COURSE DESCRIPTION:
During this supervised clinical practice, students are responsible for learning the art of history taking, the first interaction with patient. Studentslearn the skills under supervision of trained physical therapists. Students become familiar with performance of these skills in all settings (inpatient and outpatient) as well as on all types of patients (surgical, non-surgical, pediatric, geriatric, etc.). The emphasis is placed on general history taking skills as well as its pertinence to all systems (musculoskeletal, Integumentary, cardiovascular, pulmonary, and neurological.) Student is required to keepa performance record of all listed competencies and successfully performon real patients during the final evaluation of the course.
CLINICAL COMPETENCIES:
Review pertinent medical records and conduct an interview whichcollects the following data:
Past and current patient/client history
Demographics
General health status
Chief complaint
Medications
Medical/surgical history
Social history
Present and pre-morbid functional status/activity
Social/health habits
Living environment
Employment
Growth and development
Lab values
Imaging
Consultations
Documentation of the history.
CLINICAL COMPETENCIES:
Perform review of systems to determine the need for referral orfor physical therapy services.
Systems review screening includes the following.
GENERAL HEALTH CONDITION (GHC)
Fatigue
Malaise
Fever/chills/sweats
Nausea/vomiting
Dizziness/lightheadedness
Unexplained weight change
Numbness/Paresthesia
Weakness Mentation/cognition.
CARDIOVASCULAR SYSTEM (CVS)
Dyspnea
Orthopnea
Palpitations
Pain/sweats
Syncope
Peripheral edema
Cough.
PULMONARY SYSTEM (PS)
Dyspnea Onset of cough Change in cough Sputum
Hemoptysis Clubbing of nails Stridor Wheezing.
GASTROINTESTINAL SYSTEM (GIS)
Difficulty with swallowing
URINARY SYSTEM (US)
Frequency
Urgency
Incontinence.
GENITAL REPRODUCTIVE SYSTEM (GRS) MALE
FEMALE
Describe any sexual or menstrual dysfunction, difficulties, orproblems.
RECOGNITION OF RED AND YELLOW FLAGS
Screen for physical, sexual, and psychological abuse.
CARDIOVASCULAR AND PULMONARY SYSTEMS
Read a single lead EKG.
INTEGUMENTARY SYSTEM
MUSCULOSKELETAL SYSTEM
NEUROLOGICAL SYSTEM
CLINCAL COMPETENCIES EXAMINATION:
Based on best available evidence select examination tests and measures that are appropriate for the patient/client.
Perform posture tests and measures of postural alignment and positioning.
* Perform gait, locomotion and balance tests including quantitative and qualitative measures such as:
Balance during functional activities with or without the use of assistive, adaptive, orthotic, protective, supportive, or prosthetic devices or equipment Balance (dynamic and static) with or without the use of assistive, adaptive, orthotic, protective, supportive, or prosthetic devices or equipment
Gait and locomotion during functional activities with or without the use of assistive, adaptive,
PERFORM MUSCULOSKELETAL SYSTEM TESTS AND MEASURES INCLUDING:
PERFORM ORTHOTIC TESTS AND MEASURES INCLUDING
EVALUATION
DIAGNOSIS
PROGNOSIS
PLAN OF CARE
INTERVENTIONS
BODY MECHANICS AND POSITIONING
INTERVENTIONS
THERAPEUTIC EXERCISE MAY INCLUDE PERFORMING
COMPETENCIES EXAMINATION:
Analyze data based on best available evidence select examination tests and measures that are appropriate for the patient/client.
Perform posture tests and measures of postural alignment and positioning. Perform gait, locomotion and balance tests including quantitative and qualitative measures such as:
Balance during functional activities with or without the use of assistive, adaptive, orthotic, protective, supportive, or prosthetic devices or equipment Balance (dynamic and static) with or without the use of assistive, adaptive, orthotic, protective, supportive, or prosthetic devices or equipment Gait and locomotion during functional activities with or without the
▪ use of assistive, adaptive, orthotic, protective, supportive, or
▪ prosthetic devices or equipment to include:
Bed mobility Transfers (level surfaces and floor)
Wheelchair management Uneven surfaces
Safety during gait, locomotion, and balance
Perform gait assessment including step length, speed, characteristics of gait, and abnormal gait patterns.
Recognize and characterize signs and symptoms of inflammation.
Perform neurological tests and measures including:
o Arousal, attention and cognition tests and measures.
o Cranial and peripheral nerve integrity tests and measures.
