PHTY604 - Advanced Physiotherapy Practice 2: Upper Limb Rehabilitation

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

In this unit students will be provided with the opportunity to update and enhance theoretical knowledge and clinical skills in order to enable participation through upper limb management for clients across the lifespan with neurological disorders. An enhanced understanding of the causes of upper limb impairment alongside rehabilitation and management techniques will be developed. There will be a focus on current assessment and intervention rationales and practice. Specifically designed workplace activities present opportunities for physiotherapists to align theory and research, through interpretation and translation of evidence-based knowledge and skills to their practice. Within their clinical setting students can develop and apply their advanced knowledge and enhanced clinical skills and demonstrate critical analysis of upper limb assessment, goal setting, use of functional and collaborative person-centred rehabilitation models and application of evidence-based techniques.

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 and apply enhanced knowledge of upper limb anatomy, biomechanics and underlying impairments that lead to functional changes in the upper limb impacting daily activity and participation. (GA4, GA5, GA6); 

LO2 - Critically analyse upper limb movement and function with selected clients to inform goal setting and comprehensive management plans (GA4, GA5, GA6, GA7, GA8); 

LO3 - Select, apply and critique evidenced-based treatment strategies including the potential use of available technologies and relevant outcome measures to optimize holistic upper limb rehabilitation. (GA4, GA5, GA6, GA7, GA8);

LO4 - Demonstrate effective communication and application of evidence-based practice, as well as enhanced skills in upper limb assessment and management when working in a clinical context, including mentoring and coaching peers in advanced practice. (GA4, GA5, GA6, GA7, GA8, GA9); 

LO5 - Justify the benefits of a holistic, functional and collaborative interprofessional approach to person-centred upper limb rehabilitation. (GA3, GA4, GA5, GA6, GA7, 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 

GA6 - solve problems in a variety of settings taking local and international perspectives into account

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: 

Control of upper limb movement 

• Neuro-motor control of upper limb function / dominance  
• Review biomechanical analysis of upper limb movements related to task and purpose of activity (integrate postural adjustments)  
• reaching / placement / support   
• reaching, grasping and manipulation (Bimanual / unimanual)  
• holding and transporting objects during standing / walking / lifting (dual tasking) 
• Implications for assessment and goal setting with patients   
• Functional assessment, outcome measures and goal setting  
• Review functional assessment analysis of upper limb to identify cause of the movement disorder under ICF framework (Activity restriction / limitation / participation)  
• Review causes of dysfunction leading to upper limb (UL) impairments (eg CNS, arthritis, trauma) 
• Primary impairments from central nervous system/peripheral nervous system lesions including spasticity, proprioception, sensory, dyspraxia, ataxia and coordination    
• Primary impairments related to musculo-skeletal pathology (pain / weakness etc) 
• Adaptive changes (muscle / joint / connective tissue changes) secondary to ageing and / or central nervous system/peripheral nervous system disorders (e.g. range of movement, spasticity, flaccidity, co-ordination, sensation, apraxia/ dyspraxia, tremor, and proprioception. 
• Linking impairments in upper limb to impact on functional role of the UL for home, education, work, leisure activities 
• Evidenced based review of outcome measures used by physiotherapists 
• Standardised and non – standardised outcome measures 
• Impairment based versus functional assessment  
• Setting functional goals for upper limb rehabilitation and selection of outcome measures appropriate for level of function and condition  
• Setting goals for management of the non- functional upper limb within everyday activities and selection of outcome measures 

Critical review of evidenced based interventions for physiotherapy retraining/ rehabilitation upper limb function after acquired brain injury or conditions associated with ageing 

• Retraining though functional practice/ upper limb groups (consider adaptions for stroke vs arthritic group)   
• Strategies for driving recovery  
• Eliciting muscle activity for part / whole practice of tasks - Functional Electrical Stimulation  
• Adjusting task set up to enable part / whole practice of components of tasks  
• Constraint Induced Movement Therapy (CIMT) including home programs 
• Robotic training and virtual reality 
• Mirror Therapy/ Mental Rehearsal 
• Sensory retraining, coordination and dexterity retraining 
• Additional strategies for attention control training for optimal integration of UL in function when unilateral neglect present  
• Strategies for managing gleno-humeral subluxation / pain / complex regional pain syndrome after ABI  

