1. Fibromyalgia An Introduction to Problem-Based Learning Enter Tutorial

9. Concept Map of PBL List known facts List unknowns Generate possible solutions Meet the problem Research unknowns Select most viable solution Report solution PBL: 3 of 10 Exit

24. Meet Your PBL Team Exit Jana Blake Jenny Dr. Elaine Click on picture to learn more about your team members. You are now in the classroom section of the tutorial. Your team will offer their ideas just like in a real PBL experience. And now for the case study!

25. Problem Presentation Let’s watch the case client video first. Let’s look at the client’s chart first. Whatever you choose, don’t forget to take notes! Let’s read the scenario again. Click on the suggestion you want to try first. Exit

29. So now what? What is the next step in the PBL process? A . Research B . Separate known facts from unknown facts C . Analysis Let’s decide how we are going to treat this client We still don’t know very much about this case. But what caused this condition? Where are we in the PBL process? What comes next?

30. Separating Facts Exit What are the known and unknown facts about this case? Type your answer in the text box while your team writes some general considerations on the black board. Your answer should be fairly specific. Go to the next page, when you’re done.

33. Unknown Client Facts How are we going to find the client unknowns in a pretend case study? We could just make up some of the client Information. Don’t worry about the client information for now -focus on the non- client information. How can we know how a real client might answer these questions? What would you do? Your PBL instructors will probably have their own preferences on client unknowns. For now, let’s take Dr. Elaine’s suggestion. Exit

34. Research the Unknowns Let’s all go to the library and do some research Let’s divide everything up and meet back here tomorrow These are all good suggestions, but you must agree on one plan. Everyone should write up a report on all of the unknowns What do you want to do next? Can you offer a compromise? Type your answer in the text box, then go to next page. Exit

35. Team Research Let’s check out a web page. Remember the unknowns that you are researching. I bet the library has some good journal articles. Looks like your team has voted to do research together as a team. Click on the above suggestions to get the resources, or go to the main menu. Exit I’ll take notes and keep track of our references.

36. Research Reports What treatments are available and what works best? What would be our frames of reference and eval tools as O.T.s? Good! How does this all relate to our client? What is the disease process? And how does that affect tx? You and your team have finished with your research. Click on the questions above to compare your answers with your team’s answers. Exit

38. Disease Process According to Dr. Wood’s research, fibromyalgia is a result of the the neurological changes that occur when the hippocampus is overly stressed. The function of the hippocampus includes transfer of short term memory into long term memory and dampening down of stress signals as they enter the limbic system. When the hippocampus atrophies, the signals come into the brain without being processed properly. This causes an increase in CRH and cortisol. Eventually, dopamine levels decrease and the symptoms of fibromyalgia begin to appear: pain, fatigue, and insomnia. Click here to see picture of limbic system Exit

39. The Limbic System Exit Location of the Hippocampus in the Human Brain.The figure shows the underside (ventral view) of a semi-transparent human brain, with the front of the brain at the top. The red blobs show the approximate location of the hippocampus in the temporal lobes of the human brain. Note: the hippocampus is entirely covered by the ventral temporal cortex (i.e., the hippocampus is inside the transparent brain). The Limbic System

40. Implications for Tx A few implications for treatment include: 1. Strengthening and stretching without causing an increase in pain. 2. Nurturing the nervous system through proper nutrition, pain management, and energy conservation. 3. Teaching conscious control of the autonomic nervous system through mind/body techniques. 4. Encouraging better organizational skills, stress management, assertiveness, and positive self-talk. Exit

41. Assessment Tools Based on the theories we chose these would be good evaluation tools to use: 1. Comprehensive Occupational Performance Measure 2. Beck Depression Inventory 3. Dysfunctional Beliefs Inventory 4. Pain Analog Scale 5. Fibromyalgia Impact Questionnaire 6. General Perceived Self-Efficacy Scale Exit

43. Group Analysis Let’s all go home and come up with modalities we want to use. Maybe we should write a problem list first. What is the logical sequence to writing a treatment plan? We need to decide on our goals first. Your team has decided it has all the information it needs to proceed. Next, your team will need to write a treatment plan (the solution). Click on the most appropriate suggestion above. Exit

44. Setting a Goal I think her pain is a good place to start. She needs some relief fast! I think we need to work on building strength. Good ideas. Would these be short term or long term goals? I think self-efficacy is going to be important too. Choose one of the goal areas above and write a measurable, observable objective in your text box, then click on the suggestions above for examples. Exit

45. Solution Generation For each of the goal areas, name several treatment modalities appropriate for this case study, then click next page to see if your answers match. Don’t worry if they don’t- there are many different treatment approaches. Pain Weakness Self-efficacy Exit

