PSIO2025 Clinical Management 2 (Neurology & Cardiorespiratory)
Principles of Physiotherapy Practice, Clinical management 1
Aims and Objectives
To practice and apply skills learnt in CM 1 and advance their knowledge of clinical treatment approaches for common presentations of Neurological and Cardiorespiratory conditions. Thus the clinical skills learnt in CM 1 will be built on further and new approaches identified that can be applied to more complex cases. These cases will challenge students to develop their clinical reasoning further as they will require a greater level of cognitive processing, the ability to adapt and modify and learn new treatment techniques, so that the student can modify their assessment and treatment and be able to evaluate and justify their choice of treatment. This module is intended to prepare students for clinical placements in either neuro or cardiorespiratory within acute and community settings for placement 2 and 3.
Having successfully completed this module you will be able to:
- Demonstrate the assessment of a variety of more complex cardiorespiratory and neurological patients using the appropriate systematic approach, making clear accurate notes
- Identify and recognise signs and symptoms of more complex neurological, respiratory and cardiac presentations and discriminate the pathological causes in patients
- Discuss clinical reasoning applied to more complex scenarios so as to identify hypotheses and interpret assessment findings, formulate a problem list and outline a treatment plan with short and long-term goals
- Select, demonstrate and justify appropriate treatment techniques in response to assessment findings.
- Identify precautions and contraindications so that treatment can be applied in a safe and effective manner
- Discuss the current evidence base for the treatment approach selected.
- Discuss the choice of appropriate assessment tools/outcome measures to evaluate the therapeutic interventions
- Illustrate the importance of patient involvement in treatment plans and goal setting; discuss how psychosocial factors may influence the treatment strategy
CVR Content Common Pathologies: Common presentations of respiratory and cardiac disease: post-surgical decreased lung volume following cardiothoracic and abdominal surgery e.g. CABG; sputum retention and increased WOB from a variety of pathologies such as: COPD; Bronchiectasis; Pneumonia; Pneumothorax; Asthma; Pleural Effusion, Cystic Fibrosis, Pulmonary oedema, MI, heart failure cor-pulmonale. Assessment: The initial emphasis of the module will be the assessment process introduced in CM1: the A-E systems method, as respiratory patients are often hospitalised in the acute stage. Case studies will be used to practice this A-E process and be developed during the module to facilitate aspects of the International Classification of Functioning Disability and Health (World health organisation), so that students can identify the patients problems using a bio-psychosocial approach to understand what is required to facilitate discharge home. These case studies will also be used to facilitate clinical reasoning so that the students’ can identify and recognise the signs of common respiratory or cardiac presentations. There will be an opportunity for students to rehearse these assessment and clinical reasoning skills using simulated scenarios. Treatment: Students will be taught the principles of cardiorespiratory treatment: airway management, oxygen therapy, positioning; mobilisation; ACBT, manual techniques, nebulisers and commonly used adjuncts such as Incentive spirometry, Bird, CPAP, BiPAP, cough assist and clinical management of a ventilated patient such as hyperinflation and suctioning Medical management: commonly used drugs, medical management, goal setting, therapeutic techniques, MDT involvement, patient involvement and psychosocial factors and discharge planning. Evaluation: Critique of literature and a critical understanding of evidence base for interventions and assessment measures Neuro Content This module will develop the principles of neurological physiotherapy assessment and treatment taught in CM 1 using a problem solving approach and the WHO-ICF structure of impairment, activity and participation, based on more complex case scenarios. This will include upper motor neurone (multiple sclerosis, Parkinson’s disease, motor neurone disease, traumatic brain injury and spinal cord injury) and lower motor neurone conditions (Guillain Barre Syndrome, nerve injuries, Charcot-Marie-Tooth) and other neuropathies. There will be consolidation of the assessment process and development of clinical reasoning by forming multiple hypotheses, testing hypotheses, formulating detailed problem lists and treatment plans, goal setting and use of appropriate outcome measures. Differences in