UNIVERSITY OF VERMONT
College of Nursing and Health Sciences
Department of Rehabilitation and Movement Science
PT 352 International Manual Therapy Collaborative
Summer 2014
CREDITS: 3
PRE-REQUISITES: PT 349 for UVM DPT students; or completion of comparable musculoskeletal
curriculum for DPT students from other universities pending instructor approval,
or current PT licence
CO-REQUISITES: enrollment as DPT student or PT License and Instructor Permission
INSTRUCTORS:
Karen Westervelt, MS, PGDipHSc, PT, OCS,
ATC,CMP
(Course Coordinator)
310 Rowell
PH: 656-3252 (leave message for Karen)
Email: karen.westervelt@uvm.edu
Sonya Anderson Worth, PGDipHSc, PT, OCS
(Lead Lab Instructor)
310 Rowell
PH: 656-3252 (leave message for Sonya)
Email: sonya.worth@uvm.edu
CLASS MEETING TIMES:
Lecture/discussions/labs: 3 -2 hour classes prior to departure, 8am -5pm 6.27.16-7.8.16 (1/3
lecture, 2/3 lab)
Location: BOND University, Gold Coast, Queensland, Australia.
Group Team Building Activities: day outing in the Gold Coast region to appreciate the
Australian culture, wildlife and natural surroundings
Note: When UVM collaborates with Auckland University of Technology in New Zealand to teach PT
352 in Summer 2017, there will be changes to the location, dates, team building experiences and
cultural experiences to reflect the New Zealand culture and country.
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COURSE DESCRIPTION:
This Faculty Lead Program Abroad is an elective for PT students and licensed PTs interested in
learning advanced manual physical therapy skills while studying abroad.
The course involves lecture, group discussions and laboratory experiences in which students will apply
foundational and advanced biomechanical, neurophysiological, kinesiological and anatomical
principles of the spine and extremities. Students will practice the observational, verbal, written,
manual, and intellectual skills involved in advanced musculoskeletal screening, examination,
evaluation, diagnosis, prognosis, treatment design and progression of patients across the life span with
complex conditions involving the neuromusculoskeletal systems. There will be extensive practice of
advanced manual therapy techniques including spinal manipulations by and on participants with close
supervision and instruction from UVM DPT Instructors Karen Westervelt and Sonya Worth with
assistance from AUT or Bond Physiotherapy Faculty. UVM students will be collaborating with
Physical Therapy students from the host University during labs and classroom discussions.
In addition, there will be discussion on health care access in the USA and the host country with efforts
to better understand Health Care access in NZ or Australia. There will also be discussions of the
cultural aspects of treating the native Pacific Island (Maori) population or the Aboriginal Australian
population. Current research in the field of Physical Therapy and topics of special interest will be
discussed. Topics will vary year to year reflecting important international Physical Therapy research
developments as well as research interests of the UVM, AUT and Bond faculty.
TEACHING METHODS AND LEARNING EXPERIENCES:
To assist you in successful accomplishment of all course objectives, this course employs a variety of
teaching methods and learning experiences. Each involves and depends on your active participation to
maximize your learning in this course.
 Lecture/discussions – advanced knowledge to foster patient management skills
relevant to complex neuromusculoskeletal dysfunction (spine and extremities) in the
presence of co-morbidities or other mitigating factors;
 Patient/client cases – simulated cases used as the basis for skill and clinical decisionmaking discussions to place all knowledge, skills and behavior course objectives in a
relevant clinical context;
 Skills technique development - Supervised lab practice using faculty demonstration,
student-student and student-faculty practice;
 Group self-study and patient case demonstrations– for peer review, discussion and
skill practice with self and peer assessment;
 Blackboard Technology – for 24/7 access to course materials, student-student and
student-faculty discussion, and quizzes/exams. All course materials can be found at
https://bb.uvm.edu/. AUT specific materials will be made available to UVM students
using a variety of electronic and traditional paper methods, access to these materials
will be communicated to all UVM students using UVM e-mail or Blackboard
announcements.
