1. Clinical Case Study, CCS Prof. Vladimir J. Šimunović

2. Teaching methodologies  Lectures  Tutorials  Seminars  Small group learning  Clinical cases scenario  Clinical skills laboratory practice  Interactive software  Multimedia

3. Clinical case study (CCS) prepare the students to solve the problems in the real world of clinical practice

4. CCS – methodology based on learning through problem-solving or clinical procedures execution CCS: Enhance the efficiency of analytical thinking Capacitate students for decision making Capacitate students for complex situation solving in real clinical practice Influence to the development of oral communication skills Enhance the capability of the team work

5. Clinical case study Augmentation of the knowledge is not a priority Focus is on understanding of the problem, capacity to analyze, synthesize and assessment of treatment efficiency

6. CCS methodology Traditional lectures are focused on the facts and data Students are overcharged with too many data CCS intention is: To develop the thinking abilities Students learn solving the provblems by joint team effort They are not served by ready-to eat information package CCS increase the self-confidance and trust to colleagues

7. CCS example: Introduction This clinical case, based on the real one from our practice, is allocated to your group Your task is to study this case and give us a feed- back with answers to questions.

8. Anamnesis Patient A.A is a 45-years old male. Principal complain is a general ailment, pronounced in the lower extremities Patient walk with difficulty and clumsy, and speech disorder were noted Problems started 6 months ago and at present he has problems in writing, stairs climbing and he is not able to comb the hair. Muscle strength in hands is diminishing, he has problem to dress, button up or to close the zipper

9. Physical examination Twitching and trembling movement of tongue Difficult swallowing Babinsky reflex prominent, all other are normal Generalized muscular weakness, spasticity, more pronounced in the legs

10. Diagnostic procedures Nuclear magnetic resonance is normal Electromyography: denervation Blood tests: increased level of glutamate

11. Physician’s recommendation (1) Baclofen and Riluzole to alleviate the symptoms (2) Physical therapy and (3) Speech therapy.

12. Questions to be answered 1. Which ailment is presented here? 2. Is there brain damage;? Any particular disease? 3. Is there any non-neurological reason influencing the patient’s walking ability? 4. Which brain region is damaged? 5. What influence the movement function?

13. Questions to be answered, cont’ 6. How the recommender treatment will influence the brain function? 7. How will influence the existing symptoms? 8. Are you able to explain the present symptoms and signs? 9. Are you able to connect the clinical picture to any particular part of the brain or to neurotransmitters? 10. What else can be done for this patient? Sources of supplied information have to be documented

14. Differential diagnosis Neurodegenerative disesases of CNS 1. Multipl sclerosis 2. Alzheimer disease 3. Amiotrophic lateral sclerosis (ALS) 4. Parkinson disease 5. Alcochoolism 6. Huntington disease

15. Organization of clinical case study Day1: Introductory lecture Tutor presents the basic facts on body movements, and on movements disorders

16. Organization of clinical case study Day 2: Cases allocation Optimal number is 6 groups with 5 students All teaching materials are at disposal in electronic and all other forms Tutor is at disposal all the time, to explain and to steer the group

17. Supplementary materials

19. Organization of clinical case study Day 3: Preliminay reports Each of the groups report its dayly progress Every studen receive all collected facts and data

20. Organization of clinical case study Day 4: Final report Report content: 1. Summary of clinical case – 1 or 2 paragraphs 2. Answers to all questions 3. Additional information related to the case

21. Evaluation Clinical case summary: 2 points Five correct answers: 5 points Sources and references citation: 1 point Clarity of presentation: 1 point Grammar, report formatting, tidiness: 1 point Highest score: 10 points

22. Achievements and outcomes At the end of clinical case study, student would: Know brain regions responsible for intentional motor movement and their control Know specifics of different neurological conditions influencing movement disorders Understand the therapeutic options Understand the consequences of the damage in different regions of the brain

23. Pro et contra of clinical cases study (SKS) Advantages Development of thinking capabilities Knowledge is not served, but conquered in the learning process Interaction of thinking, discussing, and quest for information CCS imitate the techniques of problem-solving the reality Disadvantages CCS is not efficient when student need to acquire the large number of facts, data and principles If applied rarely, too copmplicated both for teachers and for students Do not offer all necessary information

24. The tasty dinner is earned, not served one