UNIT1BODYMECHANICS,IMMOBILIZATION,ANDBEDMOBILITY

Definethetermbodymechanicsanddiscussrelatedterms(COG,BOS,VGL,levers).
Discussprinciplesofperformingproperlifting,reaching,pushing,andpullingtechniques.
Explainspecificprecautionstobeusedwhenlifting,reaching,pushing,pulling,and
carryingobjects.
Demonstrateproperbodymechanicswhileperforminggaittrainingand
Effectsofimmobilization
Describetheeffectsofimmobilization:
integumentary
musculoskeletal
digestive
urinary
cardiovascular
respiratorysystems.
Describethepsychosocialeffectsofimmobilization.
Describepreventativemeasuresfortheeffectsofimmobilization.
Bedmobility
instructapatientwhenmovinginbed:
SidetoSide
UpwardDownward
SupinetoSidelying
SupinetoProne
PronetoSupine
SupinetoSit
SittoSupine

UNIT2POSITIONINGANDWHEELCHAIRS
Describe,select,andperformonapartner,appropriatepositioningofthehead,neck,
trunk,andextremitiesinthepositionsof:
supine
prone
sidelying
sitting
Discussindicationsandprecautionsrelatedtothepositioningofpatients.
Describethedifferencebetweenshorttermandlongtermpositioning.
Namethebonyprominencesatriskforpressureulcersin:
supine
prone
sidelying
sitting
Namethefrequencyforpositionchangesintherecumbentandseatedpositions
Discusstheissuesandpreventativepositioningassociatedwith:
LEamputation
Totalhipreplacement
Hemiplegia
Spinalcordinjury
Graftedburnarea

Wheelchairs:
Identifythevarioustypesofwheelchairsandmatcheachtypetothespecialized
needsofthewheelchairuser.
Listandidentifythecomponentsofawheelchair,andmatchthevarioustypesof
componentstothespecializedneedsofthewheelchairuser.
Statethedimensionsofastandardadultwheelchair.
Describethepotentialcomplicationsofanillfittingwheelchair.
explaintheprocedureforbasicadjustmentofwheelchaircomponents(legrest
length,wheellocks,footplates)
Describeandperformwheelchairfittingandconfirmationoffittoinclude:
seatwidth
seatdepth
seatheight
legrest/frontrigginglength
footplate/footrestclearance
armrestheight
backheight
wheelchairactivities:
wheelchairpropulsionwithbilateralUEs,oneUE/oneLE,bilateralLEs
reachinganobjectonthefloor
Performwheelchairto/fromfloortransfers(2methods)
wheelchairactivities:
ascendingacurbforward/backward
descendingacurbforward/backward
ascending/descendingaramp/inclineforwardandbackward
ascendingstairsbackward
descendingstairsforward

UNIT3PATIENTTRANSFERS

Discusstheprinciplesandpreparationsrelatingtopatienttransfers.
Describetheprecautionsandsafetyfactorsinvolvedinpatienttransfers.
Definethetermsusedtodescribethedegreeofassistance.
Discusstheprocedureforperformingagrossstrengthassessment.
Describethepropertechniqueforperformingthefollowingtransfers:
standingdependentpivot
standingassistedpivot
sitting,slidingboardtransfer
sitting,lateralswingtransfer
onepersondependentlifttransfer
twopersondependentlifttransfer(twomethods)
threepersondependentlifttransfer
mechanicallifttransfer
Applytheirknowledgetodecidewhichtransferismostappropriategivenaspecificcase
scenario.

UNIT4SPECIALEQUIPMENTANDINCIDENTSANDEMERGENCIES
SpecializedEquipment
Discussvarioustypesofmonitoringequipmentandimplicationsfortherapy.
Discussventilators,chesttubes,feedingtubes,urinarycathetersandoxygen
therapysystemsandimplicationsfortherapy.
IncidentsandEmergencyCare
Listtheresponsibilitiesofthetherapistandotherpersonnelinanemergency
situation.
Discussthesigns,symptoms,andappropriateinterventionforapatientexperiencing:
hemorrhage
cardiacarrest
insulinrelatedillnessesassociatedwithdiabetesmellitus
shock
seizures
heatrelatedillnesses
hypothermia
Discussthedifferentshockcategoriesandtheirsymptoms

