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A-O-AO&5 908 TECIHOMICS INC OAKTON VA F/6 5/A SYSTEM4 APPROACH TO NAVY MEDICAL EDUCATION AND TRAINING. APPEN--ETC(U)
GGA AUG 711 NOOOI-90-C-0246
NCLASSIFIED 14-7 gnuFunun
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1111125 RESOLI TES CHAR.
MICROCOPY RESOLUTION TEST CHART
APPENDIX 39.
I COMPETENCY CURRICULUM FORPHYSICAL THERAPY ASSISTANT
I APPLICATION OF A SYSTEM APPROACHU.S. NAVY MEDICAL DEPARTMENTEDUCATION AND TRAINING PROGRAMS
FINAL REPORT
Iv
I Prepared under Contract toOFFICE OF NAVAL RESEARCH
U.*S. DEPARTMENT OF THE NAVY
Quida C. Upchurch, Capt., NC, USN
Program ManagerEducation and Training R&D
Bureau of Medicine and Surgery (Code 71G)
K This docuflent has been crPptfopublic rol.V dsae li
dtributinn is unllimited*
UNCLASSIFIEDSECUAITY CLASSICATIG% OF THIS PAGE (Wh. OAt-.iE,,...d)
REPORT DOCUMENTATION PAGE "BKOR E COMPL&TING FORMI~ ~ 1 pJP T A Vol s I) GOVT ACCESSION. 3. RECI IENTIS CATALOG MUMMERnaeprt; (Vols. I & II)
Apendices: 1-45I,,,TYPE Of REPORT PERIOD COVEREO
A System Approach to Navy MedicalI Education and Training. / ,p er / F
I7. AUTHOR(v) p' " " 'l . NTRACT OR GRANT NUMUER(*)
I .......... ... ... ....... ... ..s. PE- R Po M IN G O R G A N IZA T IO N N A E A N D A D R ESS 10. P RO G R AM E L- M E N T. P R O E T . T A S KOffice of Naval Research AREA* WORK UNIT NUMBERS
Department of the Navy
Arlington, Virginia 22217 43-03X.029I. CEROROLING OGAIZAI NAME AND ADDRESS T.. REPRTSAT
Office of Naval Research AA A WORUI IUMBER
Department of the NavyArlington, Virginia 22217 43i I X.02U. PGE
II. MONITORING AGENCY NAME & A DORESS,rulef ee. Co n lawl Ofice) 1. SECURITY CLASS. (oT E h#e report)
Office of Naval Research
Department of the Navy (1j,7 UNCLASSIFIEDArlington, Virginia 22217 IS..DECASSIICATION/DOWNGRADING
16. DISTRIBUTION STATEMENT (of this Report)
I .Approved for public release; distribution unlimited.
17. DISTRIBUTION STATEMENT (of the abstract mtefed in gloek 20, if dlfew.0 fro Repord)
Approved for public release; distribution unlimited.IIS. SUPPLEMENTARY NOTES
m None
I 19. KEY WORDS (Continue on reverse aide If nec..eay MW Ident#& by bleck nIber)
Education and Training Medical TechnicianMedical Training Job AnalysisNurse Training Task Analysis
DI 0ntst Training Curriculum Development
ASTRACT (Continue on reovere aide if necessary od 1deniIf by block nuber)
The study objective consisted of a determination of what the health carepersonnel in the Navy's Medical Department, Bureau of Medicine and Surgeryactually do in their occupations; improving the personnel process (educa-tion and training); and building a viable career pathway for all healthcare personnel. Clearly the first task was to develop a system of jobanalyses applicable to all system wide health care manpower tasks. Ameans of postulating simplified occupational clusters covering some 50\]
DD F 1473 EDITION C- IOV 6s IS OBSOLETES/N 0 -A. UNCLASSIFIED
SECURITY CLASSIFICATION OF THIS PAGE (Whom Dots tifoeI,( +
UNCLASS IFIED-t-wP~ TY CLASSIFIC:ArTON OF THIS PAGE(Whefl Data EnIteed)
currently designated Navy enlisted occupations, 20 Naval Enlisted Classi-fication Codes (NEC's) were computerized. A set of 16 groupings thatcover all designated occupations was developed so as to enhance the ef-fectiveness of professionals and sub-professionals aie r
T k3
UNLSSFEiicutir ionIIATO ~TISpo~. DOae.
I FOREWORD
The project, "Application of a System Approach to the NavyMedical Department Education and Training Programs," wasinitiated in May of 1969 as a realistic, comprehensive responseto certain objectives set forth in ADO 43-03X, and to memorandafrom both the Secretary of Defense and the Assistant Secretaryof Defense, Manpower and Reserve Affairs. The Secretary'sconcern was stated in his memorandum of 29 June 1965, "Innovationin Defense Training and Education." More specific concerns werestated in the Assistant Secretary's memorandum of 14 June 1968,"Application of a System Approach in the Development and Management
I of Training Courses." In this he called for "vigorous andimaginative effort," and an approach "characterized by anorganized training program with precise goals and definedoperational interrelation among instructional system components."He also noted, "Job analyses with task descriptions expressedin behavioristic terms are basic and essential to the developmentof precise training goals and learning objectives."
The Project
System survey and analysis was conducted relative to allfactors affecting education and training programs. Subsequently,a job-analysis sub-system was defined and developed incorpo-rating a series of task inventories ". . . expressed inbehavioristic terms . . ." These inventories enabled the gatheringof job activity data from enlisted job incumbents, and datarelating to task sharing and delegation from officers of theMedical, Nurse and Dental Corps. A data management sub-systemwas devised to process incumbent data, then carry out neededanalyses. The development of initial competency curriculabased upon job analysis was implemented to a level of methodologydetermination. These methods and curriculum materials constituteda third (instructional) sub-system.
I Thus, as originally proposed, a system capability has beendeveloped in fulfillment of expressed needs. The system, however,remains untested and unevaluated. ADO 43-03X called for
I feasibility test and cost-effectiveness determination. Theproject was designed to so comply. Test and evaluation throughthe process of implementation has not proved feasible in theNavy Medical Department within the duration of the project.As designed and developed the system does have " . . . precisegoals and defined operational interrelation among instructionalsystem components." The latter has been achieved in terms of arecomended career structure affording productive, rewardingmanpower utilization which bridges manpower training and healthcare delivery functions.
!I
Data Management Sub-System
Job analysis, involving the application of comprehensivetask inventories to thousands of job incumbents, generates manymillions of discrete bits of response data. They can beprocessed and manipulated only by high speed computer capabilityusing rigorously designed specialty programs. In addition tonumerical data base handling, there is the problem of rapidlyand accurately manipulating a task statement data base exceedingten thousand carefully phrased behavioral statements. Throughthe use of special programs, task inventories are prepared,printouts for special purposes are created following a jobanalysis application, access and retrieval of both data andtasks are efficiently and accurately carried out, and specialdata analyses conducted. The collective programs, techniquesand procedures comprising this sub-system are referred to as theNavy Occupational Data Analysis Language (NODAL).
Job Analysis Sub-System
Some twenty task inventory booklets (and associated)response booklets) were the instruments used to obtain jobincumbent response data for more than fifty occupations. Aninventory booklet contains instructions, formatted questionsconcerning respondent information ("bio-data"), responsedimension definitions, and a list of tasks which may vary innumber from a few hundred to more than a thousand peroccupational field.