 Mobile tablet technology – AUT uses an application for mobile tablet devices to
enrich their paper lab manual. This application will be a highly recommended learning
resource for UVM students in the PT 352 class.
 Personal computer recommended but not required. It is recommended that students
have a laptop or mobile device but not required. The course manual will be available in
electronic version for those travelling with a laptop or mobile device to save space and
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

weight when travelling. However the manual is also available in hard copy for students
to pick up before we travel for those without a laptop or mobile device.
Supervised simulated patient/client situations –advanced musculoskeletal
examination and/or advanced musculoskeletal patient management skills relevant to
complex neuromusculoskeletal dysfunction (spine and extremities) followed up with
formative evaluation comments by faculty, patients, and self.
Self-directed exercises – learning modules on patient cases, review of anatomy and
kinesiology relevant to course objectives.
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RESOURCES:
Required:
 American Physical Therapy Association. Guide to Physical Therapist Practice. Latest edition,
Alexandria, VA. (purchased first semester)
 Dutton M. Orthopaedic Examination, Evaluation and Management 2nd edition. McGraw Hill. New
York, 2008. (purchased first year of your program)
 Kisner C & Colby LA. Therapeutic Exercise 5th Edition. FA Davis : Philadephia 2007 (purchased
first year of your program)
 Kendall FP et al. Muscles Testing and Function with Posture and Pain 5th edition. Lippincott
Williams & Wilkins 2005 (purchased first year of your program)
 PT 349 class notes and lab manual
Journal Articles: Assignments from various journals will be included for specific topics as needed
Recommended texts and articles:
General
 AUT manual therapy application for tablet devices. Available from AUT.
 Magee DJ. Orthopedic Physical Assessment. WB Saunders, Phila, PA, (Latest edition)
 Goodman C, Snyder T. Differential Diagnosis for Physical Therapists: Screening for Referral.
Saunders, 4th ed.
 Sahrmann S. Diagnosis and treatment of movement impairment syndromes. Mosby 2002
 Sahrmann S. Movement System Impairment Syndromes of the Extremities, Cervical and Thoracic
Spines, 1st Edition Mosby 2011. ISBN 978-0-323-05342-6
 McKinnis LN. Fundamentals of Musculoskeletal Imaging. FA Davis : Philadelphia 2010
 Wong M. Pocket Orthopaedics Evidence-Based Survival Guide. Jones & Bartlett.
 Gulick D. Ortho Notes 2nd Edition Clinical Examination Pocket Guide. FA Davis : Philadelphia
2009
 Wise CH & Gulick DT. Mobilization Notes A Rehabilitation Specialist’s Pocket Guide. FA Davis :
Philadelphia
 Norkin CC & White DJ. Measurement of Joint Motion 4th edition. FA Davis : Philadelphia 2009
Spine/Low back pain
 Maitland, G.D. Vertebral Manipulation Fifth Edition. London, Butterworth-Heinemann Ltd; 1986
 Maitland G.D. Peripheral Manipulation Third Edition. London, Butterworth-Heinemann Ltd;
1991.
 Kaltenborn F.M. Manual Mobilization of the Joints Volume II : The Spine. Fourth Edition. Oslo.
2003
Therapeutic Exercise Interventions
 Kisner C & Colby LA. Therapeutic Exercise 5th Edition. FA Davis : Philadephia 2007 (purchased
first year of your program)
Mobilization (joint/nervous system)
 Butler DS. Mobilisation of the nervous system. Churchill Livingstone, London, (latest edition)
 Mulligan, B. Manual Therapy NAGS, SNAGS, MWMs etc. (Latest Edition) Plane View Services
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
Ltd, Wellington, New Zealand; 2010
Vicenzino B, Hing W, Rivett D, Hall T. Mobilisation with Movement: The Art and Science.
