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 advance their theoretical knowledge and enhance their 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. The aim of this unit is to encourage students to further develop and apply to their practice, advanced knowledge and enhanced clinical 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 - Critically discuss the integration and application of advanced knowledge of biomechanics to the analysis of sitting, standing, standing up, walking, stair-walking and running in people who present with a range of movement problems. (GA4, GA5);

LO2 - Critically discuss the application of the principles of motor skill acquisition to optimise mobility outcomes for people with disorders requiring rehabilitation, ensuring accommodation for people with behavioural, cognitive and/or memory impairment (GA3, GA4, GA5, GA7, GA8);

LO3 - Critically review and justify a person-centred program incorporating research evidence, clinical expertise and personal preferences to promote optimal outcomes for mobility (GA3, GA4, GA5, GA7, GA8, GA9);

LO4 - Reflect on the application of advanced knowledge, enhanced clinical skills and experiential learning in the clinical setting and how this has impacted the student's practice, as well as for their 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: 

Early mobility

• Enabling early mobility including bed mobility, sitting, standing up, standing
• Using environmental set-up to increase arousal and attentional capacity
• Adapting training for people with adaptive changes/ contracture

Mobility

• Biomechanical analysis
• Walking, stair-walking, running, obstacles, turning
• Intervention
• Implications of biomechanics for training walking, stair-walking, running, obstacles, turning
• Application of evidence-based interventions for training walking, stair-walking, running, obstacles, turning
• Devices to facilitate mobility and participation
• Improving the ability to walk using devices e.g. walking aids, orthotics
• Improving participation e.g. wheelchair prescription to access the community, equipment to improve ADLs

Balance

• Balance control
• Biomechanical analysis of balance
• Delivery of effective balance training
• Individualized and group delivery
• Addressing challenges in delivery of high dosage, high challenge balance training

Training motor skills

• Principles of motor skill acquisition/ motor learning
• Implications for providing effective training eg repetition, feedback
• Intensity of practice
• Principles underpinning delivery and practice opportunities applied to a range of clinical groups
• Improving engagement and self-efficacy in rehabilitation
• Increasing effectiveness of training for people with perceptual impairments i.e. pushing behaviour, unilateral spatial neglect
• Increasing effectiveness of training for people with cognitive impairments

Exercise to promote activity to improve health 

• Application of exercise prescription principles for the person with a disability
• Application of exercise prescription principles for the older person
• Strategies to minimize sedentary behaviour
• Facilitating physical activity, including behaviour change strategies, for people with disability and older people eg aquatic therapy, equipment

Topics are aligned to the Physiotherapy scope of practice and knowledge and skills required to work as a member of an interprofessional team.

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 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 phytiotherapy 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 enjanced clinical skills in collaborative and assessment and intervention planning strategies.

Assessment strategy and rationale

PHTY603 assessments have been purposefully designed to replicate authentic physiotherapy 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 second and third 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. The third assessment task 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.

Overview of assessments

Representative texts and references

Carr, J. & Shepherd, R. (2011). Neurological rehabilitation: Optimising motor performance. (2nd ed.). Edinburgh: Churchill Livingstone.

Chastan, N., Bair, W. N., Resnick, S. M., Studenski, S. A., & Decker, L. M. (2019). Prediagnostic markers of idiopathic Parkinson's disease: Gait, visuospatial ability and executive function. Gait and Posture, 68, 500-505. doi: 10.1016/j.gaitpost.2018.12.039.

Cruz-Oliver, D. M. (2012). Gait, balance and falls. In A. J. Sinclair, J.E. Morley & B. Vellas (Eds.), Pathy's principles and practice of gericatric medicine. (5th ed., Chapter 91, p.1091-1110). Chichester, UK: John Wiley & Sons, Ltd.

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, 10(2), 55-64. doi: 10.5195/ijt.2018.6256. eCollection 2018 Fall.

Hong, Y., Bartlett, R. (Eds.). (2010). Routledge handbook of biomechanics and human movement science. Routledge, Oxon, London.

Kasser, S. L., Jacobs, J. V., Foley, J. T., Cardinal, B. J., & Maddalozzo, G. G. (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), 1840-1846.

Mehrholz, J., Kugler, J., Storch, A., Pohl, M., Hirsch, K., & Elsner, B. (2015). Treadmill training for patients with Parkinson's disease. The Cochrane Database of Systematic Reviews, 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, 5:CD006185. doi: 10.1002/14651858.CD006185.pub4.

Mera, T. O., Filikowski, D. E., Riley, D. E., Whitney, C. M., Wkater, B. L., Gybzker, S. A., & Giuffrida, J. P. (2013). Quantitative analysis of gait and balance response to deep brain stimulation in Parkinson's disease. Gait & Posture 38(1), 109-114.

Whittle, M. W. (2007). Gait analysis: An introduction (4th ed.). Edinburgh; New York: Butterworth-Heinemann Elsevier.

Winter, D. A. (1991).The biomechanics and motor control of human gait: Normal eldererly and pathological (2nd ed.). Waterloo Biomechanics.