Doctor Of Physical Therapy Internship

DOCTORAL PHYSICAL THERAPY CLINICAL EDUCATION         

Clinical Objectives for Affiliates at Sports and Orthopaedic Therapy Services

Sports and Orthopaedic Therapy Services (SP.OR.T.S.) was founded in 1987 by Robert C. Grossman, P.T., O.C.S.  and John A. Romero, M.A., P.T., S.C.S. Mr. Grossman is now the sole owner and CCCE.  The facility has 3200 sq. ft. of treatment area and office space with Isokinetic and other exercise devices, but the emphasis of treatment is on accurate assessment of somatic dysfunctions and their treatment through manual therapy. The treatment population is of all ages excluding infants. Typical diagnoses may include somatic dysfunctions of the lumbar spine, thoracic cage, cervical spine, and peripheral joints. Mr. Grossman has been providing post graduate clinical education courses across the country and specifically in Maryland, Virginia, D.C., and Delaware since 1989. He is a clinical instructor to Maryland, Shenandoah, Marymount, Temple University, and other PT programs.  Mr. Grossman has developed treatment methods termed “Closed Chain Manipulations” which are utilized when patients present with connective tissue inextensibility.

Students at SP.O.R.T.S. are expected to have a keen interest in developing their orthopaedic/sports physical therapy evaluation and treatment skills. All students receive a series of lectures covering the spine and extremities following a muscle energy model for assessment and treatment. Your clinical instructor, with your help, will design any optional lectures to be given based on specific areas in which you feel weak or on would like more information.  Students affiliating at SP.OR.T.S. will practice in a safe manner, thereby not introducing iatrogenic dysfunctions secondary to performing procedures beyond their level of competency. Students will understand the concept of reactivity, so as to treat patients safely. Students are responsible for a special project (may include literature searches, etc.) as directed by their CI.  Students are also responsible for interacting with patients, staff and other health care providers in a positive manner thereby promoting Sports and Orthopaedic Therapy Services, themselves, and the physical therapy profession.  Students assume responsibility for seeking out and acting on the need for a furtherance of their education through literature and book reviews.

The objectives for students at Sports and Orthopaedic Therapy Services are to develop the ability to perform skilled, biomechanical evaluations of the spine and extremities. The students will be exposed to osteopathic approaches to evaluation and treatment. In this regard, students are responsible for developing a strong biomechanical and anatomical approach to orthopaedic dysfunction. They must also be receptive to traditional and non-traditional treatment approaches. Students will learn how somatic dysfunctions are maintained and rational approaches for treatment of these dysfunctions based on those criteria.  They will also learn through a muscle energy model of assessment basic methods to restore movement, through various manual therapy techniques (primarily osteopathic in origin), but also including joint mobilization and soft tissue manipulation in the treatment of peripheral as well as axial skeletal somatic dysfunctions. Altered neurodynamics and their treatment is another area which the student will acquire a more comprehensive appreciation in this internship.  Basic clinical skills such as goniometry and MMT are enhanced. Students will also learn to work in an electronic medical record environment.  They will also learn to write concise SOAP notes and dictate letters to referring physicians.

Students at SP.OR.T.S. will have a fun, but challenging learning experience.

Sports and Orthopaedic Therapy Services is dedicated to clinical excellence. In that regard, the clinic is designed in a way that is conducive to learning, maintains state-of-the-art equipment, and employs therapists dedicated to continuing education. All clinical instructors will respect student needs relative to personality, learning styles, and be non-discriminatory in regard to gender, religion or race. Clinical instructors (C.I.) will organize an in-service schedule which includes Evaluation of Somatic Dysfunction of the Spine, Pelvis, peripheral joints, thoracic cage, and altered neurodynamics. The C.I. will also determine, with the students’ assistance, any areas of optional lectures to be given.  At least 10 2-3 hour lectures are given over the affiliation and the students receive approximately $4000 of free post graduate continuing education as a result of their inclusion into the lecture series and clinical instruction.

A library is provided at Sports and Orthopaedic Therapy Services, but books are required to stay in the clinic. All staff, regardless of their relationship to the student, are generally available to answer clinical questions, but students are directly responsible to their own C.I.  The C.I. is responsible for evaluating the student and filing all necessary paperwork. At the beginning and middle of the affiliation, the C.I. and student will determine areas of weaknesses and strengths, and thereby fulfill the needs of the student. The staff at Sports and Orthopaedic Therapy Services will provide a stimulating educational experience that will force the student to extend their abilities from a clinical, didactic, and administrative perspective.

