Universitat Internacional de Catalunya - Barcelona

Physiotherapy Applied to the Physical Dysfunction of the Nervous System

• code 08576
• course 3
• term Semester 1
• type OB
• credits 6

Module: Physiotherapy in clinical specialties

Matter: Physiotherapy applied to the physical dysfunction of the nervous system

Main language of instruction: Spanish

Other languages of instruction: Catalan

Head instructor

Dra. Rosa María CABANAS - rosacabanas@uic.es

Office hours

Make an appointment by e-mail:

Mr.Victor Manuel Argüelles: varguelles@csc.uic.es

Mrs. Judith Soler:   jsoler@csc.uic.es

Mrs. Almudena Medina Rincón amedina@uic.es

Holder of the subject: Dra. Rosa Cabanas Valdés: rosacabanas@uic.es

The course consists of 3 seminars:

Bobath Concept Seminar or Neurodevelopmental Treatment:

The Bobath approach is a specialized therapy applied to treat movement and posture disorders caused by central neurological injuries. Berta and Karel Bobath, who studied normal development, the effects produced by the injuries of the Central Nervous System (CNS), and how to help patients in these situations, started their research in London in the 1940s. Their hypothesis was based on the work of several neurophysiologists, including Sherrington and Magnus, who used produced injuries in the CNS of animals in order to observe the resulting effects.  This treatment is currently better known as Neuro-Developmental Treatment (NDT), especially in Anglo-Saxon countries.

The Bobath concept considers that the effective study of movement and posture is essential to make a correct assessment and give the proper treatment for the damage at a sensorimotor level, which was caused by an injury in the central nervous system, either traumatic or degenerative. It is used worldwide by different therapists to provide new and better movement strategies, especially in Europe and the United States.

Perfetti Seminar:

The Cognitive Therapeutic Exercise (ETC) or Perfetti Method was developed in Italy in the early 70s by the neurologist Carlo Perfetti and his collaborators. Today it is one of the main methods used to treat patients who suffer neurological disorders or diseases of all kinds (AVC, spinal cord injury, TBI..)
So far, this type of neurorehabilitation has evolved thanks to the interpretation and application of studies that provide the various neurosciences.
The Cognitive Therapeutic Exercise recovers the damaged functions in an integrated and customized way taking into account the problems of each patient. Movement is not considered as a simple muscle contraction but as the result of a much more complex activation which originates in the brain.
That is why the treatment is not only directed to the muscle (muscle strengthening) but takes into account how the movement is organized in the brain. Therefore, to restore movement it is necessary to activate the cognitive processes that are responsible for that organization (perception, attention, memory, language, motor image, reasoning, etc.)

Peripheral Injury Seminar:  

Peripheral Neuropathies are very frequent and can be inherited or acquired. There are more than 100 types of peripheral neuropathies, each one with its own set of characteristics, modes of development and prognosis. After a PNS injury, a wide range of disorders may occur and their therapeutic approach poses a difficult challenge to the physical therapist.

The course aims to give students the tools necessary for a proper understanding and evaluation of the disease and for treatment planning and development. 

Not specified

Bobath Concept Seminar or Neurodevelopmental treatment:

  The course aims: to discover a concept of current treatment, in order to be seen as one more possibility, within the wide range of therapeutic modalities of addressing the neurological patient.

Minimum knowledge in order to: possible criterion to choose as postgraduate training. If necessary, work with these patients. Referral to other professionals.

As more specific objectives:

• Define the evolution and history of Bobath Concept (CB) to the present.
• Understand and explain the philosophy of CB
• Describe the main neurophysiological basis where the CB is based on
• Understand the clinical reasoning, movement analysis and theoretical principles of postural control.
• Introduce different facilitation strategies "hands-on" specific to improve individual movement and posture.

Perfetti Seminar:

• Know and understand the basis of neurocognitive theories.
• Gain knowledge about the basics of Cognitive Therapeutic Exercise
• Knowing how to explore the neurological patient globaly (cognitive, motor and sensitively ) according to Perfetti method.
• Design and develop a treatment using the patient's performed examination and the relevant data of the clinical history.
• Learn how to build and run different Perfetti exercises that respond to the specific problems that each patient may present.

