Course Handbook (to be used in conjunction with the PTAP Student/Learner Handbook) PTA 211 Physical Agents Fall 2014

Transcription

1 Mercer County Community College Physical Therapist Assistant Program Course Handbook (to be used in conjunction with the PTAP Student/Learner Handbook) PTA 211 Physical Agents Fall 2014 Barbara J. Behrens Course Coordinator OFFICE HOURS: W 9-11am & 3:30-5:30pm Other days by appointment Faculty Member Office MS 350 behrensb@mccc.edu West Windsor Campus Course #: PTA 211 Course Title: Physical Agents Credit Hours (lecture/lab): 4/3 Number of weeks: 10 (due to Clinical Ed I which occurs in the fall semester) Number of Clinical weeks: N/A Clinical Contact Hours: N/A Pre-requisite Course(s): PTA 107, MAT as specified Co-requisite Course(s): PTA 210, PTA 224 Required: TEXT(S): Behrens BJ, Beinert H, (2014), Physical Agents: Theory & Practice 3rd ed. Philadelphia: FA Davis Co. ISBN-13: COURSE DESCRIPTION: This course is designed to introduce the student/learner to the use of physical agents and therapeutic modalities in physical therapy practice. Lecture and laboratory activities develop problem solving skills and critical thinking in the use of electrical stimulation, and therapeutic heat & cold, traction, hydrotherapy and aquatics to accomplish therapeutic treatment goals. Skills will be tested for competence throughout the semester. Students are expected to both receive and administer each of the therapeutic interventions discussed. Restricted to approved PTA majors. Course Outline: COURSE OUTLINE: I II Inflammation & Tissue Repair A. Responses to therapeutic interventions with Physical Agents & Therapeutic Modalities B. Clinical observations to therapeutic interventions (Assessment techniques) Therapeutic Heat & Cold

2 III IV V VI VII VIII IX Ultrasound Electrical Stimulation A. Terminology B. Treatment Goals 1. Sensory analgesia 2. Motor responses C. Treatment devices Soft Tissue Treatment Techniques: Traction Hydrotherapy & Aquatics Therapeutic Use of Light Regulatory Issues with the development of new modalities Integration of therapeutic interventions and modalities Course Grading: % of grade Activity # per semester 30 Exams 3 0 Quizzes 0 0 Papers 0 10 Presentations 1 10 Generic Abilities Continuous 20 Competency Tests & 4 30 Practical Exam 1 Generic Abilities Assessment (10% of overall course grade) Generic abilities include a collection of behaviors that in addition to knowledge and skills are considered important for student/learners to be successful as future employees in the healthcare environment. Adapted from May, et. al. Journal of Physical Therapy Education, 9:1, Spring, pts Category Requirement 2.5 Commitment to Learning - Consistently attends the entirety of all classes and/or lab sessions and if unable to attend class, proactively assumes responsibility for learning by contacting the course instructor via to alert him/her of the absence or reason for early 2.5 Communication Skills departure which would result in disruption of the learning for that day -Is respectful to classmates, guest speakers, and faculty members in all forms of communication (verbal, non-verbal, written, , etc.) - uses correct grammar, accurate spelling and expression, writes legibly 2.5 Professionalism - comes to class prepared to start on time and if unable to start class/lab on time then proactively contacts the course instructor via to alert him/her of the lateness and finding out whatever work might need to be made up from a classmate 2.5 Responsibility -is aware of and accepts responsibility for his/her own work and progress within a course which includes awareness of the impact of assignment grades on overall course grade - discusses confidential concerns with course instructor including but not limited to grades having considered potential strategies for self-improvement 2

3 Operation: SOAP NOTE Documentation is probably one of the most challenging aspects of the clinical environment. To assist learners with gaining experience with documenting and in particular the use of the SOAP note format for documentation, the PTA program has adopted the following policy for each lab course within the curriculum. This will provide learners with the opportunity to practice their documentation skills prior to the clinical education component of the curriculum and strengthen their skills through the collaboration of their peers. Learners will be required to hand in four (4) SOAP notes during the semester for each lab course. Each SOAP note would come from one of the lab experiences which has been previously identified by the Course Director in the course syllabus and will be completed at the end of that lab experience. Each SOAP note must meet the following criteria prior to being submitted for grading: 1. It must be written by a "clinician" who performed an activity during lab. 2. It then must be reviewed by a classmate utilizing the SOAP Note Assessment Forms that are available in the PTA Lab. (To get the most out of your peer review, have the classmate who was your patient during your lab experience perform the peer assessment.) 3. Submit the completed SOAP Note Assessment Form with your final SOAP note. There should be evidence that you have incorporated some of the feedback from your classmate into your documentation. 4. Please note that SOAP notes will not be accepted after the due dates that have been specified by your Course Instructor. Due dates help prepare student/learners and assure that there is sufficient time to receive feedback prior to subsequent SOAP notes and prior to the next clinical education course. PTAP Policy: COURSE GRADING One of the goals of the MCCC PTAP is to prepare student/learners to ultimately practice as PTAs after completing the PTA program. In New Jersey, as in many other states, PTAs are required to be licensed. Licensure is granted following the successful completion of a standardized licensing exam, which has a normalized passing score above what Mercer uses as a passing score. A B C A B D B C Grades below 77 are not considered passing grades for PTAP courses, and are therefore considered unacceptable. All PTAP courses must be completed with a grade of C+ or higher. Written Assignments Grading Criteria for all written assignments is provided with the assignment and it is the responsibility of the student/learner to consult with the grading criteria or grading rubric for the assignment prior to submitting the assignment, to assure that the requirements have been met to the best of his or her abilities. *Please note that a penalty of 5 points per day may be imposed for late submission of assignments. 3

