CHAPTER 15 – Muscles and Tendons, Physical Medicine and Rehabilitation (PM&R) The Languages of Orthopedics and Rehabilitation Chapter 15 Teaching Overview Without bones for structure, support, and motion, the body would be an amorphous blob. However, without muscles, the body would not be able to move at all and one of the most important vital organs, the heart, would not contract. In addition to movement, muscles perform other important tasks such as helping a person breathe through movement of the chest wall; heat production through muscle contraction; maintaining good body posture and communication through writing, speaking, grimacing and gesturing. When a muscle fails to function properly, the cause could be with the muscle or with the nerves supplying the muscle. Because of this, diagnosing muscle conditions can be difficult. To maintain flexibility and muscle strength, individuals need to move. Individuals with chronic conditions affecting the respiratory, cardiovascular and musculoskeletal systems, as well as the elderly are at risk for loss of bone density and muscle mass due to immobility, leading to falls. This chapter discusses rehabilitation that is necessary following a brain injury such as a stroke as well as post-operatively following joint replacement surgery. As with all lessons in this Lesson Planning Guide, you can and should modify them to best meet the needs of your students, your schedule, and your curricula. Teacher to Teacher: • This chapter is a great opportunity to bring in health professionals (physical therapists, occupational therapists, speech-language pathologists) to discuss the care and treatment of individuals with disorders affecting the muscles. The health professionals may be able to bring models, and slides or pictures of the three different types of muscles to class, to bring the muscular system to life for your students. • Students may have had to learn about muscles in elementary school or high school. Ask them to share some of the ways they learned the names of the muscles and their location. Chapter 15: Learning Outcomes Upon successful completion of the lessons in this chapter, your students will . . . 15.1. Identify the three different types of muscle in relation to their functions. 15.2 Describe the functions and structure of skeletal muscle. 15.3 Discuss the common disorders of skeletal muscle. 15.4 Describe the muscles and tendons of the shoulder girdle, trunk, and upper limb and their common disorders. 15.5 Describe the muscles and tendons of the pelvic girdle, thigh, leg, and foot. 15.6 Explain diagnostic procedures used in disorders of skeletal muscle and physical medicine and rehabilitation. 15.7 Describe pharmacologic agents used in the treatment of disorders of skeletal muscle and in physical medicine and rehabilitation. 15.8 Define the different types of physical medicine and rehabilitation. 15.9 Discuss the specific areas of stroke rehabilitation and amputations. 15.A Use the medical terms of the muscular system and rehabilitation to communicate in writing and document accurately and precisely in any health care setting. 15.B Use the medical terms of the muscular system and rehabilitation to communicate verbally with accuracy and precision in any health care setting. 15.C Construct medical terms used in rehabilitation medicine from their word elements (roots, combining forms, prefixes, and suffixes). 15.D Deconstruct medical terms used in rehabilitation medicine into their word elements (roots, combining forms, prefixes, and suffixes). 15.E Identify health professionals working in muscle disorders and rehabilitation medicine. 15.F Use abbreviations of medical terms used in rehabilitation medicine. Note: These lessons are designed with ultimate flexibility in mind. When customizing the lessons for your own class, always choose activities that are most relevant to your curriculum, your students, and your teaching goals—especially if you do not have time to implement all the provided activities into your class period. Lesson 15.1: Muscles and Tendons Total Time: 50 Minutes Lesson 15.1 Lesson Objectives: Your teaching objective for this lesson is to help your students accomplish these learning objectives: 15.1.1 Differentiate the three types of muscles. 15.1.2 Describe the structure of skeletal muscle and tendons. 15.1.3 Identify the functions of skeletal muscle and tendons. 15.1.4 Describe the major problems and diseases that occur in muscles and tendons. Prepare Your Materials: • Lesson 15.1 Muscular System Trivia Handout – Found on Page 15-6 of this Instructor Manual. • Lesson 15.1 Muscular System Trivia Handout Answer Key– Found on Page 15-7 of this Instructor Manual. • Lesson 15.1 PowerPoint® presentation – Found with the Instructor Resources that can be accessed through the “Library” tab on Connect, and then under “Instructor Resources”. • Lesson 15.1 Student Note-taking Handout – Create by selecting the “Handouts” option when printing the PowerPoint presentation; select 3 slides per page to print slides with blank lines to the right where students can take notes. • Additional resources on problems and diseases of the muscular system – (optional) Examples may include smart devices with Internet access (computer, tablet, cell phone), pamphlets, books, posters, educational materials from doctor’s offices or from orthopedic departments in hospitals or medical