KINGSBOROUGH COMMUNITY COLLEGE
OF THE
CITY UNIVERSITY OF NEW YORK
Physical Therapist Assistant Program
Course Syllabus
PTA 5
THERAPEUTIC EXERCISE
Course Description: This course is designed to introduce the student to therapeutic
exercise techniques. Manual muscle testing is presented and
practiced. Topics including resistive exercise, passive stretching,
and range of motion techniques are studied. Students are
introduced to therapeutic exercise equipment such as: kinetron,
egrometers, treadmill, and wall pulleys. Therapeutic exercise
techniques are studied by anatomical regions.
Textbook Requirements: Kisner, Carolyn, Therapeutic Exercise Foundations and Techniques 4th edition, F.A. Davis Company, Philadelphia, 1996
Pierson, Frank M., Principles and Techniques of Patient Care Third Edition, W.B. Saunders Company, Philadelphia, 1999
Montegomery, Jacqueline and Hislop, Helen, Daniel and Worthingham Manual Muscle Testing, 6th Edition, W.B. Saunders Company, Phil., 1995.
Pre-requisite Courses: PTA 1, PTA 10, PTA 20, PTA 2, PTA 3, BIO 7,BIO 11
Co-requisite Course: PTA 4, BIO 12
Student Learning Objectives
As evidenced by successful performance and completion of written and practical examinations, assignments, research article review, lab presentations and the role playing and analysis of clinical scenarios, the student will:
1.0 Apply principles of therapeutic exercise.
1.1. Identify the principles of range of motion, resistive exercise and manual muscle testing.
1.2. State the general principles of exercise including endurance, power, cardiovascular effects, and psychomotor considerations.
1.3. State the indications and contraindications to therapeutic exercise.
1.4. Identify the effects of pain on therapeutic exercise.
1.5. Identify components of an exercise program.
1.6. State the criteria for progressing a patient’s exercise program.
1.7 List the benefits of and (contra)indications of aquatic therapeutic exercise
1.8. Identify aquatic principles including buoyancy and resistance.
1.9. Discuss physiological and psychological impacts on therapeutic exercise.
1.10.Differentiate the various modes of range of motion including: active,
assistive and passive.
1.11.Describe the rationale for the selection of various range of motion
techniques.
1.12.Distinguish the various types of resistive exercise including: manual resistance, isotonic, isometric, isokinetic and open and closed chain.
1.13.Discuss the indications and contraindications of resistive exercise, range of motion and manual muscle testing.
1.14.Monitor patients’ endurance while performing therapeutic exercise and alter
treatment appropriately.
1.15.Distinguish the differences in manual muscle testing grades.
1.16.Outline the procedures in manual muscle testing.
1.17.Perform manual muscle testing for upper and lower extremity musculature.
1.18.Correlate different exercise regimens with mechanical principles influencing effectiveness.
1.19.Perform therapeutic exercise appropriate for the cardiovascular impaired
patient.
2.0 Implement therapeutic exercise treatments for upper and lower extremities.
2.1. Identify proper technique in range of motion activities and manual muscle testing.
2.2. Identify therapeutic exercise equipment commonly used in physical therapy practice.
2.3. State the rationale for therapeutic exercise.
2.4. Outline the techniques of therapeutic exercise as applied to different regions
of the body.
2.5. Describe factors affecting outcomes of therapeutic exercise.
2.6. Describe the factors affecting selection of therapeutic exercise equipment.
2.7. Implement therapeutic exercise techniques and concepts.
2.8. Demonstrate proper technique in range of motion and resistive exercise techniques.
2.9. Demonstrate safe use of therapeutic exercise equipment
3.0 Given patient scenarios, implement comprehensive physical therapy treatment.
3.1. List effective strategies in teaching therapeutic exercise techniques.
3.2. Explain patient response to therapeutic exercise.
3.3. Link pathological conditions and patient problems with appropriate
therapeutic exercises and exercise equipment.
3.4. Perform therapeutic exercise techniques identifying the role of the physical
therapist assistant in rehabilitation.
3.5. Perform therapeutic techniques appropriately employing universal precautions and sound body mechanics.
3.6. Perform therapeutic techniques demonstrating an understanding of organizational structure, levels of authority, and fiscal considerations of the
health care delivery system.
