Assessment Tasks Description

1. Orthopaedic Assignment: Students are to work in groups of maximum five students to critique a systematic review and meta-analysis of a specific intervention for a musculoskeletal condition.
2. OSCE: These will assess your competency in performing the neurological and orthopaedic examinations.
3. Final examination: This will cover the content of each strand for the entire semester. It tests your knowledge of the theory, and the ability to connect that knowledge to real life situations (e.g. case studies, clinical presentations). It will consist of a 3 hour written exam with multiple choice questions, short answer questions and case studies. 

Delivery mode

This unit is characterised by a moderate degree of flexibility. It incorporates a variety of learning tools and media. It will comprise:

Please note that the venues are subject to change until just before the start of the semester. So, for further details on class time and locations for this unit follow the link below:

http://students.mq.edu.au/student_admin/timetables

Unit Web Page

You can log in to iLearn System via the link listed below:

https://ilearn.mq.edu.au/login/MQ/

All lecture materials will be posted on ilearn, and there is also a link to ECHO360 for audio recordings and livestreaming of the lectures.

Required and recommended resources

Strand 1: Orthopaedics

Notes are summarised under ‘Lectures’ on iLearn for CHIR 8501

Required:

1. Magee D.J. (2013).  Orthopaedic Physical Assessment. 6^th Edition.  W.D Saunders, Philadelphia

Recommended Reading

1. Brukner P, Khan, K. (2011) Brukner & Khan's Clinical Sports Medicine. 4th Ed. McGraw-Hill Book Company Australia.
2. Souza TA. (1997) Differential Diagnosis for the Chiropractor. Aspen Publications.
3. Hammer W. 3^rd Ed.  Functional Soft Tissue Examination & Treatment by Manual Methods. Jones and Barlett, Sudbury Massachusetts.
4. Evans RC. (2008) Illustrated Orthopaedic Physical Assessment. Mosby.

NOTE: Weekly tutorial case reports, clinimetric tools, and readings will be made available through iLearn.

Strand 2: Neurology

Required:

1. CHIR8501 - Neurology Tutorial Course Manual 2020– This has been uploaded to iLearn. Please be sure to either download, print and bind the manual, or have an ipad or laptop to access the manual during the tutorial.

Recommended: 

• Blumenfeld H (2010) Neuroanatomy through Clinical Cases. 2^nd ed. Sinauer Associates Inc, Massachusetts. Distributed by Palgrave Macmillan, Victoria, Australia.
• Souza TA (2005) Differential diagnosis and management for the chiropractor 3^rd ed. Jones & Bartlett Pub, Massachusetts.
• Bickley LS (2009) Bate’s Guide to Physical Examination and History Taking 10^th ed. Wolters Kluwer/Lippencott Williams & Wilkins, PA

Required Diagnostic Equipment (Neurological Diagnosis Kit):

1. A diagnostic set with otoscope and ophthalmoscope (Welsh Allen series 97200-BI recommended - ~$515)
2. A tailor’s measuring tape
3. A 128Hz or 256Hz (vibration) and also a 512Hz (auditory) tuning fork (Al weighted)
4. Neurotips (no sewing pins or pinwheels allowed strictly by WHS/Biosafety regulations)
5. Large stem ear buds
6. Disposable tongue depressors
7. Tomahawk reflex hammer
8. A number of tactile items e.g. key, coin etc
9. A compass:

A note about textbooks:

Textbooks for this unit can be purchased online from Booktopia https://www.booktopia.com.au/coop “.

The list of Macquarie University S1 2020 units and texts can be found on the Booktopia website.

Strand 1: Orthopaedics

A systematic approach will be applied to the regional diagnosis of common lumbopelvic and lower extremity conditions. The primary outcome is the ability to form a clinical impression (working diagnosis) for various patient presentations, including physical appearance, clinical history taking, physical examination and review of additional diagnostic information from paraclinical studies e.g. X-ray.

A review of anatomy and biomechanics (affirmation of assumed knowledge) of the lower extremity regions (hip/thigh, knee/leg, ankle/foot) will precede dialogue of lower extremity conditions/pathologies. The aspects of each condition/pathology will include: epidemiology, aetiology, pathogenesis and diagnosis and prognosis. The management (including therapeutic intervention) of lower extremity conditions will be not be covered in great depth and is intended only to provide detail for the natural history of each condition. Conditions of the lower extremity by region will include:

• Trauma (fractures, dislocations and soft tissue tears)

• Joint instability and arthritides (including capsular patterns of limitation)

• Congenital and developmental anomalies

• Overuse injuries

• Common sports injuries

• Entrapment neuropathies of the lower extremity

The assessment of the lower extremity regions will include:

• History and observation

• Clinimetrics
• Static palpation including borders of triangles etc.