4 COURSE GOALS: Following the successful completion of this course with a grade of C+ or higher, the learner will be able to: 1. Safely and appropriately apply physical agents and electrical stimulation for the accomplishment of therapeutic treatment goals including: the reduction of pain, edema, joint stiffness and muscle guarding and increasing circulation, muscle strength and tissue extensibility. 2. Determine what the potential causes and remedies would be for undesirable patient responses to the application of physical agents and electrical stimulation for the accomplishment of therapeutic treatment goals and make appropriate decisions and adjustments in the application to maintain patient safety. 3. Critically discuss the available literature dealing with physical agents relating the relevance of what is published with current practice patterns in the clinical setting. 4. Safely and appropriately apply cervical and or lumbar mechanical traction for the accomplishment of therapeutic treatment goals including the reduction of nerve root radiculopathies and disc compression. 5. Differentiate between the advantages and disadvantages of a buoyant environment for a therapeutic exercise program versus a land environment and how one could safely progress a patient working on an endurance program in the aquatic environment, and manage partial weight bearing status. COURSE OBJECTIVES: Following the successful completion of this course the learner will possess skills in the following domains: Cognitive/Knowledge The student/learner will be able to successfully: 1. describe the properties of electricity (conductance, resistance, capacitance) and how this would impact the application of electrical stimulation with a patient 2. describe the mechanisms for heat transfer and how this applies to the application of heat or cold in different forms to patients 3. identify commonly accepted treatment goals for the application of physical agents & therapeutic modalities 4. identify the appropriate parameters required to accomplish treatment goals with electrical stimulation and ultrasound 5. cite potential adverse responses to the application of a therapeutic modality or physical agent and how to remedy those responses should they occur 6. outline the appropriate information necessary to document a treatment with physical agent or therapeutic modality 7. cite the indications, contraindications & precautions to the application of electrical stimulation, ultrasound, superficial and deep heating agents 8. describe the various pain pathways and potential ways to block pain perception utilizing physical agents and therapeutic modalities 9. describe the importance of pain as a perception and how pain may be indicated other than verbal by expressions 10. describe the expected visual and palpable responses of the skin to a therapeutic intervention with a physical agent modality 11. describe how two or more physical agents can be utilized together to accomplish a therapeutic treatment goal 4

5 12. describe the components of mechanical traction devices for spinal traction and provide the rationale for each of the those components and their therapeutic application to accomplish stated treatment goals 13. list the parts of a whirlpool for a therapeutic intervention with hydrotherapy, describing the variables and rationale for their selection 14. differentiate between an aquatic pool and a hydrotherapy tank for a therapeutic intervention with a patient stating advantages and disadvantages for both forms or treatment 15. describe the physical principles of water and how they may be used to in a therapeutic intervention with a patient to affect a positive outcome 16. outline the steps necessary to prepare a patient for the therapeutic application of hydrotherapy or spinal traction to accomplish a stated treatment goal Psychomotor The student/learner will be able to successfully: 1. display and explain the appropriate application techniques for therapeutic superficial and deep heat 2. demonstrate the appropriate application of therapeutic cold, light and electrical stimulation 3. describe the use of EMG biofeedback as a therapeutic intervention 4. respond appropriately to unexpected physiologic responses to a therapeutic intervention with a physical agent 5. demonstrate and defend the importance of proper patient positioning and draping techniques 6. perform pain assessment skills for treatment documentation 7. describe the rationale for the selection of physical agents and therapeutic modalities based on clinical goals and patient responses 8. perform the application of electrical stimulation to accomplish: pain reduction, muscle guarding reduction, and a motor response 9. document treatment techniques for physical agents and therapeutic modalities in SOAP format 10. recognize, respond and document normal and abnormal responses to treatment interventions with physical agents and therapeutic modalities 11. assess patient sensation prior to and after the application of a physical agent or therapeutic modality and determine what types of responses need to be documented in the patient s chart and how they should be documented Affective The student/learner will be able to successfully: 1. recognize the importance of pain as both a physical and psycho-social factor by the approach that they use when describing treatment techniques and expected treatment outcomes with a patient 2. defend the establishment of a safe and effective working environment by performing safety checks on the equipment that they will be utilizing before they apply it to a patient 3. enforce the safe and efficacious utilization of physical agents by assessing and re-assessing each patient prior to and following the application of a physical agent 4. recognize the importance of clinically based research by utilizing some of the research articles in their class presentation 5. recognize the significance of and defend the establishment of communication among members of the Health Care Delivery Team by discussing topics with other members of the team and communicating these conversations back to their classmates and instructors 6. recognize the importance of documentation skills as a quality assurance tool and document patient treatment in the patient record 7. defend the importance of skin assessment prior to, during and after therapeutic interventions with physical agents and therapeutic modalities 5