schools. Instructor Lesson Plan Date: _____________ Chapter 15—Lesson 15.1 TIME ACTIVITY & INSTRUCTIONS MATERIALS LESSON OBJECTIVES Warm-up & Introduction 15 min Activity Description: Focusing students’ attention on the muscular system. Step 1: Distribute the Muscular System Trivia handout and have students complete it individually or in small groups – or go through it as a class. Step 2: Ask students what else they know about the muscular system. Guide them to share their pre- existing knowledge about the structure of muscles and the functions they provide in the human body. Step 3: Reinforce correct facts and information about the muscular system. Lesson 15.1 Muscular System Trivia Handout 15.1.2 15.1.3 Lecture 20 min Lesson 15.1 Lecture/Discussion Reference the Speaker Notes for each slide to assist you in discussing the talking points. You can view or print “Notes Pages” to use during the lecture for easy reference (in PowerPoint, select “View,” then “Notes Page”). Lesson 15.1 PowerPoint Presentation 15.1.1 15.1.2 15.1.3 15.1.4 Active Learning & Practice 15 min Activity Description: Students will practice explaining problems and diseases that occur in the muscular system. Step 1: Assign each student a different problem or disease that occurs in the muscular system (see LO 15.3 Disorders of Skeletal Muscles in the textbook) AND a different patient (assign students patients of various ages, genders, and situations so they can practice tailoring their communication to a specific audience). For example, assign students an older patient who does not hear or see well. Tell the students they need to become familiar enough with their problem or disease that they could perform patient education, explaining the problem or disease to a patient who knows nothing about it and has little or no knowledge of the muscular system. Step 2: Give students some time to plan what words they will use to explain the problem or disease to their patient. Each student should use his or her textbook and any other resources available (e.g., smart devices with Internet access, campus library, etc.) to make sure he or she completely understands the assigned problem or disease. Textbook, Lesson 15.1 Additional resources such as smart devices with Internet access (computer, tablet, cell phone) 15.1.1 15.1.2 15.1.3 15.1.4 Step 3: Have each student present his or her explanation to the rest of the class. Students should briefly describe the patient’s age, gender, etc., and then give the explanation of the problem or disease— as if telling it to the patient. Step 4: The instructor and other students should critique the effectiveness of the explanation keeping in mind the age, gender, and situation of the patient for whom this explanation was intended. Review 5 min Step 1: Go through Lesson 15.1 exercises from the textbook as a group; explain or clarify anything that is difficult for students. Exercises may be assigned as homework if needed. Step 2: Listen for and correct mispronunciation of terms. Lesson 15.1 exercises (found in textbook) 15.1.1 15.1.2 15.1.3 15.1.4 Homework Assignment 5 min • Students read Lesson 15.2 in the textbook and complete Lesson 15.2 exercises. • Complete Lesson 15.1 exercises from the textbook, if needed. 15.1.1 15.1.2 15.1.3 15.1.4 Lesson 15.1 Masters • Lesson 15.1 Muscular System Trivia Handout Answers to Lesson 15.1 Masters • Lesson 15.1 Muscular System Trivia Handout Answer Key Medical Language for Modern Health Care: Lesson 15.1 – Muscular System Directions: Answer each question below using what you know about the muscular system. QUESTIONS: 1. There are four types of muscles. True or False: (Circle A or B.) A. True B. False 2. Skeletal muscle is attached to bone. True or False: (Circle A or B.) A. True B. False 3. Another name for skeletal muscle is striated muscle. True or False (Circle A or B) A. True B. False 4. What is the name of the largest muscle in the body? (Hint, you sit on it) Write your answer on the blank below) ___________________________________________________________________________________ 5. The large muscle located in the anterior thigh with four heads is called the triceps femoris. True or false: (Circle A or B.) A. True B. False 6. What is the name of the large group of four muscles that move the shoulder girdle? (Write the name of the muscle group in the blank below.) 7. Where is the Achilles tendon located? Write your answer on the blank below. _______________________________________________________________________ 8. Any injury to a muscle or tendon is called a sprain. True or False: (Circle A or B.) A. True B. False Medical Language for Modern Health Care: Lesson 15.1 –Muscular System – Answer Key Directions: Answer each question below using what you know about the skeletal system. QUESTIONS: 1. There are four types of muscles. Correct: B. False Rationale: There are three types of muscles: skeletal, smooth and cardiac. 2. Skeletal muscle is attached to bone. Correct: A. True Rationale: Skeletal muscle is attached to one or more bones. Ask students why they think this type of muscle is attached to bones. 3. Another name for skeletal muscle is striated muscle. Correct: A. True Rationale: Skeletal muscle is also known as striated muscle because muscle fibers contain alternating light and dark bands (striations) created by the pattern of protein filaments that are responsible for muscle contraction. Skeletal muscle is also called voluntary muscle because it is under conscious control. 