3.7. Demonstrate proper manual muscle testing technique while considering pathological conditions.
3.8. Select appropriate therapeutic exercise based on manual muscle testing
results
3.9. Implement thermal modalities in conjunction with therapeutic exercise techniques.
3.10.Describe rationale when selecting therapeutic exercise activities, considering specific characteristics of pathological conditions.
3.11.Identify patient progress as it relates to the achievement of short term goals.
3.12.Teach the uses, applications and responses of therapeutic exercise and therapeutic exercise concepts effectively with emphasis on safety and
rationale.
3.13.Demonstrate the adjunctive nature of therapeutic exercise by integrating their use in complete treatment applications.
3.14.Implement therapeutic interventions within the plan of treatment considering knowledge of assessment and measurement (including goniometry),
functional activity, modality and therapeutic exercise skills.
3.15.Implement therapeutic interventions within the plan of treatment demonstrating consideration of time management, therapeutic sequence and
procedure selection issues.
3.16.Implement physical therapy treatments for a variety of patient types
including: orthopedic, neurological and general deconditioned patients in a
variety of settings.
3.17.Demonstrate appropriate documentation of therapeutic exercise treatments considering patient response, treatment parameters, long/short term goals, and effectiveness.
3.18.Perform physical therapy treatments considering influencing factors (psychosocial, cultural, economic, legal/ethical, etc.).
3.19.Assist in discharge planning and alternative levels of care decision making.
3.20.Associate patient verbal and non-verbal response with effectiveness of therapeutic exercise procedures employed
3.21.Communicate to supervising physical therapist the patient response to
therapeutic exercise.
3.22.Deduce the effectiveness of therapeutic exercise considering pathological conditions, attainment of short term goals and the patient’s overall response.
3.23.Assess patient response to treatment and appropriately alter therapeutic intervention within the plan of treatment.
3.24.Verify the effectiveness of his/her teaching behavior by analyzing performance.
3.25.Delineate the beneficial and untoward effects of therapeutic exercise.
3.26.Analyze the relationship of therapeutic exercise with other therapeutic procedures (modalities, range of motion, functional activities) as they relate
to the achievement of rehabilitation goals.
4.0 Demonstrate appropriate professional behavior.
4.1. Attend and be on time for class, lab, and scheduled appointments.
4.2. Be prepared for lab activities; attend to tasks assigned.
4.3. Accept constructive criticism and respond and/or follows through appropriately.
4.4. Express self in a clear and easily understood manner.
4.5. Maintain appropriate personal hygiene.
4.6. Treat others with positive regard, dignity and respect.
4.7. Analyze and examine professional literature considering: specific scientific methods, interpretation of results, and clinical significance in order to foster
further personal investigation and clinical effectiveness.
4.8. Explain the importance of life long learning.
4.9. Describe how professional development can occur.
Student Assessment
As indicated in the student handbook, to receive a passing grade in this course the student must successfully complete all comprehensive examinations and assignments with a “C” or better. Additionally, the instructor assesses student competencies in skills critical to this course using the standardized skills checklists, located in the laboratory, requiring a passing score of at least 90%. Critical skills in this course include:
1. Accurate performance manual muscle testing of major extremity musculature
2. Performance therapeutic exercise techniques (active, passive, resistive) for the shoulder, elbow, wrist, hand, hip, knee, ankle and foot.
3. Organization of exercise programs considering pathological conditions
4. Teaching therapeutic exercises to peers and instructor.
5. Conveying information about exercise program and patient status to supervising therapist.
Grade Determination
Documentation Assignments 10%
Research Article Paper 10 %
Home Exercise Program Paper 10 %
Quizzes 10%
Mid - Term Examination 15 %
Lab. Practical 25 %
Final Examination 20 %
100 %
Documentation Assignments
The student is assigned to document three exercises learned and performed during lab. and submit them. These assignments are worth 10 % of the final grade.
Research Article Paper
The student is assigned to find a current research article pertaining to therapeutic exercise. The student must summarize and critique the article and submit it to the instructor during week nine. This paper is worth 10 % of the final grade.
Exercise Program
The student is given a physical therapy evaluation and treatment plan and must design an exercise program using traditional and multimedia formats. The program is worth 10 % of the final grade.
Quizzes
The student takes 4-6 quizzes throughout the semester. These quizzes are worth 10% of the final grade.
Mid-term Examination
The student takes a cumulative examination covering the first six weeks of the course. The examination includes mainly short essay and fill in type questions. The mid-term examination is worth 15% of the final grade.