47. Elaine Davis, LOTR, Ph.D. Elaine is your clinical supervisor. She has been an OT for 12 years and specializes in the treatment of chronic pain. She cares deeply for her client’s and often puts in overtime. Although she is respectful and pleasant with students, she drives you nuts because she never gives you a straight answer. Her favorite response is, “What do you think?” Exit Exit

48. Jenny INTJ Visual Learner Age: 25 Jenny was valedictorian of her small college graduating class. She has always been very concerned about academics but has had difficulty applying her “book” knowledge to the real world. She worries about her performance in this fieldwork assignment and doesn’t sleep well. Exit Exit

49. Jana ENFJ Auditory Learner Age: 29 Jana is married to a computer programmer, Steve, and has a 3 year old daughter, Rose. She wants to specialize in pediatrics, partially because Rose has been diagnosed with an autistic spectrum disorder. Jana works hard and yet has a smile for everyone. Exit Exit

50. Blake ISTP Visual/Kinesthetic Learner Age: 26 Blake is fairly quiet. He enjoys sports and he would like to specialize in sports rehabilitation. He became interested in OT because he tore his ACL in high school playing football. He gets along well with the clients and is known for his practical jokes. Exit Exit

54. Solution Presentation Exit How would you want to present this case to your class? Here are some ideas: Dramatization of a client interview and treatment A task group or self-expression activity PowerPoint Presentation A video documentary An “infomercial”

55. Evaluation Exit A good presentation should include: Overview of the case study Referenced, evidenced based research A complete treatment plan Interaction with the audience Participation by all PBL team members Handouts/notes for the class

56. Congratulations! Exit You have completed this tutorial. Remember that the examples of resources and research reports were abbreviated in this tutorial due to space and time constraints. Your instructor will probably expect your work to be more extensive. Check out the tutorial resource page next to make your real PBL experience a little easier!

57. Resources Exit Problem-Based Learning Samford University’s Center for Teaching, Learning and Scholarship www.samford.edu/ctis/pbl_process.html Elizondo-Montemayor, L.L. (2004) Formative and summative assessment of the problem-based learning tutorial session using a criterion-referenced system. JIAMSE. (14) 8-14. http://www.iamse.org/member/article/volume14-1/14-1-8-14.pdf Fibromyalgia National Fibromyalgia Association http://www.fmaware.org/ www.myalgia.com includes the Fibromyalgia Impact Questionairre www.lifebeyondpain.com Dr. Patrick Wood’s web site on fibromyalgia

58. References and Credits Exit Journal Article Wood, P.B. (2004). Fibromyalgia syndrome: A central role for the hippocampus- A theoretical construct . Journal of Musculoskeletal Pain ,12(1),19-26. Graphics Tenderpoints graphic accessed on 10/19/06 from www.um-jmh.org/ body.cfm?id=1554 Limbic system: diagram of the brain's limbic system, brainstem, and spinal cord. Governmental source:accessed on 10/30/06 from http://teens.drugabuse.gov/mom/mom_opi5.asp Hippocampus diagram: Public-domain: copyright disclaimed Washington Irving, 2/6/2004 (UTC). From Wikimedia Commons accessed on 10/3006 from: http://en.wikipedia.org/wiki/Image:Hippocampus.png All other graphics from Microsoft Office Clip Art from www.microsoft.com Video Robin Steed, portraying a client with FM

59. Journal Article Exit Wood, P.B. (2004). Fibromyalgia syndrome: A central role for the hippocampus- A theoretical construct . Journal of Musculoskeletal Pain ,12(1),19-26. The article will open as a pdf file in Adobe Reader. It may take a few seconds. Click here to open article: You can read the article and return to the tutorial whenever you are ready by clicking back on the tutorial icon. Team research Team research

62. Solution Generation For each of the goal areas, name several treatment modalities appropriate for this case study, then click next page to see if your answers match. Don’t worry if they don’t- there are many different treatment approaches. Pain ultrasound, alpha stim, cold laser, hot packs, guided imagery Weakness Self-efficacy Exit

63. Solution Generation For each of the goal areas, name several treatment modalities appropriate for this case study, then click next page to see if your answers match. Don’t worry if they don’t- there are many different treatment approaches. Pain ultrasound, alpha stim, cold laser, hot packs, guided imagery Weakness warm water exercise, yoga, tai chi, exercise ball, ROM dance Self-efficacy Exit

64. Solution Generation For each of the goal areas, name several treatment modalities appropriate for this case study, then click next page to see if your answers match. Don’t worry if they don’t- there are many different treatment approaches. successful task completion, journaling, positive self-talk, peer feedback Pain ultrasound, alpha stim, cold laser, hot packs, guided imagery Weakness warm water exercise, yoga, tai chi, exercise ball, ROM dance Self-efficacy Exit