Revised Curriculum DPT-UHS (15!09!15)
Revised Curriculum DPT-UHS (15!09!15)
Revised Curriculum DPT-UHS (15!09!15)
FOR
5 YEARS DEGREE PROGRAMME
IN
PHYSICAL THERAPY
DOCTOR OF PHYSICAL THERAPY (DPT)
GOVERNOR'S HOUSELAHORE
1
FOREWORD
2. With a view to bring about further improvement in medical education, the undergraduate
programmes are being reviewed on a continuous basis so as to improve their quality and to bring
them at par with international standards.
3. The Government has focused on other components relating to health sciences and has
particularly been successful in bringing about a significant improvement in the field of pharmacy.
In addition, the Government of Punjab has undertaken a new initiative by introducing a four years
degree programme in Allied Health Sciences. Considering the rapid technical developments in
the health systems around the world, the Allied Health Sciences programme is a step forward to
fill up the gap in the prevailing health systems in the province.
4. I am happy to point out that all medical colleges affiliated with the University of Health
Sciences have unanimously been able to put up a comprehensive programme covering 17
disciplines in the Allied Health Sciences. This indeed is a very positive, appreciative and
commendable effort.
2
VICE
CHANCELLOR
3
PREFACE
A university is the zenith of knowledge that imparts quality education and awards degrees for extensive
educational attainments in various disciplines. Protection of traditional knowledge, making exploration about
it and obtaining deep understanding about modern technology and research techniques are some of
responsibilities of the university. The mission of University of Health Sciences Lahore (UHS) is chartered to
develop an intellectually conducive environment providing excellence and innovation in medical education
and research to produce competent and community oriented doctors, dentists, allied health professionals,
nurses, bio-medical engineers and paramedics.
Allied Health Sciences is a field in medicine which has been completely neglected up till now so that there is
absolute dearth of trained Allied Health personnel who are the actual service providers to the patients. As a
matter of fact they form the connecting link between the doctors and the patients which is missing altogether
in our health care system.
Realizing all this UHS has led to organize education and training at B.Sc Honors level in all disciplines of
Allied Health Sciences. In 2007, Fifteen disciplines were identified and launched in all the UHS affiliated
medical institutions in both public and private sectors. These programmes included: Physiotherapy,
Occupational Therapy, Speech & Language Pathology, Optometry and Orthoptics, Orthotic and Prosthetic
Sciences, Nutrition, Audiology and Biomedical Engineering, & Intensive Care, Respiratory Therapy, Cardiac
Perfusion, Medical Laboratory Technology, Medical Imaging Technology, Emergency Dental Technology,
Operation Theater Technology. This has been a remarkable development in the field of medicine in our
country and has contributed towards filling up the existing gaps in the health delivery system.
Keeping in lieu with UHS goal to provide the most advanced education to the students in Punjab, it has
achieved another milestone in the healthcare education in the field of Physiotherapy. UHS has recognized the
continuing trends in the upgrading of Physiotherapy curriculum nation/worldwide and has updated the current
B.Sc. Curriculum in Physiotherapy to Doctor of Physical Therapy (DPT).
All this has been achieved with constant support and guidance of Honorable Chief Minister of the Punjab Mr.
Shahbaz Sharif who has actually played a pivotal role in organizing these programmesand the untiring efforts
4
and contribution of Professor Amer Aziz Head of Department, Orthopedic and Spinal Surgery, Lahore
Medical and Dental College. Government of the Punjab in the Health Department is fully committed to
support this educational programme and has instructed all the medical institutions under its administrative
control to launch these programmes in their respective institutions.
This document precisely briefs the details of Programme in Physiotherapy as prepared by the experts
committee in lieu of internationally acknowledged standards of physical therapy education. I am pleased to
acknowledge the efforts made by Dr. Hafiz Muhammad Asim (Doctor of Physical Therapy DPT (U.S.A)
Assistant Professor/Course Supervisor, LM&DC) and member Board of Studies Allied Health Sciences UHS;
Dr. Fariha Shah (Doctor of Physical Therapy - DPT (U.S.A) / Course Supervisor, (FMH CM&D IAHS) and
Focal Person for Development of Physiotherapy Curriculum for UHS/HEC; Mr. Ahmad Qayyum
(Physiotherapy Dept/ Ghurki Hospital); Dr. Hafiz Sheraz Arshad (Physiotherapy Deptt / LMDC)and Mr.
