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MOTT COMMUNITY COLLEGE

DIVISION OF HEALTH SCIENCES

PTA PROGRAM

Course Number/Name: PTA 210 Rehabilitation Procedures I

Credit Hours: 5 Contact Hours:

Lecture 3.5

Lab 4.5

Prerequisites: PTA 104, Division Signature

Co requisites or Prerequisites: PTA 202, PTA 270

Instructor: Diane Tremblay , PT, Anar Guru, PT, DPT and Carleigh Jarvis PTA

Office Hours: Anar: SLBC: 1502D

Diane: SLBC 1502C:

Contact Information: Diane: 810-762-5019, diane.tremblay@mcc.edu

Anar: 810-762-5021, TBA

Carleigh: 810-762-5020, carleigh.jarvis@mcc.edu

Lecture: Lab: SLBC 1502

Thursday 12-2pm SLBC 1013 Monday 8:30-11:30am

Friday 10:15-11:45am SLBC 1013 Thurs 8:30-11:30am

Course Description:

Principles and techniques of wheelchair fitting and management; safety and training in the use of orthotics and prosthetics; use of standardized questionnaires/scales; self-care and home/community management. Ventilation, respiration and circulation data collection. Aerobic capacity/endurance conditioning/reconditioning. Gait/locomotion/balance data collection, safety and progression. Study and application of pathology, clinical findings, medical treatment, and physical therapy interventions for selected neurological, cardiovascular and pulmonary conditions. Review of normal neuroanatomy/neurophysiology.

Textbooks:

Osullivan, Schmitz, Fulk, Physical Rehabilitation 6th ed, 2014

ISBN-13: 978-0-8036-2579-2

Principles and Techniques of Patient Care by Pierson & Fairchild, 5th ed. W.B. Saunders Co. 2013 ISBN 978-14557-0704-1

Kisner & Colby, Therapeutic Exercise: Foundations and Techniques, 6th ed, 2012, FA Davis ISBN: 9780803619265

Neurological Intervention for Physical Therapist Assistants, 2nd ed., M. Kessler and S. Martin. 2007 Saunders, ISBN 13 978-07216-0427-5

Handbook of Physical Medicine and Rehabilitation Basics, 2nd ed, 2003, Garrison. Lippincott ISBN: 0-7817-4434-2

Goodman, Fuller, Pathology for the Physical Therapy Assistant, 1st ed, 2011, Saunders

ISBN: 9781437708943

Learning Activities:

Lecture

Lab participation

Classroom discussion and small group activities

Documentation of patient care

Written and practical examinations

Quizzes on readings.

Environmental barrier assignment

The grading scale:

60 = 0.0

60-66% = 1.0

67-72% = 1.5

73-77% = 2.0

78-82% = 2.5

83-87% = 3.0

88-91% = 3.5

92-100% = 4.0

Neuroanatomy/physiology Exam 30 pts

4 Written Examinations 140 pts

6 Quizzes (10 pts each) 60 pts

Service learning reflection 5 pts

**4 Practical Examinations (30 pts each) 120 pts

2 Progress note assignments 10 pts

1 Written paper (Architectural Barriers) & Drawing 20 pts

Policies:

*No make-ups allowed for absences

**Practicals that assess the performance of essential skills on the master skill list must be passed at a minimum of 80% to pass the course and continue in the program. Additionally, these practicals may have critical safety items that must be passed at 100%. Only one video re-take is allowed per course.

One video taped re-take is allowed for a practical examination not passed at 80%. All re-takes will be video taped. The student should schedule a session with the instructor to discuss a plan to prepare for the re-take of the practical. If the student achieves a grade of at least 80%, the 80% will be recorded as the grade for that practical.

If a grade lower than 80% is received on the re-take practical, this will result in the student not completing successfully that portion of the course material. The student will therefore not receive a passing grade in the class and not be allowed to progress in the program (see Readmission and Advanced Standing Guidelines).

The student must achieve a "2.5" grade. See OTA/PTA Student Handbook for Readmission Guidelines.