4. What is the name of the largest muscle in the body? Correct: gluteus maximus Rationale: The gluteus maximus muscle is the largest muscle in the body, covering a large part of each buttock. 5. The large muscle in the anterior thigh with four heads is called the triceps femoris. Correct: B. False Rationale: The anterior thigh (front of the thigh) contains the large quadriceps femoris muscle. This muscle has four heads: rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius. The prefix quadri- means four and -ceps is a root meaning head. Ask students why they think the muscle is named “femoris”. 6. What is the name of the large group of four muscles that move the shoulder girdle? (Write the name of the bone in the blank below.) Correct: Rotator cuff Rationale: The Rotator cuff is made up of four muscles that originate on the scapula (shoulder blade), wrap around the shoulder joint, and fuse together. The fusion creates one large tendon that keeps the ball of the humerus in its socket and provides stability for the shoulder joint. The four muscles that make up the rotator cuff are the subscapularis, supraspinatus, infraspinatus, and teres minor. 7. Where is the Achilles tendon located? Correct: The Achilles tendon attaches to the gastrocnemius muscle that forms a large part of the calf and the heel bone, the calcaneus. 8. Any injury to a muscle or tendon is called a sprain. Correct: B. False Rationale: An injury to a muscle or tendon is called a strain; an injury to a ligament is called a sprain. Lesson 15.2: Muscles and Tendons of the Shoulder Girdle, Trunk, and Upper Limb Total Time: 50 Minutes Lesson 15.2 Lesson Objectives: Your teaching objective for this lesson is to help your students accomplish these learning objectives: 15.2.1 Describe the structures and functions of the muscles and tendons of the shoulder girdle. 15.2.2 Identify the common disorders of the muscles and tendons of the shoulder girdle. 15.2.3 Specify the major muscles that join the arm to the trunk. 15.2.4 Explain the structures and functions of the muscles of the arm, elbow, forearm, wrist, and hand. 15.2.5 Name common disorders of the joints, muscles, and tendons of the elbow. 15.2.6 Define common disorders of the joints and muscles of the hand. Prepare Your Materials: • Puppet-making supplies – Card stock, craft sticks, glue, scissors, hole punch, thread or string, etc. • Lesson 15.2 PowerPoint® presentation – Found with the Instructor Resources that can be accessed through the “Library” tab on Connect, and then under “Instructor Resources”. • Lesson 15.2 Student Note-taking Handout – Create by selecting the “Handouts” option when printing the PowerPoint presentation; select 3 slides per page to print slides with blank lines to the right where students can take notes. Instructor Lesson Plan Date: _____________ Chapter 15—Lesson 15.2 TIME ACTIVITY & INSTRUCTIONS MATERIALS LESSON OBJECTIVES Warm-up & Review 10 min Activity Description: Review of Muscles. Step 1: Go over the answers to Lesson 15.1 exercises in a round robin manner. Explain or clarify anything that is difficult for students to understand. Step 2: Listen for and correct any pronunciation errors. Textbook, Lesson 15.1 exercises (Review Lesson 15.1 concepts) Introduction 5 min Step 1: Ask students if they have ever had a strain—a twist, pull, and/or tear of a muscle and/or tendon. Step 2: Share strain stories and begin to note similarities between the injuries. Some similarities across strain injuries may include the following: • Overuse • Repetitive movement • Overstretching • Lifting too much • Inadequate rest between intense activity • Too much activity, too soon • Sometimes, a blow to the body Step 3: Connect the causes of this type of injury to the coming lecture about the structure and function of muscles and tendons. Step 4: Ask students if they have ever heard of carpal tunnel syndrome, tennis elbow, or ganglion cysts. Discuss how these conditions are related to injury to tendons. Lecture 20 min Lesson 15.2 Lecture/Discussion Reference the Speaker Notes for each slide to assist you in discussing the talking points. You can view or print “Notes Pages” to use during the lecture for easy reference (in PowerPoint, select “View,” then “Notes Page”). Lesson 15.2 PowerPoint Presentation 15.2.1 15.2.2 15.2.3 15.2.4 15.2.5 15.2.6 Active Learning & Practice 10 min Activity Description: Students will create simple string puppets to better understand the function of muscles of the shoulder girdle, trunk and upper limbs. Step 1: Have students get into groups or work with a partner. Step 2: Instruct each group to use the given supplies to create a moving puppet. To keep it simple, the puppets should be two-dimensional (flat). Step 3: Tell students it is their job to figure out how to use the strings (muscles) and craft sticks (bones) to make the puppet (card stock) move; remind them that to move, the puppet must have joints (places where bones come together). Possible tasks the puppets will be able to do include the following: • Bending at the waist • Bending elbows • Raising or lowering arms Step 4: Have each group demonstrate the movement of their string puppet with the rest of the class and explain how the bones, muscles, and joints work together to create movement. Card stock String Scissors Glue Craft sticks Hole punch 15.2.1 15.2.2 15.2.3 15.2.4 15.2.5 15.2.6 Review 5 min Step 1: Go through Lesson 15.2 exercises out loud in a round robin manner. Step 2: Reinforce correct pronunciation during these exercises. Textbook, Lesson 15.2 exercises 15.2.1 15.2.2 15.2.3 15.2.4 15.2.5 15.2.6 Homework Assignment • Students read Lesson 15.3. and complete Lesson 15.3 exercises • Review the Word Analysis & Definition (WAD) Tables from Lessons 15.1 and 15.2 15.1.1-15.1.4 15.2.1-15.2.6 Lesson 15.3: Muscles and Tendons of the Pelvic Girdle and Lower Limb Total Time: 50 Minutes Lesson 15.3 Lesson Objectives: Your teaching objective for this lesson is to help your students accomplish these learning objectives: 15.3.1 Discuss the muscles of the hip and thigh. 