Technical College Of The Lowcountry Dr. Karen Monstein, PT .

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1Technical College of the Lowcountry921 Ribaut Rd.Beaufort, SC 29901Dr. Karen Monstein, PT, MS, DPT4/126kmonstein@tcl.edu(843) 525-8218PTH 240Therapeutic Exercise/ApplicationSU2017Course Lecture: PTH 240 Therapeutic Exercise/ApplicationsLecture Hours: T/Th 8:30 to 11:30*Place: Building 4, Room 124Lab Hours: T or Th 12:30 to 5:30*Place: Building 4, Room 122* times/dates/location may change based on vacation/holiday schedule/lab locationCourse DescriptionPTH 240 Therapeutic Exercise/ApplicationsCredits: 5.0 Lecture: 4.0 Lab: 3.0Prerequisites: PTH 101, PTH 202, PTH 205, BIO 211, ENG 102Co-Requisites: PTH 242, PTH 252Course FocusThis course provides the practical application of therapeutic exercise, goniometry and manual muscle testing.The use of various therapeutic exercise and data collection techniques by the physical therapist assistant ispresented and practiced within the context of the plan of care developed by a licensed physical therapist.Students practice concepts related to patient education, appropriate communication, and documentation ofpatient assessment and care activities.Text and References1. O'Sullivan & Schmitz. Physical Rehabilitation. Rittenhouse FA Davis. 6th Edition2. Coby and Kisner. Therapeutic Exercise: Foundations and Techniques. FA Davis. 6th Edition3. Norkin. Measurement of Joint Motion: A Guide to Goniometry. FA Davis. 4th Edition4. Hislop/Brown . Daniels and Worthingham's Muscle Testing: Techniques of Manual Examination andPerformance Testing. Elsevier. 9th Edition.5. Graves, RA. Clinical Decision Making for the Physical Therapist Assistant. Philadelphia: FA Davis; 2013.Reviewed by: K. Monstein 5/2017 revised 5/17/17 Approved: GMLevicki 5/2017

2Course Objectives* Designates Crucial OutcomesAt the completion of this course, students will:General:1. Complete all tests and measures.2. Apply knowledge of body mechanics, pain assessment, vital signs, and patient safety to therapeuticexercise strategies.*3. Use the SOAP note format to document the provision of physical therapy interventions as directed bythe plan of care.4. Educate others in therapeutic exercise programs.5. Be able to identify components of gait cycle and the major muscle activity that occurs at each joint.6. Be able to identify postural dysfunction and appropriate interventions to improve postural awareness.Introduction to Exercise Principles1. Describe the elements of the physical therapy patient management process.*2. Recognize the role of the PTA in patient assessment.*3. Define terms related to exercise and muscle function.4. State basic principles related to therapeutic exercise.*5. State basic principles related to motor learning.6. Apply basic principles related to motor learning/therapeutic exercise to patient situations.7. Recognize contextual factors (social determinants of health) that may influence outcomes.8. Relate rehabilitation to functional outcomes.*9. Identify strategies to enhance patient compliance.ROM1. Differentiate between passive ROM exercise, active assistive ROM exercise, active ROM exercise, andactive resistive ROM exercise.*2. Identify techniques used to perform self-ROM.3. State normal ROM values for the joints of the upper and lower extremities.*4. Identify functional ROM for the joints of the upper and lower extremities.5. Recognize patterns of substitution used to simulate increased ROM.6. Review & identify normal joint end-feels.7. State the goals of ROM exercises.*8. State contraindications to ROM exercises.*9. Demonstrate PROM utilizing correct hand placement and body mechanics.Data Collection Techniques: Goniometry1. State the purpose of goniometry in physical therapy.2. Explain the principles of goniometry.*3. Define reliability and validity with regards to assessment instruments.4. Identify techniques and practices used to increase reliability of goniometric measurements.5. Demonstrate correct alignment the goniometer when measuring joint ROM.*6. Demonstrate effective stabilization techniques during goniometric measurements.7. Accurately perform goniometric measurements of the shoulder, elbow, wrist, fingers, hip, knee, ankle, toesand trunk.*8. Correctly document the results of goniometry assessment.*Reviewed by: K. Monstein 5/2017 revised 5/17/17 Approved: GMLevicki 5/2017