Ashfaq Ahmad (Chief Physiotherapist/ HOD Physiotherapy Deptt. (Clinical), FMH). The contribution made by
them will go a long way in the education and training in the field of AHS.
I hope this programme will meet the latest trends in Physiotherapy and will certainly produce competent
Physiotherapists to fill in the gap in the system which is main objective of this programme.
Prof. M. H. Mubbashar
Hilal-e-Imtiaz, Sitara-e-Imtiaz
MB, FRCP, FCPS Psych, FRC Psych, DPM
Vice Chancellor/ Chief Executive
University of Health Sciences, Lahore
5
and psychosomatic ailments. It deals with methods of treatment based on movement, manual
therapy, physical agents, and therapeutics modalities to relieve the pain and other complications.
Hence, Physical therapy covers basic parameters of healing sciences i.e. preventive,
promotional, diagnostic, rehabilitative, and curative.
6
5. Demonstrate mastery of entry level professional clinical skills. Provision of these
services is based on the best available evidence and includes physical therapy
examination, evaluation, diagnosis, prognosis, intervention, prevention activities,
wellness initiatives and appropriate health care utilization.
6. Prepared to influence the development of human health care regulations and policies that
are consistent with the needs of the patient and of the society.
7. Demonstrate leadership, management, and communication skills to effectively participate
in physical therapy practice and the health care team.
8. Incorporate and demonstrate positive attitudes and behaviors to all persons.
9. Demonstrate the professional and social skills to adapt to changing health care
environments to effectively provide physical therapy care.
7
PHYSIOLOGY-II YES 300 200
KINESIOLOGY-II & YES 300 200
ERGONOMICS
BIOCHEMISTRY & GENETICS YES 200 200
MEDICAL PHYSICS YES 200 100
BEHAVIOURAL SCIENCES PROF EXAM 50 N/A
IN 3rd YR
HEALTH AND WELLNESS INTERNAL 50
ASESSMENT
ONLY
7 1550 900
8
RADIOLOGY & DIAGNOSTIC YES 100 100
IMAGING AND EMERGENCY
PROCEDURES AND PRIMARY
CARE
BIOSTATISTICS & EVIDENCE YES 300 100
BASED PRACTICE
SUPERVISED CLINICAL INTERNAL 200
PRACTICE III, IV ASSESSMENT
ONLY
5 1600 900
FIFTH PROFESSIONAL YEAR
FIFTH PT-II: CARDIOPULMONARY, OBS- YES 500 200
GYNEA, INTEGUMENTRY &
MANUAL PHYSICAL THERAPY
CLINICAL DECISION MAKING & YES 100 100
DIFFERENTIAL DIAGNOSIS
SCIENTIFIC INQUIRY, RESEARCH YES 350 200
METHODOLOGY & RESEARCH
PROJECT
PROFESSIONAL PRACTICE & YES 100 100
COMMUNITY BASED
REHABILITATION
PT-III, VI: PAEDIATRIC, YES 350 200
GERIATRIC, SPORTS
&PROSTHETICS & ORTHOTICS
PHYSICAL THERAPY
SUPERVISED CLINICAL LOG BOOK 200
PRACTICE V, VI SUBMISSION
TO P.T
DEPARTMENT
5 1600 800
HOUSE JOB
9
One year of house job will be incorporated at the end of five year degree program
1. ANATOMY I
2. PHYSIOLOGY-I
3. KINESIOLOGY-I& BIOMECHANICS
4. ISLAMIC (ETHICS) & PAKISTAN STUDIES
5. BEHAVIOURAL SCIENCES
6. INTRODUCTION TO COMPUTER
10
11
ANATOMY I
12
DETAILED COURSE OUTLINE
GENERAL ANATOMY
Terms related to position and movements
Functions of Bones
Classification of bones
Surface marking
Cartilage
Types of ossifications
THE MUSCLE
Introduction
Histological Classification
Aponeurosis
Fasciae
Synovial bursae
13
Raphaes
Ligaments
Condyle
Epicongyle
Ridge
Tuberosity
Tubercle
Foramen
Canal
Groove
Process
Spur
THE JOINTS
Introduction
Functional classifications
Structural classification
Movements of joints
Blood supply of Synovial joints, their nerve supply and lymphatic drainage
CARDIOVASCULAR SYSTEM
Definition
14
Function of the Heart
Anastomosis
UPPER LIMB
OSTEOLOGY:
Detailed description of all bones of upper limb and shoulder girdle along their
musculature and ligamentous attachments.
