of related material and anatomy, course manual, descriptive anatomy test.

Moderator: Josh Renzi, PT, MSPT, lecturer

Contact: Beth Glessner, Tel: 410-662-7977,

Grading: Module testing will be conducted thought online learning and testing platform. Completion of the program online testing with a grade ≥80% is required for passing. Clinical skills performance assessment will be used to evaluate performance and clinical reasoning. Passing is a grade of ≥70%.

Duration: 8 weeks

Course syllabi, course description, educational objectives, requirements for successful completion, and teaching methods.

Description: This course is designed to prepare the Physical Therapist in advanced differential diagnosis, biomechanical assessment and treatment of the thoracic spine. Online learning will portion will provide a background in descriptive anatomy, biomechanics, Differential diagnosis, and current research relevant to the thoracic spine and introduce Assessment and treatment techniques. Attention will be given to selected manual therapy interventions, indications and contraindications. The 3 day clinical intensive will focus on clinical evaluation and treatment skill covered in the online module.

Education methods will include: 24 hours classroom didactic training and lab. 26 additional hours will be required to review power point material, course manual, videos, and descriptive anatomy material. Written testing and clinical skills assessment will also be performed.

On completion of the course the therapist will be able to identify the common condition scripts for all extremity joints, pass a clinical skills evaluation, and written/online test covering the didactic and course manual material with a grade of 80% or better.

Onsite Seminar: 24 hours didactic/laboratory. 26 hours online course preparation hours

Syllabi:

Thoracic Spine Table of Contents

Principles of Diagnosis...... 4

Examination...... 6

Basis of the Cyriax Examination...... 6

Analysis of the Data and Making the Diagnosis...... 7

Systems Examination...... 9

General Neuro-musculoskeletal Examination...... 12

The Scan Examination...... 24

The Subjective Examination...... 28

Pain...... 28

Pain Quality...... 29

Pain Severity...... 30

Questions to Ask About Pain...... 31

Neurological Symptoms...... 32

Summary of Subjective History Taking...... 33

Observation...... 45

Selective Tissue Tension Testing...... 46

Active Movements...... 46

Passive Tests...... 46

Resisted Isometric Tests...... 49

Neurological Tests...... 49

Special Tests...... 51

Cancer...... 52

Orthopedic Clinical Presentation of Neoplastic Disease...... 54

Bone Metastases...... 55

Neurological Metastases...... 56

Prostate Cancer...... 57

CNS Malignancy...... 57

Lung Cancer...... 58

Pancoast Syndrome...... 60

Breast Cancer...... 60

Osteoporosis...... 62