Health Occupations Physical Therapy Specialty Module

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Health OccupationsPhysical TherapySpecialty
Module

• Designed by
• Jim Tracy MS PT
• Lori Tracy MS PT NCS
• East Carolina University
• Department of Physical Therapy

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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

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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.

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How to use this module

• Read through this PowerPoint presentation
• Click on Links
• Links include videos from this CD and links to
  Websites
• 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

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Student Goals of Module

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

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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)

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Definition of Physical Therapy

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

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American Physical Therapy Association APTA

• This link provides information on the American
  Physical Therapy Association
• Links
• American Physical Therapy Association (website)

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Physical Therapy Practice Includes Four Main
Areas

• Cardiovascular
• Musculoskeletal
• Neurological
• Integumentary (skin)

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Lets Get Started
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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)

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Vital Signs

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

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Important points about taking a patients pulse

• Count a patients pulse for 15 sec then multiply
  by 4
• Pulse is measured in beats per minute
• Never take a pulse with your thumb
• Dont press too hard or you will occlude the
  pulse
• Note the rhythm, rate and force

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Pulses

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

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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 (video)

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Patient Transfers

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

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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 (side view)
• Ankle taping (website)
• NATA (website)

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Bones

• This link has anatomical models of all the bones
  of the body
• Links
• Bone box (website)

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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

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Massage

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

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Passive Range of Motion (PROM)

• Clinical Definition Therapist moves selected
  joint(s) through full range of motion with no
  assistance from the patient

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Important points on passive range of motion

• Adequately stabilize patients joints as you move
  them. (some patients may have no active movement)
• Dont cause pain other than stretching
• Perform 5-10 motions per joint movement
• Familiarize yourself with normal directions and
  degrees of movement for each joint
• Listen to patient

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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 lower extremity (video)
• Passive range of motion techniques(website)

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Goniometric Measurement

• Measurement of joint motion by the therapist
  using a goniometer

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Important points on Goniometric measurement

• Motions measured can be either active or passive
• Standardized techniques are used for each joint
• Normal ROM measurements can be found in charts
• Joints should be adequately stabilized during
  measurement

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Goniometric Measurements

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

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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

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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

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Muscle Grades

• Normal 5/5
• Good 4/5
• Fair 3/5
• Poor 2/5
• Trace 1/5
• Zero 0/5

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Important points on manual muscle testing

• Need to place patient in standardized position
• Isolate only one joint motion
• Dont allow patient to compensate for weakness
• Compare same muscle bilaterally
• Be consistent and reliable with testing

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Manual Muscle Testing

• The following links demonstrate correct manual
  muscle testing
• Links
• Shoulder flexion (video)
• Elbow flexion (video)
• Hip flexion (video)
• Knee extension (video)
• Muscle testing (website)
• Muscle testing examples (website)

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Types of Muscle Contractions

• 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
• 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

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Muscle Attachments

• This link gives you all the muscle attachment of
  every muscle in the body
• Links
• Muscle attachment list (website)

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Functional Movements

• Describe the muscle contractions of the muscles
  in the lower extremities during this functional
  movement. Click here

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Dermatomes

• Definition specific areas areas on the skin that
  represent sensory innervation from a specific
  root level

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Important points when testing dermatomes

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

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Dermatomes

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

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Two Point Discrimination

• Patient is tested on how well they can
  discriminate between on and two points using this
  instrument
• (click here)

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Important points when testing 2-point
discrimination

• Pressure to both points must be equal
• 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
• Is a measure of dorsal column integrity

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2-Point Discrimination

• These links demonstrate correct testing of 2
  point discrimination
• Links
• 2-pt testing on arm (video)
• 2-pt testing on hand (video)

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Proprioception

• These links show the therapist performing
  proprioceptive testing
• Links
• Wrist proprioception (video)
• Ankle proprioception (video)
• Big toe proprioception (video)

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Reflexes

• Represent monosynaptic reflex loop at spinal
  levels
• Check integrity of lower motor neuron loop at
  specific spinal levels

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Reflexes

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

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Important points when testing reflexes

• Use light grip on reflex hammer
• Compare bilaterally
• Grade as normal hyperactive or hypoactive
• Results are used with dermatome to determine
  spinal root problem

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Posture Body Mechanics and Lifting

• Links
• Posture (video)
• Normal curves (video)
• Straddle lift (video)
• Tripod lift (video)
• Golfers lift (video)
• Ergonomics (website)

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Balance

• Definition Maintaining center of mass within
  your base of support
• Other Terminology used to describe balance
• Center of Gravity
• Equilibrium
• Cone of Stability

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Balance

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

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Gait

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

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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)
• Dynamic Gait Index (video)

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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
• Straight Cane
• Quad Cane (Large or Small)
• Walker (Standard or wheeled)
• Hemiwalker
• Crutches (Axillary/Loftstrand)

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Physical Therapy and Gait Training

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

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Device Fitting and Ambulation

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

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Thermal Modalities

• Modalities used to increase circulation
  (vasodilatation), increase tissue extensibility,
  decrease pain

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Thermal Modalities

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

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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)
• Another Cryotherapy (website)

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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

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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)
• Transcutaneous Electrical Stimulation (TENS)
  (website)
• TENS (website)

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Wound Management

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

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Wound Care

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

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Cultural Competency

• This link provides extensive information on
  different cultures
• Links
• Cultural competency (website)
• Another site cultural competence (website)

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Interpersonal Communication Skills

• Patient Interaction
• Communication with Health Professionals
• Note Writing

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Interpersonal Communication

• This link provides some tips to better
  communicate with patients
• Links
• Interpersonal communication (website)

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Physical Therapy Note Writing

• These links show examples of medical notes using
  the S.O.A.P. format
• Links
• Documenting patient care (website)
• S.O.A.P. Notes (website)
• S.O.A.P. Notes (website)

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Case Studies

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

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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

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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