Ryan Seals, DO

AACOM & AODME Joint Annual

Conference

April 22-25, 2015

Faculty Created

OMT Videos:

Impact on Student

Learning

Project Objectives & Outcomes

Design osteopathic manipulative technique (OMT) instruction and videos using best practices for psychomotor skill teaching.

Evaluate student and faculty feedback and student scores from the use of a video-based OMT skills teaching laboratory.

Learner Objectives

The learner will participate in a mock-OMT skills lab with video-guided instruction.

The learner will compare and contrast their experience with other instructional methods.

The learner will integrate a presented idea into their curriculum.

Project Background

Cognitive (novice)

Associative(intermediate)

Autonomous(expert)

What is being learned?

Verbal information &Procedural rule

Initial errors corrected;psycho-motor connections; deeper understanding of procedural rule

Fine tuning

How easy is knowledge retrieval?

Labor intensive & effortful

Still have to think before retrieval

Effortless; no conscious retrieval

How good is performance?

Trial & error; Erratic

More fluid with fewer interruptions

Smooth, accuracy and speed

Stages of Psychomotor Learning

Psychomotor Learning- OMM by Vaniesse Collins, PhD, Kun Huang, Center for Innovative Learning, University of North Texas Health Science Center, June 2013.

Action Steps for Psychomotor Skills Development

Conceptualization

• Familiarity with skills, awareness, why and what

Visualization

• Expert Demonstration from beginning to end

Verbalization

• Narration of steps from beginning to end

Practice

• Deliberate, concentrated

Feedback

• Faculty and Peers

End-Goal Focus

Rubric

Diagnosis Diagnose articular somatic dysfunction.

Set-up The physician and patient should be positioned so that the dysfunctional segment can be monitored and moved through all planes of physiologic range of motion of the segment and body region that will be used as a long lever.

Contact of Tissues

One hand is the Monitoring Hand. It contacts the dysfunctional segment and surrounding soft tissues and palpates tissue texture changes and position of

the dysfunctional segment during the entire procedure. It moves with but does not move the dysfunctional segment.The other hand is the Operating Hand. It contacts the distal end of the body region being used as the long lever and will serve two purposes:

1. It creates the activating force of compression or distraction. 2. It moves the distal end of the long lever through physiologic range of motion which eliminates the somatic dysfunction.

If one hand is not sufficient, the arm or arms are substituted.

Application of Principles

With the Monitoring Hand: Maintain contact throughout entire procedure and palpate surrounding tissue texture changes and position of

dysfunctional segment.

With the Operating Hand: 1. Position the dysfunctional segment using the long lever so that the segment is in the position of somatic dysfunction in

all its planes of motion.Add an activating force, either compression or traction just until it is felt with your monitoring hand at the dysfunctional

segment. Maintain this force, which is minimal but firm. Compression will loosen the surrounding tissues. Traction will create space in the joint to move it. Compression

and traction are equally effective, the choice to use one or the other is based on physician preference and patient tolerance.

3. Move the long lever fluidly and slowly in all planes of motion, through neutral and toward the initial restriction. During the procedure, correction of dysfunction can often be palpated. In synovial joints, a pop or click may be

heard.4. Release the activating force.5. Return the body to neutral position.

Retest Retest for somatic dysfunction. Determine if there is complete resolution, improvement, or no change in the original somatic dysfunction. If less than 50% improvement, this technique may be repeated 2-3 times, but is not performed in a repetitive fashion.

Still Technique, Typical Cervicals

Diagnosis Diagnose the cervical spinal segment using standard, three planediagnostic approach

Set-up This technique can be performed with patient supine or seated. The video demonstrates the seated version

• Seated: Ask the patient to sit comfortably on the edge of the table.Stand in front of patient. Adjust the table so that the patient’s head isat or just below your eye or shoulder level.

• Optional: Supine: Ask the patient to lay flat, face up on the table. Sitat the head of the table. Adjust the table so that you cancomfortably contact the patient’s occiput with both hands.

Contact of Tissues Monitoring Hand• Contact the posterior articular pillar (the side of rotation). Layer

palpate to the occipital bone to monitor for tissue texture changesand motion.

Operating Hand

• Contact the vertex (top) of the patient’s head, which will be used asthe long lever. Be sure that the hand and finger placement do notcause discomfort for the patient.

