Faculty Created

OMT Videos:
Impact on Student
Learning
Ryan Seals, DO
AACOM & AODME Joint Annual
Conference
April 22-25, 2015

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

Stages of Psychomotor Learning

Cognitive
(novice)

Associative
(intermediate)

Autonomous
(expert)

What is being
learned?

Verbal
information &
Procedural rule

Initial errors corrected;

Fine tuning
psycho-motor connections;
deeper understanding of
procedural rule

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

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

Feedback
Practice
Verbalization
Visualization
Conceptualization

Familiarity
with skills,
awareness,
why and what

Expert
Demonstration
from beginning
to end

End-Goal Focus

Narration of
steps from
beginning
to end

Deliberate,
concentrated

Faculty and
Peers

Rubric

Diagnosis
Set-up

Diagnose articular somatic dysfunction.

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.

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.

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.

Diagnosis

Set-up

Contact of Tissues

Still Technique, Typical Cervicals

Diagnose the cervical spinal segment using standard, three plane
diagnostic approach
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 patients head is
at or just below your eye or shoulder level.

Optional: Supine: Ask the patient to lay flat, face up on the table. Sit
at the head of the table. Adjust the table so that you can
comfortably contact the patients occiput with both hands.
Monitoring Hand

Contact the posterior articular pillar (the side of rotation). Layer

palpate to the occipital bone to monitor for tissue texture changes
and motion.
Operating Hand

Contact the vertex (top) of the patients head, which will be used as
the long lever. Be sure that the hand and finger placement do not
cause discomfort for the patient.

Still Technique, Typical Cervicals, continued

Application
of Principles

Retest

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 the
dysfunctional segment and will move with the dysfunctional segment.
Operating Hand
1.
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 directly
to your monitoring hand.
1.
Fluidly, move the patients head to move the dysfunctional vertebrae all 3 planes of
motion 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 patients head and neck to neutral position.
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 is
not performed in a repetitive fashion.

Rubric

3
outstanding

2
competent

1
needs improv.

Shows consistently
Shows mostly
appropriate contact of
appropriate contact of
tissues that allows for
tissues and is able to
performance of
perform technique
technique

Shows contact of
tissues which makes
Contact of
performing the
Tissues
technique difficult or
awkward
Applies some force(s) in
Applies the
Applies force in the
some general
Application of appropriate amount of correct directions and
direction(s) which
Principles- Use force in correct amount for performing makes performing the
directions to precisely
technique, but not
technique difficult or
of Force
perform technique
precisely
awkward
Demonstrates
Demonstrates
Application of positioning of partner Demonstrates adequate positioning which
positioning of partner makes performing the
and themselves
Principlesand themselves for
technique difficult for
appropriately for
Positioning performing technique performing technique themselves or partner,
or awkward

Application of
Principlesmovement
Reassessment

Applies principles of
Applies principles of
Applies principles of
technique effectively techniques adequately techniques poorly with
with no errors
with few minor errors
significant errors

0
Requires
Retest

Requires
Retest

Requires
Retest

Requires
Retest

Demonstrates
Demonstrates
improvement in
improvement in original
Diagnosis is unchanged Not performed
original diagnosis by diagnosis by less than

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
Stick with this format please! It makes lab so much
more efficient when we can progress at our own pace.

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.

Student Comments
I definitely like having the videos to
watch before class, but it doesn't
replace the live demonstrations.

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