1. Health Occupations Physical Therapy Specialty Module Designed by: Jim Tracy MS PT Lori Tracy MS PT NCS East Carolina University Department of Physical Therapy

2. Sponsored by Eastern Area Health Education Center In collaboration with Office of Generalist Programs at East Carolina University Brody School of Medicine and The North Carolina Department of Public Instruction

3. Introduction Welcome to the physical therapy specialty module. You have decided to undertake a very challenging endeavor. The purpose of this module will be to acquaint you with the major clinical areas in which physical therapists practice by doing observation and demonstrations. We hope after this experience you will be more excited than ever about pursuing a career in physical therapy.

4. How to use this module Read through this PowerPoint presentation Read through this PowerPoint presentation Click on Links Click on Links Links include videos from this CD and links to Websites Links include videos from this CD and links to Websites This is designed to be a student directed learning activity This is designed to be a student directed learning activity After review of this material you should be able to meet most of the objectives of this specialty module After review of this material you should be able to meet most of the objectives of this specialty module

5. Student Goals of Module Complete all required objectives Complete all required objectives Keep a journal of your clinical experiences Keep a journal of your clinical experiences Gain an understanding of the four areas of clinical practice in physical therapy Gain an understanding of the four areas of clinical practice in physical therapy Demonstrate specific objectives as outlined Demonstrate specific objectives as outlined

6. How long do I need to go to school to become a physical therapist? Physical therapy programs are either masters level (MPT) or entry level doctoral programs be required to complete an undergraduate (DPT). You can get a degree in the field of your choice as long as certain prerequisites are met. Start inquiring when you are first starting college about the specific requirements of the school(s) you are interested in attending. Link: Introduction to the Physical Therapy Profession (website) Introduction to the Physical Therapy Profession (website)Introduction to the Physical Therapy Profession (website)

7. Definition of Physical Therapy These links provide the student with some definitions of Physical Therapy Links: Definition of Physical Therapy (website) Definition of Physical Therapy (website) Another Definition of Physical Therapy (website) Another Definition of Physical Therapy (website) North Carolina Physical Therapy Practice Act (website) North Carolina Physical Therapy Practice Act (website)

8. American Physical Therapy Association “APTA” This link provides information on the American Physical Therapy Association Links: American Physical Therapy Association (website) American Physical Therapy Association (website)

9. Physical Therapy Practice Includes Four Main Areas: Cardiovascular Cardiovascular Musculoskeletal Musculoskeletal Neurological Neurological Integumentary (skin) Integumentary (skin)

10. Let’s Get Started

11. Medical Terminology You should have a basic understanding of medical terminology, the link below will give you an overview. The following links will give you an introduction to medical terminology Links: Medical terminology (website) Medical terminology (website) Medical terminology (website) Medical terminology (website)

12. Vital Signs Vital signs are pulse, blood pressure and respiration. You should be able to monitor each of these

13. Important points about taking a patient’s pulse Count a patient’s pulse for 15 sec then multiply by 4 Count a patient’s pulse for 15 sec then multiply by 4 Pulse is measured in beats per minute Pulse is measured in beats per minute Never take a pulse with your thumb Never take a pulse with your thumb Don’t press too hard or you will occlude the pulse Don’t press too hard or you will occlude the pulse Note the rhythm, rate and force Note the rhythm, rate and force

14. Pulses The links below shoe the therapist monitoring each of these pulses Links: Brachial artery (video) Brachial artery (video) Radial artery (video) Radial artery (video) Carotid artery (video) Carotid artery (video) Femoral artery (video) Femoral artery (video) Measuring pulses (website) Measuring pulses (website)

15. Blood Pressure The website link below will take you through the steps to accurately measure blood pressure and the video will demonstrate correct technique Links: Measuring blood pressure (website) Measuring blood pressure (website) Measuring blood pressure (video) Measuring blood pressure (video)

16. Patient Transfers The links below will demonstrate correct transfer techniques for each of the following transfers Links: Supine to sit (video) Supine to sit (video) Standing pivot transfer (video) Standing pivot transfer (video) Squat pivot transfer (video) Squat pivot transfer (video) Sliding board transfer (video) Sliding board transfer (video) Dependent transfer (video) Dependent transfer (video) Two person floor to mat transfer (video) Two person floor to mat transfer (video) Assist floor to mat (video) Assist floor to mat (video)

17. Ankle Taping The links below demonstrate correct technique for ankle taping and a link to the National Athletic Trainers Association Webpage Links: Ankle taping (top view) Ankle taping (top view) Ankle Taping (side view) Ankle Taping (side view) Ankle taping (website) Ankle taping (website) NATA (website) NATA (website)

