Physical TheraPy Clinical Handbook
third EditionPhysical therapyclinical handbookfor PTAsKathy Cikulin-Kulinski, PT, DPT, OCSPTA InstructorFox CollegeOrthopedic Clinical Specialist and LSVT BIG Certified InstructorAthletiCoTinley Park, Illinois9781284105568 FMxx 00i xxii.indd 113/01/17 6:38 PM
World HeadquartersJones & Bartlett Learning5 Wall StreetBurlington, MA .comJones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contactJones & Bartlett Learning directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jblearning.com.Substantial discounts on bulk quantities of Jones & Bartlett Learning publications are available to corporations,professional associations, and other qualified organizations. For details and specific discount information, contactthe special sales department at Jones & Bartlett Learning via the above contact information or send an email tospecialsales@jblearning.com.Copyright 2018 by Jones & Bartlett Learning, LLC, an Ascend Learning CompanyAll rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form,electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system,without written permission from the copyright owner.The content, statements, views, and opinions herein are the sole expression of the respective authors and not thatof Jones & Bartlett Learning, LLC. Reference herein to any specific commercial product, process, or service by tradename, trademark, manufacturer, or otherwise does not constitute or imply its endorsement or recommendation byJones & Bartlett Learning, LLC and such reference shall not be used for advertising or product endorsement purposes.All trademarks displayed are the trademarks of the parties noted herein. Physical Therapy Clinical Handbook for PTAs,Third Edition is an independent publication and has not been authorized, sponsored, or otherwise approved by theowners of the trademarks or service marks referenced in this product.There may be images in this book that feature models; these models do not necessarily endorse, represent, or participate in the activities represented in the images. Any screenshots in this product are for educational and instructivepurposes only. Any individuals and scenarios featured in the case studies throughout this product may be real or fictitious, but are used for instructional purposes only.Production CreditsVP, Executive Publisher: David D. CellaPublisher: Cathy L. EspertiAcquisitions Editor: Sean FaberyEditorial Assistant: Hannah DziezanowskiDirector of Production: Jenny L. CorriveauDirector of Vendor Management: Amy RoseVendor Manager: Juna AbramsAssociate Marketing Manager: Alianna OrtuVP, Manufacturing and Inventory Control: Therese ConnellComposition: Cenveo Publisher ServicesProject Management: Cenveo Publisher ServicesCover Design: Michael O’DonnellDirector of Rights & Media: Joanna GallantRights & Media Specialist: Jamey O’QuinnMedia Development Editor: Troy ListonCover Image: ShutterstockPrinting and Binding: Edwards Brothers MalloyCover Printing: Edwards Brothers MalloyLibrary of Congress Cataloging-in-Publication DataNames: Cikulin-Kulinski, Kathy, author. Preceded by (work): Dreeben-Irimia, Olga.Physical therapy clinical handbook for PTAs.Title: Physical therapy clinical handbook for PTAs / Kathy Cikulin-Kulinski.Description: Edition: 3. Burlington, MA : Jones & Bartlett Learning, 2017. Preceded by Physical therapy clinical handbook for PTAs / OlgaDreeben-Irimia. 2nd ed. c2013. Includes bibliographical references and index.Identifiers: LCCN 2016048144 ISBN 9781284105568 (alk. paper)Subjects: MESH: Physical Therapy Modalities Interpersonal Relations Allied Health Personnel Safety Management Emergency Treatment HandbooksClassification: LCC RM705 NLM WB 39 DDC 615.8/2—dc23 LC record available at https://lccn.loc.gov/20160481446048Printed in the United States of America21 20 19 18 17 10 9 8 7 6 5 4 3 2 19781284105568 FMxx 00i xxii.indd 213/01/17 6:38 PM
