The craft of manual therapy
Title: An evidence based approach to teaching the craft of manual therapy Authors: Neil Tuttle, Kerrie Evans Learning Objectives: 1.Understand the relationship between a manual therapy technique of the cervical spine, segmental mobility and patient impairments. 2.Be able to perceive the aspects of passive movements that are related to patient symptoms. 3.Be able to modify techniques according to the therapist’s characteristics, limitations and intention as well as to the patient’s moment-to-moment responses. 4.Understand generalizability of skills to other techniques or body regions. Evidence: Manual therapy techniques are amongst the most difficult of physiotherapy skills to teach and learn. Previous studies have demonstrated the wide variation in performance of techniques and in the qualitative descriptors used to communicate palpation findings. We have taken the understanding gained from measurement of changes in patterns of stiffness related to patient symptoms, real time imaging of the effects of variation of technique on intervertebral movement and computer based modeling to improve our objective knowledge of these manual therapy techniques and their relationships to patient impairments. A preliminary study has demonstrated a reduction in the forces applied by students and an improvement in their ability to discriminate stiffness following training using these methods. More than 90% of participants in two-day post-graduate courses using these methods described a significant improvement in both their clinical practice and ability to supervise students. Summary In this brief workshop, a research-based conceptual framework and rationale will be combined with sound pedagogical principles and innovative teaching methods. The workshop will concentrate on variations of what might be referred to as a single technique (cervical unilateral postero-anterior (PA) movements) as an example of the craft of manual therapy. The handling is based on methods described by Maitland, but the focus of the workshop is on how a particular therapist can best achieve their intention with a specific patient rather than on producing a ‘correct’ technique. The therapist’s intention may be to assess, perceive or to change a particular aspect of the patient’s mobility or symptoms and the application will vary according to both the characteristics of the therapist and the patient. The principles presented are not specific to the technique examples, but are equally applicable to other techniques, regions or manual therapy paradigms. We will integrate innovative teaching methods including physical models, low cost sensors providing objective feedback on forces, and early versions of virtual reality (haptic) simulators with very direct, consistent and precise hands-on feedback to maximize skill acquisition. The workshop will be predominantly experiential and ‘hands-on’ with a maximum of 12 participants for each instructor. Implications/conclusions Participants will have 1) an increased understanding of the objective characteristics of manual therapy techniques, 2) an ability to adapt techniques to suit their own physical characteristics and limitations, and 3) skills to adjust techniques on a moment-to-moment basis according to the patient’s response. This workshop will increase the participant’s and ability in two of the three pillars of evidenced informed practice – their clinical expertise and ability to respond to patient values and preferences.
IFOMPT 2012 Rendez-vous of hands and Minds