Pathophysiology for O&P / OPPAT 62101

Fall, 2020
Course Syllabus

Course Director:
Joshua B. Utay, M.Ed., CPO

Contact Information:
Joshua B. Utay, M.Ed., CPO
Associate Program Director, Orthotics and Prosthetics Program
Assistant Professor, School of Health Professions
One Baylor Plaza, MS: BCM115
DeBakey Building, Room M108
Houston, Texas 77030
utay@bcm.edu
713-798-3098 office
713-798-7694 fax
832-654-5226 mobile/text

Classroom & Lab Space:

Orthotics and Prosthetics Learning Laboratory
Remote / Virtual

Total Contact Hours: 29.5

• Lecture: 27.5
• Lab: 0
• Exam: 2
Total Credit Hours: 2

Course Description:
Pathophysiology for O&P explores a range of diseases, trauma, movement disorders, congenital
anomalies, and other conditions often indicated for, or otherwise connected to, orthotic and/or
prosthetic intervention, as well as selected surgical, therapeutic, and pharmacological interventions.
The goal for this course is to introduce the underlying causes, risk factors, natural history, and
categorical biomechanical indications by which these conditions routinely warrant O&P intervention.
Pathophysiology for O&P is scheduled and pulsed intentionally to coincide or precede analogous
content in O&P core courses where these conditions are contextualized within the provision of
comprehensive O&P clinical care.

Core Learning Objectives:

By the end of this course, students shall be able to:
1) Articulate the clinical presentations, natural histories, sequelae, and general biomechanical
goals of impacted body segments warranting orthotic and/or prosthetic intervention of
conditions and surgical procedures pertaining to the full scope of O&P practice.
2) Compare and Contrast clinical presentations, natural histories, and general biomechanical goals
of conditions and surgical procedures prominent in O&P practice in order to precisely inform
clinical decision-making and stake holders of the relevance and rationale for O&P services.
NCOPE Competencies Covered & Assessed in Pathophysiology for O&P:

C.1.2 Clinical Pathology: The study of conditions commonly referred for orthotic / prosthetic
services. Content emphasizes orthopedic, neurological, neuromuscular, vascular and
psychological disorders and diseases.
C.1.3 Clinical Pharmacology: The study of the effects of current pharmacological treatments
and the impact on clinical decisions for conditions encountered in orthotic / prosthetic
patient care. Strategies emphasize the clinical effects on physiological (i.e. volume
management, cardiac performance, pain, spasticity, dermatological reaction) and
psychological function.
C.1.7 Diagnostic Studies: The study and consideration of information derived from medical
reports, tests, and measures that aid the provision of orthotic / prosthetic care.
C.1.14 Models of Disablement: The study of frameworks used to define and delineate the
consequences of disease and injury on both personal and societal levels. Strategies
emphasize effective communication with all members of the rehabilitation team.
C.1.15 Neuroscience: The study of neuroanatomy and related neurological function. Content
emphasizes neurological disorders encountered in clinical orthotic / prosthetic practice.

C.2.6 Demonstrate a basic understanding of surgical processes and procedures related to

orthotic and/or prosthetic care and how these and their sequelae impact orthotic
and/or prosthetic design and function.
i. Surgical Procedures: Amputation Surgery and Revision, Rotationplasty, Joint
Replacement, Tendon Lengthening, Ligament Repairs / Reconstruction, Spinal
Stabilization, Jt. Fusions, Osseointegration, Targeted Muscle Reinnervation, Limb
Lengthening, Limb Salvage
ii. Surgical Processes: Perioperative O&P services, Post-operative Complications

C.2.7.4 General Musculoskeletal Dx xii. Traumatic brain injuries

i. Contractures xiv. Spasticity, general
ii. Fractures C.2.7.7 Pediatric Neurologic Conditions
iii. Repetitive stress injuries i. Cerebral Palsy
iv. Ligamentous injuries C.2.7.9 Neuropathic Disorders
v. Articular cartilage disorders ii Diabetes Mellitus
vi. Rheumatoid Arthritis iii Vascular Disease
vii. Osteoarthritis C.2.7.10 Other Disorders
C.2.7.6 Neurologic Disorders i. Burns
i. Stroke / Cerebral Vasc. Accident ii. Osteogenic Sarcoma
vii. Peripheral neuropathies iii. Metastatic Disease of the Bone
viii. Poliomyelitis, Post-Polio Synd. iv. Complex Regional Pain Synd.
ix. Spinal cord injuries C.2.7.11 Skin Conditions

Some Materials Selected from:

• “Stannard 2016.epub” Chapter 5: Evolving Concepts in Plate Fixation. Box Link for BCM:
https://bcm.box.com/s/kjurgyy4yu53jzuwu2ir0t8lcf81h8se
• Porth, CM. Essentials of Pathophysiology: Concepts of Altered Health States, Second Ed.
Philadelphia: Lippincott, Williams, and Wilkins. 2007 (1,148 pages). [Select Content provided.]
• Webster, JB, Murphy, DP. Atlas of Orthoses and Assistive Devices, Fifth Edition. Philadelphia,
PA: ELSEVIER. 2019 (463 pages). ISBN: 978-0-323-48323-0.
 • Krajbich IJ, Smith DG, Pinzur MS, Stevens P. Atlas of Amputations and Limb Deficiencies, 4th
Edition. Rosemont, IL: American Academy of Orthopedic Surgeons. 2016 (1,000 pages). ISBN-13:
978-1625524379; ISBN-10: 1625524374.
• Lusardi MM, Jorge M, Nielsen CC. Orthotics and Prosthetics in Rehabilitation, 3rd Edition.
Philadelphia, PA: Saunders. 2013 (864 pages).
• Other materials supplied by instructor(s) via BlackBoard throughout the course.

Instructional Methods:
Pathophysiology for O&P features multiple instructional methods such as live presentation,
interactive learning, individual study / in class review, guest presentations, and sharing of personal
experiences from guest speakers, members of the O&P community, and representatives of multiple
corners of medicine, healthcare, and Biomedical Sciences.

Programmatic Expectations:
• Professionalism is always expected in every action, word, decision, and non-decision.
• Assigned readings should be completed prior to the class in which the content is covered.
• This is meant to be a participatory class. Much energy is focused on maintaining student
participation, and students are expected to contribute.
• Professionalism is always expected, and appreciated, in all of your professional interactions.

Course Contents:
Copyright All course materials, including online content, are property of Baylor College of
Medicine and may not be shared, distributed, or published outside the College. Students are authorized
to view, copy, and print documents as needed for successful completion of coursework. Contents may
not be copied for personal, commercial, or non-commercial use. Course participants retain copyright of
all course assignments and posts; however, these materials may be used for educational purposes
within the given course, or future courses. In group projects, only the portion of the work completed by
that individual is copyrighted by that individual. Students must observe all applicable restrictions when
obtaining copyrighted material from libraries and other sources. The copyright law of the United States
(Title 17, United States Code) limits the use of photocopying and reproductions of copyrighted material.
Copies may not be used for any other purpose than private study, scholarship, or research. Materials
may not be shared, posted, or otherwise distributed without permission from the copyright holder.

Institutional Expectations and Student Services available at Baylor College of Medicine:

• Learning Environment – When situations arise that could impede success in learning, students should
access support and report concerns. Students may address concerns directly with faculty, staff, program
directors, and deans, and should also review the following policies regarding grievances, mistreatment,
and qualifying disabilities.

• The Ombudsman provides confidential guidance for handling problems, conflicts and concerns
(https://intranet.bcm.edu/index.cfm?fuseaction=Policies.Display_Policy&policy_number=32.1.01).
Reports through avenues described below are addressed confidentially to the extent possible to resolve
the issue. BCM enforces an anti-retaliation policy to encourage everyone at BCM to take proper steps to
point out problems and to recommend solutions.
• Professional Conduct – Students are expected to conduct themselves in a professional manner and
abide by all policies of Baylor College of Medicine, the School of Health Professions (formerly the School
of Allied Health Sciences) and their Programs. Any conduct not in keeping with the ethical or
professional standards of BCM is defined as professional misconduct. Academic misconduct is defined
as dishonesty (e.g. cheating, plagiarism, etc.) that occurs in conjunction with academic requirements
such as coursework including homework and examinations.

• Student Grievances – BCM is committed to treating all students respectfully and fairly and providing a
quality educational environment and experience. Student Services Policy 23.8.01 describes how to
appeal a grade, adverse academic action, other academic issue, or conduct, and to report nonacademic,
professionalism, and mistreatment issues (https://media.bcm.edu/documents/2015/56/23.1.08-
student-grievances-policy-web.pdf). Report grievances using the Integrity Hotline
(https://secure.ethicspoint.com) or via the Intranet (www.bcm.ethicspoint.com). Appeals of grades and
adverse academic actions must occur within 10 days of the grade being posted to the Student Portal or
within 10 business days following personal notice of an adverse action.

• Grade Verification – Due process involves providing students with a clear description of course
expectations, including grading requirements. Students may have questions about their final grade or
the grading process. If students want to verify their final grade, they are first encouraged to meet with
the course director informally to discuss those questions. After grade verification and discussion, the
student may choose to proceed with a formal grade appeal if they believe they have received a grade
unjustly. Grievances are not the same as disagreements. A student cannot file a grievance merely
because s/he disagrees with the grade. A student can file a grievance if they believe the grade was
unfair, for example, if it is felt to be an act of discrimination. Formal grievances can be filed via the
Integrity Hotline portal.