15.3.2 Describe the muscles and tendons of the lower leg, ankle, and foot. Prepare Your Materials: • Create a 10-question quiz from Lesson 15.1 and 15.2 exercises. • Lesson 15.3 PowerPoint® presentation – Found with the Instructor Resources that can be accessed through the “Library” tab on Connect, and then under “Instructor Resources”. • Lesson 15.3 Student Note-taking Handout – Create by selecting the “Handouts” option when printing the PowerPoint presentation; select 3 slides per page to print slides with blank lines to the right where students can take notes. • Charts, posters, and anatomy models – (optional) Instructor Lesson Plan Date: _____________ Chapter 15—Lesson 15.3 TIME ACTIVITY & INSTRUCTIONS MATERIALS LESSON OBJECTIVES Warm-up & Review 10 min Activity Description: Reviewing important concepts from previous lessons in Chapter 15. Step 1: Pass out the 10-question review quiz (this quiz can also be done orally, simply asking each question and calling upon students for the answers.) The quiz can also be submitted for a grade. Step 2: Once the quiz (or oral review) is finished, go over the correct answers to be certain students are ready to move on. Note: These questions can also be used to play a fun review-type game with students; small prizes could be awarded to students or teams that answer questions correctly. Create a 10-Question Review Quiz from Lessons 15.1 and 15.2 (Review Lessons 15.1 and 15.2 concepts) Introduction 10 min Activity Description: Briefly describe the muscle groups of the pelvis and lower limbs. Discuss how some of the muscles are names for body parts (femur). Asks students if they have heard of the hamstring muscles and the Achilles tendon. Ask if they know the location of each and their function. Ask students if they have experienced an injury to the knee (ligament, meniscus) and the type of recovery that involved (strengthening the quadriceps femoris muscle group). Ask students why the muscles in the pelvis and lower limbs are so large and often occur in groups of 3 – 4. Charts, posters, or anatomy models of the muscles Lecture 20 min Lesson 15.3 Lecture/Discussion Reference the Speaker Notes for each slide to assist you in discussing the talking points. You can view or print “Notes Pages” to use during the lecture for easy reference (in PowerPoint, select “View,” then “Notes Page”). Lesson 15.3 PowerPoint Presentation Active Learning & Practice 10 min Activity description: Students become familiar with the names of muscles, tendons and structures of the pelvic girdle and lower limbs. Step 1: Arrange students into small groups or partners. Step 2: Ask one student in each group to ask another student in the group to point to specific muscle groups and structures (popliteal fossa, patella, calcaneus, Achilles tendon, hamstring) on the chart, poster, or model. Repeat this process until everyone has had a turn pointing to the structures. Step 3: Read each term in the Word Analysis and Definition (WAD) Table in Lesson 15.3 out loud to ensure that the terms are pronounced correctly. Charts, posters, or anatomy models of the muscles of the pelvic girdle and lower limb. Textbook 15.3.115.3.2 Review 5 min Step 1: As a group, go through Lesson 15.3 exercises in a round robin manner. Step 2: Discuss incorrect answers with students to ensure understanding. Encourage students to use the Word Analysis and Definition (WAD) Tables for reference when needed. Textbook, Lesson 15.3 exercises 15.3.115.3.2 Homework Assignment • Review Word Analysis & Definition (WAD) Tables from Lessons 15.1 through 15.3. • Students read Lesson 15.4 and complete Lesson 15.4 exercises 15.1.1-15.1.4 15.2.1-15.2.6 15.3.1-15.3.2 Lesson 15.4: Procedures and Pharmacology Total Time: 50 Minutes Lesson 15.4 Lesson Objectives: Your teaching objective for this lesson is to help your students accomplish these learning objectives: 15.4.1 Explain the diagnostic procedures used for disorders of muscles and tendons. 15.4.2 Discuss the treatment procedures used for disorders of the wrist. 