Health OccupationsHealth OccupationsPhysical TherapyPhysical TherapySpecialty ModuleSpecialty Module

Designed by:Designed by:

Jim Tracy MS PTJim Tracy MS PT

Lori Tracy MS PT NCSLori Tracy MS PT NCS

East Carolina UniversityEast Carolina University

Department of Physical TherapyDepartment of Physical Therapy

Sponsored by Sponsored by Eastern Area Health Education CenterEastern Area Health Education Center

In collaboration withIn collaboration with Office of Generalist Programs at Office of Generalist Programs at

East Carolina University Brody School of MedicineEast Carolina University Brody School of Medicine

andand

The North Carolina Department of The North Carolina Department of

Public InstructionPublic Instruction

IntroductionIntroduction

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

How to use this moduleHow to use this module

Read through this PowerPoint presentationRead through this PowerPoint presentation Click on LinksClick on Links Links include videos from this CD and links Links include videos from this CD and links

to Websitesto Websites This is designed to be a student directed This is designed to be a student directed

learning activitylearning activity After review of this material you should be After review of this material you should be

able to meet most of the objectives of this able to meet most of the objectives of this specialty modulespecialty module

Student Goals of ModuleStudent Goals of Module

Complete all required objectives Complete all required objectives Keep a journal of your clinical experiencesKeep a journal of your clinical experiences Gain an understanding of the four areas of Gain an understanding of the four areas of

clinical practice in physical therapyclinical practice in physical therapy Demonstrate specific objectives as outlinedDemonstrate specific objectives as outlined

How long do I need to go to How long do I need to go to school to become a physical school to become a physical

therapist?therapist?

Physical therapy programs are either masters level Physical therapy programs are either masters level (MPT) or entry level doctoral programs be required to (MPT) or entry level doctoral programs be required to complete an undergraduate (DPT).complete an undergraduate (DPT).

You can get a degree in the field of your choice as long You can get a degree in the field of your choice as long as certain prerequisites are met.as certain prerequisites are met.

Start inquiring when you are first starting college about Start inquiring when you are first starting college about the specific requirements of the school(s) you are the specific requirements of the school(s) you are interested in attending.interested in attending.

Link: Link: Introduction to the Physical Therapy Profession (websitIntroduction to the Physical Therapy Profession (website)e)

Definition of Physical TherapyDefinition of Physical Therapy

These links provide the student with some These links provide the student with some definitions of Physical Therapydefinitions of Physical Therapy

Links:Links:

Definition of Physical Therapy (website)Definition of Physical Therapy (website)

Another Definition of Physical Therapy (website)Another Definition of Physical Therapy (website)

North Carolina Physical Therapy Practice Act (weNorth Carolina Physical Therapy Practice Act (website)bsite)

American Physical Therapy American Physical Therapy Association “APTA”Association “APTA”

This link provides information on the American This link provides information on the American Physical Therapy AssociationPhysical Therapy Association

Links:Links:

American Physical Therapy Association (website)American Physical Therapy Association (website)

Physical Therapy Practice Physical Therapy Practice Includes Four Main Areas:Includes Four Main Areas:

CardiovascularCardiovascular MusculoskeletalMusculoskeletal NeurologicalNeurological Integumentary (skin)Integumentary (skin)

Let’s Get StartedLet’s Get Started

Medical TerminologyMedical Terminology

You should have a basic understanding of medical You should have a basic understanding of medical terminology, the link below will give you an terminology, the link below will give you an overview. The following links will give you an overview. The following links will give you an introduction to medical terminologyintroduction to medical terminology

Links:Links:

Medical terminology (website)Medical terminology (website)

Medical terminology (website)Medical terminology (website)

Vital SignsVital Signs

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

Important points about taking a Important points about taking a patient’s pulsepatient’s pulse

Count a patient’s pulse for 15 sec then Count a patient’s pulse for 15 sec then multiply by 4multiply by 4

Pulse is measured in beats per minutePulse is measured in beats per minute Never take a pulse with your thumbNever take a pulse with your thumb Don’t press too hard or you will occlude the Don’t press too hard or you will occlude the

pulsepulse Note the rhythm, rate and forceNote the rhythm, rate and force

PulsesPulsesThe links below shoe the therapist monitoring The links below shoe the therapist monitoring each of these pulseseach of these pulses

Links:Links:

Brachial artery (video)Brachial artery (video)

Radial artery (video)Radial artery (video)

Carotid artery (video)Carotid artery (video)

Femoral artery (video)Femoral artery (video)

Measuring pulses (website)Measuring pulses (website)

