Student



Skill: 7 – UE Goniometry Student: Date: ______________________

|Criteria |Attempt 1 |Attempt 2 |Attempt 3 |

|(A no for any of a through n, if applicable, results in failure of the |Date________ |Date________ |Date________ |

|attempt) |Evaluator: |Evaluator: |Evaluator: |

|identifies and greets patient |yes no |yes no |yes no |

|identifies self as student physical therapist assistant (not SPTA) |yes no |yes no |yes no |

|maintains safe environment |yes no |yes no |yes no |

|washes hands before and after |yes no |yes no |yes no |

|obtains consent from patient prior to treatment |yes no |yes no |yes no |

|monitors patient tolerance and responds |yes no |yes no |yes no |

|applies/removes footwear as appropriate |yes no |yes no |yes no |

|uses good body mechanics: therapist and patient |yes no |yes no |yes no |

|corrects faulty movements |yes no |yes no |yes no |

|follows plan of care |yes no |yes no |yes no |

|heeds contraindications and precautions |yes no |yes no |yes no |

|checks equipment is safe/clean |yes no |yes no |yes no |

|Completes the procedure and is able to answer scenario questions within |yes no |yes no |yes no |

|specified time | | | |

|submits legible SOAP note by 3pm on the day of the competency |yes no |yes no |yes no |

|Verbal Cues: Maximum of 1 per procedure | | | |

|Criteria: | | | |

|Gives clear, concise instructions with rationale for treatment | | | |

|Speaks clearly with appropriate voice volume. Voice remains calm and | | | |

|contained and the student therapist does not become argumentative or | | | |

|confrontational to either the patient or the evaluator. | | | |

|Correctly demonstrates (either on self or passively on the patient’s | | | |

|uninvolved side) the required joint motions. (Prior to touching the patient | | | |

|you must get consent). | | | |

|Correctly identifies the landmarks for axis, SA, moving arm for each | | | |

|goniometric measurement and correctly states the normal range of motion for | | | |

|each motion to be measured. | | | |

|Positions self correctly to visualize any compensations and/or errors. | | | |

|Procedure: |yes no |yes no |yes no |

|ACCURATELY MEASURES SHOULDER MOTION (WITHIN 5 DEGREES) | | | |

|Verbal Cues: max 1 | | | |

| | | | |

| | | | |

|Procedure: |yes no |yes no |yes no |

|ACCURATELY MEASURES ELBOW MOTION (WITHIN 5 DEGREES) | | | |

|Verbal Cues: max 1 | | | |

| | | | |

| | | | |

|Procedure: |yes no |yes no |yes no |

|ACCURATELY MEASURES FOREARM MOTION (WITHIN 5 DEGREES) | | | |

|Verbal Cues: max 1 | | | |

| | | | |

| | | | |

|Procedure: |yes no |yes no |yes no |

|ACCURATELY MEASURES WRIST MOTION (WITHIN 5 DEGREES) | | | |

|Verbal Cues: max 1 | | | |

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|Comments | | | |

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|Score |100 maximum |89 maximum |79 maximum |

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