By applying NODAL and its associated indexing techniques,it is possible to assemble modified or completely differentinventories than those used in this research. Present inven-tories were applied about three years ago. While they havebeen rendered in operational format, they should not bereapplied until their task content is updated.
Response booklets were designed in OPSCAN mode for easeof recording and processing responses.
Overall job analysis objectives and a plan of administrationwere established prior to inventory preparation, including thesetting of provisional sample target sizes. Since overall dataattrition was forecast to approximate twenty percent, finalsample and sub-sample sizes were adjusted accordingly. Stratifiedrandom sampling techniques were used. Variables selected (suchas rating, NEC, environment) determined stratifications, togetherwith sub-population sizes. About fifteen percent of large sub-populations were sought while a majority of all members of smallsub-populations were sought.
Administration procedures were established with great carefor every step of the data collecting process, and were coor-dinated with sampling and data analysis plans. Once set, theprocedures were formalized as a protocol and followed rigorously.
I Instructional Sub-System
Partial "competency curricula" have been composed as anintegral sub-system bridging what is required as performance
, on the job with what is, accordingly, necessary instructionin the training process. Further, curriculum materials weredeveloped to meet essential requirements for implementing thesystem so that the system could be tested and evaluated forcost effectiveness. However, due to the fact that test andevaluation was not feasible in the Navy Medical Departmentwithin the duration of the project, it was not possible tocomplete the development of the system through the test andevaluation phase. The inability to complete this phase alsointerrupted the planned process for fully developing thecurricula; therefore, instead of completed curricula ready foruse in the system, the curricula were partially developed toestablish the necessary sub-system methodology. Thecompetency curricula are bared on tasks currently performedby job incumbents in 1971. (The currency of a given curriculumdepends upon periodic analysis of incumbents' jobs, and itsquality control resides in the evaluation of the performancecompetency of the program's graduates.)
A competency curriculum provides a planned course ofI instruction or training program made up of sequenced competencyunits which are, in turn, comprised of sequenced modules. Thesemodules, emphasizing performance objectives, are the foundationof the curriculum.
A complete module would be comprised of seven parts: a3 cluster of related tasks; a performance objective; a list of
knowledges and skills implied by the objective; a list ofinstructional strategies for presenting the knowledges andskills to the learner; an inventory of training aids forsupporting the instructional strategies; a list of examinationmodes; and a statement of the required training time. Inthis project, curriculum materials have been developed tovarious levels of adequacy, and usually comprise only the firstthree parts; the latter four need to be prepared by the user.
The performance objective, which is the most crucial partof the module, is the basis for determining curriculum content.It is composed of five essential elements: the stimulus whichinitiates the behavior; the behavior; the conditions underwhich the behavior takes place; the criteria for evaluating thebehavior; and the consequence or results of the behavior. Asixth element, namely next action, is not essential; however,it is intended to provide linkage for the next behavior.
Knowledges and skills listed in the module are those neededby the learner for meeting the requirements of the performanceobjective.
II
Instructional strategies, training aids, examination modesand training time have been specified only for the Basic HospitalCorps Curriculum. The strategies, aids and modes were selectadon the basis of those considered to be most supportive inpresenting the knowledges and skills so as to provide optimumlearning effectiveness and training efficiency. The strategiesextend from the classroom lecture as traditionally presentedby a teacher to the more sophisticated mediated program forself-instruction. The training aids, like strategies, extendfrom the traditional references and handout material in theform of a student syllabus to mediated programs for self-instruction supported by anatomical models. Examination modesextend from the traditional paper and pencil tests to proficiencyevaluation of program graduates on the job, commonly known asfeedback. Feedback is essential for determining learningeffectiveness and for quality control of a training program.The kind of instructional strategies, training aids and examinationmodes utilized for training are limited only by such factorsas staff capability and traling budget.
The training time specified in the Basic Hospital CorpsCurriculum is estimated, based upon essential knowledge andskills and program sequence.
The competency curriculum module, when complete, providesall of the requirements for training a learner to perform thetasks set forth in the module. A module may be used independentlyor related modules may be re-sequenced into modified competencyunits to provide training for a specific job segment.
Since the curricula are based upon tasks performed by jobincumbents in 1971, current analysis of jobs needs to be accom-plished using task inventories that have been updated to reflectchanges in performed tasks. Subsequent to job analysis, arevision of the curricula should be accomplished to reflect taskchanges. When the foregoing are accomplished, then faculty andother staff members may be indoctrinated to the competencycurricula and to their relationship to the education and trainingsystem.
In addition to the primary use for the systematic trainingof job incumbents, these curricula may be used to plan for newtraining program3, develop new curricula, and revise existingcurricula; develop or modify performance standards; develop ormodify proficiency examinations; define billets; credentializetraining programs; counsel on careers; select students; andidentify and select faculty.
R.j
IThe System
Three sub-systems, as described, comprise the proposedsystem for Education and Training Programs in the Navy MedicalDepartment. This exploratory and advanced developmental researchhas established an overall methodology for improved educationand training incorporating every possible means of providingbases for demonstrating feasibility and cost effectiveness.There remains only job analysis sub-system up-dating, instruc-tional sub-system completion, and full system test andevaluation.
Acknowledgements
The authors wish to acknowledge the invaluable participationof the several thousands of Naval personnel who served asrespondents in inventory application. The many military andcivilian personnel who contributed to developmental effortsare cited by name in the Final Report.
* The authors also wish to acknowledge former colleaguesfor singularly important contributions, namely, Elias H. Porter,Ph.D., Carole K. Kauffman, R.N., M.P.H., Mary Kay Munday, B.S.N.,R.N., Gail Zarren, M.S.W., and Renee Schick, B.A.
Identity and acknowledgement of the project Advisory Groupduring the project's final year is recorded in the F,.nal Report.
I Lastly, the project could not have been commenced norcarried out without the vision, guidance and outstanding
* direction of Ouida C. Upchurch, Capt., NC, USN, Project Manager.
iii
rI!