o Motor distribution of the cranial nerves (eg, muscle tests, observations)
o Motor distribution of the peripheral nerves (eg, dynamometry, muscle tests observations, thoracic outlet tests)
o Response to neural provocation (e.g. tension test, vertebral artery compression tests)
o Response to stimuli, including auditory, gustatory, olfactory, pharyngeal, vestibular, and visual (eg, observations, provocation tests) Neuromotor development and sensory integration tests
Acquisition and evolution of motor skills, including age-appropriate development
▪ Sensorimotor integration, including postural responses, equilibrium, and righting reactions Tests and measures for reflex integrity including:
o Deep reflexes (eg, myotatic reflex scale, observations, reflex tests)
o Postural reflexes and reactions, including righting, equilibrium and protective reactions
o Primitive reflexes and reactions, including developmental
o Resistance to passive stretch
o Superficial reflexes and reactions
o Resistance to velocity dependent movement
Sensory integrity tests and measures that characterize or quantify including:
o Light touch
o Sharp/dull
o Temperature
o Deep pressure
o Localization
o Vibration
o Deep sensation
o Stereognosis
o Graphesthesia
EVALUATION
DIAGNOSIS
PROGNOSIS
PLAN OF CARE
COORDINATION OF CARE
PROGRESSION OF CARE
DISCHARGE PLAN
INTERVENTIONS
APPLY BODY MECHANICS AND POSITIONING
INTERVENTIONS
ADMISSION AND DISCHARGE PLANNING
COMMUNICATION ACROSS SETTINGS, INCLUDING
THERAPEUTIC EXERCISE MAY INCLUDE PERFORMING
CLINICAL COMPETENCIESEXAMINATION :
Based on best available evidence select examination tests and measures that are appropriate for the patient/client
Perform posture tests and measures of postural alignment and positioning.
Perform gait, locomotion and balance tests including quantitativeand qualitative measures such as:
Balance during functional activities with or without the use of assistive, adaptive, orthotic, protective, supportive, or prosthetic devices or equipment Balance (dynamic and static) with or without the use of assistive,adaptive, orthotic, protective, supportive, or prosthetic devices orequipment
Gait and locomotion during functional activities with or without the Use of assistive, adaptive, orthotic, protective, supportive, or prosthetic devices or equipment to include:
Bed mobility Transfers (level surfaces and floor)
Wheelchair management
Uneven surfaces
Safety during gait, locomotion, and balance Perform gait assessment includingstep length, speed,characteristics of gait, and abnormal gait patterns.
Characterize or quantify body mechanics during self-care, homemanagement, work, community, tasks, or leisure activities. Characterize or quantify ergonomic performance during work(job/school/play):
Dexterity and coordination during work Safety in work environment
Specific work conditions or activities Tools, devices, equipment, and workstations related to workactions, tasks, or activities
Characterize or quantify environmental home and work (job/school/play) barriers:
Current and potential barriers
Physical space and environment
Community access Observe self-care and home management (including ADL andIADL)
Measure and characterize pain to include:
Pain, soreness, and nocioception
Specific body parts
Recognize and characterize signs and symptoms of inflammation. Perform cardiovascular/pulmonary tests and measures including:
Heart rate Respiratory rate, pattern and quality
Blood pressure Aerobic capacity test* (functional or standardized) such as the 6-minute walk test
Pulse Oximetry
Breath
sounds – normal/abnormal
Response to exercise (RPE)
Signs and symptoms of hypoxia
Peripheral
circulation (deep vein thrombosis, pulse, venousstasis, lymphedema).
EVALUATION
DIAGNOSIS
PROGNOSIS
PLAN OF CARE
INTERVENTIONS
THERAPEUTIC EXERCISE MAY INCLUDE PERFORMING
A. Aerobic capacity/endurance conditioning or reconditioning
B. RELAXATION
MECHANICAL MODALITIES
CLINICAL COMPETENCIESEXAMINATION:
Based on best available evidence select examination tests andmeasures that are appropriate for the patient/client.
Perform posture tests and measures of postural alignment andpositioning.
Perform gait, locomotion and balance tests including quantitativeand qualitative measures such as;
o Balance during functional activities with or without the use of assistive, adaptive, orthotic, protective, supportive, or prosthetic devices or equipment
Balance (dynamic and static) with or without the use of assistive,adaptive, orthotic, protective, supportive, or prosthetic devices orequipment
Gait and locomotion during functional activities with or without the use of assistive, adaptive, orthotic, protective, supportive, or prosthetic devices or equipment to include:
▪ Bed mobility
▪ Transfers (levelsurfaces and floor)
▪ Wheelchair management
▪ Uneven surfaces
▪ Safety during gait, locomotion, and balance
Perform gait assessment including step length, speed,characteristics of gait, and abnormal gait patterns.
Characterize or quantify body mechanics during self-care, homemanagement, work, community, tasks, or leisure activities.
Characterize or quantify ergonomic performance during work(job/school/play) Dexterity and coordination during work Safety in work environment Specific work conditions or activities
Tools, devices, equipment, and workstations related to workactions, tasks, or activities
Characterize or quantify environmental home and work (job/school/play) barriers:
Current and potential barriers
Physical space and environment
Community access
Observe self-care and home management (including ADL andIADL)
Measure and characterize pain* to include Pain, soreness, and nocioception Specific body parts
Recognize and characterize signs and symptoms of inflammation.
Perform integumentary integrity tests and measures including Activities, positioning, and postures that produce or relieve traumato the skin. Assistive, adaptive, orthotic, protective, supportive, or prosthetic devices and equipment that may produce or relieve trauma to theskin.
Skin characteristics, including blistering, continuity of skin color, dermatitis, hair growth, mobility, nail growth, sensation, temperature, texture and turgor.
Activities, positioning, and postures that aggravate the wound or scar or that produce or relieve trauma. Signs of infection.
Wound characteristics:
bleeding, depth, drainage, location, odor,size, and color.
G. Wound scar tissue characteristics including banding, pliability, sensation, and texture.
EVALUATION
DIAGNOSIS
PROGNOSIS
PLAN OF CARE
INTERVENTIONS
THERAPEUTIC EXERCISE MAY INCLUDE PERFORMING
MECHANICAL MODALITIES