Churchill Livingstone : Elsevier 2011. ISBN 978-0729538954
Kinesiology
 Norkin C, Levangie P. Joint Structure and Function. 3rd ed., FA Davis, (latest version)
 Smith LK, Weiss EL, Lehmkuhl L. Brunnstrom’s Clinical Kinesiology, FA Davis, Phila, (latest
version)
 Neumann DA. Kinesiology of the Musculoskeletal System. Mosby, St. Louis, MO, (latest version)
 PT 241, PT 242 class notes
Anatomy
 Electronic anatomy resources available in Dana
 Anatomical models of joints (in lab)
 Your anatomy textbook/notes/handouts
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COURSE OVERVIEW / OBJECTIVES:
The overall goal of this course is to enhance your skills in collecting information from a patient
through history taking and physical examination techniques, to critically assess and synthesize that
information, and select and perform appropriate physical therapy interventions to assist patients in
restoring function or compensating for limitations primarily through the use of advanced manual
therapy techniques. These skills will be applied to primarily complex neuromusculoskeletal conditions
(spine and extremities). In addition, you will be able to participate in discussions regarding
international policy of health care access and be able to demonstrate awareness of cultural differences
in treating patients of Pacific Island descent or Australian Aboriginals.
Throughout the course, it is expected that you will demonstrate excellent manual therapy skills,
interpersonal communication skills and professional demeanor.
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Foundational and clinical sciences
1. Describe the epidemiology, etiology, pathology, risk factors, natural history, joint/muscle sequelae,
clinical signs and symptoms, diagnosis (medical testing and imaging); PT intervention, and
prognosis associated with the following conditions:
 spinal pain
 lower extremity injuries
2. Apply knowledge of normal anatomy and kinesiology to describe the pathomechanics,
pathokinesiology and/or pathophysiology of selected musculoskeletal disorders (listed in #1), and
relate the pathology/pathomechanics of the disorders to risk factors, natural history and clinical
signs and symptoms.
3. Apply knowledge regarding natural history and etiology of disease, client preexisting health status,
gender and cultural factors, and efficacy of treatment to predict time course for improvement of
patient status.
4. Apply the biomechanical behaviors and properties of bone, tendon and ligament to advanced
neuromusculoskeletal examination and intervention procedures.
5. Compare/contrast the clinical theory(ies), relevant physiologic, biomechanical, kinesiological,
and/or neurological bases underlying various approaches to an advanced musculoskeletal
examination, evaluation and management of selected complex neuromusculoskeletal disorders
Patient/ family-centered care, cultural competence, communication, and
interpersonal skills
1. Consistently apply current knowledge, theory, and professional judgment while considering the
patient/client perspective in patient/client management process.
2. Obtain informed consent from the patient (or assent in the case of a minor).
3. Provide useful and constructive feedback to others regarding the effectiveness of their
communications, patient case analyses, and hands-on examination and management techniques
4. Communicate with simulated and real patients/clients, peers, faculty, staff and guest speakers with
sensitivity and tolerance to differences such as race/ethnicity, religion, gender, age, sexual
orientation, and disability.
5. Demonstrate the ability to articulate, as part of a group presentation, current evidence regarding
controversial manual therapy techniques.
6. Demonstrate the ability to articulate, as part of a group presentation/discussion, current status of
health care access in the US and the host country.
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Clinical decision-making, bioinformatics, and evidence-based practice
1. Identify factors contributing to the validity and reliability of musculoskeletal examination
approaches and tests/measures
2. Describe evidence about the efficacy of the physical therapy management approaches discussed
3. Recognize clusters of signs and symptoms that warrant referral to other health practitioners
Physical therapy management of patients/ clients with neuromusculoskeletal
conditions
1. Apply the principles, components, rationale for the essential components of the APTA’s Guidelines
for Physical Therapy Patient/Client Management model to patients with complex
neuromusculoskeletal disorders across the age span.
1. Examination
The examination is comprised of 3 components: the history, systems review, test and measures.
History
i.
