Neuromuscular Reeducation in Biofeedback
50 Hours of CE Credit / Course Fee $550
Presented by Susan Middaugh, PT, PhD
Course Concept and Description: This course is the equivalent of a three credit course and provides 50 hours of CE credit. Students learn by watching audiovisual lectures provided on CDs, reading assignments both from materials provided on the CD and standard texts, and interacting with their instructor via e-mail. They answer short essay questions after each lecture rather than taking exams. Previous students have found that a very similar course takes between 45 and 95 hours of work to perform. Students start the course whenever they wish to and proceed at their convenience. There is no limit to how long students can take to complete the course.
This course is designed to teach assessment and biofeedback protocols for treatment of musculoskeletal and neuromuscular disorders from a neuromuscular reeducation perspective, primarily using surface-recorded EMG. These protocols are based on motor learning principles and the neurophysiology of the disorders being treated. The therapeutic goals are those of physical rehabilitation: to increase muscle strength, enhance muscle relaxation, improve muscle coordination, decrease pain, and improve function during daily activities and work. The course content is taught using a clinical case study format. Protocols for assessment and treatment of a given diagnostic category, such as Bell’s Palsy, are presented in terms of a typical case. Readings are assigned to provide the basic neurophysiology and anatomy needed to understand and work effectively with that disorder. This course is designed for two different categories of students. (1) This course is appropriate for students who work from a psychology, counseling, behavioral science or education perspective and are interested in broadening their knowledge base and skills by learning about neuromuscular reeducation applications of biofeedback. (2) This course is also appropriate for those who work from a physical rehabilitation perspective, such as physical therapy or occupational therapy, and are interested in developing expertise in biofeedback procedures that are applicable to their clinical caseload. For both types of students, this course is intended to enhance the knowledge and skills of the clinician or educator who works within his or her legal scope of practice and licensure.
- Introduction to neuromuscular reeducation (NMR) approaches to EMG biofeedback (1 unit):
History, Theory, Professional scope of practice and Ethical considerations
- EMG Recording for Rehabilitation Applications (1 unit):
EMG recording methods for dynamic applications
Principles of EMG electrode placements and exceptions
Basic EMG biofeedback protocols for muscle strength, relaxation, coordination and function
- EMG biofeedback protocols for assessment and treatment using NMR approaches (8 units):
- Musculoskeletal pain and other pain disorders, Cervical and low back pain, headache and temporomandibular pain, Work-related Musculoskeletal Disorders (WRMSD) and Ergonomics, Complex Regional Pain Syndrome (CRPS) and Phantom Limb Pain;
- Pelvic Floor Disorders
- Incontinence, Retention and Pain
- Peripheral Nerve Injury: Bell’s Palsy and Nerve Transfer
- Spinal Cord Injury: Neuromuscular Reeducation, Pain and Repetitive Strain Injury
- Cerebrovascular Accident (Stroke) and Head Injury: recovery, CNS plasticity and forced use
- Cerebral Palsy: pediatric, teen and adult
- Movement Disorders: Focal Dystonia (Writer’s Cramp, Torticollis) and Parkinson’s Disease
Format: Home study supported by phone discussion and e-mail. The course is divided into 10 units. Each unit consists of a varied combination of written lectures provided on CD with power point illustrations; assigned readings; review questions to be answered in brief essay form; and a real time recitation with the instructor after the review questions are graded and returned. This discussion at the end of each unit provides the student with an opportunity to ask questions and obtain extra information on topics of special interest, and provides the instructor with an opportunity to identify and clarify gray areas. The student corrects any mistakes made on the review questions before proceeding to the next unit.
Prerequisites & professional training requirements: Basic EMG recording skills and basic experience with EMG biofeedback is required. Experience with neuromuscular reeducation applications and rehabilitation patients are not required.
None of the instructional material offered will provide you with the clinical skills needed to apply the psychophysiological assessment and interventional techniques you will learn in the clinical environment unless you are already a trained clinician or educator.
- Lundy-Ekman, Laurie, Neuroscience Fundamentals for Rehabilitation. Philadelphia: W.B. Saunders Company, 2nd Ed., 2002. (IBSN 0-7216-9373-3, paperback, available from Amazon.com & others)
- Cram, Jeffrey R., Kasman, Glenn S. & Holz, Johnathan, Introduction to Surface Electromyography. Gaithersburg: Aspen Publishers, Inc. 1998. (IBSN 0-8342-0751-6)
Selected book chapters and journal articles relevant to rehabilitation applications of EMG biofeedback will be assigned for each unit. Those not readily available on the internet will be provided. Includes:
Middaugh S, Kee W, Nicholson J: Muscle overuse and posture as factors in the development and maintenance of chronic musculoskeletal pain. Chapter in R. Grzesiak and D. Ciccone (eds.) Psychological Vulnerability to Chronic Pain. New York: Springer Publishing Co. 1994, pp 55-89.
Getting Started: Course schedule and payment: The course costs $550 (exclusive of the texts). Payment is either by credit card (using our web site www.behavmedfoundation.org) or by check in US Dollars made out to the Behavioral Medicine Research and Training Foundation and mailed to the letterhead address. The course CDs will be mailed to you upon receipt of payment. You can begin at your convenience and progress through the course at your own pace. There is no limit to how long you can take to complete the course. Questions? Just contact us at firstname.lastname@example.org or (360) 452-5020.
Faculty: The course is given by Susan Middaugh, Ph.D., PT: Susan received her degree in Physical Therapy in 1965 and her doctorate in experimental physiology in 1971. She is a professor in the departments of rehabilitation medicine and anesthesia at the medical university of South Carolina and director of its clinical biofeedback program. She also directs the department of rehabilitation medicine’s chronic pain rehabilitation program. Her primary research effort has been directed toward investigating methods for applying basic learning principles in the treatment of patients with neuromuscular and musculoskeletal diagnoses. She has a long history of grant support for her research and has published widely in her field with over 100 articles and abstracts in recognized journals. Full CV available upon request and on the course CD.
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