18. Bones This link has anatomical models of all the bones of the body Links: Bone box (website) Bone box (website)

19. Massage Definition: The scientific manipulation of the soft tissue (skin and muscle) with the purpose of increasing blood supply, increase tissue flexibility, decreasing edema, decrease pain and provide psychological benefits

20. Massage The links below demonstrate basic massage strokes Links: General Massage for Low Back (Video) General Massage for Low Back (Video) General Massage for Low Back (Video top view) General Massage for Low Back (Video top view) The art of massage (website) The art of massage (website)

21. Passive Range of Motion (PROM) Clinical Definition: Therapist moves selected joint(s) through full range of motion with no assistance from the patient

22. Important points on passive range of motion Adequately stabilize patients joints as you move them. (some patients may have no active movement) Adequately stabilize patients joints as you move them. (some patients may have no active movement) Don’t cause pain other than stretching Don’t cause pain other than stretching Perform 5-10 motions per joint movement Perform 5-10 motions per joint movement Familiarize yourself with normal directions and degrees of movement for each joint Familiarize yourself with normal directions and degrees of movement for each joint Listen to patient Listen to patient

23. Passive Range of Motion (PROM) These links demonstrate correct technique when doing passive range of motion on a patient Links: PROM Upper extremity (video) PROM Upper extremity (video) PROM lower extremity (video) PROM lower extremity (video) Passive range of motion techniques(website) Passive range of motion techniques(website)

24. Goniometric Measurement Measurement of joint motion by the therapist using a goniometer goniometer

25. Important points on Goniometric measurement Motions measured can be either active or passive Motions measured can be either active or passive Standardized techniques are used for each joint Standardized techniques are used for each joint Normal ROM measurements can be found in charts Normal ROM measurements can be found in charts Joints should be adequately stabilized during measurement Joints should be adequately stabilized during measurement

26. Goniometric Measurements These links show the therapist demonstrating goniometric measurement for the selected movements Links: Wrist extension (video) Wrist extension (video) Elbow flexion (video) Elbow flexion (video) Knee flexion (video) Knee flexion (video) Hip abduction (video) Hip abduction (video) Goniometric examples (website) Goniometric examples (website)

27. Manual Muscle Testing (MMT) Definition: subjective testing done by the therapist to assess a patients muscle strength. The muscle strength is graded to be either normal, good, fair, poor, trace or zero

28. Muscle Grades Normal: patient holds contraction against maximal resistance at end range Good: patient holds contraction against moderate resistance at end range Fair: patient moves through full range of motion against gravity but unable to hold against resistance at end range Poor: patient moves through full range of motion in a gravity minimized position Trace: therapist palpates muscle contraction as patient attempts to move Zero: therapist is unable to palpate any muscle contraction as patient attempts to move

29. Muscle Grades Normal =5/5 Good =4/5 Fair =3/5 Poor =2/5 Trace =1/5 Zero =0/5

30. Important points on manual muscle testing Need to place patient in standardized position Need to place patient in standardized position Isolate only one joint motion Isolate only one joint motion Don’t allow patient to compensate for weakness Don’t allow patient to compensate for weakness Compare same muscle bilaterally Compare same muscle bilaterally Be consistent and reliable with testing Be consistent and reliable with testing

31. Manual Muscle Testing The following links demonstrate correct manual muscle testing Links: Shoulder flexion (video) Shoulder flexion (video) Elbow flexion (video) Elbow flexion (video) Hip flexion (video) Hip flexion (video) Knee extension (video) Knee extension (video) Muscle testing (website) Muscle testing (website) Muscle testing examples (website) Muscle testing examples (website)

32. Types of Muscle Contractions Isometric: muscle stays at same length during contraction ex: pushing against an immovable object like arm wrestling Isometric: muscle stays at same length during contraction ex: pushing against an immovable object like arm wrestling Concentric: Muscle shortens during contraction ex: biceps during arm curls Concentric: Muscle shortens during contraction ex: biceps during arm curls Eccentric: Muscle lengthens during contraction. Ex: quadriceps when going down steps Eccentric: Muscle lengthens during contraction. Ex: quadriceps when going down steps This link discusses the different types of muscle contractions used in functional activities Link : Types of muscle contractions Types of muscle contractions

33. Muscle Attachments This link gives you all the muscle attachment of every muscle in the body Links: Muscle attachment list (website) Muscle attachment list (website)

