75302 - Advanced Physiotherapy - (IM)

Learning outcomes

At the end of the module the student possesses the knowledge and the ability to understand about the alterations of the peripheral nervous system and the degenerative alterations of the 1st and 2nd motor neurons susceptible to physiotherapy treatment. He is able to formulate rehabilitation hypotheses on the basis of the analysis of the neurological deficit and to plan, program, and perform a physiotherapy intervention.

Course contents

General neuroanatomy of the PNS: morphological framework, characteristics, and implications of the mechanisms of action of the sympathetic and parasympathetic ANS and ENS on the body; biochemical characteristics

· MOTOR UNIT AND INNERVATION RELATIONSHIP:
Temporal summation, spatial recruitment, synchronization, tone alterations (positive and negative signs); strength grading, discharge frequency, theory applied to strengthening exercises through Proprioceptive Neuromuscular Facilitation and the use of proper proprioception; Different types of muscle contraction, innervation relationship
· Principles of physiotherapy treatment of peripheral nerve injuries: recovery and maintenance of muscle trophism; recovery of sensory components. Therapeutic exercise, neuromuscular facilitation, proprioceptive training, occupational therapy, choice of aids, and classification of orthoses

· CLASSIFICATION OF PNS DISEASES: topographical: mono-, multi-, or polyneuropathies, plexopathy, and rhizopathy; qualitative axonal degeneration (neuroapraxia, neurotmesis, axonotmesis); principles of axonal and myelin regeneration

· CLINICAL ANALYSIS OF PNS NEUROLESIONS and etiopathogenesis (motor, sensory, and autonomic semiotics), implications of nerve strain and compression and implications for axonal transport, Double Crush Syndrome, Augmented Impulse Generating Sites, central sensitization processes

· ASSESSMENT PRINCIPLES: how to relate theoretical knowledge of neurophysiology and neuropathology to symptoms and signs, what to investigate, and therapeutic approach

. OPERATING ROOM STUPOR: insights into causes and prognosis.

· INSTRUMENTAL DIAGNOSTICS: EMG, ENG, I/T curve, V.d.C., in relation to functional recovery.

. INSTRUMENTAL PHYSICAL THERAPY: principles of application, parameters, and stimulation methods.

· ANATOMY AND CLINICAL ANALYSIS OF THE CRANIAL NERVES: principles of semeiotics related to cranial nerve pathology.

· PHYSIOTHERAPEUTIC PATHOLOGIES OF THE CRANIAL NERVES: clinical aspects and rehabilitation treatment in neuropathies of the III, IV, VI, VII, and VIII cranial nerve.

· PHYSIOTHERAPY-RELATED PATHOLOGIES OF THE CERVICAL SPINE AND BRACHIAL PLEXUS
Review of the anatomy of the brachial plexus: roots, collaterals, and terminal branches
Motor innervation and sensory territory of the cervical roots: Myotomes, dermatomes, and sclerotomes. Differentiation between central and peripheral innervation territories of the quadrant and upper limb
Nerve lesions of the brachial plexus and upper limb: clinical pictures; principles of evaluation and treatment
Clinical correlations between rotator cuff lesions and neck pain.
Evaluation of the PNS of the upper limb; Neuromechanical characteristics and neurosensitivity: implications of stretching and compression; principles of neurodynamics: decompression, slippage, and peripheral nerve tension; ROT, their course and palpation; Evocative orthopedic tests, Tinel test; Neurodynamic sequences, structural differentiations (Upper Limb Neural Test)
Thoracic Outlet Syndrome: description, assessment (Adson test, Eden test, Wright test), clinical indications and treatment principles, EAST (elevation arm stress test):
Therapeutic and rehabilitative principles and approach: basics of the technique, proprioceptive and exteroceptive stimulation; Strengthening, relaxation, and rhythmic techniques