I
TABLE OF CONTENTS
I COMPETENCY CURRICULUM FOR
I PHYSICAL THERAPY ASSISTANT
I Units/Modules Page
1. PhysicalAgents..... .. . . . .. ... . . . . 1
1. Area Preparation ... .. . . . . . 22. Patient Transfe r . .. . . .. 33. Patient Preparation . . . . . . . . . . . . . . . 44. Hydrotherapy. . . . . . . . . . . . . . . . . . . 55. Therapeutic Pool. . . . . . . . . . . . . . . . . 66. Cryotherapy . . . . . . . . . . . . . . . . . . . 77. Intermittent Cervical and Lumbar
Traction .. .. .. .. ... .8. Intermittent Compression ....... . . . 99. Superficial Heat Treatment. . . . . . . . . . . . 1010. Deep Heat Treatment ............. . 1111. Massage . . . . . . . . . . . . . . . . . . 1212. Electrical Stimulation. . . . . . . . . . . . . . 1313. Ultraviolet Treatment . . . . . . . . . . . . . . 1414. Dressing Wounds...... . . . .. . . .. . . 15
I II. Therapeutic Exercise. . . . . . . . . . . . . . . . . 16
1. Patient Preparation for Treatment . . . . 0 * . e 17I 2. Baseline Measurements ........... .. 183. Range of Motion Exercises...... . . . . . . 194. Strengthening Exercises ...... . . . . . . . 205. Respiratory Exercises ........ 216. Special Exercise Programs ...... 227. Muscle Re-education . . . . . . . . . . . . . . . 238. Posture Training. . . . . . . . . . . . . . . . . 24I 9. Mat Exercises ............ .. . 25
III. Ambulation . . e . . . . . . . . . . . . . . . 26
1. Tilt Table Procedure ........ : *272. Application/Removal and Care of Braces 283. Patient Preparation for Ambulation
Training . . . . . . . . . . . . . . . . . . . . 294. Crutch Training .......... 30
I 5. Cane and Walker Training ...... 31
!a
Units/Modules
IV. Amputee Rehabilitation ...... . . . . . . . . 32
1. Preprosthetic Care. . . . . . . . . . . . 332. Stump Dynamics ... ............ . 343. Care of Prosthesis . ... . . . . . ..... 354. Prosthetic Training I ............... 365. Prosthetic Training II ... . . . . ..... 37
V. Reporting and Recording . . . . . . . . . . . . . . 38
1. Reporting and Recording .. ..... ..... 39
b
.M
ICompetency: PHYSICAL THERAPY ASSISTANT (PTA)
COMPETENCY UNIT I: PHYSICAL AGENTSIThis unit includes the following modules:I _
Number Title Page
I 1 Area Preparation ..... ........ . 2
2 Patient Transfer ........... ... 3
1 3 Patient Preparation ............ 4
1 4 Hydrotherapy ..... . . . . . . . . . 5
5 Therapeutic Pool ..... ........... 6
6 Cryotherapy ..... ........... 7
7 Intermittent Cervical and LumbarI Traction . . . . . . . .. . . . . ............. 8
8 Intermittent Compression . . . ......... 9
! 9 Superficial Heat Treatment ...... . . . 10
10 Deep Heat Treatment . . . . . . . . . . . . 11
11 Massage . . . . . . . . . . . . . . . . . . 12
1 12 Electrical Stimulation . . . . . . . . . .. 13
13 Ultraviolet Treatment . . . . ......... 14
1 14 Dressing Wounds . . . . .............. 15
!I
I
1 1
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit I: Physical Agents
MODULE 1: AREA PREPARATION
TASKS a. Prepare area for treatmentb. Set up equipmentc. Collect essentials required for treatment
PERFORMANCE OBJECTIVE
(Stimulus) When assigned by physical therapist(Behavior) The PTA will prepare area for treatment, set
up equipment and collect essentials necessaryfor treatment
(Conditions) Wit iout supervision; using equipment and materialsrequired for treatment, e.g., shortwave diathermymachine, laboratory timer, plinth examinationtable, pillows, linens, towels
(Criteria) All materials are gathered and placed appropriatelyto facilitate patient transfer and preparationof patient for treatment; machines are plugged in
(Consequence) Area is prepared for patient treatment(Next Action) Transport patient to area
KNOWLEDGES AND SKILLS
Types of PT modality equipment and materials,e.g., shortwave diathermy machine, laboratorytimer, plinth examination table, pillows, linens,towels
Patient's disabilityEquipment safety precautions
2
I,7 Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit I: Physical Agents
j ~MODULE 2: PATIENT TRANSFER
TASKS a. Transfer patient
PERFORMANCE OBJECTIVE
(Stimulus) When assigned by physical therapist(Behavior) The PTA will transfer the patient from wheelchair
or cart to treatment table, chair, whirlpool, or
( d oother specified location(Conditions) Without supervision; using appropriate equipment
when necessary, e.g., Hoyer lift(Criteria) Utilizing sound principles of body mechanics,
safety procedures and precautions, transferprocedures and knowledge of patient's disability
(Consequence) Patient transferred for treatmentI (Next Action) Prepare patient for treatment
KNOWLEDGES AND SKILLS
Patient's disabilityBody mechanics for self and patientTypes of transfersTransfer techniquesUse and operation of transfer equipment, e.g.,
Hoyer liftI Safety precautions for PTA and patient
IIII'II
-Ii . Il. I il le . . .I . . - ~ .. I I
V|
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit I: Physical Agents
MODULE 3: PATIENT PREPARATION
TASKS a. Prepare patient for treatmentb. Position patient for treatmentc. Explain treatment and its effects to patient
PERFORMANCE OBJECTIVE
(Stimulus) When assigned by the physical therapist(Behavior) The PTA will prepare and position the patient for
treatment, explaining the treatment and itseffects to him
(Conditions) Without supervision(Criteria) PTA prepares and positions patient appropriately I
for treatment using effective and appropriatecommunication techniques to instruct patient
(Consequence) Patient prepared for treatment(Next Action) Implement patient treatment
KNOWLEDGES AND SKILLS IDraping and positioning proceduresPatient's disability/limitationEffective communication techniquesSafety precautions for patient
4I
III
II
+ I4 1,,
I,ICompetency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit I: Physical Agents
MODULE 4: HYDROTHERAPY
TASKS a. Modify hydrotherapy treatment according topatient's tolerance
b. Treat patient in whirlpoolc. Give moist air Baker treatmentd. Give contrast bathe. Administer water additivesf. Disinfect hydrotherapy equipment
i PERFORMANCE OBJECTIVE
(Stimulus) Upon instructions from physical therapist(Behavior) The PTA will prepare/give patient hydrotherapy
treatment, assist the physical therapist, whenrequested, with exercise program for patientin Hubbard's tank, clean and disinfect allhydrotherapy equipment after use and return todesignated area
(Conditions) Without direct supervision; using whirlpool,water plinth/stretcher, moist air Baker andcontrast bath
(Criteria) Treatment performed in accordance with patient'stolerance and standard accepted temperaturelevels; demonstrating empathy and awareness ofpatient's feeling of dependence
(Consequence) Improvement in patient's physical condition(Next Action) Record patient's objective and subjective response
to treatment
* KNOWLEDGES AND SKILLS
Physiological and psychological effects of heatand cold
Patient's disability/limitationsEffects of hydrotherapy on patient's conditionAnatomy/physiologySigns of adverse reaction, e.g., rash, chillingSafety precautionsEffects of buoyancy during treatment in waterIndications/contraindications for specifiedtreatment
PsychologyEmergency first aidTreatment techniques and dosageUse of water additivesFunction, operation and maintenance of hydrotherapy
equipment, e.g., moist air Baker, water plinth/stretcher, whirlpool, contrast bath
Transfer, positioning and appropriate draping of patientTechniques for changing dressings
IL_ , . .... . ' ... .... ,5
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit I: Physical Agents
MODULE 5: THERAPEUTIC POOL
TASKS a. Check therapeutic pool air and watertemperatures
b. Adjust chlorination for pH of pool waterc. Instruct patient in safety proceduresd. Treat patient in therapeutic poole. Drain and clean therapeutic poolf. Inspect therapeutic pool filtering systemg. Treat patient using walking tank
