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Mercer County Community College Physical Therapist Assistant Program Course Handbook PTA 210 PTA Techniques & Modalities Fall 2004 Barbara J. Behrens MS 156 Course Director 586-4800 x 3385 Mercer County Community College Physical Therapist Assistant Program Course Syllabus Form =============================================================== Course #: PTA 210 Course Title: PTA Techniques & Modalities Credit Hours:(Lecture/Lab) 3/2 Contact Hours during the semester: 45/30 Number of weeks: 11 Clinical Contact Hours during the semester: 0 Number of clinical weeks: 0 Pre-/co-requisite courses: Grading: PTA 106 Therapeutic Measurement 60 % exams(#) 3 NA % quizzes (#) NA % paper(s) NA % presentation(s) 5 % class/lab participation 25 % practical exam 10 % competency tests =============================================================== Text(s): Required: Minor & Minor, Patient Care Skills, Eastern Medical Publishers, Behrens & Michlovitz, Physical Agents: Theory & Practice for the Physical Therapist Assistant, F.A.Davis Company, 1996. Behrens, Physical Agents Lab Manual, F.A.Davis Co., Philadelphia, 1998. Kisner & Colby, Therapeutic Exercise 3rd ed, F.A.Davis Co., 1996. =============================================================== Course Description: Patient care and handling techniques, including positioning & bed mobility; vital signs; transfers; gait; posture; massage; bandaging; edema management; relaxation; traction; aquatics; continuous passive motion devices; hydrotherapy and aseptic techniques. Strategies for therapeutic exercise will also be introduced and practiced throughout the course. Students develop their skills through practice with each other in the laboratory providing them with the opportunity to both administer and receive care. Skills are tested for competence throughout the semester, and integration skills for these techniques and will be tested during the practical examination at the end of the semester. =============================================================== 2 Course Objectives: Following the successful completion of this course, the student will possess skills in the following domains: Cognitive/Knowledge The student will be able to successfully: 1. differentiate between clean and sterile techniques 2. describe the principles and components of a therapeutic exercise program 3. describe the sequence for postural drainage for the lobes of the lungs 4. describe the sequence for tissue healing 5. describe the differences between normal and abnormal tissue healing characteristics 6. identify the components of tissue healing that need to be documented in a patient chart 7. describe the principles of body mechanics 8. differentiate between safe and unsafe patient handling techniques 9. choose therapeutic exercises to strengthen prime-mover muscles 10. question a patient to determine their subjective complaints 11. list the possible ambulatory assistive devices that can be utilized for a patient 12. define the levels of assistance for patient activities and transfers 13. describes non-pathologic gait patterns and differentiates them from pathologic gait patterns 14. describes the components of vital signs (heart rate, respiratory rate, blood pressure) 15. lists the components of a continuous passive motion device for the knee 16. describes the components of mechanical traction devices for spinal traction 17. lists the parts of a whirlpool for a therapeutic intervention with hydrotherapy, describing the variables and rationale for their selection 18. describes the use of intermittent compression as a therapeutic intervention for lymphedema 19. describes chest wall expansion and excursion during inspiration 20. describes the characteristics of cough and sputum differentiating normal from infected sputum 21. describes the components of an aerobic conditioning therapeutic exercise program Psychomotor The student will be able to successfully: 1. demonstrate appropriate aseptic techniques to control the spread of disease 2. perform safe dependent and assisted patient transfers utilizing appropriate body mechanics 3. demonstrate body mechanics principles, assessment of vital signs and patient positioning & draping techniques 4. perform clean and sterile dressing techniques 5. distinguish between bony and non-bony landmarks with accuracy 6. perform a therapeutic massage to the cervical and lumbar musculature to relieve muscle guarding 3 7. demonstrate and guide a patient through a relaxation activity 8. prepare a patient for the application of hydrotherapy, traction, continuous passive motion or intermittent compression 9. measure a patient for ambulatory assistive devices to accommodate weight bearing status 10. demonstrate interpersonal skills to teach therapeutic exercises to patients and family members 11. demonstrates and teaches ambulation with assistive devices (walkers, crutches, canes) on all surfaces (level, curbs, steps, ramps, carpets, tile and outdoor surfaces) 12. performs manual postural drainage techniques 13. documents treatment techniques utilized with classmates in the formulation of a SOAP note 14. adjusts the level of patient activity to maintain patient safety 15. positions a patient in supine, prone, sidelying or sitting to decrease weight bearing on bony landmarks and to improve postural drainage 16. builds a therapeutic exercise program that prepares a patient for activities of daily living (ADL) 17. demonstrates wheelchair operation for patient education and safety 18. measures vital signs including blood pressure, heart rate, respiratory rate at rest and during exercise 19. describes the safety and progression of patients while performing gait, wheelchair and mobility activities 20. demonstrates safe patient interaction and support during an emergency episode with a patient communicating with the supervising PT after ensuring the safety of the patient. 