· PHYSIOTHERAPY-RELATED PATHOLOGIES OF THE LUMBAR-SACRAL SPINE AND LUMBAR AND SACRAL PLEXUSES
Review of the anatomy of the lumbar and sacral plexus: roots, collaterals, and terminal branches
Motor innervation and sensory territory of the lumbar and sacral roots: Myotomes, dermatomes, and sclerotomes
Evaluation and neurodynamics of the terminal branches of the lumbar and sacral plexus: stretching positions, peripheral nerve tension, decompression, sliding, ROT, their course and palpation, evocative orthopedic tests, neurodynamic sequences, structural differentiations (Lower Limb Neural Test), Lasegue test, Straight Leg Raise, and differentiations (PNT, TNT, sural, Wasserman test, Prone Knee Bend, SLUMP, PKB SLUMP, saphenous vein
Nerve lesions of the plexus Lumbosacral and lower limb pain, clinical conditions; principles of assessment and treatment, therapeutic options, Slider, Tensioner, etc., general techniques and therapeutic exercise
Focus on lesions of the collateral branches and nerves of the lower limb, radiculopathies and differentiation from orthopedic conditions, compression from herniated discs and narrowed spinal canals, piriformis syndrome, low back pain and sciatica, lesions of the common peroneal nerve and tibial nerve, cauda equina syndrome
Differentiation between pain of joint, disc, and radicular origin; implications and precautions related to different assessment and therapeutic approaches
Principles and therapeutic and rehabilitation approaches: basic techniques, proprioceptive and exteroceptive stimulation; strengthening, relaxation, and rhythmic techniques

THE AUTONOMIC NERVOUS SYSTEM: Anatomical description of the sympathetic, parasympathetic, and metasympathetic systems
Autonomic and clinical aspects of the ANS: dysautonomias and the main clinical correlations with pathologies of interest to physiotherapy


NEUROPATHIES Complex Regional Pain Syndrome: Reflex Sympathetic Dystrophy (RSD, CRPS-1) and Causalgia (CRPS-2), Sympathetically Maintained Pain (SMP), Morton's Metatarsalgia, CERVICAL RADICULAR SYNDROME

POLYNEUROPATHIES: Guillain-Barré Syndrome: etiopathogenesis, clinical course (prodromal, extension, state, and recovery phases), assessment (motor and sensory assessment), indications for physiotherapy treatment of the various conditions, principles of adjunctive therapy
Critical illness myopathy and neuropathy: classifications, pathophysiology, risk factors Semeiotics. Rehabilitation: management, evaluation, and treatment at various stages.

· HEREDITARY DEGENERATIVE NEUROPATHIES: Charcot-Marie-Tooth syndrome; etiopathogenesis and indications for physiotherapy treatment

· VIRAL NEUROPATHIES: Acute Anterior Poliomyelitis: etiopathogenesis and indications for rehabilitation treatment at different patient ages and possible clinical complications.
· Principles of physiotherapy treatment for peripheral nerve lesions: recovery and maintenance of muscle trophism; recovery of sensory components. Therapeutic exercise, neuromuscular facilitation, proprioceptive exercise, occupational therapy, and the choice of assistive devices

· 1st AND 2nd MN DISEASE: ALS: etiopathogenesis, incidence, symptoms, differential diagnosis, ALSSS scale
During the lessons, real or plausible clinical pictures and cases related to the topic are examined with the aim of deepening understanding, developing reasoning skills, and consolidating knowledge and skills. Theoretical knowledge is combined with practical and laboratory activities to experiment with assessment approaches, tests, treatment techniques, and exercise proposals. Group work is also included, with plenary discussion and sharing of clinical case studies.
Due to the types of activities and teaching methods adopted, attendance at this training activity requires all students to complete Modules 1 and 2 via e-learning and participate in a third specific training module on health and safety in the study/internship environment. Information on the dates and methods of attendance for the third module will be communicated to students by the training centers.

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.

Pieter Westerhuis, Renate Wiesner, Modelli clinici in Terapia Manuale, Thieme.

G. Maitland, E Hengeveld, K. Banks, K. English, Manipolazioni vertebrali di Mkaitland, seconda edizione Elsevier

Elly Hengeveld, Kevin Banks, Manipolazioni periferiche di Maitland, quarta edizione Elsevier

Adam Fisch MD, Neuroanatomy: Draw It to Know It, Oxford University press 2009 Martini, Fondamenti di anatomia e fisiologia, EdiSES

Teaching methods

Lectures on site supported by practical exercises

Assessment methods

The learning assessment procedure will be carried out through a written test. The candidate will have the opportunity to articulate what they have learned during the lessons and through their internship experiences.

 

Students with learning disabilities and temporary or permanent disabilities are encouraged to contact the dedicated office (https://site.unibo.it/studenti-con-disabilita-e-dsa/it/per-studenti) as soon as possible to discuss appropriate compensatory measures. The request must be submitted in advance (15 days before the exam date) to the instructor, who will evaluate the appropriateness of the measures, taking into account the learning objectives.

Teaching tools

The lessons will be supported by slides and practical exercises

Office hours

See the website of Simone Rodio