15.4.3 Describe the medications used for disorders of muscles and tendons. Prepare Your Materials: • Lesson 15.4 Four Questions Handout – Found on Page 15-17 of this Instructor Manual. Students will write either a diagnostic procedure question or a pharmacology question. As an alternative, you could assign students to write a question and bring it to class to use in this activity. • Dry erase board or chalkboard (or chart paper) – Prepare by dividing the board into two areas and labeling the areas “Procedures” and “Pharmacology”. • Scissors • Sticky notes • Lesson 15.4 PowerPoint® presentation – Found with the Instructor Resources that can be accessed through the “Library” tab on Connect, and then under “Instructor Resources”. • Lesson 15.4 Student Note-taking Handout – Create by selecting the “Handouts” option when printing the PowerPoint presentation; select 3 slides per page to print slides with blank lines to the right where students can take notes. • Smart device with Internet access (computer, tablet, cell phone) Instructor Lesson Plan Date: _____________ Chapter 15—Lesson 15.4 TIME ACTIVITY & INSTRUCTIONS MATERIALS LESSON OBJECTIVES Warm-up & Review 10 min Ask students to research the various types of Muscular Dystrophy and the genetic inheritance on their smart devices. Ask students to research dermatomyositis and polymyositis to answer the following questions: 1. What type of disorders are they (autoimmune – what does that mean?) 2. What organs or structures are affected? 3. What are the signs and symptoms? 4. What is the treatment? 5. What is the prognosis? Smart device with Internet access (computer, tablet, cell phone) 15.4.1 15.4.2 15.4.3 Introduction 5 min Step 1: Review with students common diagnostic testing and pharmacologic agents used in the treatment of muscular conditions. Some of the diagnostic testing will be familiar while other tests are specific for diagnosing muscular problems. Common tests can be written on a dry erase board. Dry erase board Lecture 20 min Lesson 15.4 Lecture/Discussion Reference the Speaker Notes for each slide to assist you in discussing the talking points. You can view or print “Notes Pages” to use during the lecture for easy reference (in PowerPoint, select “View,” then “Notes Page”). Lesson 15.4 PowerPoint Presentation 15.4.1 15.4.2 15.4.3 Active Learning & Practice 10 min Step 1: Divide the dry erase board or chalkboard into 2 columns. Label the first column “Procedures” and the second column “Pharmacology”. Step 2: Organize students into groups of four students. Step 3: Give each group the Four Questions handout. Instruct the groups to cut apart the four questions and give one question to each group member. The group member should write his or her question and answer on the question paper. Lesson 15.4 Four Questions handout Sticky notes Dry erase board (or chart paper) 15.4.1 15.4.2 15.4.3 Step 4: After a set amount of time (e.g., one minute, two minutes, etc.), have the group members pass their question to the person on their left. The next person should review the first person’s answer to the question and decide whether he or she agrees or disagrees with the first person. If the second student disagrees with the first student’s answer, he or she should cross it out and write a new answer on the question paper. Step 5: This continues until each of the four group members has had an opportunity to answer all four questions. Step 6: After all group members have answered all four questions, the group should discuss the questions and answers among themselves (as a team) and decide what they think is the correct answer to each question. Step 7: Each group should write the questions and answers on separate sticky notes. Step 8: The sticky note answers to each individual question should be taken up to the dry erase board and stuck to the column for the appropriate question. For example, sticky notes containing questions and answers to “Procedures” questions should be placed in the first column of the dry erase board designated as the “Procedures” Area. You could use two different colors of sticky notes: one for procedures and one for pharmacology. Review 5 min Step 1: Have students work in groups or pairs to complete Lesson 15.4 exercises. Step 2: When students are finished, go over the answers to ensure student understanding. Call on different students to read their answers out loud and correct pronunciation as necessary. Textbook, Lesson 15.4 exercises 15.4.1 15.4.2 15.4.3 Homework Assignment • Read Lesson 15.5 and complete Lesson 15.5 exercises Lesson 15.4 Masters • Lesson 15.4 Four Questions Handout Medical Language for Modern Health Care: Lesson 15.4 – Procedures and Pharmacology Directions: 1) Cut apart the four questions listed below and give one question to each group member. 2) Every group member should create a question on the paper, then pass the question to the next group member for that person to answer the question. 3) Continue until all four group members have answered all four questions. 4) Write the question and answer on a sticky note. 5) Post the sticky notes in the “Procedures” or “Pharmacology” columns. Question 1 ____________________________________ ____________________________________ ____________________________________ ____________________________________ Answers: 1. __________________________________ 2. __________________________________ 3. __________________________________ 4. __________________________________ Question 2 ____________________________________ ____________________________________ ____________________________________ ____________________________________ Answers: 1. __________________________________ 2. __________________________________ 3. __________________________________ 4. __________________________________ Question 3 ____________________________________ ____________________________________ ____________________________________ ____________________________________ Answers: 1. __________________________________ 2. __________________________________ 3. __________________________________ 4 __________________________________ Question 4 ____________________________________ ____________________________________ ____________________________________ ____________________________________ Answers: 1. __________________________________ 2. __________________________________ 3. __________________________________ 4. __________________________________ Lesson 15.5: Procedures and Pharmacology Total Time: 50 Minutes Lesson 15.5 Lesson Objectives: Your teaching objective for this lesson is to help your students accomplish these learning objectives: 15.5.1 Identify the members of the rehabilitation team. 15.5.2 Discuss the purposes of rehabilitation medicine. 