Critical review of evidenced based interventions for physiotherapy management of peoples with pain and degenerative pathology

• Evidence for management (conservative and non-conservative) of the upper limb when pain and degenerative arthridities present  
• Retraining though functional practice/ upper limb groups (consider adaptions for stroke vs arthritic group)  
• Strategies for managing pain (relate to cause of pain) 
• Arthridities  
• Complex regional pain syndrome (eg role of Mirror Box therapy)  
• Chronic / intractable pain (role of TENS)   
• Strategies for managing oedema  
• Strategies to improve range of movement / strength / control / function  
• Role and evidence for splinting/ positioning/ stretching  
• Role of aquatic therapy in rehabilitation of the upper limb 
• Management of activity limitations and Participation 
• Use of equipment to enable enhanced functional use 
• Adaptations to enable increased participation 

Application of evidenced based knowledge and skills within the work-setting: analysis and clinical problem-solving for upper limb rehabilitation in clinical settings

Learning and teaching strategy and rationale

This unit is offered through multi-mode and online delivery for inclusion of onshore and specific offshore student participation that aims to facilitate learner centred activities and workplace learning. Learning and teaching strategies for this practice unit are based on a blend of constructivism, social constructivism, and experiential learning within a framework of active participation within 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 self-reflection. In addition, students participate in individual and small group activities based on analysis of current practice, assimilation and application of enhanced knowledge leading to the development of tools to facilitate translation of learning into clinical practice and encourage engagement in extended dialogue and guide change to a more inter-professional, person-centred practice. Unit activities include: guided readings, synchronous on-line tutorials, work-based activities with reflection, use of a reflective journal during applied, experiential learning, peer review with facilitated reflection and, mentoring to enhance practice, skill development and self-reflection. Activities undertaken are aimed to facilitate acquisition of advanced knowledge and skills in collaborative and physiotherapy specific, upper limb assessment and intervention strategies. 

Assessment strategy and rationale

PHTY604 assessments have been purposefully designed to replicate authentic clinical practice. Unit 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 second and third assessment tasks, 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 to practice 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 the application of advanced skills in the 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 Master’s program. 

Overview of assessments

Representative texts and references

Amini, D. (2021). Hand impairments. Chapter 43 in D. P. Dirette & S. A. Gutman (Eds.), Occupational therapy for physical dysfunction (Eighth edition). Wolters Kluwer.

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

Copley, J., & Kuipers, K. (2014). Neurorehabilitation of the upper limb across the lifespan: Managing hypertonicity for optimal function. Hoboken: John Wiley & Sons.

Corbetta, D., Sirtori, V., Castellini, G., Moja, L., & Gatti, R. (2015). Constraint-induced movement therapy for upper extremities in people with stroke. Cochrane Database Systematic Reviews. 2015 Oct 8;2015(10):CD004433. doi: 10.1002/14651858.CD004433.pub3. PMID: 26446577; PMCID: PMC6465192.

Iruthayarajah, J., Mirkowski, M., Foley, N., et al., (2018). Chapter 10. Upper extremity interventions. In R. Teasell & J. Iruthayarajah, J. (Eds.), Evidence based review of stroke rehabilitation. 

Lannin, N. A., & McClusky, A. (2008). A systematic review of upper limb rehabilitation for adults with traumatic brain injury. Brain Impairment, 9(3), 237-246.

Sahin, N., Ugurlu, H., & Albayrak, I. (2012). The efficacy of electrical stimulation in reducing the poststroke spasticity: A randomized controlled study. Disability and Rehabilitation, 34(2), 151-6.

Shishov, N., Melzer, I., & Bar-Haim, S. (2017). Parameters and measures in assessment of motor learning in neurorehabilitation; a systematic review of the literature. Frontiers in Human Neuroscience, 11, 82-82.

Skirven, T. M., Osterman, L., Fedorczyk, J., Amadio, P. D., Felder, S., & Shin, E. K. (2021). Rehabilitation of the hand and upper extremity (7th ed.). Mosby.

Wattchow, K.A., McDonnell, M. N., & Hillier, S. L. (2018). Rehabilitation interventions for upper limb function in the first four weeks following stroke: A systematic review and meta-Analysis of the evidence. Archives of Physical Medicine and Rehabilitation, 99(2), 367-382. doi: 10.1016/j.apmr.2017.06.014. Epub 2017 Jul 20. PMID: 28734936.