Attendance/Tardy Policy:

"Attendance is taken in all classes. Students are expected to attend class, since they are held responsible for the requirements of the course. Absence from classes does not excuse the student from the course requirements." (Mott Community College Catalog pg. 36)

1. Attendance is mandatory for all PTA classes.

2. Unexcused absences or tardiness (other than from illness and/or personal emergency) are not permitted. An unexcused absence is defined as an absence without a phone call (or prior notice) stating reasonable and appropriate cause for absence.

3. More than two absences result in a NI on professional behavior assessment form (see absence issues as described in the PTA Program Student Handbook). The student must be notified in advance if this discipline is to take place.

4. The grade for assignments (papers/projects etc) accepted late will decrease by 3% each day tardy including weekends (with the exception of an extended illness/personal emergency with written verification and notification to the instructor).

5. For an excused absence: Students must call the instructor prior to the examination with appropriate justification if they are going to miss a written or practical exam. The exam must be made up on the next scheduled class day or sooner, as arranged by the student with the instructor. Failure to do so may result in a decrease by 5% per day that the exam is not completed.

For an unexcused absence: No show to class, inappropriate justification or failure to speak to the instructor or leave a message (Kathleen: 762-5021 or Diane: 762-5019) will result in a maximal possible grade of 75% for a written exam and 80% for a practical exam. The exam must be made up on the next scheduled class day or sooner, as arranged by instructor. Failure to do so will result in a zero for missed exam.

6. Quizzes will not be made-up for any reason (excused or unexcused).

7. Tardiness will not be tolerated. If you have a problem arriving on time for classes discuss this with the instructor immediately. Excessive tardiness (more than two incidents) will result in a NI on the professional behavior assessment form and a student generated contract must be written. The student must be notified in advance if this discipline is to take place.

A student who is disruptive in class may be removed from the classroom, but may not be excluded from future attendance except through the use of the student disciplinary process.

Incomplete (I) Grade

A student must initiate a request for an “I” (incomplete) from an instructor. The “I” will be given at the sole discretion of the instructor. Typically an “I” will be given only when the student (a) has completed at least 75% of the class (excluding final exam) but is unable to complete the class work because of extraordinarily unusual or unforeseen circumstances or other compelling reason, (b) has done passing work in the course, AND (c) in the instructor’s judgment, can complete the required work without repeating the course.

Withdrawal (W)

A “W” is a student initiated withdrawal and can be initialed up to the 90% point in the course. Effective Fall 2006, the instructor initiated withdrawal will no longer be available on the grading screens.

No Show (NS)

Instructors may assign an “NS” grade which indicates that the faculty member has had, in their judgment, insufficient instructional contact with the student. That can be assigned as early as 20% into the course up until the final grade.

Instructor’s Policies

1) Attendance: is regarded as mandatory. If an exam is missed, the grade will decrease by 3% for each weekday late. Late assignments are not accepted.

2) Tardiness: no extra time will be allowed for exams, quizzes or projects when tardy.

3) Integrity Policy

Plagiarism on a paper is a Code of Conduct violation and will result in a “zero” for the paper. Cheating or attempts to cheat on examination will also result in a “zero” for that examination.

4) Cell phones should be turned off. If there is an emergency put on vibrate and leave the classroom to answer.

ADA Statement

Mott Community College is committed to providing equal opportunity for participation in all programs, services and activities and adheres to Section 504 of the Rehabilitation Act (1973) and the Americans with Disabilities Act, as amended (2008) to provide effective auxiliary aids and services for qualified students with documented disabilities. Requests for accommodations by students with disabilities may be made by contacting Disability Services at 810-232-9181 or on the web at disability.mcc.edu. Once your eligibility for an accommodation has been determined, you will be issued an Instructor Notification Letter. Please present Instructor Notification Letters to instructors at the start of the semester and/or two weeks prior to the accommodation date (test, project, etc). Requests received after this date will be honored whenever possible.

