PHTY603 - Advanced Physiotherapy Practice 1 Optimising Mobility and Gait

Year

Credit points

Campus offering

Prerequisites

PHTY612 Enhancing Clinical Reasoning in Rehabilitation for Physiotherapists AND HLSC630 Holistic Rehabilitation and Restoration 1

Teaching organisation

Unit rationale, description and aim

The ability to comprehensively assess and manage balance, mobility and gait is an essential aspect of clinical practice for physiotherapists working with clients with a range of disorders requiring rehabilitation across the lifespan. PHTY603 offers post graduate physiotherapy students the opportunity to enhance their theoretical knowledge and clinical skills to facilitate development of holistic person-centred evidence based rehabilitation strategies and interventions for the management of balance, mobility and gait disorders adversely affecting activity participation. Motor learning principles, intensity of practice as well as exercise prescription will be considered and applied for the development of optimal interventions. This unit aims to encourage students to further develop and apply to their practice, enhanced knowledge and skills associated with critical analysis of balance, mobility and gait, collaborative setting of person-centred goals; as well as development and implementation of evidence based strategies with the purpose of optimising safety, foster healthy well-being and capacity for participation.

Learning outcomes

To successfully complete this unit you will be able to demonstrate you have achieved the learning outcomes (LO) detailed in the below table.

Each outcome is informed by a number of graduate capabilities (GC) to ensure your work in this, and every unit, is part of a larger goal of graduating from ACU with the attributes of insight, empathy, imagination and impact.

Explore the graduate capabilities.

On successful completion of this unit, students should be able to:

LO1 - Integrate, apply and critically discuss enhanced knowledge of biomechanics related to balance and gait, motor learning principles and intensity of practice to optimise balance and gait outcomes of people with disorders requiring rehabilitation across the lifespan for participation (GA4, GA5)

LO2 = Critically assess, and analyse balance, mobility and gait of people who present with a range of movement problems ensuring accommodation occurs for behavioural, cognitive and/or memory factors in order to collaboratively determine optimal goals aimed at maximising outcomes and participation (GA3, GA4, GA5, GA7, GA8)

LO3 - Demonstrate advanced ability to develop, implement, communicate, critically review and justify a person-centred evidenced-based treatment mobility, balance and /or gait program designed to promote optimal outcomes for management of movement problems across the lifespan (GA3, GA4, GA5, GA7, GA8, GA9)

LO4 - Reflect on application of enhanced knowledge, skills and experiential learning in the clinical setting and analyse the implications for the assessment and interventions implemented for optimal development of balance, mobility and gait of people requiring rehabilitation with acquired brain injury or disability, as well as for your personal and professional growth as a physiotherapist (GA3, GA4, GA5 GA8)

Graduate attributes

GA3 - apply ethical perspectives in informed decision making

GA4 - think critically and reflectively 

GA5 - demonstrate values, knowledge, skills and attitudes appropriate to the discipline and/or profession 

GA7 - work both autonomously and collaboratively 

GA8 - locate, organise, analyse, synthesise and evaluate information 

GA9 - demonstrate effective communication in oral and written English language and visual media 

Content

Topics will include: 

Positioning, Bed Mobility, Sitting and Standing  

• Positioning / handling / environmental set-up to maintain attention and orienting mechanisms while minimising adaptive changes in bed, sitting and standing 
• Postural Assessment: determining fixed versus flexible conditions and seating modifications 
• Enabling early mobility within hospital, home and care facilities (bed mobility and regaining the ability to sit and stand)  
• Managing verticality and pushing behaviour after stroke 
• Managing unilateral spatial neglect 
• Managing adults with / without cognitive impairments / dementia / delirium 
• Managing adaptive changes / contracture 
• Application of the principles of aquatic physiotherapy to neurological patients cross the lifespan 
• Enabling early mobility / loading / functional training / development of reactive balance for people in pain / with weakness 
• Limitations and precautions 