3Data Collection Techniques: Manual Muscle Testing1. State the purpose of manual muscle testing in physical therapy.2. Explain the principles of manual muscle testing.*3. Describe concepts related to the reliability and validity of manual muscle testing.4. Define muscle test grades.*5. Demonstrate correct positioning and grading when performing manual muscle tests.*6. Demonstrate effective stabilization techniques when preforming manual muscle tests.7. Accurately perform manual muscle tests of the shoulder, elbow, wrist, fingers, hip, knee, ankle, toes,trunk.*8. Correctly document MMT assessment.*Increasing Flexibility1. Define terms related to muscle flexibility.2. Relate hypomobility to soft tissue shortening.3. Explain the physiological responses to stretching exercises.*4. List the contraindications and precautions to muscle stretching.*5. Devise age appropriate muscle stretching techniques.*6. Evaluate various techniques used to increase muscle flexibility.*7. Demonstrate effective muscle stretching techniques utilizing correct hand placement and bodymechanics.*8. Incorporate interventions to increase muscle flexibility into a physical therapy session as directed by theplan of care.*Balance Assessment, Posture and Exercise1. Define key terms related to balance and posture.2. Explain the role of different sensory systems in balance control.*3. Assess balance using the Berg Balance Test, Functional Reach Test, and Timed Up and Go Test.*4. Recognize strategies used to maintain balance.5. Identify causes of impaired balance.6. Identify postural dysfunction.7. Describe the effects of aging on balance and posture.*8. Devise age appropriate balance and postural programs.9. Describe intervention techniques used to treat balance and postural impairments.*10. Determine methods to progress balance training programs.11. List fall prevention strategies for home safety.*9. Demonstrate patient monitoring during intervention activities related to balance and postural training.*10. Incorporate interventions to improve balance and posture into a physical therapy session as directed by theplan of care.*11. Appropriately document balance and posture to accurately reflect the provision of physical therapyintervention as directed by the plan of care.*Principles of Resistance Training1. Define terms related to resistance training.2. Explain basic concepts related to the force of muscle contraction.3. Explain the clinical implications of slow twitch and fast twitch muscle fibers.*4. Explain physiological responses to resistance training.*Reviewed by: K. Monstein 5/2017 revised 5/17/17 Approved: GMLevicki 5/2017

45.6.7.8.9.10.11.12.13.14.15.16.17.18.19.Assess patient responses to resistance training.Describe the effects of aging on muscle strength.*Determine methods to progress resistance training programs.Compare isometric, isotonic and isokinetic forms of resistance training.*Compare open-chain versus closed-chain resistance training.State appropriate treatment parameters for different types of resistance exercise.*Evaluate different equipment used for resistance training including elastic bands, free weights, andresistance machines.Compare progressive resistance training protocols.Identify contraindications and precautions to the use of resistance training.*Recognize issues pertaining to patient safety during resistance training.*Apply basic physical principles related to the use of resistance training as a physical therapy interventionincluding stabilization, positioning, and posture.Provide basic patient education related to resistance training.Relate therapeutic exercise to functional outcomes.*Demonstrate strengthening exercise techniques using elastic bands, free weights, body parts or householditems in open and closed chain for the UE & LE.*Incorporate interventions to increase muscle strength into a physical therapy session as directed by the planof care.*Aerobic Conditioning and Re-Conditioning1. Define terms related to aerobic conditioning and re-conditioning.2. Differentiate between aerobic and anaerobic activities.3. Explain physiological and psychological responses to aerobic exercise programs.*4. Describe physiological adaptations to aerobic conditioning.5. Assess patient reactions to aerobic exercise.*6. Employ recommended parameters of exercise related to the use of aerobic conditioning and reconditioning.7. Practice aerobic conditioning exercises.8. State contraindications and precautions to the use of aerobic conditioning and re-conditioning exercises.*9. Incorporate interventions to increase aerobic conditioning into a physical therapy sessions as directed bythe plan of care.*10. Utilize select data collection measurements to correctly assess aerobic condition and response to exertion.*Aquatic Exercise1. Define terms related to the properties of water.2. Explain physiological responses to immersion in water.3. Apply the properties of water to therapeutic exercise techniques.4. List precautions and contraindications to aquatic exercise.*5. Incorporate the use aquatic therapy with stretching techniques.6. Incorporate the use of aquatic therapy with resistance training.7. Differentiate uses of different aquatic exercise equipment.8. State advantages and disadvantages of aquatic therapy.*9. Recognize indications for aquatic therapy.*Gait Analysis1. Define and utilize appropriate terminology relating to gait.2. Describe key components (joint ROM and muscle action) that occur during the stance and swingphases of gait.*3. Review determinants that affect gait (displacement of center of gravity, width of base,Reviewed by: K. Monstein 5/2017 revised 5/17/17 Approved: GMLevicki 5/2017

