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2016-17 Phase I,Year 1

Musculoskeletal and nervous systems The CNS and normal neuromuscular and musculoskeletal function

CONVENER DR HEIDI BASELER

Contents

Year 1 Musculoskeletal and nervous systems

The CNS and normal neuromuscular and musculoskeletal function Introduction

WEEK 1

Welcome to the block

3

Overview of the block

4-6

Learning outcomes for the block

6

Trigger material for the block

8

Learning outcomes for trigger material

9

Personal portfolio reflection

9

Activity, disability and building the skeleton

1.1

Timetable for Week 1

11

1.2

Virtual patient: Alice Jenkins

12

1.3

Learning outcomes: Alice Jenkins

13

1.4

Virtual patient: Tara Finch

14

1.5

Learning outcomes: Tara Finch

15

1.6

Learning opportunities and their outcomes

16

1.7

Clinical skills worksheet

19

1.8

Clinical placement worksheet

27

1.9

Personal portfolio reflection

33

WEEK 2

The spine and sensory pathways

2.1

Timetable for Week 2

35

2.2

Virtual patient: Martin Taylor

36

2.3

Learning outcomes: Martin Taylor

37

2.4

Virtual patient: Jean Marion

38

2.5

Learning outcomes: Jean Marion

39

2.6

Learning opportunities and their outcomes

40

2.7

Clinical skills worksheet

43

2.8

Clinical placement worksheet

49

2.9

Personal portfolio reflection

55

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1

Contents

WEEK 3

Motor pathways and the central nervous system

3.1

Timetable for Week 3

57

3.2

Virtual patient: Jonathan Reid

58

3.3

Learning outcomes: Jonathan Reid

59

3.4

Trigger material: Journal club

60

3.5

Learning outcomes: Journal club

61

3.6

Learning opportunities and their outcomes

62

3.7

Clinical skills worksheet

65

3.8

Clinical placement worksheet

69

3.9

Personal portfolio reflection

77

WEEK 4

The brain and the autonomic nervous system

4.1

Timetable for Week 4

79

4.2

Virtual patient: Annabel McCrae

80

4.3

Learning outcomes: Annabel McCrae

81

4.4

Trigger material: Michael J Fox ‘Then and now’

82

4.5

Learning outcomes: Michael J Fox ‘Then and now’

83

4.6

Learning opportunities and their outcomes

84

4.7

Clinical skills worksheet

87

4.8

Clinical placement worksheet

89

4.9

Personal portfolio reflection

93

The contents of this guide are © copyright 2016 Hull York Medical School. The authors of the texts herein have asserted their rights under the Copyright, Design and Patents Act 1988 to be identified as the authors of this work. For enquiries, contact the Communications Office, HYMS, University of York, Heslington, York YO10 5DD. Cover photograph copyright 2014 ©iStockphoto.com/Berc. The case studies in this document are works of fiction and any resemblance to real persons, living or dead, is coincidental.

2

T H E H U L L YO R K M E D I C A L S C H O O L

Introduction

Block convener: Dr Heidi Baseler

Welcome to The CNS and normal neuromuscular and musculoskeletal function block The combination of bipedal locomotion with hands that can manipulate objects and extraordinary mental capacities have enabled us to become the uniquely cultural and technological primate species that we are. In this block you will begin to study the normal functioning and morphology of the musculoskeletal and nervous systems. You will extend your studies of the latter in the subsequent block and complete the basic study of the limbs and nervous system in Year 2. Given the ways in which these systems define us, it is not surprising that disorders affecting them have considerable impact on our individual wellbeing and independence and impact widely on society. In terms of medical practice musculoskeletal problems, whilst being mainly short lived, represent 20–30% of the workload of the primary care physician. Similarly the nervous system, being so complex, is prone to a very wide range of disorders. Some of these are very common – for instance, headaches cause 1 in 50 people in the UK to consult their GPs each year, whilst most textbooks of medicine list in excess of 25 ‘common’ conditions affecting the various components of the nervous system. To help you put your learning of the basic structure and function of the muculoskeletal and nervous systems into context you will consider some of these conditions, their treatment, and particularly how disablilities arising through disorders of these systems affect the individual, their family and the community. During your clinical placements you will consider the roles of informal carers, some manifestations of limb trauma and problems with the functioning of the spine and central nervous system. The block convener is Dr Heidi Baseler and enquiries about the block should be directed in the first instance to her at [email protected]. We thank Jonathan Silverman for permission to use and adapt the Calgary-Cambridge framework in the HYMS curriculum.