15.5.3 Define the goals for a restorative rehabilitation program for specific common problems. 15.5.4 Define the different types of rehabilitation. 15.5.5 Use the activities of daily living as a measure to assess therapy needs and effectiveness. Prepare Your Materials: • Case Report 15.2 Handout- found on Pages 15-21 and 15-22 of this Instructor Manual. • Case Report 15.2 Handout Answer Key- found on Pages 15-23 and 15-24 of this Instructor Manual. • Speaker: Health care professional (physical therapist, occupational therapist, or speech-language pathologist) to talk to the class about their role in the rehabilitation process. • Dry erase board or chalkboard • Lesson 15.5 PowerPoint® presentation – Found with the Instructor Resources that can be accessed through the “Library” tab on Connect, and then under “Instructor Resources”. • Lesson 15.5 Student Note-taking Handout – Create by selecting the “Handouts” option when printing the PowerPoint presentation; select 3 slides per page to print slides with blank lines to the right where students can take notes. Instructor Lesson Plan Date: _____________ Chapter 15—Lesson 15.5 TIME ACTIVITY & INSTRUCTIONS MATERIALS LESSON OBJECTIVES Warm-up & Review 5 min Ask students if they have ever had physical therapy. Why did they have it? How long did they have it? What types of treatments were done? Ask students if anyone they know has had a stroke and was in a rehabilitation center. How long were they there? Alternate activity: Schedule a health care professional (physical therapist, occupational therapist, speech-language pathologist) to discuss their role in a patient’s rehabilitation process. Speaker (physical therapist, occupational therapist, speech-language pathologist) 15.5.1 15.5.2 Introduction 5 min Tell students that following the recovery of acute brain conditions such as strokes and other procedures that can affect mobility and the ability to perform ADLs in a hospital setting, a patient may need additional time to recover in a rehabilitation unit. Ask students what types of activities they think happen in such a unit? What types of activities they witnessed in a rehabilitation unit? Ask students to reflect on why a patient couldn’t continue the rehabilitation process in the hospital (cost, insurance regulations, specialized equipment, trained staff, being with patients with similar situations) 15.5.1 15.5.2 15.5.3 15.5.4 Lecture 20 min Lesson 15.5 Lecture/Discussion Reference the Speaker Notes for each slide to assist you in discussing the talking points. You can view or print “Notes Pages” to use during the lecture for easy reference (in PowerPoint, select “View,” then “Notes Page”). Lesson 15.5 PowerPoint Presentation 15.5.1 15.5.2 15.5.3 15.5.4 15.5.5 Active Learning & Practice 15 min Activity description: Students read and understand medical terms documented in a medical record. Step 1: Pass out Case Report 15.2 Handout or read it in the textbook Step 2: Students can work in pairs to answer the questions. Step 3: Go over the answers in a round robin manner. Clarify or explain anything that is confusing for students. Step 4: Listen for and correct mispronunciation of terms. Case Report 15.2 Handout Textbook, Case Report 15.2 15.5.1 15.5.2 15.5.3 15.5.4 15.5.5 Review 5 min Step 1: Have students work in groups or pairs to complete Lesson 15.5 exercises. Step 2: When students are finished, go over the answers to ensure student understanding. Call on different students to read their answers out loud and correct pronunciation as necessary. Textbook, Lesson 15.5 exercises 15.5.1 15.5.2 15.5.3 15.5.4 15.5.5 Homework Assignment • Complete Chapter 15 Review exercises. • Review the Word Analysis & Definition (WAD) Tables from all Chapter 15 Lessons. 15.1.1-15.1.4 15.2.1-15.2.6 15.3.1-15.3.2 15.4.1-15.4.3 15.5.1-15.5.5 Lesson 15.5 Masters: • Case Report 15.2 • Case Report 15.2 Answer Key Lesson 15.5: Case Report 15.2 You are …a certified occupational therapist assistant (COTA) working in the Rehabilitation Unit at Fulwood Medical Center. Your patient is …Mr. Hank Johnson, a 65-year old print shop owner. One year ago, Mr. Johnson had an elective left total-hip replacement for osteoarthritis. Four months later, he had a myocardial infarction. Two weeks ago, while on his bike, he had a stroke. His right arm and leg were paralyzed, he lost his speech, and he had difficulty swallowing. He arrived in the Emergency Department within 3 hours of the stroke and received thrombolytic therapy (see Chapter 9). Mr. Johnson is now receiving physical therapy, occupational therapy, and speech therapy in the inpatient Rehabilitation Unit. He is able to say some simple words and has begun to have voluntary movements in the arm and leg. Your roles are to help him regain function in his arm and leg and to monitor and record his progress. Please answer the following questions related to this case study. 