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Clinical Examination Of The Lumbar Spine

Raymond Delacruz

Updated March 8, 2020

Transcript

Clinical Examination of the Lumbar Spine

Interactive Syllabus

Course Information

Course Number: PT 111

Credit Hours: 3

Program(s): DPT, TDPT, Continuing Education

Class Dates: Sept. 10 - Dec. 21, 2018

Classroom/ Lab: 222 - Tuesday and Thursday, 7pm-8:30pm

Virtual Office Hours: Contact Instructor

MyUSA and Blackboard

After you login to MyUSA, click on the Blackboard tab at the top of your screen on the menu bar. Select Access Blackboard Here. Next, select the box labeled Click Here to Login to Blackboard. The landing page is your course “dashboard” where you will find information on getting started, course announcements and content important to the course.

For technical support, please visit: https://my.usa.edu/ICS/Student_IT_Support.jnz

For problems related to Blackboard, please contact Blackboard Support (SST) at:

- Phone: 855-763-4653

- Email: USAsupport@USA.edu

Please bring any errors in any course-related communications to the direct attention of the course instructor.

About Your Instructor

Instructor Name: Raymond Delacruz, PT, MS, CSCS, FAAOMPT

E-mail Address: r.delacruz@usa.edu

Phone Number: 843-817-5557

Office Hours: by appointment

When contacting your instructor, be sure to use your usa.edu email address. Faculty is not permitted to communicate with you through another email service.

Instructor Bio:

Raymond Delacruz is a physical therapist practicing in an outpatient orthopedic clinical setting. He received his Master's degree in Physical Therapy from the Medical University of South Carolina and obtained his Bachelor’s degree in Exercise Science from the University of South Carolina. His fellowship training is in Orthopedics and Manual Physical Therapy from the Manual Therapy Institute. Raymond is a recognized Fellow by the American Academy of Orthopedic Manual Physical Therapists (AAOMPT). He is a mentor for fellows in training, clinicians seeking manual certifications, and is a clinical instructor for physical therapy students from various programs. Raymond is an assistant lab instructor for the Manual Therapy Institute.

Course Description

This course is focused on enhancing the learner’s ability to make decisions about clinical presentations that may indicate serious pathology in the lumbar spine region. Learners will develop a safe, effective, and efficient lumbar spine examination that has three objectives: a) to make certain the patient/client is within the scope of physical therapy practice and suitable for management, b) to recognize a possible diagnosis, and c) to direct the evaluation and management. The learners will identify an evidence-informed approach with the consideration of normal, abnormal and applied lumbar anatomy, physiology, pathology, and movement science. Learners will apply the concepts of total patient health, function, life-participation, pain behaviors and their manifestations, in their role for total patient/client management. The class will be in a blended format with online modules and interactive discussions. There will also be required class attendance twice a week over a course of 15 weeks for an hour and a half per session and will consist of a combination of lecture and lab components. Be sure to dress appropriately.

Course Pre-requisites

Admission into the DPT/ TDPT program.

Currently licensed and practicing physical therapist. (Continuing Education)

The instructor or student may seek an exception to the pre-requisites via the program director.

Course Learning Outcomes

Course Learning Outcome 1: Apply efficient decision-making processes in a clinical setting with an enhanced ability to deal with unique presentations that may indicate serious pathology.

Course Learning Outcome 2: Perform a safe, effective, and efficient lumbar spine examination on a patient/client presenting with a lumbar spine health condition.

Course Learning Outcome 3: Ensure that the patient/client is within the scope of physical therapy practice and suitable for management.

Course Learning Outcome 4: Recognize possible diagnosis for a patient/client presenting with a lumbar spine health condition to direct the evaluation and management.

Course Learning Outcome 5: Utilize a consistent clinical process to effectively screen for systemic disease and non-musculoskeletal pathology in patients with lumbar spine pain.

Course Learning Outcome 6: Outline an all-sourced evidence-based medicine management plan to address patient-specific care in various forms of lumbar spine health conditions.

Please refer to individual units for unit objectives.

Course Writing

All writing for this course (i.e., discussion board postings, emails, and submitted assignments) should reflect the attributes of graduate-level academic writing, including clarity, precision and power. Please check all work for errors in spelling, punctuation, and mechanics before submission. Students should utilize Grammarly and other tools to assure their work is error-free.

Different assignments call for various styles of writing. In many cases, such as discussion board postings, a less formal voice may be used. In other cases, a more formal voice with proper APA formatting may be required. Please check the rubric or assignment grading criteria, and if you are unsure ask your instructor for clarification.

Learning is not a top-down process. Each of us shares in the responsibility of educating and being educated. Students are expected to make positive contributions that foster a professional, analytic atmosphere. Healthy debate is encouraged, but students must remain mindful that remarks that demean others and their opinions are not tolerated.