6 Confidentiality Expectations Classmates: Periodically during the course of the semester, individuals among your classmates may be asked to share physical anomalies or previous injuries and treatments with the PTAP class. If an individual chooses to share this information with the class, it is NOT to leave the classroom. If an individual does not wish to share a personal diagnosis or anomaly with the class, it is within his or her right not to do so. Volunteers will be solicited for laboratory demonstrations. Information obtained during lab exercises is intended for demonstration purposes only. It is the right of every individual NOT to volunteer for a demonstration. However, all student/learners are expected to participate in lab activities to the best of his or her ability. This participation may involve the removal of minor articles of clothing. In the event that clothing is removed, draping techniques will be employed to preserve the dignity of the individual. Faculty: Any and all individuals who elect to allow themselves to be "the patient" during class and lab activities can expect that all information gained during the activity will remain confidential. This extends to all MCCC faculty and MCCC staff, who volunteer to be patients. Patients in a Clinical Environment: During the academic preparation to become a physical therapist assistant, there will be instances when student/leaners will be expected to collect data regarding a patient that is being seen or who is being treated. This data is intended to be used for educational purposes only. Under NO circumstances, should this data be identified with a particular patient or individual by the use of proper names. Photocopying patient information in a clinical environment is strictly prohibited by law without prior written consent from the patient! Sample acceptable data for collection: diagnosis prescribed medications age, gender overall medical condition of the patient previous medical history physical therapy plan of care summary of PT visits physical therapy evaluation findings Class Philosophy: Those who enroll in PTAP courses will be expected to accept responsibility for their learning, and as such will be considered learners. Learners identify: topic areas that are of particular interest to them for the purpose of paper assignments topic areas that present challenges to them strategies for meeting his or her individual needs to master the information Learners also: actively participate in the presentation/discussion of course materials 6

7 actively participate in the negotiation of a class schedule that meets the objectives for the course and for the learners respect the interests and needs of other learners or faculty work together toward a meaningful understanding of the materials presented. Reasonable Accommodations On July 26, 1990, the President of the United States signed the Americans with Disabilities Act (P.L ). The ADA is intended to remove barriers against the more than 43 million people with disabilities in the United States. If you have a documented learning disability, psychological disability, physical disability, or other hidden disability that requires an accommodation, it is your responsibility to make an appointment to meet with the course director and potentially the PTA program coordinator prior to the due date for any course examinations or assignments to discuss what accommodations might be necessary. Mercer County Community College & the Americans with Disabilities Act Any student/learner in any class who has special needs because of a disability is entitled to receive accommodations. Eligible students at Mercer County Community College are assured services under the Americans with Disabilities Act and Section 504 of the Rehabilitation Act of If someone believes that he or she is eligible for services, it is that individual's responsibility to contact Arlene Stinson, the Director of Academic Support Services. Ms. Stinson s office is LB217, and she can be reached at (609) A list of Essential Functions for the PTA program student/learners and graduates is available through the PTA program website. Exams in the Academic Testing Center (ATC) Mercer County Community College has an Academic Testing Center on campus in the Student Center which makes it possible for exams to be administered outside of class time, allowing student/learners the ability to schedule their own time for testing. This also permits more judicious use of class time for lectures and labs rather than testing. The following list represents some things to remember when using the (ATC) 1. Anyone taking "Scantron" exams in the testing center will need to keep the Testing Center Report Form that is provided at the completion of the exam. a. This form indicates the grade that was earned and which test questions were incorrect. b. This form should be retained as a record of the exam. 2. Anyone taking an exam in the testing center is required to present a current Mercer ID a. one that has a sticker on it indicating the current semester i. issued by the security office in the student center 3. The Academic Testing Center typically is open on the West Windsor Campus as follows: Semester Days Times Fall and Spring M-R (closed on Fridays) 9am-7:30pm Saturdays 9am-2:30pm 7

8 Summer Sessions M-R (closed on Fridays) 9am-7:30pm Saturdays 9am-12:30pm a. It is the responsibility of the student/learner to make sure that he/she has verified the operating hours for the Academic Testing Center i. This is subject to change from semester to semester Recording an Instructor: 1. Audio recording of the instructor during lecture and lab will only be permitted for those student/learners who have documentation stating that audio recordings are a reasonable accommodation for that student/learner. a. Information regarding Documentation for Reasonable Accommodation can be obtained from Arlene Stinson the Director of Academic Support Services. Ms. Stinson s office is LB217, and she can be reached at (609) or via at stinsona@mccc.edu. 2. Audio recording under these circumstances will be permitted once a copy of the appropriate documentation has been provided to the instructor. 3. Video recording of the instructor during lecture and lab are not permitted under any circumstance without prior written approval from the instructor. Attendance for PTA program Courses: 1. Mercer County Community College does not have a "cut system." Student/learners in PTA program courses are required to attend all lecture, lab, competency testing and clinical affiliation sessions. Attendance records are maintained. 2. Attendance is required for all courses for all learners. If someone is going to be absent from a scheduled class, it is the responsibility of the individual to notify the course instructor in writing to inform him or her of the absence and how the work for that day will be made up. Copies of any class handouts that might have been distributed will be available in the course folders within the classroom. It is the responsibility of the learner to check the folder for the class that was missed to see if there was a new handout. It is not the instructor s responsibility to attempt to keep track of who might have been present or who might have missed something that was discussed in class. 3. Official college closings or delayed openings are broadcast via several different mechanisms including local radio stations, the college radio station WWFM, 89.1 and MAlert which will text smartphones and send s to registered users affiliated with Mercer County Community College. It is the student/learner's responsibility to observe these notifications when they occur and act accordingly. Notices of emergency closings are also announced on the college website at Continued matriculation following acceptance in the PTA program indicates that the student/learner has agreed to accept and uphold his or her commitment to these policies. 8