34. Functional Movements Describe the muscle contractions of the muscles in the lower extremities during this functional movement. Click here Describe the muscle contractions of the muscles in the lower extremities during this functional movement. Click hereClick hereClick here

35. Dermatomes Definition: specific areas areas on the skin that represent sensory innervation from a specific root level

36. Important points when testing dermatomes Refer to dermatome chart for specific areas Refer to dermatome chart for specific areas Testing is usually done with a blunt object (paperclip) or a pin. Testing is usually done with a blunt object (paperclip) or a pin. Compare same area on opposite side Compare same area on opposite side Ask patient is it the same increased (hypersensitive) or reduced (hyposensitive) Ask patient is it the same increased (hypersensitive) or reduced (hyposensitive)

37. Dermatomes These links demonstrate correct sensory testing of the dermatomes and a dermatome chart. Links: Pinwheel test instrument (video) Pinwheel test instrument (video) Upper extremity sensory testing (video) Upper extremity sensory testing (video) Dermatome Chart (website) Dermatome Chart (website) Cutaneous innervation (website) Cutaneous innervation (website) Dermatome testing (sensory testing) (website) Dermatome testing (sensory testing) (website) Learn your nerves (website) Learn your nerves (website)

38. Two Point Discrimination Patient is tested on how well they can discriminate between on and two points using this instrument (click here) (click here)(click here)(click here)

39. Important points when testing 2-point discrimination Pressure to both points must be equal Pressure to both points must be equal Usually done on the hand where discrimination is important to fine motor control Usually done on the hand where discrimination is important to fine motor control Patient should be able to discriminate points as close together as 2-3 mm on hand Patient should be able to discriminate points as close together as 2-3 mm on hand Is a measure of dorsal column integrity Is a measure of dorsal column integrity

40. 2-Point Discrimination These links demonstrate correct testing of 2 point discrimination Links: 2-pt testing on arm (video) 2-pt testing on arm (video) 2-pt testing on hand (video) 2-pt testing on hand (video)

41. Proprioception These links show the therapist performing proprioceptive testing Links: Wrist proprioception (video) Wrist proprioception (video) Ankle proprioception (video) Ankle proprioception (video) Big toe proprioception (video) Big toe proprioception (video)

42. Reflexes Represent monosynaptic reflex loop at spinal levels Represent monosynaptic reflex loop at spinal levels Check integrity of lower motor neuron loop at specific spinal levels Check integrity of lower motor neuron loop at specific spinal levels

43. Reflexes These links describe reflex testing and show the therapist demonstrating reflex testing Links: Monosynaptic reflex arc (Website) Monosynaptic reflex arc (Website) Triceps reflex (video) Triceps reflex (video) Biceps reflex (video) Biceps reflex (video) Brachioradialis reflex (video) Brachioradialis reflex (video) Knee jerk reflex (video) Knee jerk reflex (video) Knee jerk reflex (video) Knee jerk reflex (video) Achilles reflex (video) Achilles reflex (video)

44. Important points when testing reflexes Use light grip on reflex hammer Use light grip on reflex hammer Compare bilaterally Compare bilaterally Grade as normal hyperactive or hypoactive Grade as normal hyperactive or hypoactive Results are used with dermatome to determine spinal root problem Results are used with dermatome to determine spinal root problem

45. Posture Body Mechanics and Lifting Links: Posture (video) Posture (video) Normal curves (video) Normal curves (video) Straddle lift (video) Straddle lift (video) Tripod lift (video) Tripod lift (video) Golfer’s lift (video) Golfer’s lift (video) Ergonomics (website) Ergonomics (website)

46. Balance Definition: Maintaining center of mass within your base of support Other Terminology used to describe balance: Center of Gravity Center of GravityEquilibrium Cone of Stability Cone of Stability

47. Balance The following links will help you understand balance related to functional activities and some ways therapists test a patient’s balance Links: Practicing Balance (website) Practicing Balance (website) Falls in elderly (website) Falls in elderly (website) Dynamic sitting balance (video) Dynamic sitting balance (video) Dynamic sitting balance (top view) (video) Dynamic sitting balance (top view) (video) Berg Balance Assessment (video) Berg Balance Assessment (video)

48. Gait Other terms used to describe gait: Ambulation/Locomotion Controlled movement of your base of support.

49. Gait Assessments Determining safety and efficiency of ambulation. These links will demonstrate the therapist performing gait assessment tests Links: Timed Get up and Go Test (video) Timed Get up and Go Test (video) Dynamic Gait Index (video) Dynamic Gait Index (video)

