BPT 301 Clinical Orthopedics and Traumatology

BPT, Third Year, Fifth Semester

Course Description
The course is designed to attain clinical knowledge about orthopedic condition of upper and
lower extremity. The clinical aspect includes the causes, clinical features, mechanism of injury,
classification, complications, and management.

Learning Objectives
Upon successful completion of the course, the student will be able to:
• Explain the causes, clinical features, mechanism of injury, classification,
complication and management of the fractures and dislocation of extremities, spine
and rib cage;
• Describe the causes, clinical features, complications and management of soft tissue
injuries and deformities of extremities;
• Explain the causes, clinical features, mechanism of injury, classification,
complication and management of the regional conditions, inflammatory and
infective conditions; and
• Define and explain the indications, classifications, types, principles of management
of surgical conditions.

Course Contents

Unit I: Overview 1 hour

Introduction to orthopedics. Clinical examination of patient. Common investigation procedures
including radiological and imaging techniques. General idea about inflammation & repair, soft
tissue healing, contracture, deformities

Unit II: Traumatology 2 hours

Fracture: Definition, types, signs and symptoms. Fracture healing process, its complication,
Principles of management and various approaches of management. Subluxation/ dislocation-
definition, signs & symptoms, management

Unit III: Upper Extremities 3 hours

Fracture of upper limb: causes, clinical features, mechanism of injury, classification,
complication, management of the following fractures- clavicle and scapula; greater tuberosity,
neck and shaft of humerus; capitulum, radial head, olecranon, coronoid and epicondyles; side
swipe injury of elbow; both bone fractures-radius and ulna; Fractures of forearm- monteggia,
galaezzi; chauffer’s, colle’s, smith’s, scaphoid fractures; metacarpals, Bennett’s and phalanges
fractures
Dislocation of upper limb: Anterior, Posterior and Recurrent dislocation of shoulder-
mechanism of injury, clinical features, complication and management. Dislocation of elbow
including mechanism of injury, clinical features, complications and management.

Unit IV: Fracture of Spine and Rib Cage 2 hours

Mechanism of injury, clinical features, types, complications, management of cervical, thoracic,
lumbar, coccyx and rib fractures.

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Unit V: Traumatic Spinal Cord Injuries 1 hour
Clinical features, complications and management of TSCI

Unit VI: Lower Extremities 3 hours

Fracture of pelvic and lower limb: causes, clinical features, mechanism of injury,
complications and management of the following fractures: Pelvic; neck, trochanters, shaft,
supracondylar and condyles of femur; Patella; Tibial condyles; Both bone- tibia and fibula;
Pott’s fracture- mechanism and management; Bimalleolar, Trimalleolar, and calcaneal fracture;
metatarsals fractures- stress and jone’s; Fractures of phalanges
Dislocation of lower limb: mechanism of injury, clinical features, classification,
complications, management of the following dislocations- anterior & posterior dislocation of
hip, central fracture dislocation of hip; dislocation of patella and recurrent dislocation of patella

Unit VII: Soft Tissue Injuries 2 hours

Define the following terminology- sprain, strain, contusion, tendinitis, rupture, tenosynovitis,
tendinitis, and bursitis.
Mechanism of injury, clinical features, management of soft tissue injuries- meniscal, cruciate,
medial and lateral collateral injuries of knee; lateral ligament of ankle; Wrist sprain; Strains-
Quadriceps, hamstrings, calf, biceps, triceps etc.; Contusions- quadriceps, gluteal, calf, deltoid
etc.; Tendon ruptures- Achilles, rotator cuff muscles, biceps, pectorals etc.

Unit VIII: Hand Injuries 1 hour

Mechanism of injury, clinical features and management of-crush injuries, flexor and extensor
injuries, Burn injuries of hand

Unit IX: Amputations 1 hour

Definition, different levels, indications and complications. Assessment and surgery
terminology for amputation. Define disarticulation

Unit X: Deformities 3 hours

Description, complications, management of following congenital and acquired deformities
Congenital Deformities: CTEV/Club foot, CDH, Torticollis, Scoliosis, flat foot, vertical talus;
Hand anomalies-syndactyly, polydactyly and ectrodactly; Arthrogryposis multiplex
congenital; limb deficiencies-Amelia and phocomelia; Kippel feil syndrome; Osteogenesis
imperfect, cervical rib
Acquired Deformities: Acquired Torticolis, scoliosis, kyphosis, lordosis, genu varum and
valgum, genu recurvatum, coxa vara, pes cavus, hallux rigidus, hallux valgus, hammer toe,
metatarsalgia