  Peripheral Injury Seminar:

• Acquire theoretical and practical knowledge concerning major peripheral nervous system disorders.
• To distinguish the different pathologies of the PNS and to learn how to interpret the data collected during patient assessment.
• Learn to plan the exercises and modifications that can be obtained based on patient's assessment and base knowledge.

• 01 - The ability to analysis and synthesis.
• 06 - To have comprehensive problem-solving skills.
• 09 - Demonstrate critical thinking skills.
• 10 - Develop autonomous learning skills.
• 15 - Demonstrate a concern for quality.
• 17 - The ability to work responsibly and autonomously, so as to handle job-related activities without the need for strict supervision.
• 21 - Knowledge of the physiological and structural changes that can occur after physiotherapeutic interventions.
• 25 - Knowledge of the principles and applications of measurement procedures in biomechanics and electrophysiology.
• 28.3 - Show respect, appreciation and sensitivity towards the work of others.
• 30.1 - Teamwork skills.
• 37.1 - Use discretion, use available information appropriately and respect patient dignity and confidentiality
• 37.5 - Knowledge of the profession's deontological ethics codes
• 38.1 - Respect for the rights of the patient and their family.
• 43 - Knowledge of physiotherapeutic procedures based on techniques and methods specific to physiotherapy interventions applied to the various disorders of all systems and medical and surgical specialisations, as well as health promotion and disease prevention.
• 48.2 - Ability to assess the patient's/client's needs in order to give priority to the ones that could compromise the rehabilitation process.
• 49 - Ability to design a physiotherapy treatment plan.
• 49.1 - Ability to develop a specific physiotherapy treatment plan through clinical thinking and problem-solving skills.
• 50 - Ability to execute, direct and coordinate a physiotherapy treatment plan while attending to the client's individual needs and using therapeutic tools specific to the physiotherapy profession.
• 50.1 - Ability to establish and implement physical therapy in treatments provided by all other medical and surgical specialties whenever it is deemed necessary.
• 50.10 - Ability to establish a scheduled plan to follow during treatment.
• 50.2 - Ability to design and apply therapeutic exercises specifically designed for cardiorespiratory, orthopedic, traumatologic, pediatric, rheumatologic, geriatric, neurologic, pulmonary, and sport-related diseases and injuries, as well as those for spine defects, urinary and fecal incontinence and pre/post-partum exercises.
• 50.8 - Ability to encourage the client and family to participate in the rehabilitation process.
• 51 - Ability to assess the outcomes of the physiotherapy treatment against the initial goals set and the established outcome criteria.
• 51.1 - Ability to design and set up activities related to disease prevention and health promotion.
• 51.2 - Ability to assess the patient's /client's progress.
• 51.3 - Ability to re-assess and modify treatment goals if necessary, and to adjust the intervention or treatment plan according to the new goals.
• 52 - Ability to provide effective physiotherapeutic care by providing comprehensive assistence to patients/clients.
• 53.1 - Ability to design and set up activities related to health promotion and disease prevention.
• 57 - Ability to keep up-to-date on knowledge, skills and attitudes related to professional competencies through continuous education.

The student

•                                 After this course, the student must be able to apply the treatment of neurological patients according to the Bobath Concept.
•                                 Knows and understands the principles and foundations on which the Perfetti method is based.
•                                 Applies therapy according to Perfetti method.
•                                 Applies the appropriate and adapted therapy in the peripheral neurological injuries
•                                 Plans the exercises and modifications that can be obtained based on the pathology and the problems presented by the patient.