PERFORMANCE OBJECTIVE
(Stimulus) Upon being assigned to the therapeutic pool/walking tank
(Behavior) The PTA will maintain the environment, equipmentand water, explain the procedure and relatedsafety precautions to the patient, and administeror supervise the prescribed treatment, assistingthe patient with the exercise or ambulationprogram when requested
(Conditions) Without direct supervision(Consequence) These actions will hasten patient's rehabilitation(Next Action) Record patient's progress and tolerance
KNOWLEDGES AND SKILLS
Principles and techniques of therapeutic exerciseand ambulation
Archimedes' principleTransfer, positioning and draping techniquesTreatment objectives and progressionPsychological apprehensions of patientsMaintenance of therapeutic pool, environment,
water and equipmentIndications and contraindications for treatment
in therapeutic pool/walking tankSafety precautions and proceduresFunction and use of equipmentDosage
6
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k ': -- a a
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit I: Physical Agents
MODULE 6: CRYOTHERAPY
TASKS a. Perform surface sensitivity testb. Give ice massagec. Give ice pack treatment
PERFORMANCE OBJECTIVE
(Stimulus) Upon receiving a patient for cryotherapy andfollowing administration of a sensitivity test
I by the physical therapist(Behavior) The PTA will administer the specified method(s)
of cryotherapy, e.g., ice pack, ice towel, iceI massage, ice bath
(Conditions) Without direct supervision; using cryotherapyequipment, e.g., ice pack machine, ice collars/pack
(Consequence) This action will constitute the patient's treatmentand aid in relief of pain and restoration offunctional use of the part treated
(Next Action) Observe, report and record patient's objectiveand subjective response to the procedure
1 KNOWLEDGES AND SKILLS
Physiological and psychological effects ofcryotherapy
Indications and contraindications for cryotherapyObjectives of cryotherapy
* Appropriate treatment dosagesRecognition of patient's tolerance to cryotherapySafety precautions for cryotherapyPurpose of sensitivity testingCryotherapy vs. use of heatUse and maintenance of cryotherapy equipment,
e.g., ice pack machine, ice collars/packCryotherapy principles and techniques, e.g., ice
pack, ice towel, ice massage, ice bathRecognition of listamine reaction
i! 7
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit I: Physical Agents
MODULE 7: INTERMITTENT CERVICAL AND LUMBAR TRACTION
TASKS a. Administer intermittent cervical tractionb. Administer intermittent lumbar traction
PERFORMANCE OBJECTIVE
(Stimulus) Upon receiving a patient for intermittent traction(Behavior) The PTA. will administer intermittent cervical
and/or lumbar traction(Conditions) Without direct supervision; using traction
equipment, e g., intermittent traction machine,cervical traction halter, lumbar traction belt
(Criteria) Dosage adjusted according to patient's responsewithin limits indicated by physical therapistor referral instructions
(Consequence) This action will constitute patient's treatmentand aid patient's improvement
(Next Action) Record dosage administered and the patient'ssubjective and objective response to treatment
KNOWLEDGES AND SKILLS
Mechanical effects of tractionConstant vs. intermittent tractionIndications and contraindications for intermittenttraction
Recognition of adverse reactionsProgression of treatmentPatient positioning techniquesSafety factorsPreparation of patientUse and maintenance of traction equipment, e.g.,
intermittent traction machine, cervicaltraction halter, lumbar traction belt
Techniques for adjusting dosage
LI
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit I: Physical Agents
MODULE 8: INTERMITTENT COMPRESSION
TASKS a. Measure extremity girthIb. Give intermittent compression treatment
PERFORMANCE OBJECTIVE
(Stimulus) Upon receiving a patient for intermittent compression(Behavior) The PTA will set up equipment and administer
intermittent compression to the extremities,measuring extremity girth before and aftertreatment
(Conditions) Without direct supervision; using intermittentcompression equipment, e.g., intermittent compressionunit and attachments
(Criteria) Treatment administered according to physician's/therapist's specifications for pressure and timeand to patient's subjective response
(Consequence) This action will aid in reducing edema(Next Action) Record measurements and patient's subjective
response to treatment
KNOWLEDGES AND SKILLS
Positioning of patient for intermittent compressionPhysiological and mechanical effects of intermittent
compressionFunction, use and maintenance of intermittent
compression equipment, e.g., intermittentcompression unit and attachments
Indications and contraindications for intermittentcompression
Intermittent compression principles and techniquesTechniques of extremity girth measurementApplication of various sleevesGenerally accepted pressure and time dosages
I Hygienic and safety factors
!9!1
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit I: Physical Agents
MODULE 9: SUPERFICIAL HEAT TREATMENT
TASKS a. Give hot moist pack treatmentb. Give infrared treatmentc. Give paraffin bath treatment
PERFORMANCE OBJECTIVE
(Stimulus) Upon receiving a patient for superficial heattreatment
(Behavior) The PTA will administer the appropriatetreatment, e.g., hot moist pack, infraredor paraffin bath treatment
(Conditions) Without direct supervision; using superficialheat treatment equipment, e.g., hot moist packmachine, hot moist packs, goggles, infrared lamp,paraffin bath equipment
(Criteria) According to therapist's instructions and observingproper application techniques, safety precautions,and draping and positioning techniques
(Next Action) Record patient's response to treatment
KNOWLEDGES AND SKILLS
Anatomy and physiologyPhysiological effects of heatIndications and contraindicationsPhysics related to heat and lightTechniques for application of each modalitySafety precautionsRecognition of adverse reactions to treatmentStandard temperature rangeUse, function and maintenance of superficial heat
treatment equipment, e.g., hot moist packmachine, hot moist packs, goggles, infraredlamp, paraffin bath equipment
Computation and application of inverse square law
10
IM
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit I: Physical Agents
MODULE 10: DEEP HEAT TREATMENT
TASKS a. Instruct patient in normal and abnormalIresponses during treatmentb. Give microwave diathermy treatmentc. Give constant/pulsating ultrasound treatmentd. Give combination ultrasound and electrical
stimulatione. Give shortwave diathermy treatment
PERFORMANCE OBJECTIVE
(Stimulus) Upon receiving a patient for deep heat treatment(Behavior) The PTA will question the patient for contraindications,
instruct patient in the procedure and administerthe prescribed deep heat treatment
(Conditions) Without direct supervision; using related equipment,e.g., microwave diathermy apparatus, shortwavediathermy apparatus, ultrasound machine
(Criteria) Performed according to prescription, observingI all safety factors(Consequence) This treatment will aid in relieving pain(Next Action) Record patient's progress and tolerance to the
i procedure
KNOWLEDGES AND SKILLS
I Anatomy of the neuromusculoskeletal and circulatorysystems
Physiological effects of shortwave, microwave andIultrasoundPrinciples and techniques of deep heat treatment
* Safety precautions and proceduresI Indications and contraindications for deep heat
treatmentGenerally accepted dosage and duration of treatmentEquipment usage, function and maintenance, e.g.,microwave diathermy apparatus, ultrasound machine,shortwave diathermy apparatus
Instructional/communication skills
TtI I ....... .. .... ..... .......... ...