Unit XI: Disease of Bone and Joints 2 hours

Causes, clinical features, complications and management of the following conditions:

Infective Conditions: Osteomyelitis (Acute/Chronic); Brodie abscess; TB of Spine and hip

Arthritic Conditions: Pyogenic arthritis, Septic Arthritis, syphilitic infection of joints
Bone Tumors: Osteoma, Osteosarcoma, Osteochondroma, Enchondroma, Ewing’s Sarcoma,
Giant cell tumor, multiple myeloma, metastatic tumors
Perthes disease and avascular necrosis of head of femur
Metabolic Bone Diseases- Rickets, Osteomalacia, Osteopenia, Osteoporosis

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Unit XII: Inflammatory and Degenerative Conditions 2 hours
Causes, clinical features, complications, deformities, radiological features, management of the
following conditions:
Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis, Gouty arthritis, Psoriatic
arthritis, Hemophilic arthritis, Juvenile Rheumatoid arthritis, Charcot’s joints.
Connective tissue disorders-Systemic lupus erythematosus, scleroderma, dermatomyositis,
poliomyelitis

Unit XII: Surgeries in Orthopedic 2 hours

Indications, classifications, types, principles of management of following surgeries:
arthrodesis, arthoplasty, osteotomy, external fixators, spinal stabilization surgeries, limb re-
attachments.

Unit XIV: Regional Conditions and Syndrome 7 hours

Definition, causes, clinical features, complications and management of the following
conditions-of the following conditions:
1. Shoulder: Periarthitic Shoulder (adhesive capsulitis), Rotator Cuff Injury (rotator cuff
tendinitis, supraspinatus tendinitis, infraspinatus tendinitis, bicipital tendinitis,
subacromial bursitis, painful arc syndrome) Cervico brachial syndrome, thoracic outlet
syndrome, Vertebro-basilar syndrome, Scalenus syndrome, costo clavicular syndrome,
levator scapulae syndrome, piriformis syndrome
2. Elbow: Tennis elbow, golfer’s elbow, olecranon bursitis, triceps tendinitis, cubital tunnel
syndrome.
3. Wrist and Hand: De Quervain’s Tenosynovitis, ganglion, trigger finger/thumb, mallet
finger, carpal tunnel syndrome, dupuytern’s contracture
4. Pelvis and Hip-IT Band Syndrome, Piriformis Syndrome, Trochanteric Bursitis
5. Knee: Osteochondritis Dissecans, prepatellar and suprapatellar bursitis, popliteal bursitis
&tendinitis, patellar tendinitis, chondromalacia patella, plica syndrome, Infrapatellar fat
pad syndrome
6. Ankle and foot: Ankle sprains, plantar fasciitis, calcaneal spur, tarsal tunnel syndrome,
Achilles tendinitis, metatarsalgia
7. Cervical and lumbar: Causes, clinical features, patho-physiology, investigations,
management of the following conditions: Prolapsed Intervertebral Disc (PIVD), Spinal
Canal Stenosis, Cervical and Lumbar Spondylosis, Spondylolisthesis, lumbago (Low
backache) /lumbosacral strain, sacrilization, coccydynia, vertebral anomalies
(hemivertebra, block vertebra, butterfly vertebra)

Teaching Methods
Lecture, Practical and Seminar

References
1. Essential Orthopaedics, J Maheshwari, 6th Edition
2. Essential of Orthopedics, John Ebnezar, 3rd Edition

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 BPT 302 Clinical Neurology and Neurosurgery
BPT, Third Year, Fifth Semester

Course Description
This course is designed to introduce clinical neurology and neurosurgery to the students with
the aim of enabling students to identify various neurological and neurosurgical conditions.
This course also includes multidisciplinary, problem-solving approach to management of
neurological patients. Both adult and pediatric neurological and neurosurgical conditions are
included within this course.

Learning Objectives
Upon successful completion of this course, students will be able to;
• Develop skills on neurological assessment and correlate with findings of
investigations to derive diagnosis;
• Differentiate various adult and pediatric neurological disorders;
• Develop general ideas and medical as well as surgical management plans on various
neurological conditions;
• Develop knowledge on neurological surgeries, and its consequences; and
• Learn evidence-based treatment with respect to medical and surgical management
of various neurological conditions.