Applicationof Principles

Monitoring Hand• Maintain contact throughout entire procedure and palpate surrounding tissues and

position of dysfunctional segment.

• This hand is used to ensure that the operating hand is localized to the level of thedysfunctional segment and will move with the dysfunctional segment.

Operating Hand1. Place the dysfunctional segment in the position of the somatic dysfunction in all 3

planes using the head as a lever. The monitoring hand should detect decreased tissue tension.

2. Add a downward compressive force just until the force is felt with your monitoring hand. Tension in the surrounding paraspinal musculature should decrease slightly.

Visualization: View the activating force as a vector from your operating hand directlyto your monitoring hand.

1. Fluidly, move the patient’s head to move the dysfunctional vertebrae all 3 planes ofmotion simultaneously toward, then through the restrictive barrier.

Visualization: Trace the movement in all three planes at once.1. Release the compressive force.2. Return the patient’s head and neck to neutral position.

Retest Retest for improvement in the somatic dysfunction.• Determine if there is complete resolution, improvement, or no change in the

original somatic dysfunction.

• If less than 50% improvement, this technique may be repeated 2-3 times, but isnot performed in a repetitive fashion.

Still Technique, Typical Cervicals, continued

Rubric3

outstanding2

competent1

needs improv.0

Contact of Tissues

Shows consistently appropriate contact of tissues that allows for

performance of technique

Shows mostly appropriate contact of tissues and is able to perform technique

Shows contact of tissues which makes

performing the technique difficult or

awkward

Requires Retest

Application of Principles- Use

of Force

Applies the appropriate amount of

force in correct directions to precisely

perform technique

Applies force in the correct directions and amount for performing

technique, but not precisely

Applies some force(s) in some general

direction(s) which makes performing the technique difficult or

awkward

Requires Retest

Application of Principles-Positioning

Demonstrates positioning of partner

and themselves appropriately for

performing technique

Demonstrates adequate positioning of partner

and themselves for performing technique

Demonstrates positioning which

makes performing the technique difficult for themselves or partner,

or awkward

Requires Retest

Application of Principles-movement

Applies principles of technique effectively

with no errors

Applies principles of techniques adequately with few minor errors

Applies principles of techniques poorly with

significant errors

Requires Retest

Reassessment

Demonstrates improvement in

original diagnosis by more than 50%

Demonstrates improvement in original

diagnosis by less than 50%

Diagnosis is unchanged Not performed

Skills Lab Activity- Example

• Complete Pre-Lab Survey- 3 minutes

• Diagnose the Cervical Spine: (3 minutes per partner to

do 2 and 3)

• Still Technique- Cervical Spine (5 minutes per partner)

• View video

• Recite steps of technique out loud to partner

• Practice technique, requesting assistance from faculty and

student assistants as needed, and/or review video

• Comments, Reassessment

Videos on YouTube

• Still Technique of Cervical Spine for novice

learner

• https://www.youtube.com/watch?v=Ry6GCjWjG5Y

• Still technique cervical spine quick version

(extended dysfunction)

• https://www.youtube.com/watch?v=_3z74YEXgtc

• Still technique for cervical spine quick version

(flexed dysfunction)

• https://www.youtube.com/watch?v=5NEb6SmUTlI

Faculty Feedback

“This seemed to work very well. Whether it can be a complete

replacement from the traditional lead from the stage or individual

table trainer demonstration is to be determined. I feel that the

students responded well to this because it was well done, but

also because it was something new and innovative. I'd fear that

if we entirely used these then they would lose these aspects and

we'd lose the interest of some of the students. I think it is good

to mix this in every now and then though.”

Student Comments

“I really enjoyed the videos, I liked the independent feel during

OMM class. It was also very convenient to view during

competency review.”

“It's great to have the videos because I am able to replay them as

necessary. It was harder for me to remember and apply what I

learned from class demonstrations.”

“Stick with this format please! It makes lab so much

more efficient when we can progress at our own pace.”

I definitely like having the videos to

watch before class, but it doesn't

replace the live demonstrations.

Student Comments

The videos themselves are good, however I

found it very frustrating trying to learn from

a video. I much prefer a live demonstration

and being able to watch the technique

performed directly in front of me.

Conclusions

Future Directions