Course Outline

This two-day intermediate level course is designed to enhance a therapist’s fundamental understanding of surgical approaches for the cervical and lumbar spine in order to effectively develop progressive rehabilitation protocols. The key to successful post surgical rehabilitation is understanding the mechanism of injury, physiological healing time, mechanical changes, and surgical techniques. This in-depth presentation prepares the medical professional to identify effective rehabilitation procedures for safe therapeutic management in order to achieve positive functional outcomes. A thorough understanding of the outcomes of surgery assists the therapist to develop the most effective rehab program. Emphasis is placed on understanding the neuromuscular effects of specific surgical procedures and developing protocols by utilizing neurological assessment tools, manual therapy techniques, and exercise selection for the various post surgical conditions. Extensive hands-on lab time and protocol discussion will enable the therapist to immediately apply information in the clinical setting.

Course Objectives

• Understand the basic anatomy pertinent to various pathologies and dysfunctions.
• Utilize mechanical and neurological evaluation techniques to help determine the best treatment approaches for spinal disorders.
• Identify specific active and passive interventions that address particular positive evaluation findings.
• Develop and initiate rehabilitation and exercise that maximize recovery and function in any spine program.
• Integrate the therapy program with other disciplines involved with spine management.
• Recognize the indications for surgical intervention.
• Recognize specific mechanical and neurological changes that may accompany each type of spine surgery or procedure.
• Understand the differences between postsurgical and nonsurgical evaluation emphasis.
• Adapt spinal rehabilitation techniques for nonfusion surgeries, fusion surgeries with or without hardware, anterior or posterior approaches, and various adjunct injection procedures.
• Perform interim testing to assess rate and path of program progression, as well as provide
quantitative information for the physician and insurance provider.
• Understand the impairments and corresponding functional limitations that can occur as a result of various spine problems.
• Identify common “red flags” and be able to recognize the need for referral to another practitioner.
• Understand the need for post surgical spine reporting and follow-up, especially with regard to rehabilitation and outcome.
• Understand and defend the time frames needed for proper recovery of physical function of the spine following surgery.

Schedule of instruction

	Day One		Day Two
7:30 8:00	Registration	8:00 9:00	Lumbar Fusion Surgeries
8:00 9:00	Protocol Basics		• Types of surgeries
	• Background on development of the protocols		- Approaches, columns involved, and instrumentation
	- Acute (non surgical) protocol as a basis for surgical protocols with eclectic approach		• Radiograph examples
	• Functional loss characteristics		• Discussion: mechanical changes that may be expected
	• Evaluation findings and treatment choices	9:00 10:00	Lumbar Fusion Surgery Protocols
9:00 9:45	Evaluating the Lumbar or Cervical Post Surgical Patient		• Time frame variability
	• Differences between post surgical evaluations and non surgical spine evaluations		• Strategies for pain control
	• Early post surgical evaluation (in hospital or within first 2 weeks)		• Early care vs. longer term rehab
	• Full evaluation for 4 to 6 weeks post-op	10:00 10:15	Break
	• Example forms for history and evaluation, and flow sheets	10:15 10:45	Discussion - Dealing with the Long Term Fusion Patient
9:45 10:00	Break		• Ideas for reconditioning
10:00 11:00	Evaluation Lab/Preliminary Program Planning Based on Findings		• Ideas for helping with chronic pain
	• Post surgical exam highlights and areas for Special Attention		• How do the precautions vary long-term vs. post surgery?
	- Lumbar spine		• Preliminary hardware removal protocol
	- Cervical spine	10:45 12:00	Lumbar Fusion (Lab)
	• Example treatment selections based on findings		• Exercise adaptations
	- Evidence based exercise		• Manual therapy techniques for postfusion
	- Functional activity		- Comparison with techniques for nonfusion
11:00 12:00	Lumbar Nonfusion Surgeries		- precautions and time frames
	• Basic definitions: laminectomy, discectomy, surgeries for stenosis and associated anatomy		• Expanded questionnaire for surgeons on time frames
	• Types and purposes for surgeries, trends		• Case studies
	• What structures need attention during healing?	12:00 1:00	Lunch (on your own)
	• Functional activity	1:00 2:30	Cervical Surgeries
12:00 1:00	Lunch (on your own)		• Basic surgical descriptions of ACF and PCL
1:00 2:00	Lumbar Nonfusion Protocol With Variations		• Difficulties in obtaining referrals and need for physician education
	• Suggestions for pre surgical care, when possible		• Protocols for fusions and nonfusions
	• Early care in the hospital		- Review of evaluation highlights
	• Progression to outpatient rehab		- Recommendations for early care
	• Return to activity strategies		- Rehab in the outpatient stage
2:00 3:00	Manual Therapy for Nonfusion Lumbar Surgeries (Lab)		- Determining when cervical motion can be performed and amount of range of motion
	• Soft tissue mobilization work for typical restrictions		• Exercise Selection following ACF
	• Lumbar mobility work		- Stability emphasis in neck, (evidence-based)
	• Neural mobility work		- Typical muscular restrictions, tightness and/or weakness
	• Muscular facilitation techniques		- Balance activities
3:00 3:30	Finish Lab/Case Studies	2:30 3:45	Cervical Post surgical (Lab): Manual Therapy and Exercise Strategies
	• Cases presented of typical nonfusion surgeries		• Importance of attention to maintaining neck spine posture in patients with ACF
	• Practice selecting treatments per protocol		• Soft tissue mobilizations and release techniques for typically restricted structures
	• Discuss possible outcomes		- Suboccipital region
3:30 4:30	New Procedures and Suggested Protocols to Date		- Shoulder girdle
	• IDET, and other percutaneous procedures		- Thoracic paraspinals/rib cage
	• Artificial disc replacement		• Adapting techniques for ACF vs. PCL or non fusion
	• Kyphoplasty/vertebroplasty		• Facilitating stabilization muscle recruitment
4:30 5:30	Interim Testing for Progress Assessment and Program Progression: The Physical Capacities Test (The PCT)		• Cervical case studies
		3:45 4:00	Questions and Review

Downloads

Course Brochures are in Adobe PDF format. Right click and choose "Save Target As" to download brochure. If you would like to open the brochure in your browser windows, select the link.

Course Brochure for Developing Post Surgical Rehab Programs for the Cervical Spine and Lumbar Spine

Scheduled Dates and Locations

Start Date	End Date	Location - **Click to Map It**	Tuition	Hrs	Hotel
Mar 07, 09	Mar 08, 09	MultiCare Health System, Tacoma, WA	$399.00	15.00	View Hotels
Mar 28, 09	Mar 29, 09	Palomar Medical Center, Escondido, CA	$399.00	15.00	View Hotels
Apr 25, 09	Apr 26, 09	Methodist Dallas Medical Center, Dallas, TX	$399.00	15.00	View Hotels
May 30, 09	May 31, 09	Sunrise Hospital Medical Center, Las Vegas, NV	$399.00	15.00	View Hotels
Sep 26, 09	Sep 27, 09	Holy Cross Hospital, Ft. Lauderdale, FL	$399.00	18.00	View Hotels
Oct 03, 09	Oct 04, 09	San Ramon Regional Medical Center, San Ramon, CA	$399.00	15.00	View Hotels
Nov 21, 09	Nov 22, 09	OHSU, Portland, OR	$399.00	15.00	View Hotels