YOUR INSTRUCTOR

Robert C. Grossman, PT, OCS graduated in 1981 from the physical therapy program at the University of Maryland Medical School as its valedictorian.  He is board certified as a clinical specialist in orthopaedic physical therapy by the American Board of Physical Therapy Specialists.  He was chairman of the Southern Maryland Orthopaedic Study Group for a decade.  Since his graduation, he has practiced in a number of settings, eventually landing in private practice.  Since 1987 he has practiced at his clinic, Sports and Orthopaedic Therapy Services in Silver Spring, Maryland.

Through the years Mr. Grossman has studied various manual therapy approaches and incorporates their evaluation and treatment procedures where appropriate.  He was given the opportunity early in his career to study with and has taken courses from many osteopathic physicians, and they have left a strong impact on his evaluation and treatment style. He has taught many post graduate continuing education courses across the country including those organized by the Maryland APTA, through the group Chesapeake Clinical Resources, and other organizations.  The topics of these courses vary from evaluation and treatment of somatic dysfunction of the spine and extremities, to assessment and treatment of altered neurodynamics, myofascial release, and positional release.  He has developed new techniques in which he provides instruction called “Closed Chain Manipulation”.  The techniques are used to treat movement restrictions primarily as the result of connective tissue inextensibility.  They are based on the research-based osteokinematics and arthrokinematics of the respective regions of the body.

All courses begin with a review of his philosophy of care and physiological rationales for the processes which maintain the patient in their dysfunctional state, causing their continued pain and functional deficits.

Assessment and Treatment of the Upper Quarter: Closed Chain Manipulation

Course Description

With a precise understanding of anatomy and biomechanics of the kinetic chain, restoration of movement of joints in dysfunction is enhanced.  A new technique utilizing specific positioning and patient activation is introduced – “Closed Chain Manipulation.”  These techniques will allow the therapist to provide the patient with a powerfully effective manipulation of any articulation with greater ease for the therapist to perform than typical open chain mobilizations.  “Closed Chain Manipulations” are safe to employ in either acute or chronic conditions.  In this two day seminar the participant will gain increased knowledge of the articulations through their anatomy and biomechanics, followed by specific assessment techniques to identify dysfunctions of the related joint and ligamentous tissue.  “Closed Chain Manipulation” techniques are instructed and practiced which the instructor has found effective in the treatment of altered movement characteristics of the selected articulations.  Self care exercises utilizing the fundamental principles of Closed Chain Manipulation are addressed.

Behavioral Objectives

Upon completion of this course, participants will be able to:

  1. State the mechanical process by which Closed Chain Manipulations affect the connective tissue elements of the body.
  2. State the arthrokinematic and osteokinematic relationships of the articulations covered in the course.
  3. Perform a manual assessment to identify somatic dysfunctions of the selected articulations.
  4. Utilize Closed Chain Manipulations in the treatment of altered movement characteristics of the various articulations.
  5. Devise appropriate home exercises utilizing the concepts of Closed Chain Manipulations.

Assessment and Treatment of the Lower Quarter: Closed Chain Manipulation

Course Description

With a precise understanding of anatomy and biomechanics of the kinetic chain, restoration of movement of joints in dysfunction is enhanced.  A new technique utilizing specific positioning and patient activation is introduced – “Closed Chain Manipulation.” These techniques will allow the therapist to provide the patient with a powerfully effective manipulation of any articulation with greater ease for the therapist to perform than typical open chain mobilizations.  “Closed Chain Manipulations” are safe to employ in either acute or chronic conditions.  In this two day seminar the participant will gain increased knowledge of the articulations through their anatomy and biomechanics, followed by specific assessment techniques to identify dysfunctions of the related joint and ligamentous tissue.  “Closed Chain Manipulation” techniques are instructed and practiced which the instructor has found effective in the treatment of altered movement characteristics of the selected articulations.  Self care exercises utilizing the fundamental principles of Closed Chain Manipulation are addressed.

Behavioral Objectives

Upon completion of this course, participants will be able to:

  1. State the mechanical process by which Closed Chain Manipulations affect the connective tissue elements of the body.
  2. State the arthrokinematic and osteokinematic relationships of the articulations covered in the course.
  3. Perform a manual assessment to identify somatic dysfunctions of the selected articulations.
  4. Utilize Closed Chain Manipulations in the treatment of altered movement characteristics of the various articulations.
  5. Devise appropriate home exercises utilizing the concepts of Closed Chain Manipulations.