Course Contents

Unit I: Neurological Assessment 2 hours

Principles of clinical diagnosis; higher mental function assessment, Evaluation of cranial
nerves and evaluation of autonomic nervous system, examination and differential diagnosis of
upper motor and lower motor neuron lesions

Unit III: Investigations 2 hours

Principles, method, views, normal and abnormal features of X-ray, CT, MRI of skull, brain and
spine, CSF analysis, Lumbar puncture

Unit IV: Deafness, Vertigo and Imbalance 1 hour

Physiology of hearing disorders, examination and investigation of hearing, disorders; test of
vestibular function; Dizziness examination and differential diagnosis, Peripheral and central
vestibular disorders, Causes of imbalance and differential diagnosis

Unit V: Cerebrovascular Accidents 2 hours

Define, TIA and RIA stroke; Pathophysiology, types; risk factors; differentiating features of
various types of stroke involving different arteries; stroke related syndromes, consequences of
stroke, investigation and differential diagnosis; Medical and surgical management, coma
management

Unit VI: Traumatic Brain Injury 1 hour

Etiology; classification; clinical sign and symptoms; differential diagnosis; complication of
head injury; medical management and surgical management, management of unconscious
patients

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Unit VII: Spinal Cord Disorders 3 hours
Risk factors, pathophysiology, classification, clinical signs and symptoms. Investigation,
deferential diagnosis, medical and surgical management, and complication of the following
spinal disorders: a) Spinal cord injury; b). spinal epidural abscess; c) Transverse myelitis, d)
viral myelitis e) syringomyelia; f) Spina bifida; g) myelopathy; h) Multiple sclerosis. Medical
and surgical management of bladder and bowel dysfunction

Unit VIII: Peripheral Nerve Lesions 2 hours

Acute flaccid paralysis; Polyneuropathy (GBS, Diabetic, Alcoholic); Entrapment neuropathies;
Traumatic peripheral nerve Injuries

Unit IX: Cranial Nerve Disorders and its Management 1 hour

Pathophysiology, types, differential diagnosis, medical and surgical management

Unit X: Infections of Nervous System (Brain and Spinal Cord) 1 hour

Etiology; pathophysiology; classification; clinical signs and symptoms; investigation;
differential diagnosis; medical and surgical management of a) meningitis b) encephalitis c)
poliomyelitis including post-polio syndrome

Unit XI: Epilepsy 1 hour

Types, features, differential diagnosis and medical management

Unit XII: Extrapyramidal Syndromes 2 hours

Etiology; pathophysiology; classification; clinical signs and symptoms; investigation;
differential diagnosis; medical and surgical management of medical - surgical management of
Parkinson's disease; Introduction to Parkinson plus syndrome

Unit XIII: Degenerative Diseases 2 hours

Etiology; pathophysiology; classification; clinical signs and symptoms; investigation;
differential diagnosis; medical and surgical management of medical - surgical management of
Motor Neuron Disease; Dementia and Alzheimer’s disease; Multiple sclerosis

Unit XIV: Myasthenia Gravis 1 hour

Etiology; pathophysiology; classification; clinical signs and symptoms; investigation;
differential diagnosis; medical and surgical management

Unit XV: Cerebellar Disorders 1 hour

Etiology; pathophysiology; classification; clinical signs and symptoms; investigation;
differential diagnosis; medical and surgical management

Unit XVI: Muscle Disorders 1 hour

Types, etiology, Classification, differentiating features, progression of the disease and medical
management of Myopathies, Dystrophies, inflammatory diseases of the muscles

Unit XVII: Tumors of Brain and Spinal Cord 1 hour

Classification; Differential diagnosis, investigations and prognosis; Medical and surgical
management

Unit XVIII: Neurogenic Bladder 2 hours

Classification; causes, differential diagnosis, prognosis, Management

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Unit XIX: Peripheral Nerve Lesions 2 hours
Classification; differential diagnosis, Management

Unit XX: Pediatric Neurology 1 hour

Types, etiology, classification, differentiating features, Cerebral palsy; Down syndrome; Spina
Bifida; and Autism

Unit XXI: Neurosurgery 3 hours

Principles; Types of neurosurgery; Indications (conditions); General pre and post-operative
management; Evidence based common surgeries used in major neurological conditions (Case
discussion)