Bobath Concept Seminar:

Theory

1. Bobath History

2. Definition and bases of Bobath Concept, both the old and the contemporary.  

3. Main techniques used in Bobath Concept.

4. Postural tone and their influencing factors

5. Postural control and balance

6. Motor learning

Practice

1. Intrinsic stability of the trunk (core stability)

2. Lower extremity

3. Upper extremity

4. Standing

  Perfetti Seminar:

1. Neurocognitive Therapeutic Exercise or Perfetti Method.

1.1.    Introduction to neurocognitive theories.
1.2.    The 3 principles of Cognitive Therapeutic Exercise :
1.2.1. Recovery as learning
1.2.2. Body as a receptive surface
1.2.3. Movement as knowledge
1.3.    Exercise instruments
1.3.1. Cognitive problem
1.3.2. Perceptual hypothesis
1.3.3. Comparison or Control
1.4.    Motor Image
1.4.1. Mental Image
1.4.2. Why to use the image
1.4.3. Importance of Image in the CTE
1.4.4. Evocation of Image Example
1.5.    Patient Profile: how does he/she move?
1.5.1. How does he/she recognize
1.5.2. How does he/she use the attention
1.5.3. How does he/she use language
1.5.4. How does he/she learn
1.5.5. How does he/she imagine
1.6.    Interpretation of pathology: the specific motor
1.6.1. Introduction
1.6.2. Exaggerated response to *Estirament
1.6.3. Irradiation
1.6.4. Elementary schemes
1.6.5. Motor recruitment
1.7.    Exercise degrees
1.7.1. Introduction
1.7.2. First grade exercises
1.7.3. Second grade Exercises
1.7.4. Third grade Exercises

2. Examination and evaluation of patient

2.1.    Introduction
2.2.    How does the patient move: the specific motor
2.3.    How does he/she recognize
2.3.1. Kinesthetic sensitivity
2.3.2. Tactile sensitivity (active and passive)
2.3.3. Weight sensitivity
2.4.    Cognition
2.5.    Standing and load
2.6.    Gait

3. Choice of treatment

3.1. Preliminary considerations
3.2. Medical history and treatment review

4. Construction of exercises to rehabilitate the Upper Extremities

4.1. Introduction
4.2. Analytical exercises for Upper Extremities and hand
4.3. Global exercises for the Upper Extremities
4.3.1. "El Tablero"
4.3.2. Other global exercises

5. Construction of exercises to rehabilitate the Lower Extremities

5.1. Introduction
5.2. Analytical exercises for the Lower Extremities
5.3. Global exercises for the Lower Extremities

6. Construction of neck and trunk exercises

Peripheral Injury Seminar:

1. Physiology and pathology of the PNS
2. Rehabilitation principles for PNS injuries
3. PNS examination. Basic principles.
4. Upper Extremities injuries: Brachial plexus, radial, ulnar and median nerve.
5. Lower Extremities injuries: PlexoLumbosacro, Nervioiàtic.
6. Examination of the cranial pairs (nerves). Facial nerve.
7. Treatment of various injuries of PNS.
8. Guillain-Barre syndromes.

Bobath Concept Seminar:

Training activities: theoretical and practical lessons. 

Guided activities (50%): 

1. Presentation of theoretical content using PowerPoint presentations, with explanations and videos of patients with demonstrations by the teacher.

  2. Case work: students analyze professional situations on patients presented by the teacher in order to perform an experimental conceptualization and search for effective solutions.

3. Put into practice those skills developed in classes  

Supervised activities (50%):  

1. Supervised session where students work in groups (2-3) and receive assistance and guidance when needed.

 2. Activities carried out in spaces equipped for physical therapy practices with teacher demonstrations first and subsequent student performance of the activities.

L

The final grade for each seminar is worth 33.33% of the final grade of the course. 

In order to pass the course it is mandatory to get at least a 5 in each of the seminars (Bobath, Perfetti and peripheral injuries). If a student fails one seminar, the average of the seminars will not result in a passing mark.

Bobath Concept Seminar:

Continuous assessment (10 %), activities in class.

Theoretical exam (45%): 20 multiple choice questions, each correct answer is worth 1 point and 0.25 points will be deducted for each incorrect answer. 

Final practical exam (45%): Practical examination of one or more of the different treatments performed in class.

