Wow Joe.... digging yourself in deeper, dragging in PNF and SWD LOL.
It is true that graduated therapists practice not all that is taught.
Unfortunately a lot of the programs try and cover all subjects in ever more
"academic" settings. Meaning, like Joe mentioned before, something is
covered in the first year as part of "electrotherapy 101" and never seen
again. Too bad with PT moving more and more into the University atmosphere
some of the "old trade" is lost.
Unfortunately students indeed look at techniques like PNF as a course never
to be seen or practiced again. The same can be said about SD curves.
Back to the original question. I am not a lecturer and have no specific
opinion on where and when it should fit into the PT program.
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Dara Meldrum MSC. MISCP wrote:
I have a question for any lecturers at PT undergraduate level.
Are strength duration curves (theory and practical application) still a part
of undergraduate programs? It would appear to me that the newer technologies
of EMG and nerve conduction studies have reduced the need for therapists to
perform SD tests. Do any of you think it necessary that students are able to
perform S-D curves in the clinical environment or does a theoretical
knowledge of the principles of neuromuscular excitation and interpretation
of the results of neurological investigations such as EMG and NCS suffice?
Also I would be interested to know at what stage and as a part of which
module SD curves are taught (if they are!)
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As with a lot of branches of PT we can easily contemplate giving away SDC.
(We virtually gave away cardiac rehab to nursing and chest care to
respiratory technicians)
EMG and nerve conduction certainly has a place in diagnosis of muscle
disease and state of nerve damage. Unfortunately this often requires a trip
to the neurologist and is not necessarily repeated over time. (unless you
are suggesting we as PT's take over the ability to do nerve conduction
studies, which is not totally preposterous)
I have not looked into literature about SDC for a long time, but I seem to
remember that the court is divided on the effectiveness of the actual
treatment after you have done the SDC. And here lies the big difference of
course with EMG. With interrupted triangular pulse you can actually
stimulate the denervated muscle fibers.
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Actually, some time ago, I was seeing a patient suffering from neurotmesis
of the common peroneal nerve (poor 15 year old kid fell onto a bottle during
a village feast). One of the methods I used to gauge the level of neural
regenaration were SDC curves and they served their purposes admirably well.
Owen Sant' Angelo, PT
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I have to agree with Owen. A simple technique, when understood well it does
not take more than 15 minutes to perform, and gives extremely valuable
information. Something I cannot always say from expensive EMG and nerve
conduction studies! Also it gives my treatment parameters and clear
"Outcome measures" for future comparison of nerve regrowth or not.
As a PT Department supervisor I do encourage therapists to use the
technique, but As Joe mentions, most have forgotten what it was about and
would not consider it part of their bag of tricks. I was pleased to see
that on a newly acquired piece of electrical machine (Myomed from Enraff
Nonius) there is a program actually drawing the curve for you.
To answer your question:
Should it be in the curriculum: YES.
When should it be in the curriculum: Integrated into electrical modalities,
neurology etc.
Does EMG and nerve conduction replace SDC: Not in my books :)
Maarten
Canada
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