physical, cognitive and behavioural symptoms, and approaches to treatment in different clinical settings, between progressive and non-progressive conditions will be discussed. As far as possible service users (patients with upper and lower motor neurone conditions) will contribute to the students’ learning, through demonstration of assessment and treatment techniques, and by discussing their lived experiences of having their condition and their views on physiotherapy treatment received. Students will discuss with patients how they have coped with the impact of their disability and how these changes have affected their lifestyle and psychological well-being. Innovative and novel therapeutic approaches and techniques will be introduced and discussed, including use of rehabilitation technologies, physical training (aerobic/strength training), balance training, and patient involvement in self-management. There will be a development of critique of the literature and a critical understanding of evidence base for interventions and assessment measures
In CVR students will have the opportunity to experience clinical scenarios in a simulated environment at the university so that they can familiarise themselves with the assessment of common cardiorespiratory presentations, and so developing their communication and clinical reasoning skills prior to clinical placement. They will have the opportunity to work with nursing staff (and possibly students) whilst they undertake the assessment of the simulated patient and this will prepare them for professional practice. They will have the opportunity to reflect on their experience in a clinical debrief and repeat any psychomotor skills that they have found challenging during the scenario. In neurology, service users (patients with upper motor and lower motor neurone conditions) will be involved where possible in the teaching and learning activities. Students will have the opportunity to observe, and assess and treat where possible, common neurological symptoms in real life. This will be supplemented with observation of patients in carefully selected videos from educational video libraries.
Learning and Teaching
Teaching and learning methods
This module will use a blended approach to learning including case based learning, key -note lectures, practical sessions, A/V resources, and simulated clinical scenarios. There will be an emphasis on self-directed study activities using a range of resources such as: group discussion forums and informal presentations. It will require significant student collaboration and self-directed study utilising the on-line resources available on blackboard such as discussion forums, self-tests, links to other websites and articles.
|Practical classes and workshops||40|
|Wider reading or practice||30|
|Preparation for scheduled sessions||10|
|Total study time||187.5|
Resources & Reading list
Mary Anne Broad, Mathew Quint, Sandy Thomas, Paul Twose (2012). Cardiorespiratory Assessment of the Adult Patient, A clinicians guide.
Edwards S (Ed.) (2002). Neurological Physiotherapy: a problem solving approach.
Stephen Bourke, Graham Burns, (2011). Respiratory Medicine, Lecture notes.
West J.B. (1995). Respiratory Physiology- The Essentials.
Lennon S & Stokes M (Eds.) (2008). Pocketbook of Neurological Physiotherapy.
Physiotherapy for Respiratory and Cardiac Problems (2002). Physiotherapy for Respiratory and Cardiac Problems.
Reading and reference list can be found on the BB site http://blackboard.soton.ac.uk this site also contains key guidelines and a selection of research evidence. There are links to websites and a selection of videos that support the students’ learning..
Churchill Livingstone (2002). Chest X rays Made Easy.
Delva Shamely (Ed) (2005). Pathophysiology an Essential text for the Allied health professions.
Sue Raine, Linzi Meadows, Mary Lynch-Ellerington (Editors) (2009). Bobath Concept: Theory and Clinical Practice in Neurological Rehabilitation.
Shumway-Cook A and Woollacott MH (2012). Motor control : translating research into clinical practice.
Stokes M Stack E (Ed.) (2013). Physical Management for Neurological Conditions [Formerly Physical Management in Neurological Rehabilitation].
Gillian Mead, Frederike van Wijck (2012). Exercise and Fitness Training After Stroke.
Carr J & Shepherd R (2010). Neurological Rehabilitation: Optimizing motor performance.
Carr J & Shepherd R (2003). Stroke rehabilitation: guidelines for exercise and training to optimize motor skill.
Aehlert , B. (2002). ECG’s made easy, pocket reference.
Hough, A. (2014). Physiotherapy in Respiratory Care: An evidence based approach to respiratory and cardiac management.
Harden, B. (Ed) (2004). Emergency Physiotherapy. An on-call survival guide.
|Objective Structured Clinical Examination||100%|
Repeat type: Internal & External