Laboratory Practical Examination
All students are required to take a practical examination. This examination test the students' proficiency in therapeutic exercise and previously learned material. The laboratory practical is worth 25% of the final grade.
Final Examination
The student takes a cumulative final examination. The examination includes mainly short essay and fill in type questions. The final examination is worth 20% of the final grade.
Week #1—Principles of Therapeutic Exercise
Lecture
Assignments: Kisner Chapter 1,and 2 pp. 34-37
Pierson Chapter 6
This initial week the student is introduced to the systematic approach to therapeutic exercise. Emphasis is placed upon the need for critical thinking, identifying impairments and functional limitations. Goal setting, exercise terminology, indications and contraindications and functional outcomes are presented. Principles of manual resistance are explained.
Laboratory
Students practice passive and active range of motion techniques of both upper and lower extremities previously learned in PTA 1. Students perform general passive stretching techniques. Manual muscle testing is demonstrated and students practice positioning, hand placement and grading techniques in specific scenarios.
Treatment Application Activity
Students exhibit critical thinking and sound technical skills (transfers, goniometry and range of motion) in the management of a spinal cord injured patient as presented by the instructor and implement the prescribed plan of treatment. Following this treatment application activity, students discuss patient management and therapeutic techniques.
Week #2 –Principles of Resistive Exercise/Cardio-vascular Considerations
Lecture
Assignments: Kisner Chapter 3
The student is provided with the definition of resistive exercise including: goals, indications and contraindications. Concepts of strength and endurance assessment are presented. The affect of therapeutic exercise on the cardiovascular system is reviewed. The affects of types of exercise (isometric, isotonic, open and closed chain) on the cardiovascular system are explored.
Laboratory
Assignment: Metabolic Equivalent Handout
Students perform exercises appropriate for cardiovascular patients. Given patient scenarios, students perform therapeutic exercise techniques consistent with principles of energy expenditure for the cardiac patient. In preparation for their roles as physical therapy care educators, students practice teaching these skills.
Treatment Application Activity
Students exhibit critical thinking and sound technical skills in the management of a cardiovascular patient as presented by the instructor and implement the prescribed plan of treatment. Students perform measurement and assessment techniques (including goniometry), vital signs monitoring, range of motion and basic therapeutic exercise techniques appropriate to the scenario. While performing treatments students consider additional factors influencing patient care. Following this treatment application activity students discuss patient management and therapeutic techniques..
Week #3—Shoulder Activities
Lecture
Assignments: Kisner Chapter 9
Range of motion, goniometry, and anatomical considerations (previously learned in PTA 2) of the shoulder are reviewed. The student is provided with instruction of manual muscle testing techniques for the shoulder. Principles of active and resistive exercises for the shoulder are provided. Equipment used specifically for shoulder exercise is introduced.
Laboratory
Students apply their knowledge of post-operative and non-operative orthopedic conditions to the shoulder joint and perform exercise treatments accordingly. Additionally students begin an examination of central nervous system conditions and their affects on the shoulder. Students use specific patient scenarios to practice manual muscle testing and exercise techniques. Students assess patient response and endurance. In preparation for their roles as physical therapy care educators, students practice teaching these skills
Treatment Application Activities
Students exhibit critical thinking and sound technical skill in the management of cerebral vascular accident as presented by the instructor and implement the prescribed plan of treatment. Students perform a patient treatment consisting of appropriate therapeutic exercise as well as bed mobility, transfer training, gait training activities (as previously learned in PTA 1 and PTA 3) appropriate to the scenario. Following this treatment application activity, students discuss patient management and therapeutic techniques.
Week#4 – Shoulder and Elbow Activities
Lecture
Assignments: Kisner Chapter 9
Documentation Assignment Due
Discussion of the shoulder continues. Range of motion, goniometry, and anatomical considerations (previously learned in PTA 2) of the elbow and forearm complex are reviewed. The student is provided with instruction of manual muscle testing techniques for the elbow and forearm complex. Therapeutic exercise of the elbow and forearm complex is introduced.
Laboratory
Students apply their knowledge of peripheral nervous system conditions and general deconditioning pathologies to the shoulder joint and perform appropriate exercise treatments. Given patient scenarios, students use therapeutic exercise equipment including: wall pulleys, theraband, rickshaw, etc. Students begin to practice manual muscle testing and therapeutic exercise of the elbow and forearm complex. Students assess patient response and endurance. In preparation for their roles as physical therapy care educators, students practice teaching these skills
Treatment Application Activity
Students exhibit critical thinking and sound technical skill in the management of cervical radiculopathy as presented by the instructor and implement the prescribed plan of treatment. Students perform patient treatment activities, appropriate to this scenario, considering their knowledge of anatomy, pathology, and therapeutic exercise. Following this treatment application activity, students discuss patient management and therapeutic techniques.