Teaching Methods
Lecture, discussion, seminars

References
1. Davidson’s Principles and Practice of Medicine, 23rd edition, edited by Stuart Ralston,
Ian Penman, Mark Strachan, Richard Hobson, 2018
2. Harrison’s Principles of Internal Medicine, New work publisher
3. Paul W. Brazis, Joseph C. Masdeu, Jose Biller, Localization in clinical neurology, sixth
edition, Wolters Kluwer/Lippincott Williams and Wilkins
4. Textbook of Clinical Neurology, 3rd edition edited by Christopher Goetz, 2007
5. Oxford textbook of Neurological surgeries, edited by Ramez Kirollos, Adel Helmy,
Simon Thomson and Peter Hutchinson, 2019, Oxford press
6. Ramamurthi and Tendon’s Textbook of Neurosurgery, 3rd edition, Prakash Narain
Tandon. Ravi Ramamurthi, Jaypee publishers

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 BPT 303 Basic Musculoskeletal Physiotherapy
BPT, Third Year, Fifth Semester

Course Description
The course is designed to teach the students about basic musculoskeletal conditions, fracture,
amputation and manual therapy techniques.

Learning Objectives
Upon the successful completion of course, the students will be able to
• Define, classify and learn the physiotherapy management of fractures and
dislocations of extremities and spine;
• Learn about physiotherapy management and care in amputation; and
• Learn basic concepts of manual therapy and special tests.

Course Contents

Unit I: Introduction to Musculoskeletal Physiotherapy 1 hour

Unit II: Fractures and Dislocation 18 hours

Definitions, Classification of fractures, Mechanism of fracture, Clinical Features, Diagnosis,
Fracture healing, complications
Principle of fracture Management, conservative and operative
Fracture and dislocation of upper limb, lower limb, spine and its complications: Physiotherapy
Assessment and Management with ICF Format, goal setting and guidelines focusing on
Physiotherapy Management of complication with evidence-based practice

Unit III: Amputation 4 hours

Definition, Types and Levels, Principles and indications, Important amputations of lower
extremity, Complications, Ideal stump; ICF based physiotherapy management –Pre-operative,
Do's and Don'ts
Stump management (bandaging for B/L knee, above knee amputation as well as upper
extremity), Positioning, Balance training, Prosthetic prescription and gait training. Discuss the
treatment evidences

Unit IV: Basic Concepts of Manual Therapy 5 hours

Mulligans, Maitland, McKenzie, Kaltenborn, Butler, Cyriax
-Definition, Grades, indication and contraindications, Effects

Unit V: Myofascial and Muscle Energy Technique and Pilates 2 hours

Unit VI: Special Tests 2 hours

Teaching Methods
Lecture, demonstration and group discussion

References
1. Carolyn Kisner & Lynn Allen Colby. Therapeutic Exercise: Foundations and
techniques, 5th Edition.
2. David J Magee. Orthopedic Physical Assessment, 5th Edition.

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3. Robert A. Donatelli. Physical Therapy of the shoulder:4th edition
4. Elly Hengeveld. Maitland’s Peripheral Joint Mobilization, Management of
neuromusculoskeletal system.5th Edition. 2013
5. Geofrey Maitland, Elly Hengeveld, Kevin Banks, Key English. Maitland’s vertebral
manipulation. 7th Edition. 2005.
6. Gwen Jull. Grieve's Modern Musculoskeletal Physiotherapy, 4th Edition. 2015
7. Rudolf M.Kessler: Management of common musculoskeletal conditions,3rd
edition,1996
8. Stanley Hoppenfield, Treatment and rehabilitation of fractures
9. Karen Atkinson, Fiona Coutts Physiotherapy in orthopedics- a problem solving
approach 2nd edition.
10. The Mulligan Concept of Manual Therapy: Textbook of Techniques. Textbook by Bill
Vicenzino, Darren A. Rivett, Toby Hall, and Wayne Hing
11. The Neurodynamic Techniques, butler
12. Manual Therapy: "NAGS", "SNAGS", "MWMS" Etc Book by BRIAN MULLIGAN
13. Clinical Reasoning for Manual Therapists. Darren A. Rivett and Mark A. Jones
14. Manual Physical Therapy of the Spine. Textbook by Kenneth A. Olson
15. Mobilisation with Movement: The Art and the Science. Book by Bill Vicenzino, Darren
A. Rivett, Toby Hall, and Wayne Hing

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 BPT 304 Basic Neurological Physiotherapy
BPT, Third Year, Fifth Semester

Course Description
The course aims to provide students with understanding of physiotherapeutic evaluation and
scientific basis of management of neurological disorders. In addition to providing students with
introduction to assessment and outcome measures in neurological conditions, scientific reasons
upon which neurological rehabilitation is based upon like neuroplasticity, motor control and
motor learning, balance and coordination are included in this course. This course also includes
commonly used specialized neurological techniques.