9 PTA 211 Physical Agents Course Schedule: Fall 2014 Lecture: MW 1-3 Lab : F 8-12am or 1-5pm Location: MS 352 Course Schedule Week Date Topics Objectives Chapter(s) 1 8/25 From Injury to Repair: Pain and Inflammation C8, C9, C10, P6, P11, A1, 1 A2, A3, A7 2 9/3 (W) Observable responses to therapeutic treatment interventions C2, C5, C6, C9, C10, P1, P4, P5, P9, P10, P11, A3, A /8 Therapeutic Heat & Cold Operation SOAP Note 4 9/15 Therapeutic Ultrasound Operation SOAP Note 5 9/22 Foundations for Electrical Stimulation Physiologic Basis of Electrical Stimulation C2, C3, C5, C6, P1, P2, 4 C2, C3, C4, C5, C6, C7, C8, C10, P1, P7, P9, P10, P11 C1, C7, C8, P10, A2 11, /24 Neuromuscular Electrical Stimulation Operation SOAP Note C1, C3, C4, C5, C6, C7, P2, P8, P10 9/22-9/25 (M-R) WE #1 (in the testing center) 6 9/29 Pain Management with ES C1, C3, C4, C5, C6, C7, C8, Operation SOAP Note P2, P6, P8, P /6 Electrical Stimulation Devices C4, C5, C6, C7, C8, P2, P3, P7, P8. P10, P11,A2 8 10/13 Aquatics & Hydrotherapy C13, C14, C15,P12, 6 10/13-16 (M-R) WE #2 (in the testing center) 9 10/20 Soft Tissue Treatment Techniques: Traction C12, P12, A2, CG /27 Modality Integration C11,A1, A2, A3, A6, A /30 & 10/31 Practical Exam (tentative) CG1, CG2, CG3, CG4, CG5 Weeks 11,12,13 & 14 (November 3-December 2, 2014) PTA 224 Clinical Education I 15 12/3 Presentations 12/5 Presentations AM A4, A5, CG3 12/5 Aquatic Lab (tentative PM) 12/8 Presentations C14, C15, P12, CG5 12/10 WE #3 in MS 352 A4, A ,16 9

10 Operation SOAP Note Documentation Requirements for Lab: In preparation for Competency Testing this semester, each learner will be required to submit a SOAP note at the conclusion of each of the labs that represents a treatment intervention that would be associated with the modality that was utilized during lab. The documentation must include each of the elements of a patient SOAP note. Each learner must submit a note for: interventions associated with HP & paraffin, US, NMES, and ES for the reduction of pain. (4 complete SOAP notes) Failure to do so will be reflected in lab participation grade. Week- Date Topic Area Week- Date Topic Area 3-9/8 Therapeutic Heat (HP & 5-9/24 Neuromuscular Electrical Stimulation (NMES) for Paraffin) Muscle Strengthening 4-9/15 Therapeutic Ultrasound 6-9/29 Electrical Stimulation (ES) for Pain Reduction PTA 211 Physical Agents Competency Tests Hotpacks & Paraffin Equipment: Hydrocollator pack & Commercial Cover Paraffin unit Towels Plastic wrap Pillows for positioning your patient Thermometer Setting the Scene: Part A The patient has been diagnosed with degenerative joint disease in both knees, with the right knee being more painful and stiff than the left knee. Treatment goals include pain reduction, increased joint ROM and reduction of joint stiffness. Apply a hot pack to the right knee of this patient to accomplish stated treatment goals. (10 minute treatment time) Part B The patient is receiving physical therapy for his/her left hand, specifically the left index finger, which sustained a crush injury in April of last year. The fracture is well healed but the patient has decreased ROM and joint stiffness. Treatment goals include pain reduction and increasing joint ROM. Apply paraffin to this patient to accomplish stated treatment goals. (10 minute treatment time) You will need to demonstrate competence in the following: CSI Skill Demonstration Arrive prior to the start of the competency test and be prepared to begin on time Provide the blue CTSOS Packet to the competency tester prior to performing the hand hygiene Wear a lab coat and a name tag that ensures the clinician s name is visible Perform safe and appropriate hand-hygiene before touching the patient Introduce yourself to your patient using the program approved introduction as outlined in the practical examination rubric * Explain what you will be doing during the session to the patient, prior to inspecting the skin in the treatment area * Review the contraindications for paraffin and hot packs before selecting them as treatment interventions for this patient * Check the temperature of the paraffin unit to determine whether or not it is safe to use or whether it needs to be cooled down first * Palpate the skin in the treatment area pre-treatment for sensation, scars, overall appearance, blanching, and tissue compliance when palpated. Ask the patient for numerical ratings for discomfort for Right knee and Left index finger, visually assess ROM and record findings for each The Right knee: prepare a cervical hot pack from the Hydrocollator unit to wrap around the knee Use a commercial cover and a minimum of 4 layers of toweling in between the patient and cover Secure the hot pack in place with a strap to maintain good contact for conductive heat * Educate the patient regarding what to expect and when and what NOT to expect * Verbally check on the patient within 3 minutes of the application of any thermal agent to determine whether or not adjustments need to be made to assure patient safety during the treatment and make appropriate changes if indicated 10