Blood PressureBlood Pressure

The website link below will take you The website link below will take you through the steps to accurately measure through the steps to accurately measure blood pressure and the video will blood pressure and the video will demonstrate correct techniquedemonstrate correct technique

Links:Links:

Measuring blood pressure (website)Measuring blood pressure (website)

Measuring blood pressure (video)Measuring blood pressure (video)

Patient TransfersPatient Transfers

The links below will demonstrate correct transfer The links below will demonstrate correct transfer techniques for each of the following transferstechniques for each of the following transfers

Links:Links:Supine to sit (video)Supine to sit (video)Standing pivot transfer (video)Standing pivot transfer (video)Squat pivot transfer (video)Squat pivot transfer (video)Sliding board transfer (video)Sliding board transfer (video)Dependent transfer (video)Dependent transfer (video)Two person floor to mat transfer (video)Two person floor to mat transfer (video)Assist floor to mat (video)Assist floor to mat (video)

Ankle TapingAnkle Taping

The links below demonstrate correct The links below demonstrate correct technique for ankle taping and a link technique for ankle taping and a link to the National Athletic Trainers to the National Athletic Trainers Association WebpageAssociation Webpage

Links:Links:

Ankle taping (top view)Ankle taping (top view)

Ankle Taping (side view)Ankle Taping (side view)

Ankle taping (website)Ankle taping (website)

NATA (website)NATA (website)

BonesBones

This link has anatomical models of This link has anatomical models of all the bones of the bodyall the bones of the body

Links:Links:

Bone box (website)Bone box (website)

MassageMassage

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

MassageMassage

The links below demonstrate basic massage The links below demonstrate basic massage strokesstrokes

Links:Links:General Massage for Low Back (Video)General Massage for Low Back (Video)

General Massage for Low Back (Video top view)General Massage for Low Back (Video top view)

The art of massage (website)The art of massage (website)

Passive Range of Motion Passive Range of Motion (PROM)(PROM)

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

Important points on passive Important points on passive range of motionrange of motion

Adequately stabilize patients joints as you Adequately stabilize patients joints as you move them. (some patients may have no move them. (some patients may have no active movement)active movement)

Don’t cause pain other than stretchingDon’t cause pain other than stretching Perform 5-10 motions per joint movementPerform 5-10 motions per joint movement Familiarize yourself with normal directions Familiarize yourself with normal directions

and degrees of movement for each jointand degrees of movement for each joint Listen to patientListen to patient

Passive Range of Motion Passive Range of Motion (PROM)(PROM)

These links demonstrate correct technique when These links demonstrate correct technique when doing passive range of motion on a patient doing passive range of motion on a patient

Links:Links:

PROM Upper extremity (video)PROM Upper extremity (video)

PROM lower extremity (video)PROM lower extremity (video)

Passive range of motion techniques(website)Passive range of motion techniques(website)

Goniometric MeasurementGoniometric Measurement

Measurement of joint motion by the Measurement of joint motion by the therapist using a therapist using a goniometergoniometer

Important points on Goniometric Important points on Goniometric measurementmeasurement

Motions measured can be either active or Motions measured can be either active or passivepassive

Standardized techniques are used for each Standardized techniques are used for each jointjoint

Normal ROM measurements can be found Normal ROM measurements can be found in chartsin charts

Joints should be adequately stabilized Joints should be adequately stabilized during measurementduring measurement

Goniometric MeasurementsGoniometric MeasurementsThese links show the therapist demonstrating These links show the therapist demonstrating goniometric measurement for the selected goniometric measurement for the selected movementsmovements

Links:Links:

Wrist extension (video)Wrist extension (video)

Elbow flexion (video)Elbow flexion (video)

Knee flexion (video)Knee flexion (video)

Hip abduction (video)Hip abduction (video)

Goniometric examples (website)Goniometric examples (website)

Manual Muscle Testing (MMT)Manual Muscle Testing (MMT)

Definition: subjective testing done by Definition: subjective testing done by the therapist to assess a patients the therapist to assess a patients muscle strength. The muscle strength muscle strength. The muscle strength is graded to be either normal, good, is graded to be either normal, good, fair, poor, trace or zerofair, poor, trace or zero

Muscle GradesMuscle GradesNormal:Normal: patient holds contraction against maximal resistance patient holds contraction against maximal resistance

at end rangeat end range

Good:Good: patient holds contraction against moderate resistance patient holds contraction against moderate resistance at end rangeat end range