1. Define the following terms: Elective Total-hip replacement Osteoarthritis Myocardial infarction Stroke Thrombolytic therapy Physical therapy Occupational therapy Speech therapy Voluntary Inpatient Rehabilitation unit 2. What do you think caused Mr. Johnson’s myocardial infarction four months after the total-hip replacement? 3. Why do you think he had a stroke while he was exercising? 4. Name three (3) signs and symptoms of a stroke (besides those shown by Mr. Johnson). 5. What causes a stroke to occur? 6. What is the abbreviation for a stroke? ____________________________ 7. What does the acronym FAST mean in diagnosing a possible stroke? 8. A physician who specializes in physical medicine and rehabilitation is a _________________________; the specialty is __________________________. Lesson 15.5 Case Report – Answer Key You are …a certified occupational therapist assistant (COTA) working in the Rehabilitation Unit at Fulwood Medical Center. Your patient is …Mr. Hank Johnson, a 65-year old print shop owner. One year ago, Mr. Johnson had an elective left total-hip replacement for osteoarthritis. Four months later, he had a myocardial infarction. Two weeks ago, while on his bike, he had a stroke. His right arm and leg were paralyzed, he lost his speech, and he had difficulty swallowing. He arrived in the Emergency Department within 3 hours of the stroke and received thrombolytic therapy (see Chapter 9). Mr. Johnson is now receiving physical therapy, occupational therapy, and speech therapy in the inpatient Rehabilitation Unit. He is able to say some simple words and has begun to have voluntary movements in the arm and leg. Your roles are to help him regain function in his arm and leg and to monitor and record his progress. Please answer the following questions related to this case study. 1. Define the following terms: Elective Not an emergency procedure; performed at the convenience of patient and physician. Total-hip replacement The head of the femur, a portion of the femur and the acetabulum are replaced with a metal prosthesis. Osteoarthritis Inflammation of the bone and joints. A wear and tear disease, also called degenerative joint disease. Myocardial infarction The medical term for a heart attack. A portion of the heart muscle becomes necrotic due to a lack of oxygen to the myocardium. Stroke An area of the brain dies due to a sudden interruption of blood supply to an area of the brain, depriving brain cells of oxygen. Thrombolytic therapy A “clot buster” drug that is used for ischemic strokes to dissolve the clot that is preventing oxygenated blood to reach brain cells. A common drug is tPA (tissue plasminogen activator) which must be given within 41/2 hours of a stroke to be effective. Physical therapy Use of remedial processes to overcome a physical defect. Often involves exercises to strengthen muscles and stability and equipment such as crutches, canes and walkers. Occupational therapy Use of work and recreational activities to increase independent function. This can include adaptive equipment such as raised toilet seats and devices to help with dressing, eating and bathing. Speech therapy Performed by a speech-language pathologist. Helps the person regain speech and helps with difficulty chewing and swallowing. Voluntary Under a person’s control Inpatient The patient stays in a facility overnight; in an outpatient facility, the person has the treatment/procedure and then leaves. Rehabilitation unit A unit in a hospital where a patient regains therapeutic restoration of an ability as before; gain mobility and strength to perform ADLs following a brain injury, or other injury/surgery that limits mobility. 2. What do you think caused Mr. Johnson’s myocardial infarction four months after the total-hip replacement? Mr. Johnson may have had some mobility problems post-operatively due to pain causing him to be less active than usual. Immobility can cause blood to stagnate in the veins (venous stasis) leading to the formation of thrombi. He may have been taking a baby aspirin every day to prevent an MI but had to stop taking the medication a week before surgery. He may have resumed taking the baby aspirin but hasn’t built up enough of a therapeutic level to keep his blood free flowing. 3. Why do you think he had a stroke while he was exercising? Exercise raises heart rate. If Mr. Johnson had a clot anywhere in his blood vessels, the increased heart rate could have dislodged it, causing it to travel to the brain to cause a stroke. An elevated heart rate can raise blood pressure which can trigger an intracranial bleed from an aneurysm. 4. Name three (3) signs and symptoms of a stroke (besides those shown by Mr. Johnson). Signs and symptoms of a stroke depend on the area of the brain that is affected and include: visual difficulties including blindness; incontinence; problems with awareness, attention, learning, judgment and memory 5. What causes a stroke to occur? Strokes are caused by a sudden interruption of blood supply to an area of the brain, depriving brain cells of oxygen. There are two types of strokes: ischemic (due to atherosclerosis, thrombus or embolus), and hemorrhagic (aneurysm, arteriovenous malformation) 6. What is the abbreviation for a stroke? CVA cerebrovascular accident. 