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit I: Physical Agents
MODULE 11: MASSAGE
TASKS a. Perform facial massageb. Perform extremity massagec. Perform trunk massaged. Perform cervical massage
PERFORMANCE OBJECTIVE
(Stimulus) Upon receiving a patient for massage(Behavior) The PTA will give the indicated massage(Conditions) Without supervision; using approved media,
e.g., talc powder, oil or lotion for face,extremities or trunk
(Criteria) According to prescription, using standardaccepted strokes, e.g., effleurage, petrissage,friction, tapotement
(Consequence) The PTA gives the massage to achieve a sedativeeffect, to stimulate/increase circulation orto relieve muscle spasm
(Next Action) Record treatment
KNOWLEDGES AND SKILLS
Anatomy of musculoskeletal, circulatory andautonomic nervous systems
Physiological and psychological effects ofmassage
Proper preparation, positioning and draping of
patientPatient's history--known allergies to lotion or
powderIndications and contraindicationsObservation and evaluation of patient's condition
before, during and after treatmentStandard massage techniques/strokes, e.g.,effleurage, petrissage, friction, tapotement
Types of massage
12
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit I: Physical Agents
MODULE 12: ELECTRICAL STIMULATION
TASKS a. Perform electrical stimulation, faradic currentb. Perform electrical stimulation, galvanic current
PERFORMANCE OBJECTIVE
I (Stimulus) When instructed by the physical therapist(Behavior) The PTA .will give electrical stimulation treatment
to an injured muscle, nerve or group of musclesIusing the specified current, i.e., faradic orgalvanic
(Conditions) With direct supervision; using appropriate equipment,e.g., galvanic, faradic or sinusoidal generator,medcolator, pocket stimulator, chronaxie constantcurrent, stimulator
I (Next Action) Record treatment given and patient's response to it
KNOWLEDGES AND SKILLS
I Neuromusculoskeletal anatomyPhysiological effects of faradic and galvanic current
stimulationCommunication techniquesDifferences between faradic and galvanic currentsTypes of equipment, their therapeutic uses and
operation, e.g., galvanic/faradic/sinusoidalIgenerators, medcolator, pocket stimulator,chronaxie constant current stimulator for treatment
Safety precautionsi Low frequency current
Recognition of adverse effects of treatment
11] 13
] __ _
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit I: Physical Agents
MODULE 13: ULTRAVIOLET TREATMENT
TASKS a. Explain procedures and safety precautions topatient
b. Drape and position patient according tosafety precautions
c. Determine minimal erythemal dosage (MED)d. Give ultraviolet treatmente. Maintain ultraviolet equipment
PERFORMANCE OBJECTIVE
(Stimulus) When directed by the physical therapist(Behavior) The PTA will establish an MED for the patient and
administer ultraviolet treatment to the specifiedbody part
(Conditions) With supervision; using appropriate ultravioletequipment, e.g., stationary, spot, and protectiveequipment, e.g., goggles
(Criteria) Observing appropriate safety precautions;administering the prescribed dosage
(Consequence) The results of this treatment will range frommild erythema to desquamation, according todirections
(Next Action) Observe and report patient's objective andsubjective response to treatment; report adversereaction immediately to therapist
KNOWLEDGES AND SKILLS
Draping and positioning techniques to expose onlythe body part to be treated while protectingparts not being treated
Procedures to establish an MEDOperation and maintenance of ultraviolet equipment,
e.g., stationary ultraviolet equipment, spotultraviolet equipment
Hazards of ultraviolet treatment and safetyprocedures to protect PTA and patient
Use of safety equipment, e.g., goggles, protectivecoverings
14
7 -7 7 .
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit I: Physical Agents
MODULE 14: DRESSING WOUNDS
TASKS a. Dress woundb. Apply topical ointmentsc. Clean and maintain dressing instruments
PERFORMANCE OBJECTIVE
(Stimulus) When directed by the physical therapist to dressa wound
(Behavior) The PTA will set up and maintain a sterile field,apply topical medications, when necessary, and selectand apply appropriate dressings
(Conditions) Without direct supervision; using appropriateI materials and instruments(Criteria) Dressing applied properly to allow free circulation,
protect the wound and, when possible and desirable,allow freedom of motion to the bandaged part
KNOWLEDGES AND SKILLS
Positioning of body parts to be bandagedSelection of appropriate dressing materialsSterile technique
II Bandaging procedures to allow freedom of motionBandaging procedures to allow freedom of
circulationBandaging procedures to inhibit motion of partTopical ointments and procedures for their applicationUse and maintenance of dressing instrumentsBandaging to reduce edema
*1I
1 15
I
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
COMPETENCY UNIT II: THERAPEUTIC EXERCISE
This unit includes the following modules:
Number Title Page
1 Patient Preparation for Treatment ...... . 17
2 Baseline Measurements. . . .... ...... 18
3 Range of Motion Exercises . . . ........ 19
4 Strengthening Exercises .. . . . ... . 20
5 Respiratory Exercises . . . . 21
6 Special Exercise Programs . . ......... 22 V7 Muscle Re-education ............. 23
8 Posture Training . . . . . . .......... 24
9 Mat Exercises . . . . . . . . . . . . . . . . 25
16
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit II: Therapeutic Exercise
MODULE 1: PATIENT PREPARATION FOR TREATMENT
TASKS a. Set up equipment/supplies for exercise/programsI b. Assess patient's tolerance of exercise oractivity
c. Observe for contracturesd. Modify equipment according to patient's
disabilitye. Position/hold limbs during treatment
I PERFORMANCE OBJECTIVE
(Stimulus) Upon receiving a patient for therapeutic exercise(Behavior) The PTA will select and set up the equipment and
supplies needed, assess the patient's toleranceand limitatiorn, modify the equipment according tothe patient's disability, and make suggestionsregarding the patient's exercise program
(Conditions) With direct supervision(Criteria) Modification of care according to patient's responses(Consequence) These actions will ensure maximum therapeutic
effectiveness of the exercise program
KNOWLEDGES AND SKILLS
Equipment and supplies required for variousexercises
Physiological effects of exerciseStandard tolerance levels for a patient with a
specific disease or disabilityJoint and muscle anatomyKinesiologyEquipment and care modificationI Exercise program progressionAppropriate patient positioningBody mechanicsRecognition of patient's tolerance and response
to treatment
1I11 17
I
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit II: Therapeutic Exercise
MODULE 2: BASELINE MEASUREMENTS
TASKS a. Measure muscle girthb. Assist with measurement of joint motionc. Measure hand grip and pinch strengthd. Record baseline measurements
PERFORMANCE OBJECTIVE
(Stimulus) When requested to assist a physical therapistwith baseline measurements
(Behavior) The PTA will accurately measure joints and muscles,determine hand strengths and record results
(Conditions) With supervision and assistance; using appropriateinstruments, e.g., goniometer, dynamometer,and recording forms
(Criteria) Accurate manipulation of instruments and accuratereading and recording of results
(Consequence) This information will allow objective reportingof the patient's condition and will provide a basisfor comparison when future measurements are taken
KNOWLEDGES AND SKILLS
Procedures to measure muscle girthProcedures to measure joint motionProcedures to measure hand grip and pinch strengthAppropriate recording formsTechniques for assisting with placement, use andreading of goniometer
Types of goniometersRecording proceduresFunction and use of dynamometer
18
I
- 7 - --- ~~!hI
IH Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit II: Therapeutic Exercise
MODULE 3: RANGE OF MOTION EXERCISES
TASKS a. Give passive range of motion exercisesb. Assist patient in performing active-assistive
range of motion exercisesc. Instruct patient in'active range of motion
exercisesd. Instruct patient in self-stretching activitiese. Modify program according to patient's response
PERFORMANCE OBJECTIVE
(Stimulus) Upon receiving a patient for range of motionIexercises
(Behavior) The PTA will assist the physical therapist indetermining the type of range of motion exercisesto be given and will perform passive RON,assist patient with active-assistive ROM or instructpatient in active ROM and/or self-stretching
*activities, as indicated(Conditions) With direct supervision; using appropriate equipment
for active-assistive and active ROM, e.g., bicycleexerciser, finger ladder, shoulder wheel, rowingmachine, wand, reciprocal pulley
(Consequence) These actions will constitute the patient's treatmentand will maintain or increase joint range of
Nmotion
KNOWLEDGES AND SKILLS
Joint anatomy including normal range of motionSafety precautionsEffects of gravity on patient positioningPlanes and axes of the bodyEffects of and how to release spasticity bypassive station
Physiological effects of exercise, e.g.,cardiorespiratory response
Dangers of contracturePhysiology of contracture
I Adaptation/modification of program to patient'sneeds/abilities
Use of equipment for active-assistive and activeROM, e.g., bicycle exerciser, finger ladder,shoulder wheel, rowing machine, wand, reciprocalpulley
Contraindications and indications of differentpathologies
Communication skillsI Diagonal pattern range of motion
1 19
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit II: Therapeutic Exercise
MODULE 4: STRENGTHENING EXERCISES
TASKS a. Instruct patient in active-assistive exercisesb. Instruct patient in active exercisesc. Instruct patient in active-resistive exercisesd. Instruct patient in isometric exercisese. Instruct patient in use of exercise equipment
including isokinetic exerciserf. Modify program according to patient's response
PERFORMANCE OBJECTIVE
(Stimulus) When instructed by the physical therapist(Behavior) The PTA will aid in determining the muscle
strengthening program to be used, instruct thepatient in the indicated exercises, observe patient'sperformance and modify treatment according topatient's response
(Conditions) With direction and occasional supervision; usingappropriate exercising equipment
(Consequence) These actions will strengthen the muscles ormuscle groups involved
KNOWLEDGES AND SKILLS
Physiology of muscle contractionAdaptation/modification of program to patient's
needs/abilitiesIsometric exercise vs. isotonic exercise vs.
