Health Occupations Physical Therapy Specialty Module

1. Health OccupationsPhysical TherapySpecialty 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 • 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

5. 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

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)

7. 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)

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

9. Physical Therapy Practice Includes Four Main Areas: • Cardiovascular • Musculoskeletal • Neurological • 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)

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 • Pulse is measured in beats per minute • Never take a pulse with your thumb • Don’t press too hard or you will occlude the pulse • Note the rhythm, rate and force

14. 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)

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 (video)

16. 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)

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

18. Bones This link has anatomical models of all the bones of the body Links: 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 top view) 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) • Don’t 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

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

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

25. 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

26. 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)

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 • Isolate only one joint motion • Don’t allow patient to compensate for weakness • Compare same muscle bilaterally • Be consistent and reliable with testing

31. 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)

32. 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

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

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

37. 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)

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

39. 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

40. 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)

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

42. Reflexes • Represent monosynaptic reflex loop at 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) Triceps reflex (video) Biceps reflex (video) Brachioradialis reflex (video) Knee jerk reflex (video) Knee jerk reflex (video) Achilles reflex (video)

44. 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

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

46. Balance Definition: Maintaining center of mass within your base of support Other Terminology used to describe balance: Center of Gravity Equilibrium 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) Falls in elderly (website) Dynamic sitting balance (video) Dynamic sitting balance (top view) (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) 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: • Straight Cane • Quad Cane (Large or Small) • Walker (Standard or wheeled) • Hemiwalker • Crutches (Axillary/Loftstrand)