Assessment and Treatment of Altered Neurodynamics of the Upper and Lower Quarter

Course Description

Since 1991 when David Butler published his groundbreaking book “Mobilization of the Nervous System” there has occurred a fundamental change in the way physical therapists evaluate and treat upper and lower quarter pain presentations.  Mr. Butler was instrumental in taking the work of Alf Breig, M.D., and others who had studied the nervous system and its connective tissue coverings and making it useful in the assessment of the extensibility of the nervous system.  Years ago it was considered inappropriate to place tension on the nervous system.  Since this time, it has become common for physical therapists to evaluate and treat patients who demonstrate objective findings indicative of restricted neurodynamics.  This course is designed to allow the participants to better understand the pathophysiology of altered neurodynamics and as a result, determine the most appropriate treatment technique which will resolve the dysfunction.  Coursework will provide the participants with the ability to assess manually for the area of greatest restriction within the pathway of each terminal branch of the plexi in the upper and lower quarter.  Participants will learn methods of direct and indirect treatment to address these areas of restriction, as well as develop home programs appropriate for these conditions.

Behavioral Objectives

At the end of the course, participants will be able to:

  1. Perform/demonstrate testing to identify the presence of abnormal movement of the nervous system for the terminal branches of the brachial plexus, lumbar plexus, sacral plexus, and L4 trunk.
  2. State the two most common pathohysiological processes by which somatic dysfunction are maintained.
  3. State the appropriate treatment approach for patients who present with reactive versus chronic altered neurodynamics.
  4. Perform/demonstrate palpatory assessment to identify tissue texture abnormality in the area of greatest restriction within the pathway of the terminal branches of the brachial plexus, lumbar plexus, sacral plexus, and L4 trunk.
  5. Learn, discuss and practice direct and indirect treatment approaches that may assist in normalizing patients extensibility when they present with altered neurodynamics.
  6. Name the pathways and entrapment sites for all terminal branches of the upper and lower quarter.
  7. Identify how the proximal relationship of the nervous systems is affected by spinal motion and how this relationship affects distal movement patterns of tension of the peripheral nervous system.

Pre-seminar and post-seminar written test questions will be used to assess class participant competency

Assessment and Treatment of the Cervicothoracic Spine and Rib Cage

Course Description

This two day seminar is designed to allow clinicians to effectively evaluate and treat the subcranial, midcervical, and upper thoracic spine.  A muscle energy model of assessment and treatment will be employed.  The strong influence in dysfunctional movement patterns in the spine and extremities caused from restricted neurodynamics, will also be addressed.  The basis of any regional assessment approach requires a thorough understanding of anatomy and biomechanics and will be an emphasis in this course.  Home programs which help maintain and gain movement from a neuromuscular and articular perspective will be discussed.  By course end, each participant will have a refined ability to make a correct functional diagnosis and effectively treat the dysfunctions noted on examination, thereby restoring pain free and friction free motion to the cervicothoracic spine.

Behavioral Objectives

Upon completion of this course, participants will be able to:

  • State the diagnostic criteria for identifying a somatic dysfunction within the Cervicothoracic spine.
  • Identify through palpation of anatomical landmarks and movement restrictions, a diagnosis of Cervicothoracic and/or common rib cage somatic dysfunction.
  • Position patients and either use muscle energy or counterstrain to treat somatic dysfunctions of the cervical spine, upper thoracic spine, or rib cage.
  • Demonstrate appropriate home exercises to address movement restriction of the cervicothoracic spine.
  • State the two most common pathohysiological processes by which somatic dysfunction are maintained.
  • Clinically examine for restriction in the nervous system.
  • Plan and administer direct treatment to altered neurodynamics affecting the area of greatest restriction as it affects the roots, trunks, brachial plexus and its terminal branches.

Method of assessment will be a pre and post test format.

Format of the course will be didactic lectures and laboratory, 2/3 of course will be laboratory with a high instructor to student ratio

Assessment and Treatment of the Thoracic Spine

and RIB Cage

Course Description

This two day seminar examines the movement behaviors of the thoracic spine and the rib cage.  Pain which occurs in the thoracic spine may be from visceral origin and needs to be ruled out from that coming from somatic structures of the thoracic spine and cage.  This will allow for proper referral when assessment does not correlate with dysfunction of the somatic structures of the spine and cage.  Anatomical and biomechanical considerations are paramount in understanding the dysfunctions which will be treated in the course.  Muscle energy, strain/counterstrain, and manipulation techniques will be presented and practiced in the laboratory sessions of the course.  At the end of the course each participant should be able to identify and correctly diagnose, as well as treat all of the common somatic dysfunctions of the thoracic spine as well as structural rib restrictions, inspiratory and expiratory rib restrictions, and torsional rib restrictions.

