Student



Skill: Comp 4 - UE and LE Muscle Length Student: Date______________

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

|(A no for any of a through n, if applicable, results |Date______ |Date______ |Date______ |

|in failure of the attempt) |Evaluator: |Evaluator: |Evaluator: |

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

|identifies self as student physical therapist |yes no |yes no |yes no |

|assistant (not SPTA) | | | |

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

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

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

|uses gait belt |Not applicable |Not applicable |Not applicable |

|applies correct footwear |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 |Not applicable |Not applicable |Not applicable |

|maintains weight bearing status |yes no |yes no |yes no |

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

|Submits legible SOAP note 30 minutes upon completion |yes no |yes no |yes no |

|of competency | | | |

|Verbal cues per procedure (no cues on a through n) | | | |

|Criteria for all Muscle Length | | | |

|Clear instructions of the procedure. | | | |

|Correct positioning of the patient (both body and | | | |

|extremity) based on the previous assessment. | | | |

|Passively completes the test with appropriate support | | | |

|of the extremity throughout the test. | | | |

|Correct use of landmarks for measurement of muscle | | | |

|length (and can verbally provide landmarks used for | | | |

|measurement). | | | |

|Takes the measurement just prior to any compensation. | | | |

|Accurate Assessment of the actual muscle length | | | |

|(within 5 degrees of evaluator for goniometry). | | | |

|Verbally states normal values and muscles tested for | | | |

|given muscle length. | | | |

|Procedure: UE Muscle length |yes no |yes no |yes no |

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|Procedure: UE Muscle length |yes no |yes no |yes no |

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|Procedure: LE/Spine Muscle length |yes no |yes no |yes no |

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|Procedure: LE/Spine Muscle length |yes no |yes no |yes no |

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|Comments | | | |

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

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