isokinetic exercisePurposes, principles, and progression of strengthening
programsTechniques to instruct patient in active-assistive,
active, active-resistive exercises which involveisotonic, isometric and isokinetic contractions
Function and use of exercise equipment, e.g., wristroller, weight lifting equipment, spring exerciser,pull-up bars, Elgin steel frame exercise unit,N-K exercise unit, ankle exerciser, quad bridges(stump blocks), isometric table, isometricmachine, isokinetic exercisers
Positioning and variations for various muscle groupsKinesiologyPRE, weight loading, brief maximal exerciseIndications and contraindications for strengtheningexercises
Normal muscular strength expectationsRecognition of signs of fatigue
20
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit II: Therapeutic Exercise
MODULE 5: RESPIRATORY EXERCISES
TASKS a. Explain rationale for postural drainage~to patient
b. Position/assist patient for postural drainagec. Give percussion and vibration treatmentd. Instruct patient in coughing and breathing
exercisese. Modify program according to patient's response
I PERFORMANCE OBJECTIVE
(Stimulus) Upon receiving a patient for postural drainage(Behavior) The PTA will explain the purpose of the procedure
to the patient, position the patient for posturaldrainage on the tilt table or in bed, instructhim in coughing and breathing exercises and/or givepercussion and vibration treatment
(Conditions) With direction from the physical therapist; usingexercising equipment, e.g., tilt table, mechanicalpulmonary-assist machinery, suctioning equipment
(Consequence) These actions will assist the patient to coughand generate secretions
(Next Action) Observe, report and record patient's response andtolerance to the procedure
KNOWLEDGES AND SKILLS
Anatomy, especially internal organsPulmonary physiologyPrinciples, objectives and techniques of pulmonaryprograms and exercises
i Use of gravity, percussion, resistance, range ofmotion and re-education
Indications and contraindications according topathologies
Sputum/mucous culture techniquesPsychological factorsUse of equipment, e.g., tilt table, mechanicalpulmonary-assist machinery, suctioning equipment
Techniques for positioning patientTechniques for percussion and vibration proceduresTechniques to instruct patient in coughing and
deep breathingRecognition of adverse reactions
i Emergency first aid care
12
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit II: Therapeutic Exercise
MODULE 6: SPECIAL EXERCISE PROGRAMS
TASKS a. Instruct patient in back exercises, e.g.,Williams' regime
b. Instruct patient in coordination exercises,e.g., Frenkel exercise
c. Instruct patient in vascular exercises, e.g.,Buerger-Allen
d. Instruct patient in pre- and post-thoracostomyexercises
e. Instruct patient in breathing exercisesf. Instruct patient in prenatal exercisesg. Instruct patient in postpartum exercisesh. Modify program according to patient's
response
PERFORMANCE OBJECTIVE
(Stimulus) Upon receiving a patient for a special exerciseprogram
(Behavior) The PTA will explain the purpose of the program andinstruct the patient in the appropriate specialexercises
(Conditions) With direction(Consequence) This action is designed to improve the patient's
condition and insure that the program is performedaccurately without the supervision of tAie PTA
(Next Action) Record patient's performance and schedu'e patientfor a recheck
KNOWLEDGES AND SKILLS
General principles and purpose of each exerciseprogram
Psychological responses to exercise programsPhysiological effects of exerciseAnatomy of the chest and pelvisCirculatory physiologyAnatomic and physiologic changes with pregnancyTechniques of program adaptation to needs and
limitations of individual patientIndications and contraindications for eachexercise program
Progression of particular programsTechniques of demonstration and instruction in
special treatment programs
22
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit II: Therapeutic Exercise
MODULE 7: MUSCLE RE-EDUCATION
TASKS a. Re-educate muscle groups weakened by diseaseor injury to the peripheral nervous system
b. Perform muscle re-education following tendon/muscle transplant
c. Modify patient care according to patient'sresponse
PERFORMANCE OBJECTIVE
(Stimulus) Upon receiving a patient for re-education of amuscle or muscle groups
(Behavior) The PTA will instruct or assist the patient inmuscle re-education actively, manually or withmechanical assistance
(Conditions) With supervision(Consequence) This action will improve the patient's awareness
of the involved part and aid in restoring strengthto the part
I (Next Action) Record patient response to treatment
KNOWLEDGES AND SKILLS
Neuromusculoskeletal system anatomyIndications and contraindications for musclere-education exercise
Purposes and goals of muscle re-educationTypes of nerve lesionsTypes of muscle/tendon transplantsManual and mechanical assistance techniques for
re-education of muscle/muscle groupsActive muscle re-education techniquesI Neurophysiology of the peripheral nervous system
III!1 23
i I. ................ ........