DedicationTo Tim, Charleigh, and Alyssa for your patience, support, encouragement, and loveTo Dad, Mom, and Nick for always believing in me and giving me a solid foundation tobuild upon9781284105568 FMxx 00i xxii.indd 313/01/17 6:38 PM
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ContentsPrefaceAcknowledgmentsAbout the AuthorReviewersxviixixxxxxiPart 1: Safety in the Clinical Environment1Section 1-1: Physical Therapist and Physical Therapist Assistant Relationship3The Collaborative Path Between the PT and the PTAPTA Duties (as per the American Physical Therapy Association)The PTA’s Clinical Considerations During InterventionsSection 1-2: Patient CommunicationGeneral Recommendations for Verbal CommunicationMethods of Effective Patient CommunicationInformed ConsentMethods of Effective ListeningSection 1-3: Cultural CompetenceGeneral Methods to Increase Cultural CompetenceGuidelines to Cultural CompetenceReligious Beliefs and Health ConceptsIntervention Strategies Considering Cultural DiversitySection 1-4: Infection ControlPersonal Protective Equipment OverviewCenters for Disease Control and Prevention’s Recommended Standard PrecautionsCDC Guidelines for Airborne, Droplet, and ContactTransmission-Based PrecautionsOccupational Safety and Health Administration’s Universal PrecautionsRecommendationsAsepsis MethodsTypes of Nosocomial InfectionsInfectious DiseasesSection 1-5: Family ViolenceFamily Violence OverviewElder AbuseChild AbuseHow to Recognize Forms of Family AbuseDifficulties in Identifying and Helping Victims of Family ViolenceMethods to Overcome Difficulties in Identifying and HelpingVictims of Family ViolenceSigns Indicating a Victim of Family 2627v9781284105568 FMxx 00i xxii.indd 513/01/17 6:38 PM
Family Violence Signs Requiring ScreeningThe Joint Commission’s Guidelines and Goals for IdentifyingVictims of Family ViolenceSection 1-6: Patient Safety During InterventionsVital Signs NormativesPatient Emergency SituationsGeneral Signs and Symptoms that Warrant Discontinuing PhysicalTherapy InterventionsSigns and Symptoms of Hyperglycemia: High Blood Sugar ofMore Than 200 mg/dLSigns and Symptoms of Hypoglycemia: Low Blood Sugar ofLess Than 50 mg/dLIntervention Precautions for Patients with DiabetesSigns and Symptoms of Electrolyte Disturbances: Hyperkalemia(High Potassium Level in Blood)Signs and Symptoms of Electrolyte Disturbances: Hypokalemia(Low Potassium Level in Blood)Signs and Symptoms of Electrolyte Disturbances: Hypernatremia(High Sodium Level in Blood)Signs and Symptoms of Electrolyte Disturbances: Hyponatremia(Low Sodium Level in Blood)Signs and Symptoms of Electrolyte Disturbances: Hypercalcemia(High Calcium Level in Blood)Signs and Symptoms of Electrolyte Disturbances: Hypocalcemia(Low Calcium Level in Blood)Signs and Symptoms of Respiratory Acidosis: CO2 Retention andImpaired Alveolar VentilationSigns and Symptoms of Respiratory Alkalosis: Low CO2 andAlveolar HyperventilationSigns and Symptoms of Overhydration: Excess of Body FluidSigns and Symptoms of Dehydration: Extreme Decrease of Body FluidClinical Safety Measures for Anticoagulation TherapyAcute Care SafetyOut-patient SafetyHome Health SafetyMedications and Patients’ Adverse Reactions in the ClinicContraindications to and Precautions for Physical Agents and 3536373739394040404047Part 2: Clinical Documentation49Section 2-1: Documentation Guidelines51General Documentation GuidelinesAmerican Physical Therapy Association’s (APTA’s) Documentation GuidelinesAPTA’s Documentation Guidelines on Family ViolenceSection 2-2: Documentation ElementsInitial Examination and Evaluation ElementsPatient History ElementsProgress Report Elementsvi52525254555556Contents9781284105568 FMxx 00i xxii.indd 613/01/17 6:38 PM