UNIT5GAITTRAININGANDASSISTIVEDEVICES

Discussthebasicphasesofgait.
Discussappropriatepreparationandevaluationtobeperformedpriortogaittraining.
Defineweightbearingterms/abbreviations.
Discusspreambulatoryactivitiesthatcanbeperformedpriortoambulationwithan
assistivedevice.
Discusstheapplications,prosandconsofthefollowingassistivedevices:
Axillarycrutches
Lofstrandcrutches
Walkers(standard,rolling,reciprocal)
Platformattachments
Hemiwalker
Quadcanes(LargeBasedandSmallBased)
Standardcanes
Discusstheproperfittingofthevariousassistivedevicesandtheerrorsthatcanoccurif
thefitisnotcorrect.
Discussambulationwiththefollowingassistivedevices:
Walkers(standard,rolling,reciprocal)
Axillarycrutches
Lofstrandcrutches
Canes(straightcane,SBQC,LBQC,hemiwalker)
Describethebasicgaitpatternsincluding:
FourPoint
TwoPoint
ModifiedFourPoint
ModifiedTwoPoint
ThreePoint
ModifiedThreePoint
Performandinstructalabpartnertoambulateusingthefollowingassistive
deviceswiththeappropriategaitpatterns:
Canes(straightcane,SBQC,LBQC,hemiwalker)
4point(2canes)
Modified4point(1cane)
2point(2canes)
Modified2point(1cane)
Axillarycrutches&Lofstrandcrutches
3point
Modified3point
4point(2crutches)
Modified4point(1crutch)
2point(2crutches)
Modified2point(1crutch)
WalkersStandard,Rolling,andPlatform
3point
Modified3point
WalkersReciprocal
4point
2point
guardingtechniqueswhenteachingand/orassistingapatienttoambulatewiththe
aboveassistivedevicesandgaitpatterns.
Sittingtoandfromstandingtransfers
Ambulationthroughaselfclosingdoor
Ambulationascendinganddescendingcurbs
Stairnegotiation
Ambulationascendinganddescendingramps
Standingtoandfromfloortransfers

UNIT6POSTURE
Posture(Pg.80infairchild)
Definetermsrelatedtopostureassessment.
Describethecharacteristicsofnormalposturefromlateraland
posteriorviews.
Lateral:
Slightlyanteriortothelateralmalleolus
Slightlyanteriortothemidlinethroughtheknee
Approximatelythroughthegreatertrochanter
Throughtheshoulderjoint(midacromion)
Throughthelobeoftheear
Posterior:
Midlinebetweenthecalcanei
Throughtheglutealcleft
Midlinethroughthethorax/spine(lumbar,thoracicand
cervical)
Identifythefollowingposturaldeviationsgiventhefindings
characteristictoeach:
lateralview:
kypholordotic
swayback
flatback
posteriorview:
Handednessposture
Scoliosis
Discussareasofincreasedstressorcompressionrelatedtothepostural
deviationslistedabove.
Definetermsrelatedtopostureassessment.

UNIT7DRAPINGANDBASICSOFEXERCISE
Draping
Discusstherationalefordraping.
Drapingapatientisessentialinordertoprotecttheirmodestyandto
providewarmthduringtreatmentsessions
Describe,selectandperformappropriatedrapingtechniques.
DrapingChecklist:
Thepatientisaskedifclothing/gowncanbeadjustedorremoved.
Thepatientsmodestyisprotected.
Theareatobetreatedisexposedsoobservationand/orpalpation
oftheareacanoccur.
Theareatobetreatedhasfreedomofmovement,yetthedrapeis
secure.
Thesectionofdrapingunderthepatientisfreeoffolds/wrinkles

Exercise
Definepassiveandactiveexercise.
Passiveexercise
performedonapersonbymanualormechanicalmeans.
Thismeansthatnovoluntarycontractionoccurs.Someoneorsomething
elseisdoingtheworkforthepatient.
Activeexercise
Anytypeofactivitythatisperformedbytheindividual.
Includes:
active assisted
activefree
active resisted
Activeassisted
patientisabletodowithsomeassistancefromeitheranindividual
oramachine.
Activefreeexercise
rangeofmotionagainstgravitywithouttheassistanceor
resistancefromanyoneoranything.
Activeresisted
basicallyliftingweights.Itistheperformanceofanexercise
bythepatientwithsometypeofresistanceadded.

Discussbenefitsandlimitationsofpassiveandactiveexercise.
Passiveexercisebenefits
preservingandmaintainingROM
minimizecontractureformationtomaintainmechanicalelasticityof
muscle
promoteandmaintainlocalcirculation.
canalsohelppromotesensoryawarenessofjointmotion
enhancecartilagenutrition
inhibitorreducepain.
Abenefitofpassiveexercise/rangeofmotionisthatweareableto
evaluatejoint integrityandmotion.
Passiveexerciselimitations
Itcannotpreventmuscleatrophy.
Itcannotmaintainorincreasemuscletone,strengthorcontractile
endurance.
Itcannotdecreasecontracturesorincreaserangeofmotion.
Finally,itcannotreduceadiposetissue(darn!).
Activeexercisebenefits
Maintainingphysiologicelasticity,strengthandcontractile
enduranceofmuscle
Increasinglocalcirculation
Increasingawarenessofjointmotion
Maintainingandimprovingcardiopulmonaryfunction
MaypreventthrombusformationinLE
Maintainingandpromotingstructuralintegrityoftendonbone
interface
Improvingmusclestrengthwithuseofexternalresistance

Discusshowbothactiveandpassiveexercisecanbeappropriatelyapplied
duringtherapy.
Activeexerciseisindicatedwhenthepatientisabletovoluntarily
contract,controlandcoordinatemuscularmovements.Inaddition,active
exerciseshouldbeusedwhenthebenefitsaredesirabletofulfillthegoals
ofthepatientstreatment.