Learning Objectives:

Upon completion of the course the student will demonstrate the ability to:

(NEUROANATOMY/NEUROPHYSIOLOGY REVIEW)

By completing a written outline: state and/or describe the following

1. types of nerve cells

2. neuron structures

3. synapses

4. axons

5. white matter

6. gray matter

7. fibers and pathways

8. the central nervous system (CNS) and its major parts: lobes, association cortex, motor areas, hemispheric specialization, (L) and ®) hemisphere function, hemispheric connections, deep brain structures, cerebellum and brain stem

9. the peripheral nervous system

10. spinal cord and its tracts – afferent and efferent

11. sensory system

12. PNS – Somatic Nervous System

13. cervical, brachial and lumbosacral plexi

14. peripheral nerves

15. autonomic nervous system

16. cerebral circulation

17. reaction to injury

18. All review questions at end of chapter.

19. Identify and color selected structures to be identified on handout to accompany written outline.

(GAIT/LOCOMOTION UNIT)

1. Explain the critical factors associated with normal gait

2. Detect abnormal sub-phase(s) of gait and identify the gait deviation(s).

3. Describe possible cause(s) for given gait deviation(s).

4. Describe possible intervention(s) for given gait deviation(s).

(ASSISTIVE, ADAPTIVE, ORTHOTIC, PROTECTIVE, SUPPORTIVE and PROSTHETIC UNIT)

1. Identify the major components and fitting of UE, LE and trunk orthoses.

2. Perform functional training with orthotics

a. Identify the individual’s/caregiver’s ability to care for the device

b. Recognize changes in skin condition while using the device/equipment

c. Recognize safety factors while using the device

3. Identify the major components of the prosthesis

4. Describe the proper fit of a prosthesis and related problems with fitting

a. recognize changes in skin condition while using the device/equipment

b. recognize safety factors while using the device

5. Functional training activities/exercises for a patient with a prosthesis or in preparation for a prosthesis

a. recognizes common gait deviations seen with lower extremity amputations and performs gait activities to improve gait pattern

b. residual limb wrapping techniques, mobility training with and without a

prosthesis

c. explain/describe stretching and strengthening exercises for AK residual limb, BK residual limb, UEs, and unaffected limb

d. recognize safety factors while using the device

e. describe the safety, status and progression of patients while engaged in locomotion/gait

6. Identify the ability of the individual and the caregiver to care for the device

7. Recognize changes in skin condition while using the device

a. describe appropriate aspects of self-care to teach the prosthetic or non-

prosthetic candidate

b. recognize normal and abnormal integumentary changes

(RESPIRATATION, VENTILATION, BREATHING EXERCISE/ COUGHING TECHNIQUES)

1. Describe the etiology, pathology. clinical findings, medical treatment and prognosis for selected pulmonary conditions

2. Describe the limit of scope of care a PTA is able to provide for the given diagnosis

3. Define a glossary of terms

4. Define chest physical therapy and its goals

5. State the purpose and procedure for use of a pulse oximeter

6. Perform/recognize the data collection procedures pertinent to treatment of patients with ventilation, respiration and/or circulatory deficiencies

a. recognize cyanosis

b. recognize activities that aggravate or relive edema, pain, dyspnea, or other symptoms

c. describe chest wall expansion and excursion

d. describe cough and sputum characteristics

e. describe and monitor thoracoabdominal movements and breathing patterns with activity

f. recognizes level of functional status

7. Perform and teach specific breathing and chest mobility exercises

a. state the goals and technique for teaching specific breathing exercises

8. Perform and teach coughing techniques

a. describe the normal cough mechanism

9. Perform postural drainage

a. state the goals and procedures for postural drainage

b. list the precautions/contraindications of postural drainage

10. Demonstrate the use of effective/appropriate teaching techniques during lab

patient-care simulations

11. Analyze given patient scenario and develop progression/modification of therapeutic exercise program appropriately within guidelines established by the physical therapist.

(CIRCULATION DATA COLLECTION; AEROBIC CAPACITY AND

ENDURANCE UNIT)

1. Describe the etiology, pathology. clinical findings, medical treatment and prognosis for selected cardiac, vascular and/or lymphatic conditions

2. Describe the limit of scope of care a PTA is able to provide for the given diagnosis

3. Define a list of terms related to endurance exercise.

4. Compare the effects of endurance exercise on muscle fiber types.

5. List the physiological changes and goals of aerobic exercise.

6. Perform/recognize the data collection procedures pertinent to treatment of patients with cardiac and/or circulatory deficiencies

a. recognize cyanosis

b. recognize activities that aggravate or relive edema, pain, dyspnea, or other symptoms

c. perform: Target Heart Rate for partner (both methods and label each). Palpation of pulses (normal, absent or diminished) for femoral (B), tibial (B)

and dorsal pedis (B). Skin temperature check, skin integrity check. Rubor test

(reactive hyperemia). Girth measurements (every 10cm in one LE). Homan’s

test

7. Discuss methods used to match the exercise program to the patient's fitness/health level.

8. State precautions if the patient has an orthopedic consideration.

9. Explain the protocol for establishing a conditioning program including warm-up and cool down, time frame, reps, times per week etc.