TEACHING AND ASSESSMENT METHODS:

Instructional mediums will include, but are not be limited to, online engagement, slide presentations, case scenarios, written testing situations, practicals and individual study of instructional materials. The level of teaching and examination will include the cognitive levels of comprehension, application, analysis, synthesis, and evaluation. The written examinations will consist of a combination of fill in the blank, matching, and multiple-choice questions. The lab practical component will utilize the psychomotor skills required to perform a thorough lumbar spine examination. The signature assignment is a project/examination incorporating course learning outcomes. The project rubric is available on the course platform.

Teaching Assessments

Course Grading

Grade calculation:

Discussion Board- 5 (2% each)= 10%

Written Exam- 5 (10% each) = 50%

Oral Exam – 2 (10% each) = 20%

Practical Exam- 2 (10% each) = 20%

Total =100%

Per policy, no extra credit points will be awarded in this course.

Week 13: Fracture, Disc Herniation, Stenosis & Instability

Due: 12/07/18

Week 14: Segmental Hypomobility (Opening/ Closing Restrictions), Degenerative vs. Isthmic Spondylolisthes

Due: 12/14/18

Week 15: Abdominal Aortic Aneurysm & Cauda Equina Syndrome

Due: 12/20/18

Discussion: Initial Post

Due: 12/12/18 by 11:59pm EST

Final Post

Due: 12/16/18

Written Exam

Due: 12/20/18

Required readings, videos and other resources will be provided through the library and links.

Students are responsible for purchasing required textbooks for the course.

Resources

TEXTBOOKS

REQUIRED:

• Bogduk, N. (2012). Clinical and radiological anatomy of the lumbar spine (5th). London. Elsevier

• Magee, D. (2013). Orthopedic physical assessment. (6th). Canada: W.B. Saunders and Co.

RECOMMENDED:

• Jull, G., Moore, A. Falla, D., McCarthy, C., & Sterling, M. (2015). Grieve’s modern musculoskeletal physiotherapy (4th). New York, NY: Elsevier

• Kendall, F.P., McCreary, E.K., Provance, P.G., Rodgers, M.M., Romani, W.A. (2010). Muscles testing and function with posture and pain (5th). North America: Lippincott Williams and Wilkins

Textbooks

READINGS

Readings

Cook, C., Brismee, J.M., & Sizer, P.S. (2006). Subjective and objective descriptors of clinical lumbar spine instability: A delphi study. Manual therapy. 11(1). 11-21

Delitto, A, Shulmann, A.D., & Rose, S.J. (1992). Reliability of a clinical examination to classify patients with low back syndrome. Physical therapy practice. 1(3), 1-9

Dutton, M. (2016). Dutton’s orthopaedic examination, evaluation and intervention. China: McGraw Hill

Manual Therapy Institute. (2012). Evaluation and treatment of the lumbar spine.

VIDEOS

Videos

Cooper, G. (n.a.). Acute lower back pain- a veritas health video [Video file] Retrieved from https://www.spine-health.com/video/acute-lower-back-pain-video

Cooper, G. (n.a.). Causes of lower back pain- a veritas health video [Video file] Retrieved from https://www.spine-health.com/video/causes-lower-back-pain-video

Kenhub. (2015, Nov. 8). Lumbar spine- anatomy, diagram and definition- Human anatomy. Retrieved from https://www.youtube.com/watch?v=VEPp4od4RjY

Nucleus medical media. (2011, Sep. 22). Back pain: lumbar disc injury. Retrieved from https://www.youtube.com/watch?v=nV4ILsaVSXc

Passarelli, C. (2016, Mar.13). Lumbar spine assessment. Retrieved from https://www.youtube.com/watch?v=QnDBAGCy7LI

Veritas (n.a.). Lumbar herniated disc video. [Video file] Retrieved from https://www.spine-health.com/video/lumbar-herniated-disc-video

Veritas (n.a.). Lumbar spinal stenosis video. [Video file] Retrieved from https://www.spine-health.com/video/lumbar-spinal-stenosis-video

Veritas (n.a.). Lumbar spine anatomy video. [Video file] Retrieved from https://www.spine-health.com/video/lumbar-spine-anatomy-video

Veritas (n.a.). Lumbar spondylolysis video. [Video file] Retrieved from https://www.spine-health.com/video/lumbar-spondylolysis-video

Veritas (n.a.). Metastatic spinal cancer video. [Video file] Retrieved from https://www.spine-health.com/video/metastatic-spinal-cancer-video

Veritas (n.a.). Sciatica video. [Video file] Retrieved from https://www.spine-health.com/video/sciatica-interactive-video

Veritas (n.a.). Spine anatomy interactive video. [Video file] Retrieved from https://www.spine-health.com/video/spine-anatomy-interactive-video

Professional Behaviors

The readings and online modules should be completed prior to that week’s in-person lecture/ labs. Initial discussion posts should be posted on Wednesday by 11:59pm, and you must reply to at least two other classmates prior to that Sunday at 11:59pm EST. Be sure to provide references using APA format.