Week #5—Elbow and Wrist Activities
Lecture
Assignments: Kisner Chapter 10
Range of motion, goniometry, and anatomical considerations (previously learned in PTA 2) of the wrist are reviewed. The student is provided with instruction of manual muscle testing techniques for the wrist. The student is introduced to therapeutic exercise of the wrist.
Laboratory
Students’ knowledge of orthopedic, neurological and general deconditioning pathologies are applied to the elbow and forearm complex. Given patient scenarios, students perform therapeutic exercises. Students begin to practice manual muscle testing and therapeutic exercise of the wrist. Students assess patient response and endurance. In preparation for their roles as physical therapy care educators, students practice teaching these skills
Treatment Application Activity
Students exhibit critical thinking and sound technical skill in the management of a generally deconditioned patient with severe rheumatoid arthritis affecting the wrist as presented by the instructor and implement the prescribed plan of treatment. Students perform patient treatment activities considering their knowledge of anatomy, pathology, goniometry, thermal modalities and therapeutic exercise appropriate to the scenario. Following this treatment application activity, students discuss patient management and therapeutic techniques.
Week #6 –Wrist and Hand Activities
Lecture
Assignments: Kisner Chapter 11
Range of motion, goniometry, and anatomical considerations (previously learned in PTA 2) of the hand are reviewed. Manual muscle testing of the hand is presented. The student is introduced to therapeutic exercise of the hand.
Laboratory
Students’ knowledge of orthopedic, neurological and general deconditioning pathologies is applied to the wrist and hand. Students practice manual muscle testing of the wrist and hand. Given patient scenarios, students perform therapeutic exercises. Students assess patient response and endurance. In preparation for their roles as physical therapy care educators, students practice teaching these skills
Treatment Application Activity
Students exhibit critical thinking and sound technical skill in the management of a post upper extremity fracture case as presented by the instructor and implement the prescribed plan of treatment. . Students perform patient treatment activities considering their knowledge of anatomy, pathology, goniometry, thermal modalities and therapeutic exercise appropriate to the scenario. Following this treatment application activity, students discuss patient management and therapeutic techniques.
Week #7—Mid-Term Examination/Upper Extremity Activities
Lecture
Assignment: Documentation Assignment Due
Mid-Term Examination
Laboratory
Students are provided with multiple opportunities to apply upper extremity range of motion, manual muscle testing, and therapeutic exercise. Principles of endurance, treatment organization, program progression, effects of pain, and outcome assessments, are emphasized. Students give rationale for therapeutic exercise program selection including the use of exercise equipment and manual techniques. Construction of home exercise programs is practiced. Students continue to practice the communication of patient status to the supervising physical therapist.
Week #8--Hip Activities
Lecture
Assignment: Kisner, Chapter 12
Range of motion, goniometry, and anatomical considerations of the hip are reviewed. Manual muscle testing of the hip is presented. The student is introduced to therapeutic exercise of the hip.
Laboratory
Students’ knowledge of orthopedic, neurological and general deconditioning pathologies are applied to the hip joint.. Given patient scenarios, students perform therapeutic exercises. Students practice manual muscle testing and therapeutic exercise of the hip. Students practice both manual and mechanical therapeutic exercise of the hip. Students assess patient response and endurance. In preparation for their roles as physical therapy care educators, students practice teaching these skills
Treatment Application Activity
Students exhibit critical thinking and sound technical skill in the management of a patient with osteoarthritis of the hip as presented by the instructor and implement the prescribed plan of treatment. Students perform patient treatment activities considering their knowledge of anatomy, pathology, goniometry, thermal modalities, functional and transfer activities and therapeutic exercise appropriate to the scenario. Following this treatment application activity, students discuss patient management and therapeutic techniques.
Week #9--Hip and Knee Activities
Lecture
Assignment: Kisner, Chapter 12
Documentation Assignment Due
Therapeutic exercise and the hip is explored further. Range of motion, goniometry, and anatomical considerations of the knee are reviewed. Manual muscle testing of the knee is presented. The student is introduced to therapeutic exercise of the knee.
