Manual therapy: (modul A, part 1, manual therapy theory and clinical skills)
Spring (first semester) and autumn (second semester)
Place of Instruction
The students will use their skills at an approved clinical work placement under supervision from their supervisor, who is approved by the group for Master studies in physiotherapy at the University of Bergen. On admission, each student is assigned where they will have their clinical placement. The work placements are distributed around Norway, and most of the placements are not in Bergen.
Objectives and Content
To make the student able to develop an advanced level of knowledge and skill in clinical examinations, treatment and handling of illness and diseases in the neuro-muscular-articulate system.
Understanding of the concepts in manual therapy are reviewed and discussed. An introduction to the historical development of manual therapy nationally and internationally is given. The different directions dominating the field today are reviewed. Lectures will also be given on the function of the manual therapist in the Norwegian health care system ¿ both as primary contact and in the second line.
The students are given an introduction to possible effect mechanisms in different treatments. The teaching focuses further on examination procedures in the different areas of the human musculoskeletal system, and the importance of making therapeutic conclusions after the examination, is emphasized. Methods for conducting examinations and treatment for the extremities, jaw, pelvic girdles and columna are taught. The teaching is based on basic knowledge from the bachelor education in physiotherapy. In every subject, anatomical descriptions of joints and joint systems, soft tissue, neurology, circulation, biomechanical conditions and pathology are integrated. The main focus is that an examination should end with a diagnostic conclusion which leads to therapeutic actions. These actions are if possible, based on evidence based documentation and clinical reasoning, with a logical connection between clinical findings and remedial actions.
The therapeutic part of the subject is to optimize movement with regards to specific and general function. The study focuses further on traditional physiotherapy methods in improving function. The manipulation concept is introduced. Manipulation as a therapeutic tool is taught thoroughly and practiced extensively to make the student capable of using the most basic techniques in their practice. In the last semester, the utilization areas of various treatment techniques are thoroughly discussed.
The course emphasizes on giving the students practical skills necessary for working as a manual therapist. The aims of treatment are to reduce pain and normalize function. The students learn to combine various remedial actions to achieve this. Recommended national and international guidelines for these measures are reviewed, and the students are taught to choose treatment measures that are in line with these. This implies that different patients may need different treatments, where the therapeutic tool may involve elements of information, measures to control pathologically increased mobility, articulation or manipulation for reduced segmental function, and follow-up activities such as exercises and practice of motor control ect. that may contribute to optimal function.
With a basis in clinical problems, the students will gain experience in identifying, defining, analyzing, explaining and discussing practical or theoretical problems or phenomena. They will consequently gain insight in their skills, and through this make their own agenda describing aims and needs for their patients. The students will learn how to maintain a good working posture themselves and how to use their own bodies when executing the techniques.
To ensure the integration of knowledge and skills in practical execution of manual therapy, a natural connection between practice and theory is necessary. In between the theory sessions, every student is in a supervised clinical work placement.
Central aims in the clinical placement module, are to understand the connection between structure and function in the neuro-muscular-articulate system, to acquire and understand various procedures in examinations, and to develop the ability to conduct themselves physically and verbally around co-students and patients.
After completing the course, the students should hold advanced knowledge and skills in clinical examination, treatment and handling of illness nad disease in the neuro-muscular-articulate system. The students will show skills and understanding regarding procedures of examination and treatment techniques used in manual therapy, and will be able to use these on patients.
The students will gain insight in the historical basis of manual therapy, and in various theoretical arguments considering this.
The student will demonstrate technical skills regarding joint mobilization
(articulation, stretching and manipulation). Practical skills are acquired by experience, but the student should be familiar with the uses of various diagnostic and therapeutic means. The student should also be familiar with indications and counter-indications in use of different techniques.
The student should be able to critically assess different theoretical explanation models and remedial actions based on recent knowledge and research.
After completing the course, the students should be able to
- perform general and specific examination techniques of the neuro-muscular-articulate system
- use knowledge/findings from patient history and clinical examinations when treating patients
- demonstrate a reasonable skill level in soft tissue techniques on extremities and columna
- demonstrate a reasonable skill level in articulation techniques on extremities and columna
- demonstrate a reasonable skill level in manipulation techniques on extremities and columna
- demonstrate a reasonable skill level in the use of common orthopedic, neurologic and circulatory examination procedures
- demonstrate good insight in general and specific exercise and in ergonomic counseling for injuries in the neuro-muscular-articulate system
Required Previous Knowledge
The teaching is based on skills and knowledge from the bachelor education in physiotherapy
Teaching Methods and Extent of Organized Teaching
Learning and skill training of procedures for examination and manual therapeutic techniques take place in compulsory teaching at the university. The lessons vary between theoretical and practical introductions. Demonstrations, assignments, personal guidance and colloquia are used as pedagogical aids when introducing practical skills. These are subsequently used in patient treatments in the clinical work placement periods. The students will use their skills at an approved clinical work placement under supervision from their supervisor, who is approved by the group for the Master programme in physiotherapy at the University of Bergen. The supervisor should make sure that all the techniques and procedures taught at the university are used. All students must experience having the procedures and techniques tried on themselves, as they practice on each other in the teaching.
The first and second semester hold in total 180 hours of theoretical and practical lessons at the university. In the periods in between, the students attend their allotted clinical work placements 28 hours per week, where they work with patients under supervision by a physiotherapist specialized in manual therapy. During one year, the student should have examined and treated a minimum of 900 patients and had 125 hours of supervision.
Compulsory Assignments and Attendance
The teaching and work placement is compulsory.
900 patient consultations and 125 hours supervision must be documented.
To be allowed to take the exam, the student¿s absence rate must be maximum 20% or lower.
Forms of Assessment
The student is evaluated continuously according to expected learning outcomes and measures of quality.
A clinical exam is held at the end of the second semester. This is a practical oral exam where the candidate has one examination assignment and one treatment assignment. The student is evaluated with regard to the level of technical skills and the ability to understand the test¿s values and uses. The examination lasts about 30 minutes, and is performed by one of the MT lecturers at UiB. The exam is censored and evaluated by an external examiner present at the examination, who may also ask additional questions.
The students will write a protocol, written by set standards, describing treatments made during the work placement. The student is to complete a minimum of 900 patient consultations during the first year. The protocol is handed in every six months. The student¿s supervisor continuously evaluates the student¿s ability to communicate with the patients, colleagues and collaborators, as well as their various written and oral communication tools in the diagnostic process. Written feedback to the student and the course coordinator is given every six months.
Grading scale A - F
Literature that composes the basis for the students¿ learning activity will be suggested. This literature will be usable in various exams and assessments.