Revision/Preparation guidance

1. Introduction and instructions

Hello and welcome.

This workbook has been collated in response to your interview requests  for signposting and advice about how you can prepare your academic knowledge and skills for the start of the Physiotherapy Apprenticeship.

The current physio apprentices suggested two topics to focus your preparation time and energies on. The first is human biology (the first 5 chapters of this workbook) and the second was academic writing ( the last chapter). 

There is a lot in here, so be selective with where you start and maybe prioritise chapters about topics you are least familiar with. You do not need to work through the chapters in sequence.

Navigate the workbook via the side panel on the right.

Human biology: anatomy and physiology

Two complementary branches of science—anatomy and  physiology—provide the concepts that help us to understand the  human body.

Anatomy studies the structure of body parts and their relationships to one another. Anatomy has a certain appeal because it is concrete. Body structures can be seen, felt, and examined closely. You don’t need to imagine what they look like. Physiology concerns the function of the body, in other words, how the body parts work and carry out their life-sustaining activities. When all is said and done, physiology is explainable only in terms of the underlying anatomy.

Your first module in the Physiotherapy Apprenticeship assumes you have a broad grasp of 'normal' anatomy and physiology and builds upon this to explore common pathological anatomical and pathological physiological issues that cause people to consult physiotherapists.  The purpose of the first 5 chapters of this workbook are to help you refresh some key 'normal' anatomy and physiology concepts in preparation for this module. 

There are videos to watch, text to read and tasks/questions to complete in this book. Your engagement  will not be monitored and you will not need to submit evidence of your answers. The resources and information is provided for guidance, to help you feel prepared for starting the apprenticeship only.

There is likely to be a lot of new language and some of the resources included  use technical anatomical terminology; such as flexion-extension and proximal-distal. Therefore, before you start with the main content watch the two video's below which explain some of this terminology for you, and keep a list of new words you aren't sure about and we can review when you get into the first module.

Anatomical Positions and Directions (approx 13 mins)

Joint Movements ( approx 6 mins)

2. Human anatomy and physiology overview

Organisation of the Human Body.

The images below are of the core text book we use for you Pathoanatomy and Pathophysiology module. ( Human Anatomy Marieb and Hoehn). Read section 1.2.

Use whatever resources you have to complete as much of the table below as you can. The image is not interactive, so draw your own version to complete and bring it with you in the first week. We'll look at everyones ideas in small groups during teaching. 

3. Nervous system

The brain

The largest organ of the nervous system is the brain. It is highly developed and organised. Without it our other body systems would not function. Watch the video below that introduces you to the key structures and sections of the brain. It is quiet long, so break it up into chunks, and/or watch a few times. As you watch, look for answers to the questions below. 

(approx 19 mins)

Q)

1. What are the 4 lobes of the cortex called and what are their main functions?
2. The basal ganglia does what to conscious movements?
3. What structure sorts and directs information entering the brain?
4. Which structure forms an important part of the endocrine system?
5. How many pairs of the cranial nerves do humans have?
6. Which of these structures is not part of the brain stem? A) Pons. B) Medulla. C) Somatosensory cortex

The spinal cord

Information travels to and from the brain via the spinal cord. Information about the body  - known as sensory or afferent information - travels up the cord. Information from the brain to the body  - known as motor or efferent information -  travels down the cord. With so much information traveling in different directions the spinal cords anatomical  organisation is important to avoid information getting mixed up and mis laid.

This video gives an overview of the spinal cord anatomy. Watch it so you can answer the questions below.

(approx 6 mins)

Q)

1. If afferent information enters the spinal cord at the back. Where does efferent information leave the spinal cord?
2. What is the convention for labelling spinal nerves?
3. Information traveling up and down the spinal cord does so in bundles of nerves called spinal what?

4. Musculoskeletal

Joints of the Human body ( approx 12 mins)

This video explains some important  joints types found in the human body. Watch it and pay particular attention to information pertaining to 'synovial joints'. The anatomical term for a joint is an 'articulation', which is formed where two bones move relative to each other. 

Muscles of the human body

Muscles attach at either end to bones. They attach via tendons at specific lumps, bumps and crevices on the bones surface. The anatomical term for these lumps and bumps are  tubercules, tuberosities and fossa's. 

Muscles attach to both the bones articulating at a joint, so that when the muscle shortens (contracts) it moves one bones relative to the other. 

For the muscles/muscle groups listed below, use these two UTube channels  (and any other sources you have to hand) to identify:

• Which bones it attaches to,
• Where specifically on the bone it attaches
• What movement (s) it produces ( this is sometimes referred to as the muscle's function, or 'what it does') at which joints.

Upper limb and trunk:

1. Trapezius
2. Levator scapulae
3. Rhomboids
4. Sternocleidomastoid
5. Scalene
6. Pectorialis Major
7. Supraspinatus
8. Infraspinatus
9. Subscapularis
10. Teres major and minor
11. Latissimus Dorsi
12. Deltoid
13. Biceps 
14. Brachialis 
15. Brachioradialis 
16. Triceps 
17. Pronator Teres
18. Erector Spinae

Lower limb:

1. Quadriceps
2. Iliopsoas
3. Hamstrings
4. Gluteals: maximus, medius and minimus
5. Adductors: longus, magnus and brevis
6. Tibialis anterior 
7. Peroneus longus, brevis and tertius.

5. Cardiovasulcar system

The heart

The heart is a 'double pump' organ responsible for transporting blood and its constituting parts around the body. It is a specialised type of muscle that contracts to produce the force to push blood around the body.  The technical term for the heart muscle contraction is 'systole'. Once contracted, the heart muscle relaxes to allow more blood to refill it's chambers. The technical term for heart muscle relaxation is 'dyastole'.