Discontinuation of Physical Therapy Report ElementsPossible Indications for Patient’s Discontinuation of Physical Therapy5656Section 2-3: International Classification of Functioning, Disability,and Health (ICF) Overview57ICF OverviewMaking Links Between the ICF Components and DocumentationExamples of Impairments in Body Function and Structure and RelatedActivity Limitation, and/or Participation RestrictionConsiderations for Making Links When DocumentingSubjective DataObjective Data585859596060Section 2-4: Daily/Weekly SOAP Note Elements61Strategies for Writing Subjective DataObjective Data GuidelinesStrategies for Writing Objective DataAssessment DataStrategies for Writing Assessment DataPlan DataStrategies for Writing Plan Data62626263636363Section 2-5: Patient Education64The PTA’s Responsibilities During Patient EducationPatient Education for Patients/Clients Who Have Difficulty ReadingPatient/Client Education for Older AdultsPatient Education for Patients/Clients Who Have Visual ImpairmentsPatient Education for Patients/Clients Who Have Hearing ImpairmentsPatient Education for Patients/Clients Who Cannot Speak EnglishBasic Requirements for the Home Exercise ProgramExample of a Home Exercise Program to Improve Upper Body Postural ControlSection 2-6: Electronic Medical Documentation656565666666676768Documentation Summary PearlsDocumentation TipsTelephone Referral DocumentationHealth Insurance Portability and Accountability Act and Documentation71717172Section 2-7: Patient Confidentiality73APTA Standards of Ethical Conduct and Guide for Conduct of thePhysical Therapist AssistantSignificance of Patient ConfidentialitySituations When the Patient’s Written Authorization for Release ofMedical Information Is RequiredReferences74747475Part 3: Musculoskeletal Interventions77Section 3-1: Phases of Tissue Healing and Clinical Interventions79Tissue Healing and Interventions80Section 3-2: Bones81Human SkeletonCarpal BonesTarsal Bones828383Contents9781284105568 FMxx 00i xxii.indd 7vii13/01/17 6:38 PM
Section 3-3: Muscles: Function, Nerve, Origin, Insertion, and PalpationPelvis and Hip MusclesKnee MusclesAnkle and Foot MusclesShoulder MusclesRotator Cuff MusclesElbow and Forearm MusclesWrist, Hand, and Finger MusclesThenar and Hypothenar MusclesNeck, Trunk, and Back MusclesSection 3-4: Musculoskeletal Data CollectionGoniometry—Joint Measurements: Body Position, Goniometer Alignment,and Normal Range of Motion Degrees (per AAOS)Cervical and Thoracolumbar Range of Motion Normatives (per AAOS)Manual Muscle Testing: Grading System of Hislop and MontgomeryUpper Extremity Manual Muscle TestingFinger and Thumb Manual Muscle TestingLower Extremity Manual Muscle TestingBig Toe and Other Toes Manual Muscle TestingMyotomes TestingPain RatingDeep Tendon Reflexes and GradesOrthopedic Special Tests: Shoulder, Elbow, Wrist, and HandOrthopedic Special Tests: Hip, Knee, and AnkleCommon Injuries of the Brachial PlexusCommon Muscle SubstitutionsSection 3-5: Basic Clinical Impairments and Activity LimitationsRelated to Common Musculoskeletal ConditionsClinical Impairments and Activity Limitations of Arthritic DisordersClinical Impairments and Activity Limitations of OtherMusculoskeletal ConditionsSection 3-6: Types of Musculoskeletal InterventionsTherapeutic Exercises: Indications and ContraindicationsRelaxation