Barbara
J. Behrens, Physical Agents Laboratory Manual, F.A. Davis Co., Philadelphia, 1997
Kingsborough Community College
of
The City University of New York
Physical Therapist Assistant Program
Course Syllabus
PTA 4
Modalities and Procedures 1
Course Description: This course is designed to introduce the student to the physical
basis of physical therapy modalities of heat and cold, along with
physiological principles, indications, contraindications and precautions.
The origins and management of pain are also discussed. This course also introduces the student to basic
assessment techniques necessary to evaluate the efficacy of the applied modality including: length and girth assessments, and skin and sensation assessments.
Pre-requisite Courses: PTA1, PTA 2, PTA 3, PTA 10, PTA 20, BIO 11
Co-requisite Courses: PTA5, BIO12
Textbook Requirements: Susan L. Michlovitz, Physical Agents: Theory and Practice
for the Physical Therapist Assistant, F.A. Davis, Philadelphia,
1966 Barbara
J. Behrens, Physical Agents Laboratory Manual, F.A. Davis Co., Philadelphia, 1997
examinations, oral reports, and professional literature reviews and critiques and participation in and analysis of clinical scenarios, the student will:
1.0 Perform basic clinical measurements and assessments including, analog pain scales, skin sensation tests and circumferential, length and volumetric measurements.
1.1 Identify basic assessment techniques.
1.2 Describe clinical scenarios that employ basic assessment techniques.
1.3 Perform basic assessment techniques.
1.4 State the rationale for the use or selection of specific assessment and
measurement techniques.
1.5 Perform and integrate vital sign monitoring , manual muscle testing and goniometry into assessment activities and clinical practice.
1.6 analyze and interpret the result of basic assessment techniques.
1.7 Contrast results of basic assessment techniques with modality selection, treatment outcomes and responses to treatment.
1.8 Select and implement therapeutic techniques appropriately considering results of basic assessments and measurements and the plan of care.
2.0 Demonstrate an understanding of the role of thermal modalities in rehabilitation.
2.1 State the historical perspective of thermal modalities.
2.2 Define and recognize the physiological responses to heat and cold.
2.3 State the adjunctive nature of physical agents in rehabilitation.
2.4 Discuss general indications and contraindications of thermal modalities.
2.5 Define the affective aspects of therapeutic modality administration.
2.6 Identify and describe pathologies treated with thermal modalities.
2.7 Describe the nature of acute, and chronic pain conditions as they relate to the
administration of thermal modalities.
2.8 Describe the therapeutic role of thermal modalities in physical therapy.
2.9 Describe inflammation and its physiological events.
2.10 Describe the physiological events associated with tissue repair.
2.11 Identify basic concepts and theories of pain, pain management, and tissue repair as
they relate to the application of thermal modalities.
2.12 State the usage and application of thermal modalities and theories of pain, pain management, and tissue repair.
3.0 Implement superficial thermal treatments including: hot packs, cold
packs, paraffin, infrared and fluidotherapy.
3.1 Define superficial thermal modalities in regard to type, modes of transmission, application methods, indications and contraindications.
3.2 Define the physiological effects of heat and cold and their relationship to pathology.
3.3 Define and list the laws and properties of radiant heat and light.
3.4 State the adjunctive nature of physical agents in rehabilitation.
3.5 State the rationale for selection or various forms of thermal therapeutic modalities.
3.6 Perform thermal modalities in a safe manner.
4.0 Implement deep thermal treatments including ultrasound, shortwave, and microwave diathermy.
4.1 Define deep thermal modalities in regard to type, modes of transmission, application methods, indications and contraindications.
4.2 Discuss the biophysics of ultrasound.
4.3 Describe the uses, indications and contraindications, and rationales of ultrasound.
4.4 Perform ultrasound treatments considering anatomical factors, dosage, mode of delivery and pathological condition.
4.5 Describe the biophysics of shortwave and microwave diathermy.
4.6 Describe the uses and indications and contraindications of shortwave and microwave diathermy.
4.7 Perform diathermy treatments considering anatomical factors, dosage, mode of delivery and pathological conditions.
5.0 Implement hydrotherapy treatments for the management of pain, muscle
weakness, soft tissue pathologies and open wounds.