11 Once the time has ended, remove the strap and hot pack, replacing it in the Hydrocollator Re-inspect the skin for excessive erythema and act appropriately * Palpate the skin in the treatment area post-treatment for sensation, scars, overall appearance, blanching, and tissue compliance when palpated acting appropriately if there is an abnormal response Ask the patient for numerical ratings for discomfort for Right knee * The Left hand: inspect hand for open areas, cuts scars and check for sensation (act accordingly) Ask the patient to wash the hand and set the water temperature asking patient to distinguish between warm and cold water * Check the temperature of the paraffin unit to determine whether or not it is safe to use Prepare plastic wrap, towels for paraffin application Instruct the patient in what he or she will be doing and feeling with paraffin and then demo Allow pt. to dip and once the appropriate number of dips has concluded, wrap in plastic and a towel * Position the patient appropriately for the modality that is selected. This includes supporting and elevating the treatment area and supporting the area proximal to it. * Verbally check on the patient within 3 minutes of the application of any thermal agent to determine whether or not adjustments need to be made to assure patient safety during the treatment and make appropriate changes if Indicated Once the time has ended, remove the towel that was wrapped around the paraffin, remove the plastic and peel off the paraffin. Give the patient the paraffin to "work with" Ask the patient for numerical ratings for discomfort for Left index finger Replace the paraffin in the unit to be re-melted (in a clinical environment, follow the guidelines that have been set in that environment. ) * Palpate the skin in the treatment area post-treatment for sensation, scars, overall appearance, blanching, and tissue compliance when palpated. Share the results of all findings with the patient and perform appropriate verbal wrap-up/termination Document both treatment interventions in SOAP note format for this patient. All CSI must be demonstrated to pass each Competency Test. Therapeutic Ultrasound Equipment that you will need: an ultrasound unit acoustically conductive gel or lotion towels & pillows a hospital gown Setting the Scene: Your patient has been referred to physical therapy after a cervical strain. Treatment goals include reduction in muscle guarding, reduction in pain due to the presence of a palpable fibrocystic nodule in the belly of the right upper trapezius. Apply ultrasound to the upper trapezius to accomplish the stated treatment goals You will need to demonstrate competence in the following: CSI Skill Demonstration Arrive prior to the start of the competency test and be prepared to begin on time Provide the blue CTSOS Packet to the competency tester prior to performing the hand hygiene Wear a lab coat and a name tag that ensures the clinician s name is visible Perform safe and appropriate hand-hygiene before touching the patient Introduce yourself to your patient using the program approved introduction as outlined in the practical examination rubric Explain what you will be doing during the session to the patient, prior to inspecting the skin in the treatment area * Review the contraindications for ultrasound before selecting it as a treatment intervention for this patient * Palpate the treatment area to determine what parameters will be needed for this session These need to be determined: how deep the treatment area is to know what frequency of US to use How large a treatment area you will be treating to set the time How much soft tissue is in the area to set the intensity How acute the problem is to set the duty factor Once the parameters have been determined and the transducer size selected then position the patient Ask the patient to provide a numerical pain rating for his or her discomfort when pressure is applied directly to the palpable 11