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3

4

Overview of The CNS and normal neuromuscular and musculoskeletal function – Summary Table

Activity, disability and building the skeleton

Week 2 The spine and sensory pathways

Week 3 Motor pathways and the central nervous system

CLINICAL SKILLS

CLINICAL PLACEMENT

LECTURES

Alice Jenkins 49-yr-old woman who has fallen and broken her wrist

Skills for evaluating Equip yourself with a range of skills that can be used in evaluation

Tara Finch 28-yr-old woman with a congenital dislocation of one hip

w w w w w w w

Activities of daily living Locomotion Development of the central nervous system Patterns of impairment and disability Building and maintaining the skeleton The nervous system: introduction Bone metabolism – Ca 2 /PO4 metabolism, Vitamin D

Muscles, joints, movements and human locomotion (RS)

Consulting with people with communication impairments Gain experience in talking with a person who has a hearing impairment; Appreciate the communication difficulties that can arise in consulting with people with hearing impairments

Effects of limb trauma and trauma-related complications (if in hospital)

Martin Taylor 36-yr-old man with sudden onset of back pain

Examination of the spine and sensory testing Examine the thoracic and lumbar spine for deformity and movement; Perform the sciatic and femoral nerve stretch tests; Test sensations of pain and touch to outline the dermatomes Practise testing for position sense

w w w w w

Examination of the spine and sensory testing Sensory systems, spinal cord and brainstem Action potential Pain and nociception Justice and rights in health care

The spine and sensory pathways (RS)

Jean Marion 37-yr-old woman who has recently developed ‘odd feelings’ in her hand

Jonathan Reid 37-yr-old man who recently broke his spine and is now paralysed Journal club As part of your continuing professional development you read and reflect on a Cochrane review that recommends changing what used to be standard treatment in acute brain injury.

Testing muscle power and eliciting knee reflexes Look for muscle wasting; Test for muscle tone; Test for power in major muscles groups in the arms and legs

Informal care and the carer’s perspective (if in general practice)

BIOPRACTICALS AND RESOURCE SESSIONS

Sensory testing (BP)

w Motor systems, spinal cord and brainstem

Patients’ experiences of impairment and disability Clinical placement review (one-to-one with clinical placement tutor)

w w w w w

Spinal reflexes Testing the muscles Muscle physiology Informal care Why we need randomised controlled trials

Motor pathways and the CNS (RS) EMG and human nerve conduction (BP)

Introduction

T H E H U L L YO R K M E D I C A L S C H O O L

Week 1

PBL CASES

The brain and autonomic nervous system

CLINICAL SKILLS

CLINICAL PLACEMENT

Annabel McCrae 78-yr-old woman who has become confused since banging her head

Consultation recording reviewing session

Meeting patients w The basal ganglia and cerebellum: disorders of with movement neurological w Functional regions of the brain disease w The anatomy of the autonomic nervous system w The pharmacology of the autonomic nervous system

Michael J Fox ‘Then and now’ A Youtube clip of how Parkinson's Disease has affected the life of a famous actor.

PBL group review of learning progress

LECTURES

BIOPRACTICALS AND RESOURCE SESSIONS

The brain and the autonomic nervous system (RS)

Introduction

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M U S C U L O S K E L E TA L F U N C T I O N

Week 4

PBL CASES

5

Introduction

Overview of The CNS and normal neuromuscular and musculoskeletal function This block comprises four weeks. During the first two the focus is on the musculoskeletal system and during the second two on the nervous system. The topics for each week are: WEEK 1 Activity, disability and building the skeleton WEEK 2 The spine and sensory pathways WEEK 3 Motor pathways and the central nervous system WEEK 4 The brain and the autonomic nervous system.

Study aids and resources for each week’s topics can be accessed in the HYMS Year 1 > The CNS and normal neuromuscular and musculoskeletal function section on Blackboard.

Learning outcomes for The CNS and normal neuromuscular and musculoskeletal function The tables below illustrate how the four themes in the HYMS curriculum combine to help you achieve the block learning outcomes. Learning outcomes for individual learning opportunities are provided in the sections for each week.

THEME Applied life sciences

BLOCK LEARNING OUTCOMES n Outline the growth and development of the locomotor system n Describe the structure and function of the spine and relate this to radiographs n Outline the structure and function of muscle, bone and joints n Describe the cellular components of the nervous system n Describe the physiology of nerve conduction and synaptic transmission n Outline the structure and function of the spinal cord, brain stem, cerebrum, cerebellum

and the meninges n Outline the anatomy and physiology of the autonomic nervous system (ANS) n Outline bone and muscle repair mechanisms n Outline the physiology of pain n Outline the pathophysiology of low back pain n Outline the pathophysiology of spinal cord injury n Outline the pathophysiology of common movement disorders n Describe the pharmacology of the ANS n Outline the pharmacology of pain n Outline the pathophysiology of osteoporosis n Understand the pharmacological treatment of bone disease

6

T H E H U L L YO R K M E D I C A L S C H O O L

Introduction

THEME Clinical skills and reasoning

BLOCK LEARNING OUTCOMES

THEME

BLOCK LEARNING OUTCOMES

Health and society

n Be able to communicate effectively with patients while performing physical examinations n Demonstrate how to perform a basic neurological examination n Demonstrate how to perform a basic spinal examination

n Outline the rationale and design of a randomised controlled trial n Outline the current pattern of disability in the UK n Identify the implications of statistical power in interpreting research findings n Recognise the impact of impairment and disability on the individual and society n Understand the social and medical models of impairment disability and handicap n Discuss different ways in which patient safety can be compromised n Outline what a doctor or medical student should do if something goes wrong n Describe the range of resources available to provide continuing care in the community