5.1 Discuss the history, usage, indications and contraindications of
hydrotherapy.
5.2 Discuss and outline the physical characteristics of water including buoyancy,
temperature and resistance. 5.3 Outline the phases of wound healing and tissue repair.
5.4 Apply the principles of hydrotherapy and the characteristics of water to:
wound healing, therapeutic exercise, soft tissue pathology and pain
management.
5.5 Perform sterile technique in wound care management.
5.6 Perform hydrotherapy techniques utilizing universal precautions.
6. 0 Given patient scenarios implement comprehensive physical therapy treatment.
6.1 Perform therapeutic techniques demonstrating an understanding of the role
of the physical therapist assistant in rehabilitation.
6.2 Perform therapeutic techniques appropriately employing universal
precautions and sound body mechanics.
6.3 Perform therapeutic techniques demonstrating an understanding of organizational structure, levels of authority, and fiscal considerations of the health care delivery system.
6.4 Teach patients, families, and other health workers, the uses, applications and responses of modalities and procedures with emphasis on safety and rationale.
6.5 Demonstrate the adjunctive nature of modalities and procedures by integrating their use in complete treatment applications, utilizing knowledge and skills attained in previous and concurrent courses.
6.6 Implement therapeutic interventions within the plan of treatment considering knowledge of assessment and measurement, functional activity, thermal modality, pathology, kinesiology, and therapeutic exercise.
6.7 Implement therapeutic interventions within the plan of treatment demonstrating consideration of time management, therapeutic sequence and rationale for procedure selection issues.
6.8 Demonstrate appropriate documentation of modality and procedure use, considering patient response, treatment parameters, long/short term goals,
and effectiveness.
6.9 Perform physical therapy treatments and interact with patient and families considering influencing factors (psychosocial, cultural, economic, legal,
ethical, etc.).
6.10 Assist in discharge planning and alternative levels of care decision making.
6.11 Identify clinical responses and situations that require the attention of the supervising physical therapist.
6.12 Communicate patient status and response to supervising physical therapist.
6.13 Analyze the effectiveness of modalities and procedures in specific clinical situations.
6.14 Assess patient status and response to treatment and appropriately alter or
progress therapeutic interventions within the plan of treatment.
6.15 Delineate beneficial and untoward effects of thermal modalities.
6.16 Analyze the relationship of thermal modalities with other therapeutic
procedures (therapeutic exercise, range of motion, functional activities) as
as they relate to the achievement of rehabilitation goals.
6.17 Verify effectiveness of teaching behavior by analyzing patient performance.
7. 0 Demonstrate appropriate professional behavior
7.1 Attend and be on time for class , lab, and scheduled appointments.
7.2 Be prepared for lab activities; attend to tasks assigned.
7.3 Accept constructive criticism and respond and/or follows through appropriately.
7.4 Express self in a clear and easily understood manner.
7.5 Maintain appropriate personal hygiene.
7.6 Treat others with positive regard, dignity and respect.
7.7 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.
7.8 Explain the importance of life long learning.
7.9 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 grade
of “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. Performance of basic assessment skills including: pain, limb girth and length, and
sensation.
2. Application of the following modalities: hot/cold packs, paraffin, infrared,
fluidotherapy, shortwave diathermy, and ultrasound
3. administration of hydrotherapy for wound healing and thermal effects
4. Application of sterile techniques and use of universal precautions.
5. Instruction of the effects and uses of thermal modalities.
6. Performance of physical therapy treatments using thermal modalities and therapeutic
execise
7. Reporting to supervising physical therapist
Grade Determination
Weekly Reading Assignment Quizzes 20%
Mid -Term Examination 15%
Group Presentation 10%
Research Article Critique 5%
Laboratory Practical Examination 30%
Final Examination 20%
100%
Weekly Reading Assignment Quizzes
A series of questions are assigned for weekly readings. Quizzes must be typewritten and
submitted the day of the lecture associated with the reading assignment. Each quiz is worth approximately two percentage points for twenty percent of the total grade. Missed quizzes will be accepted without penalty up to one week after the due date. After that the quiz will not be accepted.
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 fifteen percent of the final grade.
Research Article Critique
Each student must independently select a research article related to a thermal modality.