12 nodule in the R upper trapezius and record that number Drape the patient * Plug in the ultrasound equipment prior to touching the patient with the transducer * Turn the power to the unit on prior to touching the patient with the transducer * Select and set the parameters except intensity prior to touching the patient with the transducer Apply acoustically conductive lotion or gel to the transducer Move the transducer while increasing the intensity (at no time should the intensity be set prior to the transducer being in contact * with a patient or with the transducer stationary on a patient) * Treat an area no larger than twice the size of the selected transducer Once the treatment time has ended, remove and clean the transducer safely storing the transducer Clean the lotion/gel from the patient Re-palpate the treatment area and ask the patient for his or her numerical indication of discomfort Turn the power to the ultrasound off Unplug the ultrasound unit * Demonstrate appropriate trouble shooting if any difficulty with equipment is encountered Instruct the patient in what sensations he or she might feel after treatment that should be reported back to the clinician Share the results of all findings with the patient and perform appropriate verbal wrap-up/termination Document treatment technique in SOAP format All CSI must be demonstrated to pass each Competency Test. NMES for Muscle Strengthening Equipment that you will need: NMES Unit Straps to stabilize LE Electrodes appropriate for the size of the muscle Water to hydrate electrodes Bolster to position patient Setting the Scene: Your patient has been referred to physical therapy with a diagnosis of post-operative arthroscopic medial meniscectomy which resulted in vastus medialis weakness in the Left LE. Treatment goal: increase muscle strength Apply electrical stimulation to the area to assist the patient in eliciting voluntary isometric muscle contractions to accomplish stated goal. You will need to demonstrate competence in the following: CSI Skill Demonstration Arrive prior to the start of the competency test and be prepared to begin on time * Review contraindications for the application of electrical stimulation with this patient Review the requirements for electrical stimulation and select a unit capable of providing muscle strong contractions for muscle strengthening Provide the blue CTSOS Packet to the competency tester prior to performing the hand hygiene Wear a lab coat and a name tag that ensures that the clinician s name is visible Perform safe and appropriate hand-hygiene before touching the patient Introduce yourself to your patient using the program approved introduction as outlined in the practical examination rubric Explain to the patient what you will be doing during the session prior to positioning your patient * Ask the patient relevant questions prior to inspecting the skin in the treatment area for sensation, blanching, scars, heat/cold * Plug in the stimulator to the wall outlet after checking to make sure that wires are not frayed and outputs are set at zero before attaching anything to the patient * Turn on the power to the electrical stimulation device before applying anything to the patient * Plug in lead wires to stimulator before applying anything to the patient * Attach electrodes to lead wires before applying anything to the patient * Position the patient so that a strong isometric muscle contraction of the vastus medialis and rectus femoris on the Left LE may be elicited by supporting it with bolsters and straps as appropriate 12

13 * Palpate a voluntary contraction of the Left vastus medialis Hydrate electrodes * Attach electrodes to the patient * Select the parameters to accomplish the treatment goal: adjusting the intensity only when the stimulator is in an ON time Ask the patient to contact during the ON time against resistance * Demonstrate appropriate trouble shooting if any difficulty with equipment is encountered * Once the treatment time has concluded, reset output intensities to zero Remove electrodes from the patient & replace them on the plastic Remove straps and supports from lower extremity * Re-inspect the patient's skin for erythema and appropriately respond to unanticipated patient responses * Turn the power of the stimulator off & unplug it from the wall (only AFTER it has been disconnected from the patient) Ask the patient for a subjective response to the treatment Ask the patient if he or she has any questions about what was done during the application of the NMES * Educate the patient about what to expect after treatment with NMES Share the results of all findings with the patient and perform appropriate verbal wrap-up/termination Document your treatment in a SOAP Note All CSI must be demonstrated to pass each Competency Test. ES for Pain Relief Equipment that you will need: Water to hydrate electrodes Electrical Stimulation Unit (lead wires) Electrodes sufficient in quantity to include painful area Electrodes to accomplish treatment goals Draping sheets, pillows Setting the Scene: Your patient has been receiving physical therapy treatments to help reduce his/her lower back pain (centrally located at L4- L5).There is no radiating pain. Treatment goal: include pain reduction to reduce muscle guarding which is caused by the patient's expression of pain. Apply electrical stimulation to provide a sense of sensory analgesia throughout the painful area. You will need to demonstrate competence in the following: CSI Skill Demonstration Arrive prior to the start of the competency test and be prepared to begin on time * Review contraindications for the application of electrical stimulation with this patient Review the requirements for electrical stimulation and select a unit capable of providing a sense of deep sensory analgesia throughout the painful area Provide the blue CTSOS Packet to the competency tester prior to performing the hand hygiene Wear a lab coat and a name tag that ensures that the clinician s name is visible Perform safe and appropriate hand-hygiene before touching the patient Introduce yourself to your patient using the program approved introduction as outlined in the practical examination rubric Explain to the patient what you will be doing during the session prior to positioning your patient Ask the patient relevant questions prior to inspecting the skin in the treatment area for sensation, blanching, scars, heat/cold * Plug in the stimulator to the wall outlet after checking to make sure that wires are not frayed and outputs are set at zero (BEFORE it is attached to a patient) Turn on the power to the electrical stimulation device (BEFORE it is attached to a patient) Plug in lead wires to stimulator (BEFORE they are attached to a patient) Attach electrodes to lead wires (BEFORE they are attached to a patient) Position your patient so that the lumbar spinal musculature is in neutral supporting him/her with pillows as appropriate Palpate the paraspinal muscles and ask the patient to indicate where he/she feels discomfort and also to provide a number on a scale of 0-10 to reflect the amount of discomfort perceived in that area Hydrate electrodes 13