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit II: Therapeutic Exercise
MODULE 8: POSTURE TRAINING
TASKS a. Instruct patient in posture principlesb. Instruct patient in general and specific
posture exercises
PERFORMANCE OBJECTIVE
(Stimulus) Upon receiving a patient for general postureexercises and after evaluation by the physicaltherapist
(Behavior) The PTA, without direct supervision, will instructthe patient in posture principles and generalexercises. With direction and supervision, thePTA will also instruct the patient in specific
posture exercises(Consequence) These actions will constitute the patient's
treatment and aid in maintaining or restoringproper posture
(Next Action) Record patient's response to instruction andschedule patient for re-check of exercises
KNOWLEDGES AND SKILLS
Normal postureBasic postural and vertebral durationsPosture terminologyPosture exercisesIdentification and application of various braces,
splints and corsetsSafe body mechanicsPathologies of the musculoskeletal systemIndications and contraindications for exerciseTechniques for instruction in posture principles,
body mechanics and exercises
24
wwi
IICompetency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit II: Therapeutic Exercise
I MODULE 9: MAT EXERCISES
TASKS a. Instruct patient in various mat activities,e.g., rolling, crawling, sitting balance, kneewalking, mat crutches and group exercises
b. Modify program according to patient'sI response
PERFORMANCE OBJECTIVE
I (Stimulus) When instructed by the physical therapist(Behavior) The PTA will instruct/supervise patient in mat
i activities(Conditions) With remote supervision by the therapist; using
large mat, mat crutches and triceps blocks(Consequence) Increased coordination, tolerance, function, etc.(Next Action) When ready, progress to next step in sequence
KNOWLEDGES AND SKILLS
4 UAnatomy and physiologyTherapeutic mat exercisesPatient's disability/limitationsInstructional techniquesSafety precautionsPathologiesDevelopmental sequence of exercise programsGait patterns
II
IIII
| 25
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
COMPETENCY UNIT III: AMBULATION
This unit includes the following modules: Io
Number Title Page
1 Tilt Table Procedure ............. 27
2 Application/Removal and Care of Braces . . .. 28
3 Patient Preparation for AmbulationTraining . . . . . . . . . . . . . . . . . . . 29
4 Crutch Tra ining . . 0... .. ..... 30
5 Cane and Walker Training. . . ..... . .. 31
[
26
I Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit III: Ambulation
I MODULE 1: TILT TABLE PROCEDURE
TASKS a. Administer tilt table treatment
PERFORMANCE OBJECTIVE
(Stimulus) When necessary prior to ambulation training(Behavior) The PTA will transfer and position patient on
tilt table and administer tilt table treatment(Conditions) Without direct supervision; using tilt table,
safety equipment (straps, belts, etc.) andvital sign instruments
(Criteria) Observing all safety precautions; patient mustshow stable vital signs to begin gait training
(Consequence) Patient will have enough tolerance of uprightposition to begin ambulation training
(Next Action) Begin ambulation training on parallel bars,crutches or walker
I KNOWLEDGES AND SKILLS
Physiology of the circulatory systemEmergency procedures for syncopePatient's conditionContraindications to treatmentPrinciples of tilt table procedure
IPsychological approachTechniques to take and interpret vital signsTechniques to transfer and position patient on
tilt tableRecognition of patient's response to treatmentsFunction and use of related equipment, e.g., tilt
table, vital sign instruments, safety equipment(straps, belts, etc.)
II,!I
I!2I xmn
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit III: Ambulation
MODULE 2: APPLICATION/REMOVAL AND CARE OF BRACES
TASKS a. Apply/remove braceb. Instruct patient in how to apply/remove bracec. Maintain/adjust/modify splints and braces
PERFORMANCE OBJECTIVE
(Stimulus) When assigned(Behavior) The PTA will instruct and supervise patient on how
to apply/remove splint or brace and on maintenance,adjustment and modification of splints and braces
(Conditions) With remote supervision; using brace or splint,e.g., keystone splints
(Consequence) Patient able to perform all tasks needed for properuse of splint or brace
(Next Action) Recheck patient periodically
KNOWLEDGES AND SKILLS
Type of brace or splint being used, e.g., keystonesplint/braces
Techniques of application/removalPatient's disabilityBiomechanics of braces/splintsSurface anatomyRecognition of need for maintenance, adjustmentor modification of brace or splint
Protection of skin and clothingRecognition of pressure areas or other skin infections
caused by braces or splints
28
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit III: Ambulation
MODULE 3: PATIENT PREPARATION FOR AMBULATION TRAINING
TASKS a. Wrap paralyzed extremities for venous supportb. Adjust parallel bars to correct heightc. Teach patient to balanced. Fit crutchese. Fit canef. Adjust walker to correct heightg. Recommend temporary shoe lifth. Place safety belt on patient
PERFORMANCE OBJECTIVE
(Stimulus) Patient arriving at clinic for ambulation training(Behavior) The PTA will prepare the patient for ambulation
training, e.g., instruct in balancing activitieson parallel bars, adjust crutches/walker/cane toproper length, recommend shoe lift when appropriate,instruct patient in safety precautions forassisted ambulation
(Conditions) Without direct supervision; using adjustable parallelbars, posture training glass mirror, crutches, caneor walker and safety belt
(Criteria) Patient must have necessary balance and correctfitting of crutches, cane or walker to completeambulation training
I (Next Action) Begin instruction in gait training
KNOWLEDGES AND SKILLS
Techniques for application/removal of upper andlower extremity splints
Operation of locking mechanism on upper and lowerextremity splints
I Function and use of ambulation equipment, e.g.,parallel bars, posture training mirror, crutches,
i cane and walkerTechniques for adjusting crutches or walkerPatient's injuryContraindications to ambulation trainingSafety precautions in assisted ambulation
29
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit III: Ambulation
MODULE 4: CRUTCH TRAINING
TASKS a. Teach patient safety precautionsb. Teach patient three-point crutch gaitc. Teach patient four-point crutch gaitd. Teach patient two-point crutch gaite. Teach patient swing-to or swing-through gaitf. Teach patient in body cast to use crutchesg. Teach patient to use axillary crutchesh. Teach patient to use Lofstrand crutchesi. Teach patient to perform daily activities
on crutches
PERFORMANCE OBJECTIVE J(Stimulus) Upon completion of patient's ambulation preparation(Behavior) The PTA will instruct and supervise patient in use
of the prescribed crutch gait and in performingdaily activities on crutches
(Conditions) Without direct supervision; using axillary orLofstrand crutches, safety belt
(Criteria) Observing proper safety techniques(Consequence) Patient able to perform crutch gait(s) and daily
activities, adhering to all safety precautions 1KNOWLEDGES AND SKILLS
Techniques for instruction in all crutch gaitsusing axillary or Lofstrand crutches
Observational techniques to verify that safetyprecautions and appropriate gait patterns are Icarried out
Biomechanics of normal gait -
Techniques for instruction in daily activities usingcrutches, e.g., in and out of car, up and downstairs and ramps, on and off toilets, in andout of chairs, through doors
Patient's injury and limitations, including bodycasts
Degree of weight bearing
.