The student must outline and critique the article (typewritten, double spaced). This project will not be accepted beyond the tenth week. A project format outline is distributed in class. This assignment is worth ten percent of the final grade.
.Students are divided into study groups of three to five. Each group is assigned a relevant research article. The group is responsible for making a comprehensive presentation and critique of the assigned article. Presentations are made from the sixth
week through the twelfth week of the course. The presentation is worth ten percent of the final grade.
Laboratory Practical Examination
All students are required to take a practical examination. This examination tests the students’ proficiency in thermal modality application and documentation. The laboratory examination is scheduled during finals week and is worth thirty percent of the final grade.
Week # 1
Lecture-Introduction to Modalities
Assignments: Chapter 1 pp. 1-15
Discussion questions 1-3
The student is introduced to modalities. Historical perspectives and usage indications are studied. Origins and theories of pain are undertaken.
Laboratory
Students are given descriptive pain scenarios and discussions about treatment possibilities are undertaken. Hot and cold pack application is demonstrated, Students practice applying hot and cold to the body. Students identify physical responses to hot and cold.
Lecture- Tissue Repair
Assignments: Chapter 1 pp. 15-23
Discussions questions 4-5
Tissue repair (previously learned Bio 7) is reviewed. Tissue repair topics specifically addressed include: tissues response to trauma, phase of repair and influencing factors.
Effective modalities used for tissue for tissue repair are discussed.
Given patient scenarios, color slides, and video presentations, students practice identifying phases and influencing factors of tissue repair. Basic assessment techniques including: pain ratings, analog scales, mobility/function (previously learned in PTA 3) are
demonstrated. Students perform and practice basic assessment techniques.
Lecture-Introduction to Assessment Techniques
Assignments: Chapter 2pp. 29-45
Discussion questions p. 45
Modalities are discussed in regard approaches to therapeutic intervention and appropriate goal setting. Observable responses and basic assessment techniques are studied.
Laboratory
Assignments: Behrens, Laboratory Manual, Chapter 1, pp. 1-4
Group Presentations Due
Students perform circumferential measurement, volumetric displacement and sensation testing activities. Students apply other thermal modalities to observe and describe physiological responses. Students perform and practice reporting results of basic assessments to supervising physical therapist.
Treatment Application Activity
Students exhibit critical thinking and sound technical skills in the management of a total knee replacement case as presented by the instructor and implement the prescribed plan of treatment. Students perform pain assessments, circumferential measurements, manual muscle testing, goniometry and functional training activities appropriate to the scenario. While performing treatments, students consider additional factors influencing patient care and the contemporary practice of physical therapy including, psycho-social issues and other issues impacting the health care delivery system. Students demonstrate appropriate documentation of their activities. Following this treatment application activity, students discuss patient management and therapeutic techniques.
Week # 4- Introduction to Superficial Heat
Lecture
Assignments: Chapter 3 pp. 52-64
Discussion questions 1-4
This week the student studies superficial heat in regard to heat exchange, physiological effects, indications/contraindications and methods of application.
Laboratory
Assignments: Behrens, Laboratory Manual, Chapter 2, pp. 15-22
Students practice applying hot packs to the upper quarter while considering positioning and draping techniques (previously learned in PTA 3). Students also practice paraffin application. Given patient scenarios, students perform patient education activities related to physiological responses to heat, and indications/contraindications. Additionally students practice application techniques including patient preparation, proper placement, safety techniques ,etc. Students also practice reporting patient response and treatment
course to supervising physical therapist.
Treatment Application Activity
Students exhibit critical thinking and sound technical skills in the management of a rheumatoid arthritis case as presented by the instructor and implement the prescribed plan of treatment. Students perform pain assessments, goniometry, range of motion activities and thermal modality treatments appropriate to the scenario. While performing treatments, students consider additional factors influencing patient care and the contemporary practice of physical therapy including, psycho-social issues and other issues impacting the health care delivery system. Students practice reporting and documenting consequences of treatment to supervising physical therapist. Following this treatment application activity, students discuss patient management and therapeutic techniques.
Week # 5- Superficial Heat con’t
Lecture
Assignments: Chapter 3 pp. 52-64
Superficial heat discussion continues with emphasis on the treatment’s objective.