ExercisesClosed Kinetic Chain Exercises to Increase Weight-Bearing Controland StabilityPatient Education Topics Related to the Lumbar SpineAbdominal Strengthening ExercisesExercise Topics for the Obstetric PatientBiophysical Agents and Modalities: Indications and ApplicationsTherapeutic Massage ApplicationOrthoticsOrthotic InterventionsTranstibial (Below Knee) ProsthesesTransfemoral (Above Knee) ProsthesesProsthetics: Levels of AmputationProsthetics: Pressure-Tolerant and Pressure-Sensitive AreasProsthetic Wearing Schedule Patient EducationProsthetic 9781284105568 FMxx 00i xxii.indd 813/01/17 6:38 PM
Phases of Gait CyclesMuscle Activation PatternsCommon Gait Deviations: Stance PhaseCommon Gait Deviations: Swing PhaseGait Training PointsWheelchair ManagementMobility Training181181182183183184189Section 3-7: Musculoskeletal Intervention Strategies191APTA’s Guide to Physical Therapist Practice Intervention CategoriesMost Related to the Musculoskeletal SystemArthritic Disorders: InterventionsOveruse SyndromesStrains, Sprains, Dislocations, and Fractures: InterventionsThoracic Outlet Syndrome, Adhesive Capsulitis, Low Back Disorders,Plantar Fasciitis, and Arthroplasties: InterventionsReferences192196197199202212Part 4: Neurologic Interventions215Section 4-1: Review of Nervous System Anatomy and Physiology217Parts of the Brain and Their FunctionsCerebral Hemispheres and Their FunctionsSpinal CordAscending (Sensory) TractsDescending (Motor) TractsAutonomic Nervous SystemBrain Meninges and VentriclesRole of Cerebrospinal FluidBrain Blood SupplyMuscle Sensory Receptors and Their Functions218220222223224224224225226226Section 4-2: Neurologic Data Collection227Patient Arousal LevelsMemory and Amnesia TermsOrientation TermsRanchos Los Amigos Levels of Cognitive FunctioningTerms of Cognitive–Perceptual DeficitsSpeech and Communication Functions and ImpairmentsSensory Function: Sensory ReceptorsSensory Function: DermatomesMotor Function: Tonal AbnormalitiesMotor Function: Myotatic Reflexes (Stretch Reflexes)Motor Function: Grading Scale for Muscle Stretch ReflexMotor Function: Babinski’s ReflexMotor Function: Cranial Nerve Functions and ImpairmentsMotor Function: Cerebellar Dysfunction CharacteristicsMotor Function: Basal Ganglia Dysfunction CharacteristicsMotor Function: Characteristics of Upper Motor Neuron and LowerMotor Neuron LesionsMotor Function: Coordination Tests and ScoringMotor Function: Balance Tests and 38239239240Contents9781284105568 FMxx 00i xxii.indd 9ix13/01/17 6:38 PM
Functional Balance Test: Berg Balance ScaleFunctional Balance Test: Performance-Oriented Assessment ofMobility I: POMA I (Tinetti)Functional Balance Test: Timed Get Up and Go Test and NormativesMotor Deficits Associated with Cerebral Vascular Accident: AbnormalSynergy PatternsBrunnstrom’s Spasticity PatternsMotor Deficits Associated with Cerebral Vascular Accident: Brunnstrom’sStages of RecoveryCerebral Vascular Accident: Gait DeficitsTraumatic Spinal Cord Injury: Functional Capabilities and AssistanceTraumatic Spinal Cord Injury: Mechanisms of InjurySpinal Cord Injury SyndromesClassification of Spinal Cord InjuryClassification of Multiple SclerosisClassification of Amyotrophic Lateral Sclerosis (ALS)ALS - Summary of the StagesSection 4-3: Clinical Impairments and Activity Limitationsof Neurologic ConditionsClinical Impairments and Activity Limitations: Cerebral Vascular AccidentClinical Impairments and Activity Limitations: Parkinson’s DiseaseClinical Impairments and Activity Limitations: Multiple SclerosisClinical Impairments and Activity Limitations: Traumatic Brain InjuryClinical Impairments and Activity Limitations: Traumatic Spinal