21. demonstrates and performs passive range of motion exercises with patients on all peripheral joints 22. recognizes positions, activities and postures that aggravate or relieve pain 23. approaches the supervising PT when there is a question about an unanticipated patient response to a therapeutic intervention Affective The student will be able to successfully: 1. defend the importance of relaxation techniques and strategies 2. defend a patients right to privacy 3. act as an advocate for the patient by draping them to maintain patient dignity 4. advocate for the value of massage as an essential therapeutic tool 5. appreciate patient privacy and dignity issues without prompting 6. advocates for the documentation of objective signs & symptoms in patient charts 7. weigh patient responses to therapeutic exercise and massage to assess patient progress 8. internalize professional behaviors when interacting as a clinician 9. recognizes cyanosis 10. recognizes activities that aggravate or relieve edema, pain or dyspnea 11. recognizes an emergency situation =============================================================== 4 Course Outline: I Patient Care Skills A. Vital Signs B. Body Mechanics C. Bed Mobility 1. Positioning & Draping D. Transfers 1. Passive 2. Assisted E. Aseptic Techniques & Dressings 1. Wounds 2. Burns II Treatment Techniques A. Palpation B. Massage C. Relaxation D. Traction E. CPM F. Edema Management G. Pulmonary H. Gait 1. Normal 2. Abnormal 3. Assistive Devices I. Hydrotherapy III Foundations for Therapeutic Exercise A. Strength B. Power C. Resistance D. Endurance =============================================================== Course Schedule: Fall 2004 Monday & Wednesdays: 9-11 Location: MS 352 Friday: Lab =============================================================== PTAP Policy: Course Grading One of the goals of the MCCC PTAP is to prepare students to practice as PTAs. 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, with a score equivalent to 77 or higher. In recognition of this standard, set by a board that is external to MCCC, the PTAP will adopt 77 as the minimal passing grade. Other grade ranges are as follows: A = 93-100 A-= 90-92 B+ = 87-98 B = 83-86 B- = 80-82 C+ = 77-79 5 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. PTA Program Attendance and Deportment Policy Statements Physical Therapy is a respected profession. Members of the profession abide by the Code of Ethics for Professional Conduct and the Guide for Professional Conduct. The MCCC PTA program faculty believe that professional conduct and deportment are essential components for success as a Physical Therapist Assistant. Enrollment in a PTAP course will be viewed as a commitment that is made between the student and the instructor. Enrollment in PTA program courses is viewed as a similar agreement to the one that exists between an employer and an employee. Both parties agree and understand that: Attendance is expected for every scheduled lecture, laboratory and clinical education course. Excused absences of didactic courses may be permitted at the discretion of the Course Director, if the absence is discussed in advance of the occurrence. It is the responsibility of the student to leave a message with Barbara Behrens, the PTA Program Coordinator, if the student is going to be absent from a scheduled lecture, laboratory or clinical education course (609-5864800x 3385). This message is to be left prior to the absence of the student. Lateness to a scheduled lecture, laboratory or clinical education course in unacceptable. The student and the Course Director will negotiate based upon the frequency and circumstances, to determine what action will be taken. Repeated latenesses may adversely affect student performance and progression within the PTA program. Students and faculty are expected to behave at all times, in a manner that is consistent with the behaviors of their chosen profession and those of a civilized society.(Nothing in this statement should be construed to prohibit an individual from having an individual lifestyle outside of the clinic environment that may differ from the expected behaviors in the clinic or classroom.) Failure to exhibit behaviors consistent with this policy may result in the need for Program counseling to determine the appropriateness of the choice of major. 6 Continued matriculation following acceptance in the PTA program indicates that the student has agreed to accept and uphold their commitment to these policies. On July 26, 1990, the President of the United States signed the Americans with Disabilities Act (P.L. 101-336). 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 PTA program coordinator prior to the due date for any course examinations or assignments to discuss what accommodations might be necessary. A list of Essential Functions for the PTA program students and graduates is available to all students by request, from the PTA program coordinator. Class Philosophy Participants will be expected to accept responsibility for their learning, and as such will be considered learners. Learners will 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 will also: • actively participate in the presentation/discussion of course materials • 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. Confidentiality Expectations Patients: During the academic preparation to become a physical therapist assistant, there will be instances when you will be expected to collect data regarding a 7 patient that you have seen or are seeing. This data will 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. Sample acceptable data for collection: diagnosis prescribed medications age, gender overall medical condition of the patient previous medical history physical therapy plan of care record of PT visits physical therapy documentation 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 their rights not to do so. Volunteers will be solicited for laboratory demonstrations. Information obtained during these lab exercises is intended for demonstration purposes only. It is the right of every individual NOT to volunteer for a demonstration. However, all students are expected to volunteer to be a patient for their classmates. This may involve the removal of minor articles of clothing. In the event that clothing is removed, draping techniques will be employed to preserve patient dignity. 