Superficial heat in the reduction of pain, diminution muscle spasms and enhancement of soft tissue extensibility are studied.
Laboratory
Assignments: Behrens, Chapter 2 pp. 15-25
Group Presentations Due
Students practice hot pack application to the lower quarter while considering positioning and draping techniques (previously learned in PTA 3). Students also practice paraffin application for the lower extremity. Given patient scenarios, students perform patient education activities related to physiological responses to heat, and indications and contraindications. Additionally students practice application techniques including, patient preparation, proper placement, safety techniques,etc. Students perform fluidotherapy treatments.
Treatment Application Activity
Students exhibit critical thinking and sound technical skills in the management of a low back strain case as presented by the instructor and implement the prescribed plan of treatment . Students perform pain assessments, range of motion activities , functional training , and thermal modality treatments appropriate to the scenario. While performing treatments, students consider additional factors influencing patient care and the contemporary practice of physical therapy including, psycho-social issues and other issues impacting the health care delivery system. Students practice reporting and documenting consequences of treatment to supervising physical therapist. Following this treatment application activity, students discuss patient management and therapeutic techniques.
Week # 6 – Radiant Heat
Lecture
Assignments: Chapter 5 pp. 119-123
The student is introduced to radiant heat, specifically infrared. The properties of light, inverse square/cosine laws, indications and application techniques of infrared are studied.
Laboratory
Students practice applying infrared. Given patient scenarios, students practice applying infrared to various parts of the body while explaining its effects and precautions. Students continue to practice in the use and application of all superficial heat modalities. Students practice reporting patient response, treatment course, and assessment of goals to the supervising physical therapist.
Treatment Application Activity
Students exhibit critical thinking and sound technical skills in the management of a degenerative lumbar disc disease case as presented by the instructor and implement the prescribed plan of treatment. Students perform pain assessments, range of motion activities, functional training, and thermal modality treatments appropriate to the scenario. While performing treatments, students consider additional factors influencing patient care and the contemporary practice of physical therapy including, psycho-social issues an other issues impacting the health care delivery system. Students practice reporting and documenting consequences of treatment to supervising physical therapist. Following this treatment application activity, students discuss patient management and therapeutic techniques
Week # 7-Cryotherapy
Lecture
Assignments: Chapter 3 pp. 65-74
Discussions questions 5-8
The student is introduced to cryotherapy. The physiological effects, methods and guideline, indications and contraindications of cryotherapy are studied.
Laboratory
Assignments: Behrens, Laboratory Manual, Chapter 1, pp. 6-13
Using patient scenarios, student’s practice applying cold packs, ice massages and cold/ice baths while considering precautions, indications and contraindications, and positioning and draping techniques. Students practice reporting consequences of treatment to the supervising physical therapist. In preparation for their roles as physical therapy care educators, students practice relating physiological effects of cryotherapy to each other.
Treatment Application Activity
Students exhibit critical thinking and sound technical skills in the management of an acute
ankle sprain as presented by the instructor and implement the prescribed plan of treatment.
Students perform pain and sensation assessments, range of motion activities, functional and gait training activities, and thermal modality treatments appropriate to the scenario. While performing treatments, students consider additional factors influencing patient care and the contemporary practice of physical therapy including, psycho-social issues and other issues impacting the health care delivery system. Students practice reporting and documenting consequences of treatment to supervising physical therapist. Following this treatment application activity, students discuss patient management and therapeutic techniques.
Week # 8-Hydrotherapy
Lecture
Assignments: Chapter 6 pp. 135-141
Midterm Examination
Laboratory
Assignment, Behrens, Laboratory Manual, Chapter 10, pp. 107-126
The student is introduced to the physical principles of water, hydrotherapy benefits and temperature regulation. Given patient scenarios, the students perform hydrotherapy and explain the rationale of treatment.
Treatment Application Activities
Students exhibit critical thinking and sound technical skills in the management of a below the knee amputee with an open wound as presented by the instructor and implement the prescribed plan of treatment. Students perform pain assessments, functional and transfer training, and hydrotherapy appropriate to the scenario. While performing treatments, students consider additional factors influencing patient care and the contemporary practice of physical therapy including, psycho-social issues and other issues impacting the health care delivery system. Students practice reporting and documenting consequences of treatment to supervising physical therapist. Following this treatment application activity, students discuss patient management and therapeutic techniques.