5lateral pelvic tilt, and arm swing).*4. Identify unsafe gait and effectively communicate with appropriate parties.*5. Recognize key qualities of typical gait that occur across the lifespan.6. Identify or describe common atypical gaits caused by the following*:a. Muscle weakness or paralysisb. Joint muscle ROM limitationc. Unequal leg lengthRelaxation Exercises1. Describe different relaxation techniques.2. Explain the theories of physiological relaxation responses.*3. Identify physical indicators of a relaxed state.4. Identify precautions to relaxation exercises.*5. Recognize modalities used to aid in muscle relaxation.Pregnancy1. Identify the stages of pregnancy.2. Identify partum and post-partum conditions related to therapeutic exercise.3. Explain indications and contraindications of therapeutic exercise during each of the above.*4. Identify postural considerations and functional requirements related to each of the above.*Student ContributionsClasses are designed to employ a variety of teaching techniques. In order to maximize learning, requiredreadings and Web enhanced sections should be done prior to class. If a student is falling behind in laboratoryperformance and/or academic achievement, it is imperative to seek immediate assistance from the instructor.Laboratory Requirements and Dress CodeEach student is required to actively participate in laboratory sessions by practicing the application of assessmentand treatment techniques on fellow classmates. Appropriate and professional behavior is expected at all timesin the laboratory setting. Solid colored shorts and solid colored tank tops are the required attire for alllaboratory activities. Clothing must plain (i.e. devoid of pictures, lettering, or designs). A solid colored sweatshirtor solid colored sweatpants may be worn over these if such clothing does not interfere with the laboratoryactivities. Students may wear TCL logoed attire to lab. Clothing must allow access to various parts of the bodyduring specified laboratory activities. Male students may be required to remove their shirt. Failure to complywith the dress code will result in dismissal from the lab, resulting in an absence.In order to perform at a satisfactory level in the laboratory area, students must be prepared each lab session todo the following.1.2.3.4.5.Arrive on time and in proper attire;Complete laboratory assignments on time and in the prescribed manner;Perform physical therapy techniques safely and competently;Accurately perform physical therapy skills and procedures learned in campus lab;Correctly apply all previously mastered knowledge, skills, and abilities.DRESS CODE (General)Reviewed by: K. Monstein 5/2017 revised 5/17/17 Approved: GMLevicki 5/2017

61. Students are expected to attend class dressed neatly and well groomed.2. Clothes must be clean, non-stained, in good repair, tucked in as appropriate, pressed and free ofwrinkles.3. Clothing must be non-seductive, and not exotic or extreme in style.4. Clothing should fit properly, proportionately correct for body size (not too tight, oversized, too short,too long, etc.).5. Clothing should be plain and casual.6. TCL branded clothing is acceptable.7. All students are expected to wear appropriate undergarments that are not visible (for example: colors,prints, thongs, etc.) and must be worn under the exterior garment.8. A bra must be worn by females including under a camisole.9. Caps and sunglasses will be removed in the classroom.10. Clothing must not reveal the navel, breast or bottom.11. A student in violation of the dress code will be dismissed from the classroom resulting in an absence.Physical Therapy laboratory. Learning experiences in the physical therapy laboratory provide an opportunityfor the student to become familiar with equipment and techniques. The student utilizes the physical therapylaboratory to practice new skills. Skills must be practiced in the laboratory before being used in the clinicalsetting. Competence must be demonstrated in the physical therapy laboratory. Students are responsible formaterial covered in campus laboratory. In order to progress in the course and program, by the end of thecourse each student MUST achieve a satisfactory skill criterion and demonstrate competence in laboratory skills.Competency skill checks and laboratory practical’s are given to assist in the evaluation of individual studentprogress and to support student success. The student is responsible for maintaining their skill competencycheck lists and turning them into the instructor as required.At the conclusion of each laboratory experience, the student’s lab performance is evaluated. The student isawarded 1 point for each satisfactory performance and 0 points if performance is unsatisfactory. The student’sperformance is evaluated based on environmental contribution, attendance, and preparedness. Expectationsinclude:1. Contributing to a productive learning environment for self and others bya. being prepared for the lab activities by reading and watching required material as applicableb. answering questions and identifying steps or processes about skillc. demonstrating mastery of skillsd. remaining attentive2. Arriving and departing on time. Attendance is expected for each scheduled laboratory experience.See Course Evaluation for point requirements in this course.Reviewed by: K. Monstein 5/2017 revised 5/17/17 Approved: GMLevicki 5/2017