Systematically and respectfully obtain a history from hypothetical patients and their
families, if appropriate,
Systems review
ii.
Demonstrate a systems review for a hypothetical patient with a diagnosed or suspected
neuromuscular condition that is culturally sensitive, appropriate to the clinical setting and
the patient problem.
Tests and measures
iii.
Safely and effectively demonstrate these examination and screening skills:
 advanced spine and LQ examination
 CAD testing including upper cervical spine ligamentous testing.
2. Evaluation
iv.
Synthesize and interpret examination data from the medical and social history, systems
review, and physical therapy tests and measures to make sound clinical judgments.
3. Diagnosis
v. Use diagnostic processes to establish differential diagnoses for patients with complex
neuro-musculoskeletal conditions across the lifespan based on the evaluation of the
physical therapy examination data and the available medical and biopsychosocial
information so as to best guide patient/client management in the context of current best
practice.
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4. Prognosis and Plan of Care
vi.
Apply prognostic processes to determine the predicted optimal level of improvement in
function in the context of current best practice and the amount of time needed to reach that
level.
vii.
Reassess and modify treatment based on re-examination and evaluation of a patient/client
by obtaining pertinent data from the patient/client and from other relevant sources, by
performing relevant systems review, and by selecting appropriate age-related tests and
measures and re-assessment of outcomes.
5. Intervention
Procedural Interventions
viii.
Safely and effectively demonstrate and employ these intervention skills:
 Selected advanced mobilizations and manipulations (high velocity thrust) of the spine,
SIJ, ribs and extremities
 Advanced physical therapy interventions for complex neuromusculoskeletal problems
with age span considerations.
 Selected neural mobilization techniques
Coordination, communication, and documentation
ix.
Describe patient evaluations/assessments that demonstrate sound analytic sense and
consider the patient holistically.
Social and policy contexts of practice, and ethics, values, and advocacy
1. Discuss the need for informed consent of patients, confidentiality of patient information, and
accurate and analytical documentation.
2. Demonstrate adherence to APTA professional core values in all interactions.
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EXPECTED STUDENT OUTCOMES
The following is a list of the expected outcomes for students at the end of the physical therapy
program. The faculty of this course has identified those outcomes that are supported through work in
this course.
Expected Outcome
Manage patients/clients of all ages and many
cultural and socioeconomic backgrounds safely and
effectively in a variety of practice environments.
Integrate the foundational and clinical sciences and
apply knowledge to the management of
patients/clients.
Demonstrate and articulate clinical decision-making
that is based in evidence and considers the needs
and desires of patients.
Use computerized databases for accessing, recording
and storing various types of information.
Provide consultation as requested by patients and
their associates, other health care providers,
community groups or colleagues or make referrals
as needed.
Access, analyze and critique evidence in making
decisions about management of patients/clients.
Communicate with various constituents in a manner
that reflects their level of knowledge, considers
health literacy, is sensitive to cultural issues and
demonstrates respect.
Educate others, including patients/clients and their
associates, colleagues, other healthcare providers
and community groups through various methods and
in various venues.
Identify and analyze factors which affect society’s
overall health, its healthcare policies, access,
delivery and quality.
Advocate for patients and communities to improve
access to physical therapy services and overall
quality healthcare.
Apply ethical and legal principles to daily practice.
Demonstrate patient/client-centered care by placing
their needs above one’s own.
Integrate quality improvement activities into daily
practice.
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Taught
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Practiced
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Evaluated
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Identify the basic components of good business
practices, including planning, personnel supervision,
resource allocation, marketing and regulatory issues.
Work effectively on interprofessional teams.
EVALUATION METHODS:
EVALUATION METHODS CONTINUED:
Discussion on international health care access
Participation in labs and discussions
Brief written manual therapy paper and discussion
Competency List of Manual therapy skills
Journaling
10%
30%
10%
40%
10%
100%
GRADING POLICY FOR ASSIGNMENT PRESENTATIONS
There are no re-takes on the presentations. Each presentation will be graded on the material
presented to the group.