Fair:Fair: patient moves through full range of motion against patient moves through full range of motion against gravity but unable to hold against resistance at end rangegravity but unable to hold against resistance at end range

Poor:Poor: patient moves through full range of motion in a gravity patient moves through full range of motion in a gravity minimized positionminimized position

Trace:Trace: therapist palpates muscle contraction as patient therapist palpates muscle contraction as patient attempts to move attempts to move

Zero:Zero: therapist is unable to palpate any muscle contraction as therapist is unable to palpate any muscle contraction as patient attempts to movepatient attempts to move

Muscle GradesMuscle Grades

Normal =Normal = 5/55/5

Good =Good = 4/54/5

Fair =Fair = 3/53/5

PoorPoor = = 2/52/5

Trace =Trace = 1/51/5

Zero =Zero = 0/50/5

Important points on manual Important points on manual muscle testingmuscle testing

Need to place patient in standardized Need to place patient in standardized positionposition

Isolate only one joint motionIsolate only one joint motion Don’t allow patient to compensate for Don’t allow patient to compensate for

weaknessweakness Compare same muscle bilaterallyCompare same muscle bilaterally Be consistent and reliable with testingBe consistent and reliable with testing

Manual Muscle TestingManual Muscle Testing

The following links demonstrate correct The following links demonstrate correct manual muscle testingmanual muscle testing

Links:Links:

Shoulder flexion (video)Shoulder flexion (video)

Elbow flexion (video)Elbow flexion (video)

Hip flexion (video)Hip flexion (video)

Knee extension (video)Knee extension (video)

Muscle testing (website)Muscle testing (website)

Muscle testing examples (website)Muscle testing examples (website)

Types of Muscle ContractionsTypes of Muscle Contractions Isometric:Isometric: muscle stays at same length during muscle stays at same length during

contraction ex: pushing against an immovable contraction ex: pushing against an immovable object like arm wrestlingobject like arm wrestling

Concentric:Concentric: Muscle shortens during contraction Muscle shortens during contraction ex: biceps during arm curlsex: biceps during arm curls

Eccentric:Eccentric: Muscle lengthens during contraction. Muscle lengthens during contraction. Ex: quadriceps when going down stepsEx: quadriceps when going down steps

This link discusses the different types of muscle This link discusses the different types of muscle contractions used in functional activitiescontractions used in functional activities

Link :Link :Types of muscle contractionsTypes of muscle contractions

Muscle AttachmentsMuscle Attachments

This link gives you all the muscle attachment This link gives you all the muscle attachment of every muscle in the body of every muscle in the body

Links:Links:

Muscle attachment list (website)Muscle attachment list (website)

Functional MovementsFunctional Movements

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

DermatomesDermatomes

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

Important points when testing Important points when testing dermatomesdermatomes

Refer to dermatome chart for specific areasRefer to dermatome chart for specific areas Testing is usually done with a blunt object Testing is usually done with a blunt object

(paperclip) or a pin.(paperclip) or a pin. Compare same area on opposite sideCompare same area on opposite side Ask patient is it the same increased Ask patient is it the same increased

(hypersensitive) or reduced (hyposensitive)(hypersensitive) or reduced (hyposensitive)

DermatomesDermatomes

These links demonstrate correct sensory testing of These links demonstrate correct sensory testing of the dermatomes and a dermatome chart. Links:the dermatomes and a dermatome chart. Links:

Pinwheel test instrument (video)Pinwheel test instrument (video)

Upper extremity sensory testing (video)Upper extremity sensory testing (video)

Dermatome Chart (website)Dermatome Chart (website)

Cutaneous innervationCutaneous innervation (website) (website)

Dermatome testing (sensory testing) (website)Dermatome testing (sensory testing) (website)

Learn your nerves (website)Learn your nerves (website)

Two Point DiscriminationTwo Point Discrimination

Patient is tested on how well they can Patient is tested on how well they can discriminate between on and two discriminate between on and two points using this instrumentpoints using this instrument

(click here)(click here)

Important points when testing Important points when testing 2-point discrimination2-point discrimination

Pressure to both points must be equalPressure to both points must be equal Usually done on the hand where Usually done on the hand where

discrimination is important to fine motor discrimination is important to fine motor controlcontrol

Patient should be able to discriminate points Patient should be able to discriminate points as close together as 2-3 mm on handas close together as 2-3 mm on hand

Is a measure of dorsal column integrityIs a measure of dorsal column integrity

2-Point Discrimination2-Point Discrimination

These links demonstrate correct These links demonstrate correct testing of 2 point discriminationtesting of 2 point discrimination

Links:Links:

2-pt testing on arm (video)2-pt testing on arm (video)

2-pt testing on hand (video)2-pt testing on hand (video)

ProprioceptionProprioception

These links show the therapist performing These links show the therapist performing proprioceptive testingproprioceptive testing

Links:Links:

WristWrist proprioception proprioception (video) (video)

AnkleAnkle proprioception proprioception (video) (video)

Big toeBig toe proprioception proprioception (video) (video)

ReflexesReflexes

Represent Represent monosynaptic reflex monosynaptic reflex loop at spinal levelsloop at spinal levels

Check integrity of Check integrity of lower motor neuron lower motor neuron loop at specific spinal loop at specific spinal levelslevels

ReflexesReflexes

These links describe reflex testing and show the These links describe reflex testing and show the therapist demonstrating reflex testingtherapist demonstrating reflex testing

Links:Links:

Monosynaptic reflex arc (Website)Monosynaptic reflex arc (Website)

Triceps reflex (video)Triceps reflex (video)

Biceps reflex (video)Biceps reflex (video)

BrachioradialisBrachioradialis reflex (video) reflex (video)

Knee jerk reflex (video)Knee jerk reflex (video)

Knee jerk reflex (video)Knee jerk reflex (video)

Achilles reflex (video)Achilles reflex (video)

Important points when testing Important points when testing reflexesreflexes

Use light grip on reflex hammerUse light grip on reflex hammer Compare bilaterallyCompare bilaterally Grade as normal hyperactive or hypoactiveGrade as normal hyperactive or hypoactive Results are used with dermatome to Results are used with dermatome to

determine spinal root problemdetermine spinal root problem

Posture Body Mechanics and Posture Body Mechanics and LiftingLifting

Links:Links:

Posture (video)Posture (video)

Normal curves (video)Normal curves (video)

Straddle lift (video)Straddle lift (video)

Tripod lift (video)Tripod lift (video)

Golfer’s lift (video)Golfer’s lift (video)

Ergonomics (website)Ergonomics (website)

BalanceBalance

Definition: Maintaining center of mass within Definition: Maintaining center of mass within your base of supportyour base of support

Other Terminology used to describe balance: Other Terminology used to describe balance:

Center of GravityCenter of Gravity

EquilibriumEquilibrium

Cone of StabilityCone of Stability

BalanceBalance

The following links will help you understand The following links will help you understand balance related to functional activities and some balance related to functional activities and some ways therapists test a patient’s balanceways therapists test a patient’s balance

Links: Links:

Practicing Balance (website)Practicing Balance (website)

Falls in elderly (website)Falls in elderly (website)

Dynamic sitting balance (video)Dynamic sitting balance (video)

Dynamic sitting balance (top view) (video)Dynamic sitting balance (top view) (video)

Berg Balance Assessment (video)Berg Balance Assessment (video)

GaitGait

Other terms used to describe gait: Other terms used to describe gait:

Ambulation/LocomotionAmbulation/Locomotion

Controlled movement of your base of Controlled movement of your base of support.support.

Gait AssessmentsGait Assessments

Determining safety and efficiency of Determining safety and efficiency of ambulation.ambulation.

These links will demonstrate the therapist These links will demonstrate the therapist performing gait assessment testsperforming gait assessment tests

Links:Links:

Timed Get up and Go Test (video)Timed Get up and Go Test (video)

Dynamic Gait Index (video)Dynamic Gait Index (video)

Gait with Assistive DevicesGait with Assistive Devices

Determining appropriate assistive device is based Determining appropriate assistive device is based upon: Client safety, client preference, upon: Client safety, client preference, impairment/injury, and environmental impairment/injury, and environmental circumstancescircumstances

Types of devices may include:Types of devices may include: Straight CaneStraight Cane Quad Cane (Large or Small)Quad Cane (Large or Small) Walker (Standard or wheeled)Walker (Standard or wheeled) HemiwalkerHemiwalker Crutches (Axillary/Loftstrand)Crutches (Axillary/Loftstrand)

Physical Therapy and Gait Physical Therapy and Gait TrainingTraining

Determining appropriate deviceDetermining appropriate device Measuring device for proper fitMeasuring device for proper fit Education of gait with assistive deviceEducation of gait with assistive device Sitting, standing and balancing with Sitting, standing and balancing with

assistive deviceassistive device Progression of gait to include Progression of gait to include

environmental surfaces client will encounter environmental surfaces client will encounter during daily activities.during daily activities.