Cord InjuryClinical Impairments and Activity Limitations: Guillain-BarréSyndrome (Polyneuritis)Clinical Impairments and Activity Limitations: Amyotrophic Lateral SclerosisSection 4-4: Types of Neurologic InterventionsMotor Function Interventions: Postural Strategies to Regain BalanceMotor Function Interventions: Developmental Motor Skills(Essential Functional Skills)Motor Function Interventions: Restore Movement and FunctionalMobility (Using Developmental Sequence Postures)Motor Function Interventions: Basic Motor Learning StrategiesNeurologic Facilitation TechniquesPNF Diagonal PatternsNeurologic Inhibition TechniquesLocomotion TrainingConstraint-Induced Movement Therapy as a Form of Functional TrainingSection 4-5: Neurologic InterventionsAPTA’s Guide to Physical Therapist Practice: SuggestedNeuromuscular InterventionsCerebral Vascular Accident InterventionsParkinson’s Disease InterventionsMultiple Sclerosis InterventionsTraumatic Brain Injury InterventionsSpinal Cord Injury InterventionsGuillain-Barré Syndrome 05568 FMxx 00i xxii.indd 1013/01/17 6:38 PM
Amyotrophic Lateral Sclerosis InterventionsRecent Advances in Neurological Physical Therapy: Virtual RealityReferences300301306Part 5: Cardiopulmonary Interventions309Section 5-1: Reivew of Cardiopulmonary System and Anatomy311Overview of the HeartArteries and Veins of the BodyOverview of the Coronary Circulation (Hemodynamics)Blood Supply to the HeartOverview of the Electrical Conduction of the HeartAutonomic Nervous System Influences on the HeartOverview of the Pulmonary Anatomy, Including the Respiratory Muscles312313315315316316316Section 5-2: Cardiopulmonary Data Collection319Vital Signs and NormativesAbnormal Breathing PatternsDyspnea GradesBlood Values and NormativesHeart and Lung SoundsSputum AnalysisCardiopulmonary Signs and SymptomsElectrocardiogram (EKG or ECG)Cardiac CycleCardiac Terminology and NormativesPulmonary Terminology and NormativesContraindications to Exercise Tolerance TestsTermination Criteria for Exercise Tolerance TestMedical Cardiac Tests and Procedures: Left Heart Cardiac Catheterization,Echocardiogram, Coronary Artery Bypass Graft Surgery, and PercutaneousTransluminal Coronary AngioplastySection 5-3: Body Structure and Function Impairments Related to theCardiopulmonary System330332Coronary Artery Disease: ImpairmentsCongestive Heart Failure: ImpairmentsChronic Obstructive Pulmonary Disease: ImpairmentsChronic Restrictive Lung Disease: Impairments333334334336Section 5-4: Patient Safety During Cardiopulmonary Interventions337Basic Cardiac Life Support for AdultsSigns and Symptoms That Warrant Discontinuing Cardiac InterventionsSigns and Symptoms That Warrant Changing or DiscontinuingInterventions in Pulmonary RehabilitationPostural Drainage: Possible Complications and Safety InterventionsDuring Pulmonary RehabilitationOxygen SafetyCardiac Safety Rehabilitation Guidelines After Medical Cardiac ProceduresOrthostatic Hypotension in Cardiopulmonary RehabilitationContents9781284105568 FMxx 00i xxii.indd 340341341342xi13/01/17 6:38 PM
Section 5-5: Types of Cardiopulmonary InterventionsMethods for Monitoring Patients During CardiopulmonaryRehabilitation/InterventionsRating of Perceived Exertion (RPE)Metabolic Equivalents and ActivitiesPatient Education Topics for Cardiac DiseasePhases of Cardiac Rehabilitation After Myocardial InfarctionPrevention Interventions for Coronary Artery DiseasePulmonary Interventions: Terms Related to Postural DrainagePostural Drainage Positions: Indications, Contraindications, and PrecautionsPercussion and Shaking Techniques: Indications, Contraindications,and PrecautionsOther Interventions for Pulmonary