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 elect to be “patients”. 8 Mercer County Community College Physical Therapist Assistant Program Patient: Practical Examination Score Sheet Student: ___________________ Date: ___________________ 106 Problem: 210 & 211 212 retake # 1 2 Instructions: You will select one of the possible test scenarios that you will need to perform with an assigned patient. You will make your selection approximately __15___ minutes before your actual testing time. During that time, you may review you notes, texts, reference materials, etc., and make notes on a separate piece of paper that you may bring into the test with you. Each test will take a total of __60__ minutes to complete. The tester will be looking for the following: (from the individual being tested) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. preparation of the treatment/assessment area for your patient (before and after the session) preparation of yourself, handwashing before touching a patient to see how you introduce yourself to a patient to see that you respect the dignity of your patient to see that you position your patient appropriately for what you are doing with them to see that you explain what you are going to do with the patient to the patient to see that your session and measurements are accurate and in agreement with the testers visual assessment of the measurements and the session to see that you record your session and measurements in a meaningful and accurate manner Patient Safety: to see that you have prioritized what you are going to do with the patient and that you have a physiologically sound and rational plan for the session Patient Safety: to see that you perform the selected tasks with evidence of skill and safety in the techniques performed The tester will be looking for the following from the “patient” during the test: that you do ONLY what you are told to do the you do NOT try to help the clinician that you do NOT ask questions of the tester that you do NOT prepare or clean up the area that you respect the stress of the clinician and do not try to make it more difficult for them to successfully complete the practical Please note: Patient safety is a critical component for the successful completion of this and all PTA program courses within the PTA curriculum. Items 9 & 10 on the list are considered to be skills that must have a score of “8” of higher for the student to pass this practical examination. 9 Scoring 10 = entry level performance for a PTA 9 = competent for a PTA student at this level 8 = frazzled but safe 7 = inappropriate 6 = unsafe 5 4 3 2 1 = fraudulent = disrespectful to the patient = forgotten or incomplete task performance = = 1. preparation of the treatment/assessment area for your patient (before and after the session) Score: Comments 2. preparation of yourself, hand-washing before touching a patient, lab coat and name tag Score: Comments 3. to see how you introduce yourself to a patient (name & title), (clarity and speed) Score: Comments 4. to see that you respect the dignity of your patient (making eye contact at eye level, pt.draping) Score: Comments 5. to see that you position your patient appropriately for what you are doing with them and that you do not have them change positions un-necessarily. Score: Comments 6. to see that you explain what you are going to do with the patient to the patient in terms that they will understand Score: Comments 7. to see that your session and measurements are accurate and in agreement with the testers visual assessment of the measurements and the session, recording only what is done and planned Score: Comments 8. to see that you record your session and measurements in a meaningful and accurate manner, using correct abbreviations, spelling, and documentation format in black ink Score: Comments 9. Patient Safety: to see that you have prioritized what you are going to do with the patient and that you have a physiologically sound and rational plan for the session Score: Comments 10. Patient Safety: to see that you perform the selected tasks with evidence of skill and safety in the techniques performed Score: Comments 10 The following items will be specifically watched by the tester during the test. does the student/patient do ONLY what he/she is told to do does the student/patient try to help the clinician does the student/patient ask questions of the tester does the patient/student prepare or clean up the area does the student/patient respect the stress of the clinician and do not try to make it more difficult for them to successfully complete the practical If any of these behaviors is observed, points will be deducted from the total score for the patient once they are the clinician. (5 points per observed infraction) Points to be deducted from the patient’s score once they are the clinician: ______________ Comments/Infractions: Total Score for the Clinician: _____________________ Review Date: Point Deductions (as a patient): _____________________ Student Initials: Final Score: Pass / Fail Tester: bjb 7/04 11 Mercer County Community College Physical Therapist Assistant Program PTA 210 Date 8/30 9/3 9/8 PTA Techniques & Modalities Fall 2004 Topic(s) Vital Signs BodyMechanics LAB Reading Minor: Chapter 3 Minor: pp.12-14 Body Mechanics Bed Mobility & Transfers LAB Minor: Chapters 2 & 5 Minor: Chapter 4 9/17 Bed Mobility & Transfers Aseptic & Dressing Techniques LAB 9/20 Written Exam # 1 Therapeutic Exercise LAB Kisner: Chapter 21 9/22 Normal Gait Normal/Abnormal Gait LAB Lippert: Chapter 16 9/10 9/13 9/27 10/1 10/4 10/8 Normal/Abnormal Gait Measurement for Assistive Devices Minor: Chapter 9 LAB 10/11 Written Exam # 2 Gait with Assistive Devices LAB Minor: Chapter 9 10/15 Palpation & Massage Relaxation, Traction, CPM LAB Kisner: Chapter 7 Behrens: Chapters 7 & 8 Edema Management Pulmonary Techniques LAB Behrens: Chapter 9 Kisner: Chapters 19 & 20 10/18 10/22 10/25 10/29 12 10/29 WE # 3 Take home exam 12/6 TBA Hydrotherapy & Aqatics LAB 12/13 Practice Case Scenarios 12/17 PRACTICAL EXAM Behrens: Chapter 6 Competency Tests PTA 210 PTA Techniques & Modalities This course incorporates many different patient care skills. Students will be expected to demonstrate each of the skills and internalize the concepts of body mechanics, aseptic techniques, relaxation techniques and positioning concepts when interacting with their “patients”. Vital Signs: Equipment: Watch or clock with a second hand Stethoscope Sphygmomanometer chart to record patient data Preparation: prepare your patient to have their vital signs taken supine sitting Skill Demonstration: monitor and record: blood pressure heart rate respiration Students must be able to provide a rationale for recording each of the monitored signs, and explain the significance of each. Documentation: record each of the monitored vital signs as they would be recorded in a patient progress note Aseptic Techniques Objective Demonstrate universal precautions while changing the dressing of a sacral decubitus ulcer. The student is expected to be able to: don and doff sterile and clean gloves set up a clean environment for the removal of a dressing dispose of medical waste from a soiled dressing measure and describe the size of the ulcer utilizing appropriate terminology for medical documentation set up a sterile environment to a clean dressing to a wound apply a clean dressing to a sacral ulcer 13 The student is responsible for: providing the rationale for clean and sterile environments outlining and defending the importance of universal precautions Therapeutic Exercise Equipment: free weights cane theraband exercise equipment as necessary Preparation: assemble the tools that you will need to progress a patient through a progressive resistance exercise program for upper extremity strength and endurance Skill Demonstration: instruct your patient in a PRE program for general upper body strengthening and endurance demonstrate the activities that you would like them to perform indicate how you would know when the progress the patient and by how much Documentation: document what your patient performed during the test Transfers & Gait with Assistive Devices: Equipment: Preparation: Skill Demonstration: Documentation: Wheelchair Walker Crutches Cane transport your patient in a wheel chair measure your patient for each of the assistive devices transfer from sitting to standing teach your patient how to stand and ambulate using: walker NWB on L (15 feet x2) crutches PWB on L (15 feet x2 + stairs) cane PWB on L (15 feet x2 + stairs) document patient progress in ambulation and transfer techniques Massage: Equipment: Preparation: treatment plinth linens massage lotion towels prepare your patient for an entire back massage 14 Skill Demonstration: Documentation: position & drape appropriately identify each of the types of strokes and their indications perform a relaxing, back massage to relieve minor muscle tightness demonstrate at least 3 types of strokes during the performance of an entire back massage initiate and terminate the massage appropriately instruct the patient appropriately regarding expectations for the massage document what you palpated, performed and the patient response 15 Mercer County Community College Physical Therapist Assistant Program I, the undersigned, have received a copy of the course handbook for _______PTA Techniques __. My signature acknowledges that this information has been explained to me and that I have been given the opportunity to ask questions about the content of the handbook. I understand that I will be held accountable for the expectations of students within this course handbook and the PTA program handbook as stated or implied within them. My signature is provided voluntarily. There were a total of __16___ pages. This signature page is page number ___16____. I have retained my copy of the other pages. I will keep this handbook as my guide throughout this semester. student name signature date Mercer County Community College Physical Therapist Assistant Program I, the undersigned, have received a copy of the course handbook for _____PTA Techniques __. My signature acknowledges that this information has been explained to me and that I have been given the opportunity to ask questions about the content of the handbook. I understand that I will be held accountable for the expectations of students within this course handbook and the PTA program handbook as stated or implied within them. My signature is provided voluntarily. There were a total of _16__ pages. This signature page is page number __16__. I have retained my copy of the other pages. I will keep this handbook as my guide throughout this semester. student name signature date 16