Device Fitting and AmbulationDevice Fitting and Ambulation

These links will demonstrate correct These links will demonstrate correct instruction and assistance with gaitinstruction and assistance with gait

Links:Links:Measurement of Device (Video)Measurement of Device (Video)

Gait Patterns:Gait Patterns:

Two point reciprocal gait pattern (Video)Two point reciprocal gait pattern (Video)

Gait with standard walker (video)Gait with standard walker (video)

Crutch training non-weight bearing swing to(Video)Crutch training non-weight bearing swing to(Video)

Crutch training non-weight bearing swing through (video)Crutch training non-weight bearing swing through (video)

Stair training with crutches non-weight bearing (video)Stair training with crutches non-weight bearing (video)

Thermal ModalitiesThermal Modalities

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

Thermal ModalitiesThermal Modalities Hot packsHot packs DiathermyDiathermy FluidotherapyFluidotherapy UltrasoundUltrasound MicrowaveMicrowave InfraredInfrared WhirlpoolWhirlpool ParaffinParaffinThese links will describe physiological rationale for These links will describe physiological rationale for

thermal modalitiesthermal modalitiesLinks: Links: Introduction to Thermal Modalities (website)Introduction to Thermal Modalities (website)

Thermal agents (website)Thermal agents (website)

CryotherapyCryotherapyThe use of cold modalities for the purpose The use of cold modalities for the purpose of vasoconstriction to produce a decrease of vasoconstriction to produce a decrease in the following: cell metabolism, in the following: cell metabolism, inflammation, pain and muscle spasminflammation, pain and muscle spasm

These links will describe physiological rationale for use These links will describe physiological rationale for use of cold modalitiesof cold modalities

Links:Links:

CryotherapyCryotherapy (website) (website)

AnotherAnother Cryotherapy Cryotherapy (website) (website)

Electrical ModalitiesElectrical Modalities

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

Electrical ModalitiesElectrical Modalities

These links will describe physiological rationale for These links will describe physiological rationale for use of electrical modalities and some description of use of electrical modalities and some description of different uses of electrical stimulationdifferent uses of electrical stimulation

Links:Links:Electrical therapeutic modalities (website)Electrical therapeutic modalities (website)

TranscutaneousTranscutaneous Electrical Stimulation (TENS) (website) Electrical Stimulation (TENS) (website)

TENS (website)TENS (website)

Wound ManagementWound Management

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

Wound CareWound CareThese links describe different kinds of These links describe different kinds of wounds and explain how to best treat themwounds and explain how to best treat them

Links:Links:

Selection of Dressings (website)Selection of Dressings (website)

World Wide Wounds (website)World Wide Wounds (website)

Wound care information (website)Wound care information (website)

Wound Care institute (website)Wound Care institute (website)

Wound Care Strategies (website)Wound Care Strategies (website)

Cultural CompetencyCultural Competency

This link provides extensive information on This link provides extensive information on different culturesdifferent cultures

Links:Links:

Cultural competency (website)Cultural competency (website)

Another site cultural competence (website)Another site cultural competence (website)

Interpersonal Communication Interpersonal Communication SkillsSkills

Patient InteractionPatient Interaction

Communication with Health ProfessionalsCommunication with Health Professionals

Note WritingNote Writing

Interpersonal CommunicationInterpersonal Communication

This link provides some tips to better This link provides some tips to better communicate with patientscommunicate with patients

Links:Links:

Interpersonal communication (website)Interpersonal communication (website)

Physical Therapy Note Writing Physical Therapy Note Writing

These links show examples of medical notes These links show examples of medical notes using the S.O.A.P. formatusing the S.O.A.P. format

Links:Links:

Documenting patient care (website)Documenting patient care (website)

S.O.A.P. Notes (website)S.O.A.P. Notes (website)

S.O.A.P. Notes (website)S.O.A.P. Notes (website)

Case StudiesCase Studies

The following links are case studies for you to The following links are case studies for you to reviewreview

Links:Links:

Total Hip replacement case study (website)Total Hip replacement case study (website)

Information about total hip replacement (websInformation about total hip replacement (website)ite)

Wound Management case study (website)Wound Management case study (website)

Self Study TestSelf Study Test

When you have finished the specialty When you have finished the specialty module you are ready to take this 50 module you are ready to take this 50 question Self Study Testquestion Self Study Test

Link: Self Study TestLink: Self Study Test

ConclusionConclusion

You have now completed this You have now completed this specialty module in physical therapy.specialty module in physical therapy.

Please fill out the evaluation for this Please fill out the evaluation for this module by clicking on this link.module by clicking on this link.

Course EvaluationCourse Evaluation