7. What does the acronym FAST mean in diagnosing a possible stroke? F = Face. Ask the person to smile. Is the face symmetrical or does one corner of the mouth droop? Is there drooling from the corner of the mouth? A = Arms. Ask the person to raise both arms out straight in front of them. Does one arm drift downward? S = Speech. Ask the person to repeat a simple sentence (the sky is blue). Is the speech clear, slurred or garbled? Can the person speak? T = Time. How long have the signs and symptoms been going on? Time to call 9-1-1. A person who exhibits any or all these signs may be having a stroke or TIA. It is critical that EMS is called, and the person is transported to the hospital for evaluation. 8. A physician who specializes in physical medicine and rehabilitation is a physiatrist; the specialty is physiatry. End of Chapter Answer Exercises Page 515 A. Ans 1: hyper- Ans 2: excessive Ans 3: -trophy Ans 4: nourishment Ans 5: n/a Ans 6: n/a Ans 7: con- Ans 8: with, together Ans 9: -tract Ans 10: draw Ans 11: n/a Ans 12: n/a Ans 13: a- Ans 14: without Ans 15: -trophy Ans 16: nourishment Ans 17: n/a Ans 18: n/a B. Ans 1: striated Ans 2: bone Ans 3: voluntary Ans 4: atrophy Exercises Page 517 A. Ans 1: B: prefix Ans 2: A: combining form B. Ans 1: fibromyalgia Ans 2: rhabdomyolysis Ans 3: strain Ans 4: tenosynovitis Exercises Page 519 A. Ans 1: A: supraspinatus Ans 2: D: teres major Ans 3: B: subscapularis Exercises Page 521 A. Ans 1: C: flexes the forearm at the elbow joint Ans 2: D: moves the arm at the shoulder joint Ans 3: A: the largest back muscle Ans 4: E: extends the forearm at the elbow joint Ans 5: B: located on the chest; moves the arm at the shoulder joint B. Ans 1: CTS Ans 2: ganglion Ans 3: tenosynovitis Exercises Page 523 A. Ans 1: B: quadri- Ans 2: D: duct- Ans 3: D: -or Ans 4: C: head B. Ans 1: gluteus Ans 2: minimus Ans 3: calcaneus Ans 4: medius Ans 5: maximus Exercises Page 525 A. Ans 1: EMG Ans 2: Bx Ans 3: CK Ans 4: ESR Exercises Page 527 A. Ans 1: E: inflammatory Ans 2: C: muscle relaxant Ans 3: D: paracetamol Ans 4: C: indomethacin Ans 5: B: antipyretic Exercises Page 529 A. Ans 1: orthotic Ans 2: therapy Ans 3: therapeutic Ans 4: orthotist Ans 5: therapist Exercises Page 531 A. Ans 1: A: above Ans 2: C: arm Ans 3: A: True B. Ans 1: D: long-term therapy; helps to prevent loss of current strength Ans 2: B: short-term therapy, aimed at returning the patient to prior function Ans 3: E: focuses on the patient’s functional abilities Ans 4: A: activities specific to independent living Ans 5: C: routine activities of personal care Chapter 15 Review A. Ans 1: D: physical therapist Ans 2: A: orthotist Ans 3: B: physiatrist Ans 4: C: occupational therapist B. Ans 1: communication Ans 2: heat Ans 3: movement Ans 4: posture Ans 5: respiration C. Ans 1: C: cardiac Ans 2: C: fibers Ans 3: A: striations Ans 4: C: atrophy Ans 5: D: hypertrophy Ans 6: B: insertion Ans 7: D: latissimus dorsi Ans 8: C: synovial tendon sheaths Ans 9: B: rotator cuff Ans 10: A: strain D. Ans 1: D: destruction of muscle to produce myoglobin Ans 2: C: inflammation of tendon and its surrounding synovial sheath Ans 3: A: symmetrical weakness and wasting of pelvic, shoulder, and proximal limb muscles Ans 4: E: inflammation of a tendon Ans 5: F: pain in muscle fibers Ans 6: B: overstretch of a muscle or tendon E. Ans 1: C: minimus Ans 2: B: quadriceps Ans 3: D: infraspinatus Ans 4: C: thenar eminence Ans 5: A: scapula Ans 6: D: big, long, and round Ans 7: A: triceps brachii Ans 8: C: gluteus maximus F. Ans 1: D: carpal tunnel syndrome Ans 2: C: rotator cuff tear Ans 3: B: tennis elbow Ans 4: A: bursitis G. Ans 1: C: treatment Ans 2: B: treatment Ans 3: A: prefix Ans 4: A: work Ans 5: C: nature of H. Ans 1: orthopedist Ans 2: tendonitis or tendinitis Ans 3: rotator cuff Ans 4: physiatrist I. Ans 1: G: below, deficient Ans 2: E: three Ans 3: C: toward Ans 4: F: four Ans 5: B: together Ans 6: D: above Ans 7: A: two J. Ans 1: C: a professional that assists people in improving their activities of daily living Ans 2: F: a type of medication used to treat muscle pain Ans 3: E: repetitive movements that cause a feeling of “pins and needles” in the hand Ans 4: B: removal of the lower leg and foot Ans 5: A: examples include toileting, brushing one’s hair, brushing one’s teeth Ans 6: D: hereditary muscular condition with general muscle weakness and atrophy K. Ans 1: B: COTA Ans 2: D: he can choose to move his arm and leg Ans 3: D: brush his hair and teeth L. Ans 1: n/a Ans 2: n/a Ans 3: dors- Ans 4: back Ans 5: -al Ans 6: pertaining to Ans 7: pertaining to the back Ans 8: an- Ans 9: without Ans 10: alges- Ans 11: sensation of pain Ans 12: -ia Ans 13: condition Ans 14: condition without sensation of pain Ans 15: n/a Ans 16: n/a Ans 17: delt- Ans 18: triangle Ans 19: -oid Ans 20: resembling Ans 21: resembling a triangle Ans 22: hyper- Ans 23: excessive Ans 24: -trophy Ans 25: nourishment Ans 26: n/a Ans 27: n/a Ans 28: excessive nourishment Ans 29: infra- Ans 30: below, beneath Ans 31: spinat- Ans 32: having spines Ans 33: -us Ans 34: pertaining to Ans 35: pertaining to beneath the spines (of the scapula) Instructor Manual for Medical Language for Modern Health Care David M. Allan, Rachel C. Basco 9780077820725, 9781260084931
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