Week # 9- Hydrotherapy con’t
Lecture
Assignments: Chapter 6 pp. 135-141
The discussions of hydrotherapy continues. The effect of hydrotherapy on wound healing and soft tissue repair is studied.
Laboratory
Students continue to study hydrotherapy. Students practice performing hydrotherapy using universal precautions and sterile technique in the dressing of wounds. The use of hydrotherapy as an adjunct to exercise and modalities is discussed. Students further practice the reporting of observations and consequences of treatment to the supervising physical therapist.
Treatment Application Activity
Students exhibit critical thinking and sound technical skills in the management of a great toe amputee as presented by the instructor and implement the prescribed plan of treatment. Students perform pain and sensation assessments, functional and gait training; hydrotherapy and sterile technique appropriate to the scenario. While performing treatments, students consider additional factors influencing patient care and the contemporary practice of physical therapy including, psycho-social issues and other issues impacting the health care delivery system. Students practice reporting and documenting consequences of treatment to supervising physical therapist.
While performing treatments, students consider additional factors influencing patient care and the contemporary practice of physical therapy including , psycho-social issues and other issues impacting the health care delivery system. Students practice reporting and documenting consequences of treatment to supervising physical therapist.
Following this treatment application activity, students discuss patient management and therapeutic techniques.
Week #10- Deep Heat
Lecture
Assignments: Chapter 4
Discussion questions p. 113
The student is introduced to deep heat, specifically ultrasound. The biophysics of ultrasound is studied. Indications, contraindications and precautions of ultrasound are discussed. Phonophoresis is discussed.
Laboratory
Assignments: Behrens, Laboratory Manual, Chapter 3, pp. 34-44
Given patient scenarios, students apply ultrasound treatments considering, anatomical factors, treatment goals, positioning, dosage, mode of delivery, and pathological condition. In preparation for their roles as physical therapy care educators, students explain the physiological effects and physical perceptions of treatment.
Treatment Application Activity
Students exhibit critical thinking and sound technical skills in the management of a rotator cuff strain as presented by the instructor and implement the prescribed plan of treatment. Students perform pain and sensation assessments, range of motion activities, goniometry, manual muscle testing, therapeutic exercise and ultrasound therapy appropriate to the scenario. While performing treatments, students consider additional factors influencing patient care and the contemporary practice of physical therapy including, psycho-social issues and other issues impacting the health care delivery system. Students practice reporting and documenting consequences of treatment to supervising physical therapist. Following this treatment application activity, students discuss patient management and therapeutic techniques.
Week # 11- Deep Heat con’t
Lecture
Assignments: Chapter 4
Ultrasound discussion continues. The student is also introduced to short wave and microwave diathermy. The uses of diathermy as well as the precautions and contraindications are studied.
Laboratory
Assignments: Behrens, Laboratory Manual, Chapter 2, pp. 25-31
Students practice applying ultrasound and diathermy while considering indications, contraindications and indications.
Treatment Application Activity
Students exhibit critical thinking and sound technical skills in the management of a chronic hip condition as presented by the instructor and implement the prescribed plan of treatment. Students perform pain assessments, manual muscle testing, goniometry, therapeutic exercise, range of motion activities, functional and gait training, and thermal modality treatments appropriate to the scenario. While performing treatments, students consider additional factors influencing patient care and the contemporary practice of physical therapy including, psycho-social issues and other issues impacting the health care deliver y system. Students practice reporting and documenting consequences of treatment to supervising physical therapist. Following this treatment application activity, students discuss patient management and therapeutic techniques.
Week # 12-Thermal Modalities and the Comprehensive Approach
Lecture
Assignments: Chapter 17 pp. 410-424
The use of heat and cold modalities as adjuncts to other treatments are reviewed.
Modalities in conjunction with exercise are discussed in relation to laboratory activities performed in this and other courses. Important issues including: time management, treatment organization, goals assessment, patient progression, and assessment of effectiveness are considered and re-emphasized.
Laboratory/Treatment Application Activities
Students are given patient scenarios and perform comprehensive treatments.