75302 - Advanced Physiotherapy - (IM)

Learning outcomes

At the end of this module, students will have acquired knowledge and ability to understand about peripheral nervous system disorders and about degenerative changes of the I and II motor neuron that could be treated by physiotherapy. They will also be able to formulate rehabilitation hypotheses based on an analysis of the neurological damage and to plan, program and execute a physiotherapy intervention.

Course contents

General elements of Neuroanatomy of the SNP (Peripheral Nervous System)

• MOTOR UNITS AND INNERVATION

Temporal summation, spatial recruitment, synchronization; force’s gradation, firing rate, PNF (Neuromuscular proprioceptive facilitation) theory and exercise, types of muscle contraction.

Treatment of peripheral nervous lesions: recovery and maintenance of muscle tissue; recovery of sensitive system components. Therapeutic exercise, neuromuscular facilitations; proprioceptive training; occupational therapy, orthoses and orthopedic aids.

• CLASSIFICATIONS OF SNP DISEASES

Topographic: mononeuropathy, polyneuropathy, plexus disease, disease of nerve root. Qualitative: neuronal apraxia, nerve trunk lesion, exon lesion; principles of axon and myelin regeneration.

• CLINICAL OF THE SNP LESIONS and etiopathogenesis ( motor, sensitive and autonomic semiotics).

• SURGERY STUPOR: insights about causes and prognosis.

• DIAGNOSTIC AND IMAGING: EMG, ENG, I/t curve.

• CRANIAL NERVES: ANATOMY AND CLINICAL FUNCTIONALITY (semiotics about c.n.)

• CRANIAL NERVES DISORDERS WITH A PHYSIOTHERAPIC INTEREST ( assessment and rehabilitation of neuropathy of the III, IV, VI, VII, VIII c.n.)

• CERVICAL SPINE AND BRACHIAL PLEXUS DISORDERS

Anatomy of Brachial Plexus: roots, collateral and terminal branches.

Cervical root’s motor and sensitive innervation: myotome, dermatome, sclerotome.

Assessment of upper limb’s SNP; neurodynamic principles: decompression, slippage, peripheral nerve tension; R.O.T. (deep tendon reflexes, course and palpation), Orthopedic tests, Tinel’s test.

Thoracic outlet syndrome: description, assessment (Adson’s test, Eden’s test, Wright’s test), clinical indication and treatment.

• LUMBAR SPINE AND LUMBAR-SACRAL PLEXUS DISORDERS

Anatomy: roots, collateral and terminal branches.

Lumbar root’s motor and sensitive innervation: myotome, dermatome, sclerotome.

Assessment of terminal branches of lumbar-sacral plexus: stretch positions, R.O.T. course and palpation, orthopedic tests, Lasegue’s test, Wasserman’s test. Focus on the compressions by herniated disc or narrowing of spinal canal.

PNF: basic technique, proprioceptive and external facilitation; strengthen techniques, releasing technique, and rhythmic ones; Kabat patterns.

• AUTONOMIC NERVOUS SYSTEM: Anatomy of Sympathetic, Parasympathetic and Metasympathetic.

Semiotics and clinical: dysautonomia and principal clinical correlations with common disorders.

• Polyneuropathy: Guillan-Barrè Syndrome. Etiopathogenesis, clinical course (prodromal phase, extension phase, status phase, recovery phase), assessment (both sensitive and movements), indications for physical therapy treatment, most common aids.

• Critical myopathy and neuropathy: classifications, pathophysiology, risks factor, semiotic. Rehabilitation: taking charge, assessment, treatments phase by phase.

• Viral Neuropathies. Anterior acute poliomyelitis: etiopathogenesis and indications for physical therapy treatment ( different stages and age of the patient) probable clinical complications.

• Principles of physical therapy treatment of peripheral nervous lesions: recovery and maintenance of muscles trophism; sensitive recovery. Therapeutic exercise, neuromuscular facilitations, proprioceptive exercise, occupational therapy and choose of the right orthoses.

• 1^st and 2^nd motor neuron disease. LAS: etiopathogenesis, incidence, symptomatology, differential diagnosis, ALSS scale.

Readings/Bibliography

Cyriax J., Medicina ortopedica: diagnosi clinica e trattamento appropriato, Piccin Nuova Libraria, Padova.

Formica M. M. et al., Trattato di neurologia riabilitativa, Marrapese Editore, Roma.

Kandel E. R., Schwartz J. H., Jessell T. M., Principi di neuroscienze, Casa Editrice Ambrosiana, Milano.

Kendall H. O., Kendall F. P., Wadsworth G. E., I muscoli: esame e studio funzionale, Piccin Nuova Libraria.

Knott M, Voss D. E., Facilitazione neuromuscolare propriocettiva, Piccin Editore, Padova.

Mumenthaler M., Schliack H., Lesioni dei nervi periferici, Piccin Nuova Libraria, Padova.

Prencipe R., Le neuropatie periferiche, Lombardo Editore, Roma.

Sorrentino G., Neurologia: principi di fisiopatologia, Idelson-Gnocchi editori, Napoli.

Stein J. H., Medicina interna, Art Servizi Editoriali, Milano.

Upledger J. E., Terapia Cranio-Sacrale: oltre la dura madre, Marrapese Editore, Roma.

Teaching methods

Both theoretical and practical lessons

Assessment methods

The learning mode will be through a written test (multiple questions and open questions)

Teaching tools

The lessons will be supported by slides and practical exercises

Office hours

See the website of Domenico Romanello