In order to pass the course it is mandatory to get at least a 5 in each of the seminars. If students fail one seminar, the average of the seminars will not result in a passing mark.

Students are allowed to miss 20% of the hours of the seminar, if exceeded, the seminar and consequently the subject, will be failed.

For the first resit, a theoretical and practical exam will take place, each one will be worth 50%.

In order to pass the seminar it is essential to obtain at least a 4 in each of the blocks (continuous assessment, theoretical examination, final practical exam). If a student obtains less than a 4 in any block, the average of the blocks will result in a failing overall mark for the subject.

Perfetti Seminar:

Continuous assessment (40%)

Theoretical exam (20%)

Final practical exam (40%)

In order to pass the seminar it is essential to obtain at least 4 in each of the blocks (continuous assessment, theoretical examination, final practical exam). If a student obtains less than a 4 in any block, the average of the 3 blocks will result in a remaining failing overall mark for the subject.

Peripheral Injury Seminar:

50% theoretical and practical examinas

50% continuous assessment

To pass the subject it is necessary to pass the theoretical and practical exams with a 5 or more.

Attendance Regulations

The subjects in the Physiotherapy Degree present theoretical and practical content in which the main objective is the acquisition and development of procedures and technical skills that are directly related to the professional practice. These classes are structed in small groups where there is direct and continuous supervision of the teacher. Therefore, attendance to seminars is considered essential and necessary to ensure the acquisition of these skills. Based on what has been presented above, absences will only be excused to those who have missed class due to major causes and even under these circumstances, if they miss more than 20% of the training work, students will have to retake the subject in the next academic year, without the possibility of a resit. The consequences derived from non-compliance with this regulation can have very negative effects directly related to the registration process (overlapping and / or academic incompatibilities), as well as the corresponding expectations in the completion of the Degree.

 Bobath Concept Seminar:

 · Bente E. BassǾe Gjelsvick. THE BOBATH CONCEPT IN ADULT NEUROLOGY.  ed. Thieme Medical Publishers. Edition: 01/2007. ISBN-10: 1588906213, ISBN-13: 978-1588906212

 · Anne Shumway-Cook, Marjorie H. Woollacott. MOTOR CONTROL. Ed.Lippincott Williams & Wilkins. The Point. USA. Edition: 02/2009.ISBN: 0-683-30643-X

 · Sue Raine, Linzi Meadows, Mary Lynch-Ellerrington.BOBATH CONCEPT. THEORY AND CLINICAL PRACTICE IN NEUROLOGICAL REHABILITATION.  Ed. Wiley-Blackwell. United Kingdom. Edition: 01/2009. ISBN-10: 1405170417, ISBN-13: 978-1405170413

Control y Aprendizaje Motor, Cano de la Cuerda Editorial Médica Panamericana

Perfetti Seminar:

Main Literature:

Carlo Perfetti, El ejercicio terapéutico cognoscitivo para la reeducación del hemipléjico adulto, Edikamed.

Other references:

Paola Reggiani, L’immagine motoria come strumento per l’esercizio terapéutico, Biblioteca A.R.Lurija

Carlo Perfetti, Aldo Pieroni, Cervelletto e processi cognitivi: Implicazione riabilitative, Biblioteca A.R.Lurija

R.Cogo, E.Crea, C. Rizzello, Il recupero della motilità del tronco nell’emiplegico: il tattamento in posizone seduta, Gnocchi

S.Fornari, P.Magnusson, F.Pantè, C. Rizzello, C. Perfetti, A. Marchetti, L’esercizio nell’aprassia: materiale per la preparazione della lezione, ARS

Aldo Pieroni, Dall’osservazione all’esercizio: la pianificazione del trattamento riabilitativo, Gnocchi

Revistas Riabilitazione Neurocognitiva, quadrimestrale di Scienze del Recupero, Riabilitazione Cultura

Peripheral Injury Seminar:

Mandatory reading:

Electronic dossier.

E: exam date | R: revision date | 1: first session | 2: second session:

• E2 02/07/2019 11:30h G5