Learning Objectives
Upon successful completion of this course, students will be able to
• Understand neurological assessment based on SOAP format and selection of
appropriate outcome measures;
• Appreciate the importance and principle of neuroplasticity and its implication in
neuro rehabilitation;
• Understand the stages, theories, and importance of motor control and motor
learning;
• Understand the different systems responsible for maintaining balance and
coordination; and
• Comprehend about commonly used specialized techniques in neurological
rehabilitation like PNF, Bobath Concept and Motor relearning programme.

Course Contents

Unit I: Neurological Assessment 2 hours

General neurological assessment (SOAP format)

Unit II: Use of Outcome Measures in Neurorehabilitation 4 hours

Selection of appropriate outcome measures for various domains e.g. GAS

Unit III: Neuroplasticity 6 hours

Basic understanding and importance of neuroplasticity; Mechanism of neuroplasticity:
Cellular, biochemical and systemic; Principles of exercise dependent neuroplasticity;
Application of neuroplasticity: Positive and negative neuroplasticity, acute and chronic
pathology

Unit IV: Motor Control and Motor Learning 8 hours

Basic understanding and importance of motor control and motor learning; Motor control:
Motor behavior and various stages of information processing for motor behavior, motor
program, motor plan and motor memory, different theories of motor control; Motor learning:
various forms, stages and theory of motor learning

Unit V: Balance and Coordination 6 hours

Balance: definition and systems essential for balance (Sensory strategy, biomechanical
constraints, cognition, orientation in space, control of dynamics, movement strategy);
Coordination: Definition and systems involved for maintaining coordination

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Unit VI: Specialized Neurological Techniques 6 hours
Proprioceptive neuromuscular facilitation (PNF): Principle of PNF and various techniques of
PNF used in neuro rehabilitation; Bobath concept: Basic understanding and principles of
Bobath concept and application; Motor relearning Program: Steps of motor relearning program
Recent techniques used for management in neurological conditions

Teaching Methods
Lecture, group discussion, seminar

References
1. Physical rehabilitation: O’Sullivan
2. Improving functional outcomes in physical rehabilitation: Susan B O’ Sullivan
3. Bickerstaff neurological examination in clinical practice-John spillane
4. Neurological examination made easy: Geraint Fuller
5. Motor control: Anne Shumway cook
6. Neurological rehabilitation: Darcy Ann Umphred
7. Dejong’s The Neurologic examination: Campbell, William W
8. Bickerstaff neurological examination in clinical practice-John spillane
9. Motor control and learning-Latash
10. Motor control-Patricia C. Montgomery
11. Physical Rehabilitation: Michelle H. Cameron, Linda G. Monroe

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 BPT 305 Application of Assistive And Adaptive Devices
BPT, Third Year, Fifth Semester

Course Description
This subject outline the basic concept of design and prescription of assistive technology in
various conditions. Knowledge on assistive devices and technologies guides physiotherapists
to maintain or improve an individual’s functioning and independence and facilitate
participation to enhance overall well-being.

Learning Objectives
Upon successful completion of the subject, the students will be able to:
• Identify various types of assistive devices;
• Measure assistive devices and prescribe to patients/client; and
• Gain awareness of the benefits of assistive technologies used.

Course Contents

Unit I: Introduction to Bio-Engineering 10 hours

Classification of Orthoses and prostheses; Biomechanical principles of orthotic and prosthetic
application; Designing of upper extremity, lower extremity and spinal orthosis; Prescription and
designing of footwear and modifications; Designing and devising of adaptive devises used in
ADL; Knowledge of preparing following splints using POP, Orthoplast, Aluminum stripes and
Rexene material; Short cock-up/long cock-up, Knuckle bender hand splints Opponens, Phase
I and II casts, Anterior guard, Post guard lower limb orthosis, Foot drop splint, Facial splint;
Identification of the type of collegian / brace / prosthesis -used for spine and lower limb

