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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)


j ~MODULE 2: PATIENT TRANSFER

TASKS a. Transfer patient


(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


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|



MODULE 3: PATIENT PREPARATION

TASKS a. Prepare patient for treatmentb. Position patient for treatmentc. Explain treatment and its effects to patient


(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)


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



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


(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


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



MODULE 6: CRYOTHERAPY

TASKS a. Perform surface sensitivity testb. Give ice massagec. Give ice pack treatment


(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



MODULE 7: INTERMITTENT CERVICAL AND LUMBAR TRACTION

TASKS a. Administer intermittent cervical tractionb. Administer intermittent lumbar traction


(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


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



MODULE 8: INTERMITTENT COMPRESSION

TASKS a. Measure extremity girthIb. Give intermittent compression treatment


(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


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



MODULE 9: SUPERFICIAL HEAT TREATMENT

TASKS a. Give hot moist pack treatmentb. Give infrared treatmentc. Give paraffin bath treatment


(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


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



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


(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


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 ....... .. .... ..... .......... ...



MODULE 11: MASSAGE

TASKS a. Perform facial massageb. Perform extremity massagec. Perform trunk massaged. Perform cervical massage


(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


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



MODULE 12: ELECTRICAL STIMULATION

TASKS a. Perform electrical stimulation, faradic currentb. Perform electrical stimulation, galvanic current


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


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

] __ _



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


(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


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 .



MODULE 14: DRESSING WOUNDS

TASKS a. Dress woundb. Apply topical ointmentsc. Clean and maintain dressing instruments


(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


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

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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


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


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



MODULE 2: BASELINE MEASUREMENTS

TASKS a. Measure muscle girthb. Assist with measurement of joint motionc. Measure hand grip and pinch strengthd. Record baseline measurements


(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


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

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IH Competency: PHYSICAL THERAPY ASSISTANT (PTA)


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


(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


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



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


(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


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



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


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

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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


(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


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



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


(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


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

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i I. ................ ........



MODULE 8: POSTURE TRAINING

TASKS a. Instruct patient in posture principlesb. Instruct patient in general and specific

posture exercises


(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


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

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IICompetency: PHYSICAL THERAPY ASSISTANT (PTA)


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


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


4 UAnatomy and physiologyTherapeutic mat exercisesPatient's disability/limitationsInstructional techniquesSafety precautionsPathologiesDevelopmental sequence of exercise programsGait patterns

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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


(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

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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


(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


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

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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


(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


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

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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)


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


(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


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

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.1"


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

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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


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

!


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


(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.

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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


(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


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

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MODULE 4: PROSTHETIC TRAINING I

TASKS a. Apply/remove prosthetic applianceb. Teach patient how to dress with and over prosthesil


(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


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



MODULE 5: PROSTHETIC TRAINING II

TASKS a. Reinforce prosthetic training initiated bythe physical therapist


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

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COMPETENCY UNIT V: REPORTING AND RECORDING

This unit includes the following module:

Number Title Page

I Reporting and Recording . . . . . . . . . . . . 39

38


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


Observational techniquesRecognition of relevant observationsRecording and reporting proceduresAppropriate medical terminologySelection and use of appropriate forms

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I I I II ...- .......,II I I-

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