50. Gait with Assistive Devices Determining appropriate assistive device is based upon: Client safety, client preference, impairment/injury, and environmental circumstances Types of devices may include: Types of devices may include: Straight Cane Straight Cane Quad Cane (Large or Small) Quad Cane (Large or Small) Walker (Standard or wheeled) Walker (Standard or wheeled) Hemiwalker Hemiwalker Crutches (Axillary/Loftstrand) Crutches (Axillary/Loftstrand)

51. Physical Therapy and Gait Training Determining appropriate device Determining appropriate device Measuring device for proper fit Measuring device for proper fit Education of gait with assistive device Education of gait with assistive device Sitting, standing and balancing with assistive device Sitting, standing and balancing with assistive device Progression of gait to include environmental surfaces client will encounter during daily activities. Progression of gait to include environmental surfaces client will encounter during daily activities.

52. Device Fitting and Ambulation These links will demonstrate correct instruction and assistance with gait Links: Measurement of Device (Video) Measurement of Device (Video) Gait Patterns: Two point reciprocal gait pattern (Video) Two point reciprocal gait pattern (Video) Gait with standard walker (video) Gait with standard walker (video) Crutch training non-weight bearing swing to(Video) Crutch training non-weight bearing swing to(Video) Crutch training non-weight bearing swing through (video) Crutch training non-weight bearing swing through (video) Stair training with crutches non-weight bearing (video) Stair training with crutches non-weight bearing (video)

53. Thermal Modalities Modalities used to increase circulation (vasodilatation), increase tissue extensibility, decrease pain

54. Thermal Modalities Hot packs Hot packs Diathermy Diathermy Fluidotherapy Fluidotherapy Ultrasound Ultrasound Microwave Microwave Infrared Infrared Whirlpool Whirlpool Paraffin Paraffin These links will describe physiological rationale for thermal modalities Links: Introduction to Thermal Modalities (website) Introduction to Thermal Modalities (website)Introduction to Thermal Modalities (website) Thermal agents (website) Thermal agents (website)

55. Cryotherapy The use of cold modalities for the purpose of vasoconstriction to produce a decrease in the following: cell metabolism, inflammation, pain and muscle spasm These links will describe physiological rationale for use of cold modalities Links: Cryotherapy (website) Cryotherapy (website) Another Cryotherapy (website) Another Cryotherapy (website)

56. Electrical Modalities The use of electrical current for specific physiological effects on the body such as contraction of muscle, reduction of pain, diagnostic purposes wound healing decreased spasticity

57. Electrical Modalities These links will describe physiological rationale for use of electrical modalities and some description of different uses of electrical stimulation Links: Electrical therapeutic modalities (website) Electrical therapeutic modalities (website) Transcutaneous Electrical Stimulation (TENS) (website) Transcutaneous Electrical Stimulation (TENS) (website) TENS (website) TENS (website)

58. Wound Management Physical therapists are often involved in the treatment of wounds that are caused from trauma, infection, diabetes or circulatory problems.

59. Wound Care These links describe different kinds of wounds and explain how to best treat them Links: Selection of Dressings (website) Selection of Dressings (website) World Wide Wounds (website) World Wide Wounds (website) Wound care information (website) Wound care information (website) Wound Care institute (website) Wound Care institute (website) Wound Care Strategies (website) Wound Care Strategies (website)

60. Cultural Competency This link provides extensive information on different cultures Links: Cultural competency (website) Cultural competency (website) Another site cultural competence (website) Another site cultural competence (website)

61. Interpersonal Communication Skills Patient Interaction Communication with Health Professionals Note Writing

62. Interpersonal Communication This link provides some tips to better communicate with patients Links: Interpersonal communication (website) Interpersonal communication (website)

63. Physical Therapy Note Writing These links show examples of medical notes using the S.O.A.P. format Links: Documenting patient care (website) Documenting patient care (website) S.O.A.P. Notes (website) S.O.A.P. Notes (website) S.O.A.P. Notes (website) S.O.A.P. Notes (website)

64. Case Studies The following links are case studies for you to review Links: Total Hip replacement case study (website) Total Hip replacement case study (website) Information about total hip replacement (website) Information about total hip replacement (website) Wound Management case study (website) Wound Management case study (website)

65. Self Study Test When you have finished the specialty module you are ready to take this 50 question Self Study Test Link: Self Study Test

66. Conclusion You have now completed this specialty module in physical therapy. Please fill out the evaluation for this module by clicking on this link. Course Evaluation