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