Unit II: Various Implants Used in Orthopedic and Neurological Surgeries (Internal and
External); Biomechanics of Implants 4 hours

Unit III: Walking Aids (Crutches, Cane, Walker, Rollator) 8 hours

Standing frame& special chair; Types, Advantages / Disadvantages, Indications, Selection/
Prescription, Complications, Method of using walking aids, Measurement, Repair and
maintenance

Unit IV: Wheelchair Assessment and Prescription 10 hours

WHO steps of wheelchair service Knowledge on: Wheelchair users & Wheelchair service;
Pressure sores, Cushion making for pressure sores; Appropriate wheelchair, Types of
Cushions, Wheelchair mobility; Physical assessment, Fitting assessment; Basic user training,
Sitting upright; Wheelchair transfers techniques; Selection (type of wheelchair) and
Prescription; Different types of wheelchair

Teaching Methods
Lecture and demonstration

References
1. WHO, Wheelchair service training package- Basic level
2. Textbook of rehabilitation, Sunder
3. Orthotics and prosthetics in rehabilitation, Michelle M. Lusardi
4. Treatment and rehabilitation of fractures, Stanley Hoppenfeld

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5. Gopalans Orthopaedic Principles A Review
6. Physical rehabilitation: O’Sullivan, 6th edition
7. Nordin Biomechanics of implants

84
 BPT 306 Evidence Based Practice and Clinical Decision Making
BPT, Third Year, Fifth Semester

Course Description
This course includes series of topics on evidence-based practice, its components, and access to
research evidence. Students learn different research designs, sampling techniques,
measurement tools and critical analysis of the articles. Additionally, this course includes steps,
and techniques of clinical decision-making as well as clinical reasoning, and consideration of
factors influencing clinical decision-making.

Learning Objectives
Upon the completion of this course, students will be able to;
• Describe evidence-based practice, its components, and process of applying it in
research and clinical practice;
• Develop knowledge on critical appraisal of the evidence and extraction of the
information; and
• Gain knowledge about process and techniques of clinical decision making in
physiotherapy and consideration of factors influencing it.

Course Contents

Section A: Evidence Based Practice (32 hours)

Unit I: Evidence Based Practice 2 hours

Introduction; importance in physiotherapy and process of evidence-based practice

Unit II: Components of Evidence-Based Practice 4 hours

Evidence; Patients related factors and Skills gained from the experience

Unit III: Introduction to Research Process 6 hours

Brief introduction to research design, sampling methods, statistical analysis, selection criteria,
ethical approval, examples of measurement tools

Unit IV: Level of Evidence 2 hours

Identifying valid and reliable evidence, level or hierarchy of evidence pyramid, Introduction to
GRADE, NHMRC, Sackett, Oxford

Unit V: Appraisal of Articles 8 hours

Analyzing various components of an article, appraisal of scientific evidence or article, use of
scientific tools or guidelines to critically appraise various types of articles

Unit VI: Information Extraction from an Article 4 hours

Techniques of extraction of reliable information from an article for implication in clinical
practice

Unit VII: Group work and Presentation 6 hours

Each group of students has to search and find an article that is different type from that of rest
of the groups. The article has to be critically appraised using scientific tools or guidelines and
present the appraisal findings to the class

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Section B: Clinical Decision Making (16 hours)

Unit VIII: Clinical Decision Making 1 hour

Definition, introduction; Theories

Unit IX: Process of Clinical Decision Making 1 hour

Unit X: Barriers to Clinical Decision Making 1 hour

Unit XI: Factors Influencing Clinical Decision Making (based on ICF) 2 hours

Unit XII: Intervention Model and Therapeutic Process for Clinical Decision-Making
4 hours
Intervention selection and modification; parameter selection; exercise prescription; exercise
progression; and outcome prediction

Unit XIII: Clinical Reasoning 3 hours

Critical thinking; problem solving behaviors / techniques; and reflection

Unit XIV: Clinical Application of Clinical Decision Making in Clinical Practice

4 hours
Case discussion in Nepalese context and cultural background

Teaching Methods
Lecture and group discussion/group work, seminar and case discussion

References
1. Wolf, Steven L., Clinical decision making in Physical Therapy, 1st edition
2. Megan Smith JHaEE. Factors influencing clinical decision making.
3. Wainwright SF, McGinnis PQ. Factors that influence the clinical decision-making of
rehabilitation professionals in long-term care settings. J Allied Health. 2009;38(3):143-
51.
4. Edwards I, Richardson B. Clinical reasoning and population health: decision making
for an emerging paradigm of health care. Physiother Theory Pract. 2008;24(3):183-93.
5. Edwards I, Jones M, Carr J, Braunack-Mayer A, Jensen GM. Clinical reasoning
strategies in physical therapy. Phys Ther. 2004;84(4):312-30; discussion 31-5.
6. Gilliland S, Wainwright SF. Patterns of Clinical Reasoning in Physical Therapist
Students. Phys Ther. 2017;97(5):499-511.