10. State the effect of muscle fatigue, general fatigue and oxygen debt on the protocol of the program.

11. Analyze given patient scenario and develop progression/modification of therapeutic exercise program appropriately within guidelines established by the physical therapist.

12. Describe equipment clients may use to perform aerobic/endurance exercise.

13. Set-up and monitor a safe and effective aerobic conditioning and conditioning/reconditioning exercise program including monitoring of vital signs.

14. Describe a Cardiac/Vascular Rehabilitation program in each of the three phases

15. Monitor program and respond appropriately to the patient’s changing status during the exercise program:

a. Adjust interventions within the plan of care established by the physical therapist in response to patient clinical indications and report this to the supervising physical therapist.

b. Recognize when intervention should not be provided due to changes in the patient’s status and reports this to the supervising physical therapist.

c. Report any changes in the patient’s status to the supervising physical therapist.

d. Recognize when the direction to perform an intervention is beyond that which is appropriate for a physical therapist assistant and initiates

e. Recognizes level of functional status

(SPINAL CORD INJURED UNIT)

1. Describe the pathology, etiology, clinical findings, medical treatment, and

precautions associated with physical therapy interventions for the spinal cord injured patient.

2. Describe the limit of scope of care a PTA is able to provide for the given

diagnosis

3. Define a glossary of terms

4. Describe/apply interventions appropriate for the spinal cord injured in lecture and lab/practical settings including:

a. Functional Training

i. Activities of daily living

ii. Assistive/adaptive devices

iii. Developmental activities

iv. Gait and locomotion training

b. Manual Therapy Techniques

i. PROM

c. Therapeutic Exercise

i. Balance and coordination exercises

ii. Breathing/coughing exercises

iii. Posture awareness training

iv. AROM and AAROM exercises

v. Stretching exercises

vi. Strengthening

5. Demonstrate understanding and application of components of data collection

skills for the spinal cord injured

a. Assistive, Adaptive, Orthotic, Protective, Supportive, and Prosthetic Devices

i. Recognizes changes in skin condition while using devices/equipment

ii. Recognizes safety factors while using orthotic device(s)

b. Gait, Locomotion, and Balance

i. Describe the safety/status and progression of patients while engaged in gait, locomotion, balance, wheelchair management and mobility.

c. Integumentary Integrity

i. Recognizes absent or altered sensation

ii. Recognizes normal and abnormal integumentary changes

iii. Recognizes activities, positioning and postures that aggravate or relieve pain or altered sensations, or that can produce associated skin trauma

d. Muscle Performance

i. Understand/describe changes in muscle tone

e. Self-care and Home Management and Community or Work

i. Administer standardized questionnaires to patients and other

Unit 3: Rehabilitation of Spinal Cord Injury (SCI)

I. Spinal Cord Injured -- Clinical Medicine Review

A. Etiology and pathophysiology

B. Classification and functional significance

C. Medical treatment

D. Clinical Signs and symptoms

1. spinal shock

2. respiratory impairment

3. spasticity

4. bowel and bladder dysfunction

5. sexual dysfunction

5. secondary complications

II. Rehabilitation Management of the Spinal Cord Injured

A. Acute phase

1. emergency

2. fracture stabilization

3. surgical intervention

4. assessment

5. treatment

a. respiratory management

b. range of motion

c. strengthening

d. vertical position

6. precautions

B. Subacute phase

1. assessment

2. continue acute management

3. mat activities

4. transfers

6. wheelchair prescription and management

7. gait training

8. discharge planning

9. self-care

10. precautions

(SELF-CARE AND HOME MANAGEMENT AND COMMUNITY/WORK UNIT)

1. Describe architectural barriers and possible modifications for a patient with given limitations.

2. Define specific minimal measurements to allow WC access/mobility such as: door width, hall width, turning space, ramp height/length ratio etc.