• Mistreatment – BCM is committed to providing a safe and supportive environment for all members of
the BCM community. All individuals have the right to be free from all forms of sex and gender-based
discrimination which includes sexual harassment, acts of sexual violence, domestic violence, dating
violence and stalking. BCM enforces policies related to Harassment, Discrimination, and Retaliation
(https://intranet.bcm.edu/index.cfm?fuseaction=Policies.Display_Policy&policy_number=02.2.25) and
sexual misconduct and other prohibited conduct (https://media.bcm.edu/documents/2015/88/02.2.26-
sexual-harassment-and-sexual-violence-policy-web.pdf). These policies define prohibited conduct,
describe mechanisms for reporting alleged violations, explain BCM’s centralized investigation and
adjudication procedures, and identify potential disciplinary actions and remedies. Report prohibited
conduct you experience or witness via the Integrity Hotline (https://secure.ethicspoint.com) or the
Intranet (www.bcm.ethicspoint.com). Anonymous reports are investigated to the extent allowed by the
information provided, and a system exists to provide confidential follow-up about steps taken.

• Disability Services – BCM is committed to providing equal educational access for qualified students with
disabilities in accordance with state and federal laws including the Americans with Disabilities Act of
1990, as amended in 2008, and Section 504 of the Rehabilitation Act of 1973. The goal is to provide
students with disabilities access to needed resources so that they are afforded every opportunity to do
their best work. Further information about these services is available at:
https://www.bcm.edu/education/academic-faculty-affairs/student-services/student-disability-services.
Students with documented disabilities can seek accommodations by contacting Student Disability
Services (713-798-8137) or by the Title IX Coordinator, If an accommodation is granted, the student is
responsible for informing the course director of the approved accommodation prior to the first
examination.

Assessments and Evaluations:

1. Exam I 47%
2. Reflection & Feedback 6%
3. Exam II 47%

The course’s final grade is assigned with a letter according to the grading scale listed below.
A passing grade in this course is a B as defined in the grading policy section of the student manual.

Grading Scale
Grade Score Range Quality Pts Interpretation
A 90 – 100 4.0 Exceptional performance
B 76 – 89 3.0 Performance meeting expectations
C 70 – 75 2.0 Below passing performance (failure)
D 60 – 69 1.0 Performance below expectations (failure)
F 0 – 59 0.0 Unsatisfactory performance (failure)
 Course Schedule:

# Date* Hrs Topic Source Material / Suggested Reading

1 06/25 1.0 Course Intro, Syllabus, History of O&P Edu. (Utay)
2 06/26 1.0 Diabetes Mellitus (Mullen)
3 06/26 1.0 PVD / PAD / Vascular Disease (Utay) Orthotics Atlas, Ch 26
4 07/01 1.0 Wounds & Wound Care (Stacy Flynn, DPT, CCCS)
5 07/06 1.0 General Orthopedic Principles & Terms (Utay) Porth, Ch. 41 (Scans)
6 07/07 1.0 Neuromuscular Junction (Mullen)
7 07/07 1.5 Infection Control / Epidemiology / Isolation (Utay)
8 07/09 1.5 Abnormal Muscle Tone (DiBello)
9 07/09 1.5 Neural Pathways (Tomson)
10 07/10 1.0 Osteology & Orthopedic Surgery (Dr. Jack Dawson)
11 07/15 1.0 Exam I
12 07/16 1.5 Congenital Limb Differences (Sherman)
13 07/17 1.0 Neoplasms / Cancer (Utay) Porth, Ch 41, pg. 999-1002 (Scans)
14 08/27 1.5 Stroke / CVA (DiBello)
15 09/18 1.5 Arthrogryposis Multiplex Congenita (Rhett)
16 / 1.5 The Traumatic Residual Limb (Schultea)
17 / 2.0 Pain: Def., Meds. (Drs. Davis & Bullerwell, CRNA, DNP)
18 / 1.5 Skin Conditions in O&P (Utay) Prx Atlas, Ch. 56
19 / 2.0 Cerebral Palsy (DiBello)
20 / 1.5 Burns in O&P (Sherman)
21 / 1.0 _____TBD_____
22 10/__ 1.0 Exam II **

*The dates listed here represent the best estimate as of the completion of this document. If any dates
change as a result of schedule demands or speaker availability, students will be notified in writing
(email) with as much notice as possible.

** Exam II is not cumulative; it covers only the material presented after the Mid-Term Exam. With guest
presenters from outside the Program, it is sometimes necessary to reschedule individual presentations.
If this impacts the content on either exam, students will be in notified either in class, by email, or both.