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 BPT 341 Practical 10 (Basic Musculoskeletal Physiotherapy)
BPT, Third Year, Fifth Semester

Course Description
The course is designed to teach the students about practical aspect of fracture management and
hands on manual therapy techniques.

Learning Objectives
Upon the successful completion of the course, the students will be able to
• Assess, manage and care for amputation;
• Apply mobilization skills to the extremities and spine; and
• Perform special tests for the extremities and spine.

Course Contents

Unit I: Amputation 4 hours

Stump management (bandaging for B/L knee, above knee amputation as well as upper
extremity), Positioning, Balance training, Prosthetic prescription and gait training. Discuss the
treatment evidences

Unit II: Special Tests 24 hours

Upper Limb
Shoulder: Tendon test, Impingement test, Labral test, Instability test
Elbow: Tendon tests, Ligament/ instability test, Neurological test:
Wrist: Ligament / instability test, TFCC test, Carpal tunnel tests, Thumb test

Lower Limb
Hip: Patrick's test/ FABER test, FADIR test, log roll test, Scour test, Patellar pubic percussion
test, Tests for IT band length – Ober's test and modified Ober's test, Thomas test, Ely's test,
Trendelenburg Test
Knee : Ottawa knee rule for ruling out fractures, Tests for ACL injury - Anterior drawer test,
Lachman’s test, Test for PCL injury -Poster drawer test, posterior sag sign, Tests for Meniscal
injury – McMurray’s test,, Apley’s test, Ege’s test, Thessaly test, Tests for MCL and LCL –
Valgus and varus tests, Tests for PFP – Clark’s test, McConnell’s test, Moving patellar
apprehension test, tests for orientation of patella, Assessing Q-angles, Tests for knee joint
effusion/ inflammation –fluctuation test, patellar tap test.
Ankle (and foot): Ottawa Ankle rule, Ankle squeeze test, Dorsiflexion compression test, Ankle
impingement sign, Anterior drawer’s test, Windlass Test, Test for tarsal tunnel syndrome test

Spine
Cervical: Neurological test, Ligamentous tests, vertebral artery, cervical radiculopathy test,
Cervical myelopathy test
Lumbar spine: Neurodynamic tests, Lumbar instability test, Lumbar joint dysfunction test,
Intermittent claudication, Muscle dysfunction
Sacroiliac Joint tests: Thigh thrust / SIJ provocation, Distraction provocation test/
Gapping/Transverse Anterior stress, Compression provocation test/ Approximation (transverse
post stress), Sacral thrust provocation test/Sacral apex pressure, Gillet/ stork test/knee flexion
test, ASLR, Gaenslen's provocation test

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Unit III: Mobilization 20 hours
Definition, Grades, indication and contraindications, Effects
UL-Shoulder, Elbow, Wrist and Fingers joints
LL-Hip, Knee, Ankle and Foot Joints
Spine-Cervical, Lumber and Sacroiliac Joint

Teaching Methods
Practical, demonstration, group discussion

References
1. Carolyn Kisner & Lynn Allen Colby. Therapeutic Exercise: Foundations and
techniques, 5th Edition.
2. David J Magee. Orthopedic Physical Assessment, 5th Edition.
3. Robert A. Donatelli. Physical Therapy of the shoulder:4th edition
4. Elly Hengeveld. Maitland’s Peripheral Joint Mobilization, Management of
neuromusculoskeletal system.5th Edition. 2013
5. Geofrey Maitland, EllyHengeveld, Kevin Banks, Key English. Maitland’s vertebral
manipulation. 7th Edition. 2005.
6. Gwen Jull. Grieve's Modern Musculoskeletal Physiotherapy, 4th Edition. 2015
7. Rudolf M. Kessler: Management of common musculoskeletal conditions,3rd
edition,1996
8. Stanley Hoppenfield, Treatment and rehabilitation of fractures
9. Karen Atkinson, Fiona Coutts Physiotherapy in orthopedics- a problem solving
approach 2nd edition.
10. The Mulligan Concept of Manual Therapy: Textbook of Techniques. Textbook by Bill
Vicenzino, Darren A. Rivett, Toby Hall, and Wayne Hing
11. The Neurodynamic Techniques, butler
12. Manual Therapy: "NAGS", "SNAGS", "MWMS" Etc Book by BRIAN MULLIGAN
13. Clinical Reasoning for Manual Therapists. Darren A. Rivett and Mark A. Jones
14. Manual Physical Therapy of the Spine. Textbook by Kenneth A. Olson
15. Mobilisation with Movement: The Art and the Science. Book by Bill Vicenzino, Darren
A. Rivett, Toby Hall, and Wayne Hing