Ambulation 

• The domains of community ambulation   
• Gait 
• Balance control and biomechanical analysis of gait / stair walking / negotiating obstacles and during turning  
• Effect of increasing speed and running on gait / implications for practice  
• Measures of gait using clinical and laboratory measures  
• Wheelchair 
• Wheelchair prescription with deteriorating conditions – how to manage change 
• Wheelchair / seating / equipment prescription to enable optimal mobility and participation  
• Advances in power wheelchair technology to enhance functional participation 

Intensity and exercise prescription  

• Principles of motor skill acquisition/ motor learning / repetition / providing feedback   
• Intensity of practice: Strategies for enabling increased intensity of practice in rehabilitation settings – principles underpinning delivery and practice opportunities (in common and applied to a range of clinical groups)  
• Self-awareness and self-efficacy as a basis for goal setting – application to the person with a neurological condition to enable increased activity and participation  
• Exercise prescription and increasing activity (in common) - application to the person with a neurological condition for healthier ageing / adapted for those with pain or pathology 

Balance and Gait Retraining  

• Critical review of evidenced based interventions for retraining balance  
• Functional / task focused programs - elements for effective training 
• Biofeedback tools 
• Individualised and group delivery as workstations  
• Importance of patient education re environmental challenges and sensori motor responses for optimal translation of exercises within the home context   
• Critical review of evidenced based interventions for retraining gait   
• Electro-mechanical Assistive Devices (Lite Gait / Treadmill training ±Body weight support)   
• Functional Electrical Stimulation   
• Biofeedback tools for enhancing gait retraining 

Application of knowledge and skills with a range of patients within the clinical setting   

• Analysis of balance and gait across the lifespan or following Acquired Brain Injury 
• Application of evidenced based knowledge and skills for optimal balance and gait retraining people across the lifespan or with a neurological disorder    
• Critical review of balance and gait outcome measures to identify the minimally important clinical changes required during interventions  
• Community participation 

Learning and teaching strategy and rationale

This unit is offered through multi-mode and online delivery for specific on and offshore cohorts. Both modes aim to facilitate learner centred activities, and workplace learning. Learning and teaching strategies within this Graduate Diploma level unit are based on a blend of constructivism, social constructivism, and experiential learning. These strategies focus on active participation and developing a community of inquiry. Purposefully designed content and activities that are the same or similar for all participants regardless of the mode of delivery have been identified. This has led to the development of purposefully designed learning activities that are transferable and work well across both delivery mediums whilst maintaining the flexibility to create and deliver mode specific activities focusing on inquiry based learning principles aimed at encouraging critical thinking, application of knowledge and skills, evidence for practice, collaborative peer learning, and critical self-reflection.  

In addition, students participate in individual and small group activities based on analysis of current practice, to assimilate application of enhanced knowledge and facilitate translation of learning into practice. Engagement in extended dialogue is encouraged to guide change to a more interprofessional, person-centred practice. Unit activities include, but are not limited to: guided readings, synchronous on-line tutorials, work-based activities with reflection, use of a reflective journal during experiential learning, skill development, and mentoring to enhance practice. To facilitate practical application of knowledge and skills, multi-mode delivery requires participation in a required mid unit intensive practical workshop. Where possible, workshop activities are designed as reusable learning activities able to be provided online or modified slightly as required for current information and communication technologies for online delivery. As required, for example in different time zones learning and teaching strategies will be adapted for online delivery for specific cohorts. Activities undertaken in both modes are aimed to facilitate acquisition of advanced knowledge and skills in collaborative and assessment and intervention planning strategies.

Assessment strategy and rationale

PHTY603 assessments have been purposefully designed to replicate authentic clinical practice. Significantly, the unit’s assessments have also been designed from an “Assessment for Learning” approach in order to not only provide evidence for judgement of learning, but also to reinforce, facilitate and support learning and application of learning. The assessment tools have been designed to provide for a broad range of tasks aligned to andragogic principles of adult learning, facilitating choice and self-direction for the post graduate student. The design enables timely judgement to ensure students have appropriate knowledge and skills prior to the workplace application segment of the unit. In addition, the range of assessment activities at the end of the unit encourage application of evidence to practice and embed clinical reasoning, problem solving and implementation of advanced knowledge and skills.  