3. Using a case scenario, perform an architectural barrier assessment on a home

or apartment.

4. Recognize work hardening/conditioning programs:

a. differentiate between hardening/conditioning programs

b. assist in designing a work conditioning program

Wheel Chair Management Skills:

1. Perform and instruct in wheelchair handling skills

a. describe safety status and progression of patients while engaged in

gait/locomotion and wheel chair management and mobility

b. select appropriate WC activity appropriate for the patient's stated

impairments and within the physical therapist's plan

c. recognize safety and barriers in home, community and work environments

2. Describe the measurement and fitting of various WC types and various WC

equipment

a. identify major components of wheelchairs

b. describe the purpose of all of the major components of the wheelchair.

COURSE CALENDAR

Sept 4 Lab Gait Deviations Video (DT)

Lecture Gait Deviations; O’Sull: Ch 10 (DT)

Sept 5 Lecture Neuro Review (RM) (not on first exam)

Sept 8 Lab Gait Deviations (DT)

Sept 11 Lab Neuro models and worksheets (DT)

Lecture Neuro Review Cont (RM) (not on 1st exam)

Quiz I Gait Deviations

Sept 12 Lecture Orthotic Devices; O’Sullivan (DT)

Sept 15 Lab Orthotic Devices (DT)

Sept 18 Lab Check offs/Orthotic Devices; George Siroonian Orthotist

(DT)

Lecture Arch Barriers; O”sull Ch 12 (Eval SLBC) (DT)

Sept 19 Lecture Exam I

Sept 22 Lab Lab Practical I (AG & DT)

Sept 25 Lab Intro to SCI techniques/Injury levels/exercise (AG & DT)

Lecture Neuro Exam intro SC Pathology; Martin/Kessler Ch 12

Sept 26 Lecture SC Pathology

Sept 29 Lab Spinal Cord Injured (mat mobility/transfers) (AG & DT)

Oct 2 Lab Spinal Cord Injured – balance/gait/falls/WC (AG & DT)

Oct 2 & 3 Lecture SCI Functional levels Kessler: Ch 12 & Video

Quiz II SC Anatomy/Pathology

Oct 9 Lab Check offs (AG & DT)

Lecture EXAM II & Architectural barrier presentations

Oct 16 Lab Practical II (AG & DT & CJ)

Lec Architectural barrier presentations cont

Oct 17 Lecture WC fitting

Oct 23 Lab Breath Sounds, Chest PT data collection; (AG & CJ)

Lecture Respiratory pathology

Quiz III Respiratory Pathology

Oct 24 Lec Resp patho cont Chest PT

Oct 30 Lab Breathing, chest mobility, postural drainage (AG & CJ) Lecture Coronary Artery Disease;

Oct 31 Lec Cardiac Rehabilitation (K&C)

Nov 6 Lab Aerobic conditioning (AG & CJ)

Lecture Cardiac Rehabilitation case studies

Quiz IV Coronary artery disease

Nov 7 Lec Chronic peripheral arterial, venous and lymphatic patho

Nov 13 Lab PVD Data Collection/Interventions/ Aerobic conditioning

(AG & CJ)

Lecture Endocrine patho/ cardio pulm case studies

Nov 14 Lecture Amputation; O’Sullivan (not on Exam III)

Quiz V Cardiac Rehab

Nov 20 Lab Practical III (AG & CJ)

Nov 22 Lec Exam III

Nov 27/28 Thanksgiving Break

Dec 1 Lab Pre prosthetic training (AG & CJ)

Dec 4 Lab BKA prosthetic training and gait deviations (AG & CJ)

Lecture Prosthetic devices

Dec 5 Lecture Prosthetic devices/case studies

Quiz VI Amputation

Dec 8 Lab AKA prosthetic training and gait deviations (AG & CJ)

Dec 11 Lecture Field Trip to Wright and Filippis

Lab AKA prosthetic training and gait deviations (AG & CJ)

Dec 12 Lecture Exam IV

Service Learning reflections

Dec 15 Lab Practical IV (AG & CJ)

Have a wonderful Holiday season(

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