Attendance is required for each classroom session but if you are unable to attend due to unforeseen circumstances it can be made up by scheduling an appointment to review that day's assignment with the instructor. On the rare occasion that the online component of the course is unavailable, please contact your instructor for further directions or for extensions on testing and assignments. All assignments within the online course have specific due dates. In most cases, assignments will be graded within 48 hours but lengthier assignments may take up to 7 days to grade. You will be e-mailed within 4 days of your unit assignment deadline if your assignment has not been received. When submitting assignments online, you can check the Assignment Submission area or the Gradebook within Blackboard to confirm submission details.

Audio/Video/Media Recording

This course prohibits the audio-visual recording, transmission, or distribution of classroom lectures and discussions unless expressed written permission from the course instructor has been obtained. Any recording of lectures or class presentations should be authorized solely for the purpose of individual study. Such recording may not be reproduced or uploaded to publicly accessible web environments. Recordings of classes or course materials may not be exchanged or distributed for commercial purposes, for compensation, or for any other purpose other than individual study.

Late Assignments

Learners are responsible for all missed or incomplete work. Late assignments may be subject to a 20% penalty every 24 hour period the assignment is tardy. The instructor reserves the right to deduct additional points if the assignment is overdue beyond the initial 24-hour tardy period. In certain cases, an extension may be granted. Please contact your instructor with any extension requests.

Attendance

All students are expected to attend each class session as well as log in to their course and complete online modules. If unable to attend due to unforeseen circumstances it can be made up by scheduling an appointment to review that day's assignment with the instructor. Failure to do so could lead to removal from the course for lack of expected satisfactory academic progress (please see the handbook for more information) and could result in termination of Title IV funding. Additional attendance requirements will be outlined by your instructor and may vary by course.

Academic Integrity

The University recognizes the principles of honesty and truth as fundamental to ethical business dealings and a vibrant academic community of faculty and students. All members of an academic community shall be confident that each person's work has been responsibly and honorably acquired, developed and presented. The work that a student submits shall be a fair representation of his/her ability, knowledge and skill. The University expects students to respect and exhibit these principles as they form the basis of the quality of the institution and the quality of USAHS's graduates. The Academic Integrity Policy is clearly defined in the student handbook. Penalties for not following this policy could range from a zero on an assignment to dismissal from the University.

Plagiarism and Citation of Sources

Academic honesty is expected of all students. It is expected that all student work will be that of the student's, or it will be cited as a source if it is the work of another author or scholar. Plagiarism occurs when a student uses another person's ideas or words without properly citing the source of that material. A graduate student is expected to properly cite sources and to know what constitutes plagiarism. If a student is not sure what constitutes plagiarism, it is recommended they visit the website: http://sja.ucdavis.edu/files/plagiarism.pdf

Most courses at the University of St. Augustine require students to follow the style guidelines of the American Psychological Association (APA) or the American Medical Association (AMA). Both styles have publications available to assist the student in conforming to these styles. The USA Writing Center provides online style guides for both these citation styles: https://my.usa.edu/ICS/Student_Services/Writing_Center/Referencing.jnz

Students can also access the full AMA Manual of Style publication and APA Style Central online through the USA Writing Center.

When students use their work in subsequent course assignments, the citation must be formatted with the student as a primary author and previous coursework as unpublished papers.

NOTE: Instructors are trained to detect work that does not appear to be the original work of a student. This is completed through the use of web search engines or library database tools as well as any number of plagiarism-detection applications. If a student is found to have submitted plagiarized work, the result may be a failing mark for the assignment. Additionally, the faculty member may report the offense to the university administration for further action as found in the universities policies on academic dishonesty.

Self-Citation

Course Evaluations

Course evaluations are due upon completion of your course. These evaluations will be available to you after the third week of the course start date. Please locate the course evaluation link(s) at MyUSA. All assigned course evaluations will be listed, and each link will take you to the course evaluation of the corresponding course. You may enter your feedback at any time during the term. In fact, you can return to the course evaluation and pick up where you left off if you select "save progress & return." If you click on the "submit survey" button, you cannot return to the evaluation. Please do not submit until the last week of your course. All course evaluations may be completed on any mobile device. Your feedback is valuable to this process as course evaluation, and modification is dependent on your input. Make sure your comments are constructive as course modifications depend on your feedback.

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