The first assessment task provides students with the opportunity to demonstrate advanced and critical analysis of a case study performing a mobility related task and to identify and apply optimal evidence based interventions. The focus of the final two assessment items, is to reflect on personal and collaborative practice, and communicate reflections, evidence based reasoning and decision making, to management and peers. In the second assessment task students will identify an evidence based intervention for implementation in their work setting. Students will outline the evidence gap, appraise the relevant evidence and apply to their work setting, and communicate the implementation plan for this evidence practice gap within their work setting. Assessment task 3 enables students to demonstrate advanced skills in the planning and where applicable delivery on an evidence based intervention with a client, their clinical reasoning and clinical decision making. 

These assessments incorporate the advanced level of professional knowledge and skills, enhanced critical analysis and professional presentation modes developed throughout the post graduate program. Scheduling of assessments will be equitable for both modes of delivery. Assessment tasks may be delivered and assessed locally with moderation according to University Policies and Procedures. All assessments will be submitted electronically.

Overview of assessments

Representative texts and references

Carr J & Shepherd R (2011) Neurological Rehabilitation: Optimising motor performance. (2nd Ed.) Edinburgh: Churchill Livingstone. 616.8043CAR 

Chastan N, Bair WN, Resnick SM, Studenski SA, Decker LM. Prediagnostic markers of idiopathic Parkinson's disease: Gait, visuospatial ability and executive function. Gait and Posture. 2019 Feb;68:500-505. doi: 10.1016/j.gaitpost.2018.12.039.  

Cruz-Oliver DM. Gait, Balance and Falls Chichester, UK: John Wiley & Sons, Ltd (2012) Pathy's Principles and Practice of Geriatric Medicine, Medicine and Prescribing in Old Age, Chapter 91, p.1091-1110   

Fjeldstad-Pardo C, Thiessen A, Pardo G. (2018) Telerehabilitation in Multiple Sclerosis: Results of a Randomized Feasibility and Efficacy Pilot Study. International Journal of Telerehabilitation. 2018 Dec 11;10(2):55-64. doi: 10.5195/ijt.2018.6256. eCollection 2018 Fall. 

Hong, Y, Bartlett, R,. (2010) Routledge Handbook of Biomechanics and Human Movement Science / Roger Bartlett, Youlian Hong 2010: Routledge, Oxon, London 

Kasser SL, Jacobs JV, Foley JT, Cardinal BJ & Maddalozzo GG. (2011) A Prospective Evaluation of Balance, Gait, and Strength to Predict Falling in Women With Multiple Sclerosis Archives of Physical Medicine and Rehabilitation, 92(11), pp. 1840-1846 

Mehrholz J, Kugler J, Storch A, Pohl M, Hirsch K, Elsner B. Treadmill training for patients with Parkinson's disease. The Cochrane Database of Systematic Reviews. 2015 Sep 13;(9):CD007830. doi: 10.1002/14651858.CD007830.pub4. Review. 

Mehrholz, J, Thomas S, Werner C, Kugler J, Pohl M, Elsner B. (2017) Electromechanical-assisted training for walking after stroke. The Cochrane Database of Systematic Reviews, 2017 May 10,5:CD006185. Doi: 10.1002/14651858.CD006185.pub4. 

Mera TO, Filikowski DE, Riley DE, Whitney CM, Wkater BL, Gybzker SA, & Giuffrida JP. (2013) Quantitative analysis of gait and balance response to deep brain stimulation in Parkinson's disease. Gait & Posture.38(1), pp.109-114   

Shumway-Cook A and Woollacott MH. 2017 Motor Control: Translating Research into Clinical Practice 5th Ed Lippincott Williams and Wilkins. Phil USA 616.SHU 

Whittle MW. (2007). Gait analysis: an introduction / 4th ed. Edinburgh; New York: Butterworth-Heinemann Elsevier 612.76 WHI