• Range of motion assessment (active and passive range of motion and resisted isometric movements)

• Orthopaedic special tests (OSTs)
• Discussion of neurological, vascular and functional assessment along with discussion of relevant paraclinical procedures for each condition

TIMETABLE

Orthopaedics Timetable

  Strand 2: Neurology

A number of topics are covered that relate to common patient neurological presentations. The aetiology, clinical presentation (symptoms and signs), relevant neuroscience and neuropathology, and latest research, are revised and discussed. Students develop the skill of differential diagnosis. Clinical neurological examination is taught in tutorials. The lectures cover the neurological examination from a theoretical perspective and evaluate the diagnostic test accuracy and clinimetric aspects of examination, as well as provide the depth of theory required for strong differential diagnosis. A strong component of this course is the evaluation of history taking, neurological testing and differential diagnosis through case studies and OSCEs. 

Clinimetrics focuses on the quality of clinical measurement. A link to a paper on this topic is available on ilearn in the neurology tutorial section: de Wet HCW, Terwee CB, Bouter LM (2003) Current challenges in clinimetrics. Journal of Clinical Epidemiology 56: 1137 – 41

Topic 1: Neurodynamic testing (“nerve tension tests”) and mobilisation techniques

Students acquire skills in the competent practical application of upper and lower limb neurodynamic tests and mobilisation techniques

Topic 2: Pain

The pain sensory pathways and the pain suppression pathways are revised. The research on chronic pain is discussed, and the differences among acute physiological nociceptive pain, pathophysiological nociceptive pain and neuropathic pain are analysed. Common pain presentations, prognosis and management are discussed.

Topic 3: Altered cognition

Some of the conditions that result in cognitive impairment and altered thought processing are explored and the red flag conditions are highlighted. The discussion includes cognitive impairment, memory loss, dementia, brain trauma, acute confusional states and seizures. The mental status examination is fully elaborated.

Topic 4: Psychiatric disorders

The basis of the classification of psychiatric disorders and an overview of major classified conditions are discussed and critiqued.

Topic 5: Seizures

Seizures are classified and each type is discussed with regard to aetiology, pathophysiology, clinical manifestations and diagnosis.

Topic 6: Eye presentations

Common eye problems are explored, including extraocular eye muscle palsies, strabismus, decreased visual acuity, reduced visual fields and abnormal fundal findings on ophthalmic examination. The integration among visual input, proprioception and vestibular input for control of posture, movement and balance is discussed, and the postulated functional consequences of deficits in this integration are explored.

Topic 7: Hearing and balance presentations

The common presentations of hearing loss are discussed. The multisensory integration in vestibular processing is explored and its importance in gaze stabilisation, head orientation and posture during movement. The vestibular-ocular pathways are revisited, and the vestibular reflexes are covered. The possible causes, mechanisms, clinical presentation and neurological testing for vertigo are outlined. The differential diagnoses for central and peripheral vertigo are discussed, and the evidence for abnormal cervical proprioceptive input as a cause for dizziness is considered. Management of common conditions is discussed.

Topic 8: Cerebrovascular disease and Neoplasms

The blood supply of the nervous system is revised. The cascade of biochemical events that occur following cerebral ischaemia is discussed, and the consequent functional losses are covered. The clinical manifestations and diagnostic evaluation of cerebrovascular accident/stroke (thrombotic, embolic, haemorrhagic, lacunar) are discussed.

The classification, common location, clinical manifestations and prognosis of intracranial tumours are discussed.

Topic 9: Lesions of the Spinal Cord and localisation of the lesion

The sensory and motor pathways in the spinal cord are revised. Spinal cord trauma is an area of focus, and the causes and consequences (including initial spinal cord shock and autonomic hyper-reflexia) are described. History taking, neuroexamination and clinical differentiation between upper and lower motor neuron lesions are discussed. Weakness patterns and localisation of the lesion are described, and presentations of common lesions, and their differential diagnoses are reviewed.

Topic 10: Common Lesions of the Nervous System

The aetiology, symptoms and signs and differential diagnosis of common central and peripheral lesions of the nervous system are covered. Neuronal damage, the classification of nerve injury, plasticity, regeneration and neurogenesis are reviewed.

The Neurology Timetable:

A greater emphasis will be placed on case studies during tutorials, with the use of the Chiropractic Decision Aid, The Clinical Decision Framework. This tool is used in a number of units in the Master of Chiropractic degree. Tutorials will also include the role playing of case studies.