14 Attach electrodes to the patient making sure that they cross the area Select the parameters to accomplish the treatment goal: adjusting the intensity only when the stimulator is in a constant mode Increase the intensity to a level where the patient indicates that the sensation is strong but comfortable * Verbally check on the patient within 3 minutes of the application of any thermal agent to determine whether or not adjustments need to be made to assure patient safety during the treatment and make appropriate changes if indicated * Demonstrate appropriate trouble shooting if any difficulty with equipment is encountered Once the treatment time has concluded, reset output intensities to zero Remove electrodes from the patient & replace them on the plastic for storage * Re-inspect the patient's skin for erythema and provide appropriate response if erythema is excessive * Turn the power of the stimulator off & unplug it from the wall (ONLY if the patient has been disconnected first) Ask the patient for a subjective response to the treatment and a numerical rating Ask the patient if he or she has any questions about what was done Educate the patient about what to expect after treatment Share the results of all findings with the patient and perform appropriate verbal wrap-up/termination Document your treatment in a SOAP Note All CSI must be demonstrated to pass each Competency Test. Competency Test Schedule: starting Hot Packs & Paraffin Week # 5 Date: 9/21 Therapeutic Ultrasound Week # 6 Date: 9/28 NMES for Muscle Strengthening Week # 7 Date: 10/5 ES to Reduce Pain Week # 8 Date: 10/12 Sample Practical Exam Rubric The tester will be looking for the following: (from the individual being tested) 1. preparation of the treatment/assessment area for the patient (before and after the session) Scores Equivalent to: Observations Entry level performance for a PTA Competent for a PTA learner at this level Set up with appropriate equipment, supplies, assistive devices, gait belt, towels, foot stool, all were put away at end of Rx Set up was mostly appropriate with minor exceptions, the learner needed to leave the patient to get something, but the patient was safe & supported Nervous but safe Set up was appropriate with minor exceptions, learner just forgot several things and left pt.(several times) but pt. was supported & safe Inappropriate Did not use a sheet on the treatment plinth during Rx Unsafe left the patient unsupported when going to retrieve something needed for treatment Disrespectful to the patient Forgotten or incomplete task performance Comment: Not speaking to the patient to explain where/why leaving pt. to retrieve something,leaving a patient in the treatment area at the conclusion of Rx, not concluding Rx with any type of remark to the pt. Forgetting to clean up Rx area before starting to document or until prompted to do so 2. preparation of the clinician, hand-washing before touching a patient, lab coat and name tag Scores Equivalent to: Observations Entry level performance for a PTA hot water, towel to turn on and off water, 15 second scrub with soap, sleeves away from wrists, name tag with his or her name, coat buttoned & neat 14

15 9 9 9 Competent for a PTA learner at this level hot water, towel to turn on and off water, 15 second scrub with soap, sleeves away from wrists, name tag Nervous but safe hot water, towel to turn on and off water, 15 second scrub with soap, sleeves away from wrists, as above, but may have needed to start over Inappropriate cold water, no towel to turn on and off water, 5 second scrub with soap,no name tag, continually touching self and re-washing hands (leaving pt.) Circle infraction(s) Unsafe cold water, no towel to turn on and off water, touching oneself after washing hands and not re-washing hands Circle infraction(s) Fraudulent wrong name on name tag Disrespectful to the patient Forgotten or incomplete task performance Comment: no lab coat, or no name tag, exposed tattoos, inappropriate clinical attire, hair in face, colored nail polish, etc. forgot to wash hands, touched self and forgot to wash hands, forgot lab coat or name tag 3. to see how the clinician introduces him/herself to the patient (name & title), (clarity and speed) Scores Equivalent to: Observations Entry level performance for a PTA My name is I am a Physical Therapist Assistant Student from Mercer County Community College and I will be working with you today. Slow, clear, easily audible, looked for acknowledgment by pt. (name can be Competent for a PTA learner at this level repeated by pt. name tag fully visible to pt.) as above but the volume, speed or clarity could be improved Nervous but safe as above but Physical Therapy Assistant Student and/or the volume, speed or clarity could be improved Inappropriate as above but Physical Therapy Assistant or Physical Therapist Assistant and /or the volume, speed or clarity could be improved Fraudulent My name is I am a Physical Therapist Student (or I am a Physical Therapist Assistant) and I will be working with you today. Slow, clear, easily audible, looked for acknowledgment by pt Disrespectful to the patient Forgotten or incomplete task performance Comment: No eye contact, utilization of poor grammar Hi, I m goin to be working with you today no introduction Come with me or "come on back!" 4. to see that the dignity of the patient is respected by making eye contact at eye level, draping the patient, allowing the pt. to do as much as he/she can do for him/herself Scores Equivalent to: Entry level performance for a PTA Competent for a PTA learner at this level Observations intro at eye level, greet pt., have pt. propel him or herself to Rx area if capable, pt. Hx in Rx area, drape pt. at all times, pt. is responsible for w/c as above, may not remember to speak to pt. from the front Nervous but safe Inappropriate reviewing Hx.in Rx area or pushing pt. to Rx area, or not permitting able pt. to perform tasks (one of these) not allowing the pt. to perform skills that were practiced to his or her ability Unsafe Pt. precautions were violated by allowing pt. to do too much for him/herself Disrespectful to the patient Forgotten or Not draping the pt.,more than one of the items from inappropriate 15