30 Ii.
I Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit III: Ambulation
MODULE 5: CANE AND WALKER TRAINING
TASKS a. Teach patient use of cane on level andnon-level surfaces
b. Teach patient use of walker with full weight,partial weight or non-weightbearing gait
c. Teach patient use of cane and walker instanding up and sitting down
d. Teach patient to use walker on curbs
PERFORMANCE OBJECTIVE
(Stimulus) Upon receiving directions for cane or walkertraining
(Behavior) The PTA will teach patient how to manage cane/walker on level and non-level surfaces and indaily activities
(Conditions) With remote supervision; using canes, walkers,safety belt
(consequence) Patient able to manage cane/walker safely and toI perform daily activities independently
KNOWLEDGES AND SKILLS
Techniques of instructing patient in use ofcane/walker on level surfaces and non-levelsurfaces, e.g., ramps, stairs, curbs, andin standing up and sitting down
Safety precautions for walkers and canesTechniques of instructing patient in walker gaits
with varying degrees of weightbearing
3II
1 31
.1"
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
COMPETENCY UNIT IV: AMPUTEE REHABILITATION
This unit includes the following modules:
Number Title
1 Preprosthetic Caree........... 33
2 Stump Dynamics . . . . . . . . . . . . . . 34
3 Care of Prosthesis ......... . . . . 35
4 Prosthetic Training I ............ 36
5 Prosthetic Training II ............ 37
32
lA
ICompetency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit IV: Amputee Rehabilitation
MODULE 1: PREPROSTHETIC CARE
TASKS a. Wrap stump for shape/shrinkageb. Instruct patient. in body and stump positioningc. Teach patient to wrap stumpd. Teach stump hygienee. Teach patient to toughen and mature stump, e.g.,
tapotement
i PERFORMANCE OBJECTIVE
(Stimulus) When instructed by the physical therapist(3ehavior) The PTA will wrap the stump for shaping and
I shrinking and instruct the patient in stump wrapping.He will also teach the patient body and stumppositioning to prevent contractures, good stumphygiene'and how to toughen and mature the stumpby tapping or slapping
(Conditions) Without direct supervisioni (Next Action) Fit prosthesis
KNOWLEDGES AND SKILLS
Psychological impact of amputationPsychological approach to amputeesLevels of amputations, surgical aspectsPhysiology of circulatory, muscular and nervous
systemsAnatomy of muscles, joints and surfaceImmediate postop fitting of an amputeeLimitations of range of motion, dangers ofcontracture
Composition of amputee rehabilitation teamTechniques to reassure patientPrinciples and techniques of stump wrapping,toughening and conditioningI Instructional techniques
3!I1 33
!
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit IV: Arputee Rehabilitation
MODULE 2: STUMP DYNAMICS
TASKS a. Instruct and supervise patient in stumpdynamics to strengthen muscle groups
b. Instruct and supervise patient in stumpdynamics to maintain/increase range of motion
PERFORMANCE OBJECTIVE
(Stimulus) When instructed by the physical therapist(Behavior) The PTA will instruct and supervise a patient in
stump dynamics to maintain/increase range of motionand to strengthen various muscle groups
(Conditions) Without direct supervision(Criteria) According to principles of therapeutic exercise(Consequence) Patient with full range of motion and normal
strength, able to fully utilize prosthesis(Next Action) Instruct patient in use and care of prosthesis
KNOW-LEDGES AND SKILLS
GoniometryPhysiological effects of exerciseJoint anatomyPurposes and principles of exercisePatient's psychological response to exercisesSequence of exercise and progress of programsthrough various types of exercise
Levers and consequences of change of length of leverNew kinesthetic sense and afferent inputBalance problems for amputee levelsIndications and contraindications for strengtheningmuscle groups
Surgical aspects and construction of bicepscineplasty
Techniques to instruct patient in exercise procedureand strengthening routines
Application of manual/equipment methods of stretchinTechniques to support limbs and perform passive and
active-assistive range of motion exercisesTechniques to measure excursion of biceps cineplasty.
34
raw,.
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
I Unit IV: Amputee Rehabilitation
MODULE 3: CARE OF PROSTHESIS
TASKS a. Instruct patient in basic components ofprosthesis
b. Instruct patient in care of prosthesis
PERFORMANCE OBJECTIVE
(Stimulus) When a patient is ready for prosthetic trainingand upon receiving a prosthesis
(Behavior) The PTA will instruct the patient in the basiccomponents of the prosthesis and how to care forit. In the case of a lower extremity amputation,the PTA will also instruct patient in use of thepylon
(Conditions) Without direct supervision(Consequence) A patient familiar with and able to care for his
prosthesis, ensuring better acceptance of prosthesisby the patient
(Next Action) Train the patient to put on and remove prosthesis
KNOWLEDGES AND SKILLS
aNormal gait kinesiologyPrinciples and techniques of pylon useBasic components of prostheses including harnessing
and various supportsConstruction and fabrication of various prosthesesGeneral care and maintenance of prosthesesProcedures to check for proper fit of prosthesisProcedures to check for proper alignment of
prosthesisInstructional techniquesRecognition of cause of gait deviations, e.g.,
fit, alignment, lack of amputee proficiency
I
35
swi
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit IV: Amputee Rehabilitation
MODULE 4: PROSTHETIC TRAINING I
TASKS a. Apply/remove prosthetic applianceb. Teach patient how to dress with and over prosthesil
PERFORMANCE OBJECTIVE
(Stimulus) After introducing the patient to his prosthesis(Behavior) The PTA.will teach the patient how to put on,
align and remove the prosthesis to insure properfunctioning
(Conditions) With direct supervision(Next Action) Continue training
KNOWLEDGES AND SKILLS
Extremity anatomyReliefs and bulges in the socket of prosthesisVarious types of socketsProsthetic harnessing, supports-and attachmentsMechanics of application, removal and alignment
of prosthetic devicesTechniques to instruct patient in dressing with
and over prosthesisRecognition of proper prosthetic fit for comfort
and safetyRecognition of pressure areas
36
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit IV: Amputee Rehabilitation
MODULE 5: PROSTHETIC TRAINING II
TASKS a. Reinforce prosthetic training initiated bythe physical therapist
PERFORMANCE OBJECTIVE
I (Stimulus) After the patient learns the principlesof prosthetic application
(Behavior) The PTA will explain the principles and progressof prosthetic training
(Conditions) With direct supervision(Consequence) Knowledge of these principles will enable the
patient to better assess his own progress andachievements(Next Action) Notify amputee rehabilitation team
I KNOWLEDGES AND SKILLS
Gait analysisTechniques to instruct in sequence of task
activities for lower extremity prosthesesRecreational activities and equipment suitable for
the prosthetic weareritoTechniques to instruct in operation of prosthesesObservation of pressure areas on skinProper fit for comfort and safety
III
I
I 37
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
COMPETENCY UNIT V: REPORTING AND RECORDING
This unit includes the following module:
Number Title Page
I Reporting and Recording . . . . . . . . . . . . 39
38
Competency: PHYSICAL THERAPY ASSISTANT (PTA)
Unit V: Reporting and Recording
MODULE 1: REPORTING AND RECORDING
TASKS a. Record objective findings re patient treatmentand patient's response to treatment on patient'schart
b. Report findings to supervising therapist atestablished intervals
c. Report adverse patient response to supervisingtherapist immediately
IPERFORMANCE OBJECTIVE(Stimulus) Upon completion of patient treatment(Behavior) The PTA will record findings, treatment given and
patient's subjective and objective response inpatient's chart. Periodically the PTA will reportto the supervising therapist
(Criteria) Concisely and objectively, using proper medicalterminology
(Consequence) This will keep the treatment team members informedIof the specific treatment approach being usedand its results
KNOWLEDGES AND SKILLS
Observational techniquesRecognition of relevant observationsRecording and reporting proceduresAppropriate medical terminologySelection and use of appropriate forms
I
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' I 39
I I I II ...- .......,II I I-