THEME Professionalism

BLOCK LEARNING OUTCOMES n Discuss different ways in which patient safety can be compromised n Outline what a doctor or medical student should do if something goes wrong n Describe moral, legal, and human rights relevant to clinical practice n Describe the features of good and poor team working n Outline how multidisciplinary teamwork relates to quality of care for patients

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7

Introduction

Trigger material for The CNS and normal neuromuscular and musculoskeletal function During the four-week block you will have the following PBL trigger material. n WEEK 1 Alice Jenkins Alice Jenkins is a 49-year-old woman who has fallen and broken her wrist.

Tara Finch Tara Finch is a 28-year-old woman who suffers from a congenital dislocation of one hip.

n WEEK 2 Martin Taylor Martin Taylor is a 36-year-old man with sudden onset of lower back pain.

Jean Marion Jean Marion is a 37-year-old woman who has recently developed ‘odd feelings’ in her hand.

n WEEK 3 Jonathan Reid Jonathan Reid is a 37-year-old man who recently broke his spine and is now paralysed.

Journal club As part of your continuing professional development you read and reflect on a Cochrane review that recommends changing what used to be standard treatment in acute brain injury.

n WEEK 4 Annabel McCrae Annabel McCrae is a 78-year-old woman who has become confused since banging her head.

Michael J Fox ‘Then and now’ A Youtube clip of how Parkinson’s disease has affected the life of a famous actor.

8

T H E H U L L YO R K M E D I C A L S C H O O L

Introduction

Learning outcomes for the trigger material By now you should be thoroughly familiar with the PBL process which you need to employ for each item of trigger material. This is just a summary to remind you of the main features. w Identify any problems that the trigger material presents. There may be problems identified in

previous blocks carried forward. w Identify the learning outcomes which arise from the trigger material. w When you are given the learning outcomes identified by the course organisers at the end

of the session on Monday, compare them with the learning outcomes identified by your PBL group. w Ensure you cover all the course organisers’ list of learning outcomes. Your group may choose

to cover additional learning outcomes you have identified as a result of your discussions.

Personal portfolio reflection These pages are for personal notes on experiences from the week. While they remain private, you will need to draw on the content of these reflections in order to demonstrate progress on personal and professional development in your interviews with clinical placement supervisors and personal tutors at the end of each term. The aims of the HYMS Curriculum listed below are a starting point for reflection. They require that the student aims to: w possess the necessary… attitudes and values to investigate patients as appropriate w be able to communicate effectively with patients and their relatives, their own colleagues and

other agencies w possess the attitudes and values that engender ethical understanding and behaviour; the

attributes of empathy, humanity, and social awareness w possess the skills and attitudes to ensure their own continuous professional development and

lifelong learning through reflective practice, and the self-awareness to recognise personal limitations and to seek help when appropriate.

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9

Introduction

10

T H E H U L L YO R K M E D I C A L S C H O O L

You should always check your e-timetable for an up to date version of the timetable as there may have been changes since the study guide was printed.

WEEK 1

Activity, disability and building the skeleton 1.1 Timetable WEEK 1

9.00–10.00

10.00–11.00

11.00–12.00

Thursday 26 Jan 17

Friday 27 Jan 17

Monday 30 Jan 17

Tuesday 31 Jan 17

Wednesday 1 Feb 17

Lecture

SDL

RS

Lecture

SSIP

HS

ALS

Activities of daily living Dr A Clough

The nervous system: introduction Dr P Bazira

Lecture

Lecture

RS

Lecture

ALS

HS

ALS

Locomotion Dr L Fitton

Patterns of impairment and disability Dr J Seymour

Bone metabolism Ca2/P04 Metabolism Vitamin D Dr P Genever

Lecture

Lecture

ALS

ALS

Development of the central nervous system Dr S Cobb (11.00–11.50)

Building and maintaining the skeleton Prof P O’Higgins

RS

SDL

12.00–12.50

14.00–15.30

16.00–17.30

PBL

PBL

CP

Alice Jenkins Tara Finch

Alice Jenkins Tara Finch

Effects of limb trauma and trauma-related complications (if in hospital) or Informal care and the carer’s perspective (if in general practice)

CSP

CSP

Skills for evaluating

Consulting with people with communication impairments

ALS Applied Life Sciences BP Bio Practical CP Clinical Placement

HS Health and Society P Ethics and Professionalism

SDL Self-Directed Learning SSIP Scholarship and Special Interest

PBL Problem-Based Learning

CSP Clinical Skills Practice

RS-H Resource Session (Hull only)

CSR Clinical Skills and Reasoning

RS-Y Resource Session (York only)

Free

Progra...