16 Comment: incomplete task performance 5. to see that the pt. is positioned appropriately for what is being done with them and that they are not asked to change positions un-necessarily. Scores Equivalent to: Entry level performance for a PTA Competent for a PTA learner at this level Observations initially positioning the pt. so that he/she can perform all activities that can be formed in one position before having a pt. change positions, pt. s feet are supported as above but the initial position may need to be changed resulting in more than one position change pt. s feet are supported throughout session to maintain stability Nervous but safe the SPTA realized that position changes were necessary and explained the need for a change to the patient accepting responsibility, pt. s feet are supported to maintain stability Inappropriate the SPTA had the pt. change position more than 3 times including a return to a position due to poor planning, accepting NO responsibility, pt. s feet were not supported pt. potentially unstable Unsafe the SPTA repeatedly had the pt. change position and failed to guard the changes, pt. s feet are not supported and the PTA left the pt. unattended to retrieve something leaving the pt. unstable Disrespectful to the patient Forgotten or incomplete task performance Comment: the SPTA repeatedly had the pt. change position and failed to guard the changes or explain the reasons for the change, pt. stability was compromised without regard for pt. safety The SPTA did not have the p.t change positions when it would have been more appropriate to do so 6. to see that the clinician is demonstrating appropriate concern for the patient and him or herself during the treatment session and as manifested in the treatment environment and the observation and practice of body mechanics that represent good habits and an awareness of the principles for self and others Scores Equivalent to: Entry level performance for a PTA Competent for a PTA learner at this level Observations The SPTA practices safe body mechanics techniques throughout the Rx session and explains them to the pt. as appropriate, (w/c, mat table, transfers, pt. positioning, and all aspects of care) Selected an Rx area that was conducive to both pt. needs and clinician needs. Reminded pt. of body mech during session and provided rationale behind it. As above however, when sitting, the SPTA may need to improve upon personal body mechanics & posture but left something from above out. One omission Nervous but safe Self -corrected errors in body mechanics during Rx session, More than one omission from a Inappropriate Bending at the waist to remove w/c parts, retrieve various items throughout session Unsafe Bending at the waist to transfer pt. with a narrow BOS Disrespectful to the patient Comment: Failure to educate pt. where appropriate regarding body mech when pt. demonstrated poor examples that could lead to future problems 7. to see that things are explained to the patient in terms that he/she is capable of understanding Scores Equivalent to: Observations Entry level performance for a PTA the SPTA explained all activities in lay terminology and demonstrated activities before expecting pt. to perform task, and asked pt if he or she had any?s Competent for a the SPTA used medical terminology and demonstrated activities before 16

17 PTA learner at this expecting pt. to perform task, and asked pt. if he or she had any?s level Nervous but safe the SPTA explained all activities in lay or medical terminology and demonstrated activities before expecting pt. to perform task, but may have forgotten involved side but self-corrected Inappropriate the SPTA explained all activities in medical terminology and did not demonstrate or ask pt. if he/she had any?s Unsafe the SPTA explained some but not all of the activities OR did it in an inappropriate format for THIS patient OR did not demonstrate the activity before asking the patient to perform it OR did the teaching when the pt. was standing, not sitting and supported Disrespectful to the patient Just told the pt. to do something OR did not ask the pt. if he or she had any?s before proceeding Forgotten or incomplete task performance No instruction or demonstration took place prior to the expectation that the pt. would be able to do something Comment: 8. to see that the documentation is meaningful and accurate and meets each of the following criteria: correct abbreviations, spelling, and documentation format in black ink, to see that session measurements are accurate and in agreement with the testers visual assessment of the measurements and the session, recording only what is done and planned Scores Equivalent to: Entry level performance for a PTA Competent for a PTA learner at this level Observations All activities were documented in SOAP note format with appropriate abbreviations, including the side, # sets, # reps, Rx, pt. comments, outcome, etc. and signed leaving no blank spaces and the note was legible, and neat in black ink As above but something could have been improved upon or was left out and would be with experience (e.g. side, # reps, S: too lengthy or not quoted when it should be, etc.) OR prof. designation may have been left out. Only one omission Nervous but safe There may have been some items corrected with a single crossed out line that indicated that the SPTA was nervous, spelling errors were present, OR there was more than one omission OR measurements were not in agreement with the tester Inappropriate Portions of the documentation do not match up with each other or relate to each other. MMT, ROM, Placement of items not within the correct area of the SOAP note etc. OR there might have been parameters for the application of a modality or exercises left out of the note OR illegible words in documentation Fraudulent Statement of test results that did not take place OR an adverse response of the application of a treatment intervention was left out of the documentation Disrespectful to the patient Forgotten or incomplete task performance Comment: Statement of assessments that are beyond the scope of practice for a PTA The documentation was unsigned 9. Patient Safety: to see that the treatment has been prioritized for the patient with evidence of a physiologically sound and rational plan for the session Scores Equivalent to: Entry level performance for a PTA Competent for a PTA learner at this level Please refer to the Critical Safety Indicators Document which is attached. All Critical Safety Indicators MUST be demonstrated during a practical exam for all courses before a learner can be considered safe to proceed on to the next level within the professional phase 17