Laboratory
Students’ knowledge of orthopedic, neurological and general deconditioning pathologies are applied to the knee joint.. Given patient scenarios, students perform therapeutic exercises. Students begin to practice manual muscle testing and therapeutic exercise of the knee. Students practice both manual and mechanical therapeutic exercise of the hip. Students assess patient response and endurance. In preparation for their roles as physical therapy care educators, students practice teaching these skills.
Treatment Application Activity
Students exhibit critical thinking and sound technical skill in the management of a post-operative orthopedic case as presented by the instructor and implement the prescribed plan of treatment. Students perform patient treatment activities considering their knowledge of anatomy, pathology, goniometry, thermal modalities, functional and transfer activities and therapeutic exercise appropriate to the scenario. Following this treatment application activity, students discuss patient management and therapeutic techniques.
Week #10—Knee Activities
Lecture
Assignments - Kisner Chapter 13
Research Article Paper Due
Discussion of the knee continues. The student is provided with more in depth information about therapeutic exercise in the management of common post-surgical and pathological conditions including generalized weakness, osteoarthritis, and ligament and cartilage damage.
Laboratory
Students continue to practice manual muscle testing and therapeutic exercises of the knee. Students assess patient response and endurance. Given patient scenarios, students perform therapeutic exercises for the knee using therapeutic equipment. In addition, students are exposed to different types of knee braces used in a variety of pathological conditions.
Treatment Application Activity
Students exhibit critical thinking and sound technical skill in the management of a traumatic sports injury as presented by the instructor and implement the prescribed plan of treatment. Students perform patient treatment activities considering their knowledge of anatomy, pathology, goniometry, thermal modalities, functional and transfer activities and therapeutic exercise appropriate to the scenario. Following this treatment application activity, students discuss patient management and therapeutic techniques.
Week #11-- Ankle Activities
Lecture
Assignment: Kisner, Chapter 14
Range of motion, goniometry, and anatomical considerations of the ankle and foot are reviewed. Manual muscle testing of the ankle and foot are presented. The student is introduced to therapeutic exercise of the ankle and foot.
Laboratory
Students’ knowledge of orthopedic, neurological and general deconditioning pathologies are applied to the ankle and foot. Given patient scenarios, students perform therapeutic exercises. Students practice manual muscle testing and therapeutic exercise of the ankle and foot. Students assess patient response and endurance. In preparation for their roles as physical therapy care educators, students practice teaching these skills.
Treatment Application Activity
Students exhibit critical thinking and sound technical skill in the management of a generally debilitated patient in a spinal cord injury case as presented by the instructor and implement the prescribed plan of treatment. Students perform patient treatment activities considering their knowledge of anatomy, goniometry, pathology, functional and transfer activities and therapeutic exercise appropriate to the scenario. While performing treatments students consider additional factors influencing patient care and the contemporary practice of physical therapy including psychosocial issues and other issues impacting the health care delivery system. Following this treatment application activity, students discuss patient management and therapeutic techniques.
Week # 12
Lecture
Assignments:
Home Exercise Program Due
The student is introduced the principles of aquatic therapy including buoyancy and resistance. Benefits and contraindications are reviewed. Concepts and practices of therapeutic exercise management are reviewed. Emphasis is placed on patient progression and response, appropriate goal setting and treatment diversity. Correlation of the achievement of exercise goals with changes in functional abilities is also reinforced.
Laboratory
Discussion of therapeutic principles continues. Students are provided with multiple opportunities to apply lower extremity range of motion, manual muscle testing, and therapeutic exercise. Principles of endurance, treatment organization, program progression, effects of pain, and outcome assessments, are emphasized. Students give rationale for therapeutic exercise program selection including the use of exercise equipment and manual techniques. Construction of home exercise programs is practiced. Students continue to practice the communication of patient status to the supervising physical therapist.
Treatment Application Activity
Students exhibit critical thinking and sound technical skill in the management of a patient status-post a cerebral vascular accident in an rehabilitation setting as presented by the instructor and implement the prescribed plan of treatment. Students perform patient treatment activities of the upper and lower extremity considering their knowledge of anatomy, pathology, goniometry, thermal modalities, functional and transfer activities and therapeutic exercise appropriate to the scenario. In addition, treatment includes the design and instruction of a home exercise program. Following this treatment application activity, students discuss patient management and therapeutic techniques.