PHYSIOTHERAPIST UPGRADING COURSE IN AFGHANISTAN a program coordinated by Handicap International

BACKGROUND The current physiotherapist education training program was started in 1982 by the International Assistance Mission at the request of the Ministry of Public Health ; the curriculum was a 2-year diploma program From 2003 to 2006 a number of stakeholders (international ngos and Afghan institutions and organizations) discussed to improve the length and quality of training The group finally agreed on a 3-year program which emphasizes the development of clinical problem solving and clinical reasoning skills required of independent professionals

BACKGROUND Afghan Government opted for upgrading existing 2-year diploma holders to a 3-year undergraduate level before starting with the new 3-year undergraduate curriculum A 2-year upgrading program has been designed to train the future teachers and clinical supervisors in the future 3-year curriculum A group of 15 to 20 students will be selected among experienced Afghan physiotherapists; they might already have experience as teachers or clinical supervisors and already attended informal upgrading sessions provided by several ingos in the country

OBJECTIVE of the 2-year upgrading To develop classroom teachers and clinical supervisors for the new three year curriculum and the one-year upgrading course for current qualified physiotherapists

MODULAR FORMAT The upgrading course is designed in modular format not to disrupt current employment of students It will allow flexibility for the involvement of expertises external to Afghanistan The teaching will be done by expatriate physical therapists in English with translation of lectures and some studying materials into Dari

MODULAR FORMAT Independent study and assignments out of classroom will be and important part of this course Clinical placements will be supervised by expatriate physical therapists in country.

COURSE LOCATION Lessons and laboratory will be mostly at Physical Therapy Institute in Kabul Visits to physiotherapy services (hospitals or centers) might be in Kabul or in other towns according to educational needs and available locations.

CURRICULUM OVERVIEW YEAR 1 Each module consists of classroom teaching, laboratory practice, clinical visits, and independent study. The total hours do not include independent study and credit awarded for previous work experience. According to current Afghan standards, each hour consists of 45 minutes of actual teaching time. Module Hours Weeks Introduction to Physical Therapy 40 1.0 Kinesiology, Biomechanics and Exercise Therapy 80 2.0 Physical Modalities and Electrotherapy 24 0.6 Cardio-Respiratory Physical Therapy 40 1.0 Manual Therapy 64 1.6 Neurological Physical Therapy 80 2.0 Special Topics in Physical Therapy 32 0.8 Clinical Placement I 160 3.0 Clinical Placement II 160 3.0 TOTAL 680 15.0

MODULE DESCRIPTIONS… INTRODUCTION TO PHYSICAL THERAPY To introduce, develop, and encourage critical thinking, analytical and clinical reasoning skills. Basic research and evidence-based practice principles will be introduced. Models in physical therapy as well as physical therapy practice in Afghanistan will be covered. This course will provide knowledge and skills essential to take back to the workplace and for the rest of the course. KINESIOLOGY, BIOMECHANICS AND EXERCISE THERAPY The basic facts, concepts and techniques of analysis of human movement. Students will understand the physics of posture, movement and exercises as the basis of physical therapy treatment. PHYSICAL MODALITIES AND ELECTROTHERAPY The study of the physiological effects, indications and contraindications for physical modalities and electrotherapy. Emphasis will be on evidence base for and the integration of modalities into the larger scheme of physical therapy management.

…MODULE DESCRIPTIONS… CARDIO-RESPIRATORY PHYSICAL THERAPY A review of the assessment and treatment techniques for respiratory conditions. Assessment and treatment of cardiovascular conditions will be studied. Although pathological status will be discussed the emphasis of the course will be on clinical application of cardio-respiratory physical therapy. MANUAL THERAPY Functional anatomy and pathomechanics of selected regions of the neuro-musculo-skeletal system will be studied in detail. Physiology of pain will be introduced. Then, more in-depth techniques of manual therapy assessment and treatment of neuro-musculo-skeletal disorders will be introduced.

…MODULE DESCRIPTIONS… NEUROLOGICAL PHYSICAL THERAPY Review of neuroanatomy, neurophysiology concepts related to movement, recovery physiology. Review of basic and introduction of advanced assessment and treatment techniques of neurological disorders as well as review of the most commonly seen conditions (cerebral vascular accident, spinal cord injury, peripheral nerve injury, polio, cerebral palsy, spinal bifida, and others). In particular: Proper introduction of Bobath / NDT system Review SCI Assessment and Treatment. Head Injury: (acquired brain injury - ABI) pathologies and physical therapy intervention. (unconscious patients / early mobilization / managing behavioural and cognitive complications). Detailed Normal human development. Pediatric care principles and common pathologies reviewed… Review of Cerebral Palsy assessment and treatment

…MODULE DESCRIPTIONS SPECIAL TOPICS IN PHYSICAL THERAPY The obstetrics and gynaecology section of this course covers reproductive endocrinology, normal pregnancy and delivery, as well as etiology, pathology, as well as the medical and physical therapy management of common disorders. A review of burn pathology and medical care, including acute and long-term physiotherapy management (mobilization, casting and positioning). CLINICAL PLACEMENTS To ensure that graduates have the knowledge and limited practice of an equivalent three-year graduate AND demonstrated critical thinking skills. That is, an upgraded clinical specialist in CBR / Ortho / Paeds / Amputees / etc. in their own field of work. A total of 6 weeks of supervised / guided clinical work, divided into two placements, with a prerequisite of the Introduction to Physical Therapy module. It is expected that one placement would be completed at the student’s current place of employment and the other would be completed at an alternate location.

TIMELINE Modules sequence for year one reflects educational needs and might be adjusted according to teachers availability. Preferably from April 2007 to December 2007: 1)INTRODUCTION TO PHYSICAL THERAPY 2)KINESIOLOGY, BIOMECHANICS AND EXERCISE THERAPY 3)PHYSICAL MODALITIES AND ELECTROTHERAPY 4)CARDIO-RESPIRATORY PHYSICAL THERAPY 5)MANUAL THERAPY 6)NEUROLOGICAL PHYSICAL THERAPY 7)SPECIAL TOPICS IN PHYSICAL THERAPY 8)CLINICAL PLACEMENT Modules 1 and 2 must be the first ones

EDUCATIONAL APPROACH PRINCIPLES applied; all material is taught towards practical clinical application autonomy; encouraging learners in their individual critical-thinking and problem-solving skills dignity and respect; an environment that values individuals from all ethnic groups and cultures evidence-based; appreciating the scientific basis for what is taught learner-centered; encouraging the learner to actively participate in the educational process life-long learning; instilling the idea that learning extends beyond the formal educational program itself multiple teacher roles; seeing the teacher as a fellow learner, the facilitator in the learning process, as well as a professional role-model.