RehabilitationExamples of Pulmonary ExercisesSection 5-6: Cardiopulmonary Intervention PatternsAPTA’s Guide to Physical Therapist Practice: APTA’sCardiopulmonary Intervention PatternsCoronary Artery Disease: Intervention PatternsCongestive Heart Failure: InterventionsChronic Obstructive Pulmonary Disease: InterventionsChronic Restrictive Lung Diseases, Atelectasis, and PulmonaryEdema: Intervention PatternsEffects of Medications in Cardiac RehabilitationBronchodilators Commonly Used in Pulmonary 9352353355356357359360361362363364368Part 6: Integumentary Interventions369Section 6-1: Review of Integumentary System Anatomy371Skin AnatomySensory Receptors’ Location in the Skin: Identification of Burn DepthSection 6-2: Integumentary OverviewNormal Physiology of Wound HealingBurn ClassificationBurn Wound ZonesRule of Nines and Lund-Bro
Manual Muscle Testing: Grading System of Hislop and Montgomery 114 Upper Extremity Manual Muscle Testing 115 Finger and Thumb Manual Muscle Testing 129 Lower Extremity Manual Muscle Testing 130 Big Toe and Other Toes Manual Muscle Testing 139 Myotomes Testing 139 Pain Rating 140 Deep Tendon Reflexes and Grades 140
Occupational Therapy Occupational Therapy Information 29 Occupational Therapy Programs 30 Occupational Therapy Articulation Agreements 31 Occupational Therapy Prerequisites 33 Physical Therapy Physical Therapy Information 35 Physical Therapy Programs and Prerequisites 36 Physical Therapy Articulation Agreements 37 Physical Therapy vs .
Nevada Physical Therapy Board Mission Statement Mission The mission of the Nevada Physical Therapy Board is to protect the safety and well-being of the public consumer of physical therapy. Who We License The Nevada Physical Therapy Board licenses physical therapists and physical thera-pist assistants.
0. 1 Purpose of Physical Therapy Student Handbook The Physical Therapy (PT) Student Handbook was prepared as a preliminary announcement of policies and procedures designed to promote understanding and mutual respect among faculty, staff, and graduate students within the physical therapy program (referred to herein as the "Program").
Physical Therapy Aide 4 Unit 14 Lesson 14 introduces therapeutic exercises, assisting with ambulation and gait training, various therapy agents and modalities used in physical therapy, and specialized clinical procedures. This lesson also covers job hunting skills for the physical therapy ai
Clinical Education Manual 2020-2021 Last Edited 8/26/20 12:56 PM 4 ABBREVIATIONS ADCE: Assistant Director of Clinical Education APTA: American Physical Therapy Association CAPTE: Commission on Accreditation in Physical Therapy Education CI: Clinical Instructor CPF: Clinical Performance F
Physical Therapy Assistant: a person licensed to engage in the practice of physical therapy, subject to the provisions of the Physical Therapy Practice Act, Subsection 58-24b-401(2)(a). Physical Medicine and Rehabilitation: also referred to as Physiatry or Rehabilitation Medicine: a branch of
Doctorate of Physical Therapy, Arcadia University - 2016 Masters of Health Sciences degree in Physical Therapy, Krannert School of Physical Therapy in Indianapolis -1995 Bachelor of Science Degree in Physical Therapy, Northwestern University -1987 Bachelor of Arts Degree, Southern Illinois University - 1986
Department of Physical Therapy . Physical Therapy Student Handbook . 2019-20 . Clarkson Hall . C.U. Box 5880 . Potsdam, NY 13699-5880 (315) 268-3786 (voice) . to embody the core values of the university and physical therapy profession through teaching, scholarship, and service while meeting the mission of the university, school, and program. .