The heart is described as a double pump because one pump, pushes blood to the lungs to collect oxygen. Blood traveling between the lungs and heart is passing through the pulmonary circulation.  A separate pump pushes oxygenated blood to all the other tissues of the body. Blood travelling between the rest of the body and heart is passing through the systemic circulation.

Watch  to see how blood passes through the heart. 

Check your knowledge of some key anatomical features of the heart with this interactive labelling activity.

This article maybe helpful for the labelling activity. 

Blood vessels.

The heart pumps blood around the body through blood vessels called arteries, veins and capillaries.

Watch this to check your knowledge of the function of blood vessels and their relationship to each other. 

6. Respiratory system

The lungs

The lungs are situated in the thoracic cavity and are usually thought of as 2 spongey structures for absorbing oxygen. However each lung is actually divided into several lobes by fissures.

uses 3D computer modelling to explain the position of these lobes and fissures, and their relative boney anatomy. 

Watch this short (3 min) dissection of a bronchial tree to check your understanding of the pathway gasses passes into and out of the deep tissues of the lungs.

  

Inspiration/expiration

For  blood to become oxygenated, the lungs must first extract the oxygen from the air in the environment. This is achieved by ventilation, specifically; inspiration ( breathing in ).  

This video provides a good visual explanation of the mechanics of ventilation.

Once you are happy with your understanding of ventilation, have a go at this short sentence ordering activity to check it. 

Additional challenge: can you name the bones the diaphragm and intercostal muscles attach to, and more specifically where on the bones they attach?

7. Academic writing

On this page are some examples of academic writing.

The first two examples are of  routine 'essay' assessment writing (and include some indications of where additional referencing is expected). The paragraphs are excerpts from the introduction and conclusion of the same essay. While these are not ‘perfect’ examples, they demonstrate what to expect from a clear introduction and conclusion. 

Examples three and four are of reflective, academic writing.  Several of your assignments will require you to combine your personal experiences, with published literature (an evidence base) to explain how you have learned from your evolving physiotherapy practice. Below are two short excerpts from an essay that show what this sort of writing reads like, and how to combine personal and formal academic styles.

In  examples  three and four  you will see there are numbers in superscript compared to numbers in brackets in examples one and two. The numbers denote references and is the Vancouver referencing convention that is adopted by the School of Sport Exercise and Rehabilitation Sciences (SRES). You will be excepted  to use  Vancouver  for all academic work, and you'll be introduced to it in detail at the start of year one.

Example One. Introduction

This essay will consider the purpose of evidence-based practice (EBP) in physiotherapy and discuss the possible benefits of using a range of sources to obtain evidence in clinical practice ( REFERENCE HERE NEEDED).  EBP has been defined by XXXX as XXXXXXXXX. The essay begins by describing and defining the key components of EBP, and the associated meaning of the words, ‘evidence’ and ‘research’. It then explains the ‘Hierarchy of Evidence’ (REFERENCE NEEDED HERE) and goes into detail about the rationale for the relative positions of research methods within the hierarchy. This essay concludes by considering complex systems  ( REF NEEDED HERE) and the factors that impact the compliance or non-compliance of patients to their physiotherapy interventions ( REF NEEDED HERE). The intention of this essay is to educate the reader on vital components of safe clinical practice, such as the use of evidence-based practice, and to promote knowledge of the factors that might influence a patient’s exercise compliance, which should be considered when planning physiotherapy interventions to ensure efficiency of recovery.

Example Two. Conclusion

The purpose of this essay was to consider why evidence-based practice is used in physiotherapy, and to discuss the potential benefits of using a variety of sources to obtain evidence in clinical practice. To summarise, evidence-based practice comprises the combination and application of  evidence from three sources: the ‘best available evidence’; clinical expertise; and patient preferences (1). It is imperative physiotherapists apply EBP during their practice to ensure the ‘best’, and safe treatment of a patient…………….This essay has presented essential information on the components of safe clinical practice, mainly the used of EBP, and some factors that may affect a patient’s exercise compliance.

Example Three. Reflective writing. 

There were many notable differences between me and may patient. The most obvious was our age. He was forty years my senior. This is notable because research shows generational changes every twenty years can differ drastically, for example, changes in technology, educational standards and information sharing create different attitudes and expectations within society¹⁰. For example, on one occasion the patient mentioned some herbal remedies he wanted to rub on his weakened leg caused by his stroke, with the belief his father had told him the herb was special and was a proven remedy for recovery, whilst due to my atheism and my belief in science I believed that there was no evidence this herb would help resolve his weaknesses. On occasions like this, it is important to be adaptive, therefore I encouraged him to use the herb along with actioning physiotherapeutic treatment thus incorporating both our FOR to try and benefit his physical and psychological state^2,5,10. Another example of differences is where we were both born and our religious beliefs, I was born in the UK and he was born and lived in Bangladesh for a Considerable l portion of his life. His FOR toward healthcare standards may be influenced by experiences in his own country where the standard of healthcare is not ranked as high as it is in the UK¹¹. Furthermore, as I am an atheist, I believe that science is the key to healthcare whereas those who are religious may favour religious texts being of more importance than scientific evidence-based research papers.

Example four. Reflective writing

On one interaction I politely asked if it would be ok if I briefly spoke to his wife about the discharge plan. There were no female physiotherapists on the ward at the time I approached, and he responded with a blunt “no” and proceeded to refuse  any further physiotherapeutic treatment for the rest of day. I later found out that some individual factors that made him reactive and dismissive of my help were that he was already upset at the time I spoke to him due to a negative interaction with a nurse some hours earlier. The cognitive-behaviour frame of reference theory incorporates how the aspect of emotional moods brought about from prior experiences can alter the way humans interact with each other, in this circumstance the previous experience he had in the day may have been projected onto me via a dismissive manner⁵.