88
 BPT 342 Practical 11 (Basic Neurological Physiotherapy)
BPT, Third Year, Fifth Semester

Course Description
This course aims to provide students with practical knowledge of complete neurological
assessment, designing and implementing physiotherapeutic treatment based on motor control
and motor learning. Furthermore, the course includes assessment of balance and coordination
and training deficits of balance and coordination. Different methods of transfers and bed
activities are also included.

Learning Objectives
Upon successful completion of this course students will be able to
• Perform complete neurological assessment and document problems based on ICF
model;
• Design and implement exercise based on principle of motor control and motor
learning;
• Evaluate balance and coordination deficits;
• Plan and execute physiotherapeutic treatment accordingly for balance and
coordination deficits;
• Demonstrate and perform bed mobility and patient transfer techniques efficiently;
and
• Demonstrate and implement techniques of PNF and MRP.

Course Contents

Unit I: Neurological Assessment 20 hours

Subjective: Noting chief complains, history and functional status

Objective: Clinical observation and palpation; Motor testing: muscle strength (MRC score),
muscle tone (medical note, Modified Ashworth scale,) ,Reflexes (superficial and deep),
myotomes; Sensory testing: Superficial, deep and combined cortical, dermatome (FMA);
Higher mental functions: consciousness, memory, attention, speech and language, perception
and executive functions (GCS, mini CoG); Examination of cranial nerves; Assessment of
balance (Berg balance scale, Mini Bestest, Rhomberg test); Coordination evaluation:
Equilibrium and non-equilibrium coordination testing; Gait and posture assessment: Normal
posture and gait; Functional evaluation: Evaluation at activity and participation level of ICF (
Barthel Index); General overview of diagnostic imaging and procedures used in neurology and
neurosurgery( X-ray, CT scan, MRI, LP, EMG and NCV)

Assessment: Developing a problem list based on subjective and objective assessment

Physiotherapy Diagnosis

Unit II: Motor Control and Motor Learning 4 hours

Designing exercise program using principle of motor control and motor learning

Unit III: Balance and Coordination Training 8 hours

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Different balance tests (TUG, BBS, CTSIB); Different forms of balance training based on
system involved; Different tests of coordination (Equilibrium and non-equilibrium test);
Coordination training based on involved system

Unit IV: Bed Mobility and Transfers 6 hours

Exercises and strategies for effective bed mobility- Rolling; Progression of activity beginning
from supine/ prone to sitting; Transfers- Active and passive transfer methods

Unit V: PNF and MRP 8 hours

Various techniques and applications

Unit VI: Swallowing, Speech and Language 2 hours

Neurological basis of swallowing, speech and language: Anatomy and physiology of
swallowing, speech and language, Disorders of swallowing and intervention: Introduction to
facio oral tract therapy and K point stimulation, Interventions in speech disorder: Basic
Introduction

Teaching Methods
Practical, demonstration and group discussion

References
1. Physical rehabilitation: O’Sullivan
2. Motor control: Anne Shumway cook
3. Neurology and Neurosurgery: Lindsay
4. Improving functional outcomes in physical rehabilitation: Susan B O’ Sullivan
5. Neurological examination made easy: Geraint Fuller
6. Neurological rehabilitation: Darcy Ann Umphred
7. Dejong’s The Neurologic examination: Campbell, William W
8. Bickerstaff neurological examination in clinical practice-John spillane
9. Motor control and learning-Latash
10. Motor control-Patricia C. Montgomery
11. Physical Rehabilitation: Michelle H. Cameron, Linda G. Monroe
12. PNF in practice: Adlers, Beckers, Buck

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