GRADING POLICY FOR PARTICIPATION IN LABS AND DISCUSSIONS
Students will be graded on daily participation in labs and discussions with a possible 3 grade
points a day for ‘in country’ class time. Full daily points will be allotted for attendance, volunteering
to model, volunteering to demonstrate techniques, participating in discussion, responding to questions
from instructors, and interacting other members of the class.
GRADING POLICY FOR WRITTEN ASSIGNMENTS
Written assignments will be graded on the quality of the content and references and the written
composition. Due to the short duration of this travel course, there will be no opportunities for resubmitting written assignments.
GRADING POLICY FOR COMPETENCIES
In order to pass the Lab Competencies you must accurately demonstrate the required
techniques to one of the instructors. You will be given a pass/ fail grade for each skill. You must repeat
the competency until you receive a passing grade. If you fail to pass the competencies after a
reasonable number of attempts you will be asked to do independent study before being retested.
STUDENT COURSE EVALUATION
As a matter of professional responsibility, all students are expected to complete a course and
instructor evaluation at the end of the semester. Evaluations will be anonymous and confidential.
1. Knowledge Objectives:
 principles, purposes, use and norms of advanced musculoskeletal examination and treatment
procedures relevant to complex neuromusculoskeletal dysfunction (trunk, spine, and extremities)
assessed through manual therapy skills competency, verbal discussions and written paper
 patient management skills relevant to complex neuromusculoskeletal dysfunction (trunk, spine, and
extremities) assessed through manual therapy skills competency, verbal discussion and written
paper
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2. Skills Objectives:
 formative assessment of advanced manual therapy examination and treatment skills during lab
sessions on a continuous basis; summative assessment of advanced manual therapy examination
and treatment skills through a manual therapy skills competency;
 clinical patient management skills assessed via manual therapy skills competency and verbal
discussion.
3. Behavioral Objectives:
 safety and certain professional behaviors assessed as part of lab competencies grading;
 professional behavior assessed through participation in labs and discussions
GRADING CRITERIA:
A+
97 – 100
A
93 – 96
A90 – 92
F
less than 70
B+
B
B-
87 – 89
83 – 86
82 – 80
C+
C
C-
77-79
73-76
70-72
UNIVERSITY POLICIES
Classroom Code of Conduct
Faculty and students will at all times conduct themselves in a manner that serves to maintain,
promote, and enhance the high quality academic environment befitting the University of Vermont.
Details of the code of conduct are outlined on the UVM website.
Attendance Policy
Students are expected to attend all regularly scheduled classes. It is the responsibility of the
student to inform the instructor regarding the reason for absence or tardiness from class, and to discuss
these with the instructor in advance whenever possible. Circumstances that require the student to be
absent for any length of time should be discussed with the faculty member, due to the short duration of
this travel course, there will not be opportunity for make-up work or extensions of due dates. Details of
the UVM attendance policy are outlined on the website.
Religious Holidays
Students have the right to practice the religion of their choice. Each semester students should
submit in writing to their instructors by the end of the second full week of classes their documented
religious holiday schedule for the semester. Faculty must permit students who miss work for the
purpose of religious observance to make up this work.
Academic Honesty
The principal objective of the policy on academic honesty is to promote an intellectual climate
and support the academic integrity of the University of Vermont. A full statement of the policy can be
found in The Cat's Tale . Each student is responsible for knowing and observing this policy.
ADA Student Accommodations
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In keeping with University policy, any student with a disability who needs academic/classroom
accommodations should contact ACCESS. ACCESS coordinates reasonable accommodations for
students with documented disabilities. They are located at A170 Living/Learning Center, and can be
reached by phone 802-656-7753, or by e-mail access@uvm.edu. Visit their website
http://www.uvm.edu/access. To receive accommodations in this course, please bring the primary instructor
a copy of the letter provided by the ACCESS Office and speak to him/her about a plan to implement
the recommendations.
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