Behavioral Objectives

At the end of the course, participants will be able to:

  1. State the diagnostic criteria for identifying a somatic dysfunction within the thoracic spine and rib cage.
  2. Identify through palpation of anatomical landmarks and movement restrictions a diagnosis of somatic dysfunction of the thoracic spine and cage.
  3. State the two most common pathohysiological processes by which somatic dysfunction are maintained.
  4. Position patients and either use muscle energy or counterstrain to treat somatic dysfunctions of the thoracic spine and cage.
  5. Demonstrate appropriate home exercises to address movement restriction of the thoracic spine and cage.
  6. State the arthrokinematic and osteokinematic relationships of the articulations covered in the course.

Assessment and Treatment of the Lumbo-Pelvic-Hip Girdle

Course Description

This two-day course examines ilio-sacral and sacro-iliac movement behaviors in conjunction with those of the lumbar spine which may present as somatic dysfunctions.  An osteopathic muscle energy model for assessment will be presented which will provide the participants with a framework for identifying the various types of somatic dysfunctions noted in this region.  Anatomical and biomechanical considerations are paramount in understanding the dysfunctions which will be treated in the course.  Muscle energy, strain/counterstrain, and manipulation techniques will be presented and practiced in the laboratory sessions of the course.  At the end of the course each participant should be able to identify and correctly diagnose, as well as treat all of the common ilio-sacral, sacro-iliac, and pubic symphysis lesions typically seen in an outpatient orthopedic facility.

Behavioral Objectives

Upon completion of this course, participants will be able to:

  1. State the diagnostic criteria for identifying a somatic dysfunction within the pelvic girdle.
  2. Identify through palpation of anatomical landmarks and movement restrictions a diagnosis of pelvic girdle somatic dysfunction.
  3. Position patients and either use muscle energy or counterstrain to treat somatic dysfunctions of the pelvic girdle.
  4. Demonstrate appropriate home exercises to address movement restriction of the pelvic girdle.

Method of assessment will be a pre and post test format.

Format of the course will be didactic lectures and laboratory, 2/3 of course will be laboratory with a high instructor to student ratio.

Assessment and Treatment of the Shoulder Girdle: Closed Chain Manipulation, Counterstrain, and Muscle Energy Procedures

Course Description

This two day seminar is designed to give clinicians a thorough understanding of assessment and treatment techniques to effectively normalize function of both intrinsic and extrinsic components of the shoulder girdle.  The ability to assess and accurately state the functional diagnosis at any region of the body is essential for effective treatment.  The intrinsic components of the shoulder girdle consist of the upper thoracic spine, sternoclavicular joint, acromioclavicular joint, scapulothoracic physiological joint, and the glenohumeral joint.  Each articulation will be discussed in detail from an anatomical and biomechanical perspective allowing the clinician to better evaluate each are in order to assess if for dysfunctional movement patterns.  Extrinsic components of the shoulder girdle will also be discussed.  Treatment procedures will be instructed to normalize function through utilization of muscle energy, counterstrain, and closed chain manipulation.  Home programs which assist and maintain gains in movement made from clinical treatment are given that address both neuromuscular control and articular restriction.

Behavioral Objectives:

By the completion of the course, participants will be able to:

  1. State the arthrokinematic and osteokinematic relationships of the articulations covered in the course.
  2. State the mechanical process by which Closed Chain Manipulations affect the connective tissue elements of the body.
  3. Perform a manual assessment to identify somatic dysfunctions of the selected articulations
  4. Devise appropriate home exercises utilizing the concepts of Closed Chain Manipulations
  5. State the two most common pathophysiological processes by which somatic dysfunction are maintained.
  6. Devise appropriate home exercises utilizing the concepts of Closed Chain Manipulations.
  7. Acknowledge the impact from intrinsic and extrinsic structures on motion abnormalities at the shoulder girdle.

Method of assessment will be a pre and post test format.

Format of the course will be didactic lectures and laboratory, 2/3 of the course will be laboratory with a high instructor to student ratio.

 

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