7Course EvaluationEVALUATIONMidterm ExamCumulative Final ExamMidterm Practical ExamFinal Practical ExamQuizzesCase StudyLab AssignmentsLabParticipation/PerformanceNumber 01002005050S/UPercentage of Weighted Grade1000100% and Satisfactory DING POLICYGrading scale90% - 100% AWwithdraw82% - 89% BWPwithdraw with passing grade75% - 81% CWFwithdraw with failing grade70% - 74% DIIncompleteBelow 70% FRefer to addendum for further grading information pertaining to this course.Grading Methodology. The final grade must be 75.00% or more in order to pass the course and progress in theprogram.Students absent from an examination (quiz, test and final exam) or skills check/practical will receive a “0” gradefor the examination/skills check/practical unless other arrangements are made with the individual instructorprior to the examination or skills check/practical day or on the examination or skills check/practical day beforethe examination/ skills check/practical is scheduled to be given. It is the responsibility of the student to contactthe appropriate instructor to arrange to make up the examination/ skills check/practical. Arrangements may becompleted by telephone. If the instructor is not available, a message should be left on the instructor’s voicemail first AND with another member of the core faculty, and at last resort, the Division of Health Sciencesadministrative assistant. The instructor will decide the time and method of make-up examinations/presentationon an individual basis. Messages sent by other students are unacceptable. The student is responsible fornotifying the instructor of the reason for the absence. Grades are posted on Blackboard within one week ofadministration of tests and examinations. No rounding of numbers will be used to calculate any grades. If thestudent scores lower than a 75% on a test or an assignment, it is the student’s responsibility to contact theinstructor to arrange a meeting to discuss learning strategies and or actions/indicators to improve performanceon course evaluation measures.TEST REVIEWReviewed by: K. Monstein 5/2017 revised 5/17/17 Approved: GMLevicki 5/2017

8Tests will be reviewed in class and discussion will be limited to the right answer. Students will not be allowed totake any written notes, use electronic devices to take notes or make an image of the tests. All items have to beremoved from the desk/table top during the test review. For any discussion beyond the right answer, set up anappointment with the instructor to further discuss.Prior to the final exam, test review will be done during the last class of the semester. All items have to beremoved from desk/table top during the test review. No notes can be taken and no electronic devices can beused to take notes or make images of the tests. This is an opportunity to ask questions about concepts that youdo not understand. If individualized time is need for test review, an appointment can be made with theinstructor, but not during exam week and the time limit will be 15 minutes. All tests will be reviewed under thesupervision of an instructor. Students cannot bring any class notes with them.ADA STATEMENTThe Technical College of the Lowcountry provides access, equal opportunity and reasonable accommodation inits services, programs, activities, education and employment for individuals with disabilities. To request disabilityaccommodation, contact the counselor for students with disabilities at (843) 525-8219 or (843) 525-8242 duringthe first ten business days of the academic term.ATTENDANCE1. The College’s statement of policy indicates that students must attend ninety percent of total class hoursor they will be in violation of the attendance policy.2. Students not physically attending class during the first ten calendar days from the start of the semestermust be dropped from the class for NOT ATTENDING.3. Students taking an online/internet class must sign in and communicate with the instructor within thefirst ten calendar days from the start of the semester to indicate attendance in the class. Students notattending class during the first ten calendar days from the start of the semester must be dropped fromthe class for NOT ATTENDING.4. Reinstatement requires the signature of the division dean.a. In the event it becomes necessary for a student to withdraw from the course OR if a student stopsattending class, it is the student’s responsibility to initiate and complete the necessary paperwork.Withdrawing from class may hav

Data Collection Techniques: Manual Muscle Testing 1. State the purpose of manual muscle testing in physical therapy. 2. Explain the principles of manual muscle testing.* 3. Describe concepts related to the reliability and validity of manual muscle testing. 4. Define muscle test grades.* 5.

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