Defineanddifferentiatethethreetypesofmusclecontractions:
1. ConcentricCBFwithmuscleshortening
2. eccentricCBFW/musclelengthening
3. isometricCBFW/Ochangeinlength,greatesttensionproduced
Discusstheconceptofendfeel.
Thefeelingofresistancewhenmobilizingajointattheextremesofits
ROM.CanbefeltafterapplyingoverpressureattheendsoftheROM.
Measurementofhowmuchrangeisavailable.
Nameanddescribethethreebasictypesofendfeelandprovide
examples
Softendfeelisusuallywheretwosofttissuestructuresapproximate(i.e.
musclebulk).Thisismostoftenfoundwithelbowflexionandkneeflexion.
Afirmendfeelisfoundwhereligaments,thejointcapsuleor
muscles/tendonsarestretched.Anexampleofthisisankleinversionora
straightlegraise.
Ahardendfeelisexactlywhatitsoundslikehard!Itoccurswhenbone
contactsbone.Themostcommonlocationforthistypeofendfeeliswith
elbowextensionastheolecranoncomesintocontactwiththedistalendof
thehumerus.

Defineanddiscusstheuseofisotonic,isometricandisokineticexercise.
Isotoniccontractions
includeconcentricandeccentriccontractions.
muscleischanginglength.
Aconcentriccontraction
involvesmuscleshorteningwhilethemuscleisgeneratingforce
eccentriccontractioninvolvesmusclelengtheningwhilethe
muscleisgeneratingforce.
isometriccontractioniswhenthejointdoesnotmove,butthemuscleis
contractingandthemusclelengthremainsthesame
isokineticcontraction
involvestheuseofamachinesuchasCybexorKincom,itis
whenthemusclecontractsatthesamespeedinresponsetoan
outsideforce.

Defineanddifferentiateeachofthefivemusclestrengthgrades.
systemisbasedontheamountofresistancethemusclecanholdandis
gradedasfollows:

0/5zero:Novisibleorpalpablecontraction,nojointmovement

1/5trace:Thereisavisibleorpalpablecontraction,nojoint
movement

2/5poor:Thejointmovesfullrangeinagravityeliminated
position

3/5fair:Thejointmovesfullrangeagainstgravity

4/5good:Thejointmovesfullrangeagainstgravityandcantake
moderateresistance

5/5normal:Thejointmovesfullrangeagainstgravityandcan
takemaximumresistance

Explainhoweachofthefivemusclegradesappliestotheapplicationofactive
andpassiveexercise.

UNIT8PASSIVERANGEOFMOTION

Performpassiverangeofmotiononthedesignatedjointswithappropriate:
Patientexposureanddraping
Patientandtherapistpositioning
Stabilization
Supportofthemovingsegment
Speed,controlandthroughthefullrangeofmotion
Communication
Techniquefordeterminingtheendfeel
Safetyprecautionsincludinginfectioncontrol

UNIT9FINEMOTORANDADA
HandFunction
Defineanddescribeprehensionandgrasppatterns.
Determinedifferenttypesofprehensionandgrasppatternsneededfora
varietyofactivitiesofdailyliving(ADLs),workandplayactivities.
Demonstratetheuseofmeasurementtoolsusedspecificallyfortheupper
extremity.
ADA
ExplainthepurposeoftheADA.
DescribethepurposeorintentofthefourmajortitlesoftheADA.
Definetermsrelatedtotheactincludingapersonwithadisability,qualifiedADA

UNIT10GONIOMETRYPRINCIPLES
Explaintheconceptofdegreesoffreedomofajointorjointcomplex
Relatetheconceptofquantityofrangeofmotion,qualityofmovementthroughrange,
andqualityofendfeel,tohypothesesofthedysfunctionthatmaybepresentaffectingthe
jointorjointcomplex.
Describetheimportanceofstabilizationingoniometricrangeofmotionassessment.
Compareandcontrastthedifferenttypesofgoniometricinstruments.

UNIT11GONIOMETRY:UPPERANDLOWEREXTREMITY
Performpassiverangeofmotiongoniometricmeasurementsonthedesignatedjoints
withappropriate:
Patientexposureanddraping
Patientandtherapistpositioning
Stabilization
Supportofthemovingsegment
Verbalizationandpalpationoflandmarks
Readingofthegoniometerandrecordingofrange
Communication
Techniquefordeterminingtheendfeel
Safetyprecautionsincludinginfectioncontrol

UNIT12SPINEGONIOMETRYANDALTERNATIVEMEASUREMENTS
Describehowtomeasurethevariousmovementsofthespineusingeithergoniometry,
CROM,inclinometersortapemeasures.
landmarksusedforeachmeasurement
Discusssomeofthesourcesoferrorassociatedwiththedifferentformsof
measurement