MYOLOGY
Muscles connecting upper limb to the axial skeletal
Muscles of forearm
Muscles of hand.
Retinacula,
Palmar apouenrosis
NEUROLOGY
Course, distribution and functions of all nerves of upper limb
Brachial plexus
ANGIOLOGY (CIRCULATION).
Course and distribution of all arteries and veins of upper limb.
Cubital fossa
ARTHROLOGY
Acromioclavicular and sternoclavicular joints
Shoulder joint
Elbow joint
15
Wrist joint
Radioulnar joints
The learner should know the type of joint,surrounding ligaments, movements and relevant
clinical aspects.
DEMONSTARIONS:
Demonstration on Shoulder joint, attached muscles and articulating surfaces.
LOWER LIMB
OSTEOLOGY
Detailed description of all bones of lower limb and pelvis along their musculature and
ligamentous attachments.
MYOLOGY
Muscles of gluteal region
16
NEUROLOGY
Course, distribution, supply of all nerves of lower limb and gluteal region
Lumbosacral plexus.
ANGIOLOGY
Course and distribution of all arteries, veins and lymphatic drainage of lower limb
ARTHROLOGY
Pelvis
Hip joint
Knee joint
Ankle joint
GENERAL HISTOLOGY
Cell
Epithelium
Connective tissue
Bone
Muscles tissue
Nervous tissues
Blood vessels
Lymphatic organs
THORAX
STRUCTURES OF THE THORACIC WALL:
Dorsal spine (Vertebrae)
Sternum
17
TABLE OF SPECIFICATIONS-ANATOMY I
18
1stYEAR DPT
Asst No. of
Topic K S A Total
Tools Items
19
20
PHYSIOLOGY I
21
DETAILED COURSE OUTLINE
1. Cell
Contents:
Cell: morphology, Structure and function of cell organelles
Structure of cell membrane
Transport across cell membrane
Intercellular communication
Homeostasis
Control systems in the body
Genes: control and function(Biochemistry)
Nerve Physiology
Muscle Physiology
22
How strength of muscle contraction can be increased? Temporal and spatial summation.
tetanization and treppe.
Description of neuromuscular junction transmission
Myasthenia gravis
Excitation contraction coupling.
Structure and function of motor unit.
Rigor mortis.
Hypertrophy and hyperplasia.
Atrophy and its types.
Description of physiologic anatomy, contraction, action potential, characteristics of
smooth muscle contraction, important differences between skeletal and smooth muscles.
Clinical Module
23
Types of lymphocytes
Structure and function of antibodies
Allergy and hypersensitivity
Clinical
1. Cardiovascular system
General Objectives
At the end of this unit the student should be able to:
1. Describe anatomical and biophysical consideration of arterial, arteriolar & capillary
venous level, Lymphatic circulation.
2. Describe the functional classification of blood vessels.
3. Describe the physiology of Heart.
4. Describe the properties of Cardiac Muscle.
5. Draw and describe action potential of S-A Node
6. Draw and describe action potential of ventricular muscle.
7. Describe the conducting parts of Heart.
8. Describe the spread of cardiac impulse
9. Define cardiac cycle and describe the different stages of cardiac cycle.
10. Describe the ventricular pressure-volume changes, pressure-volume loop.
11. Define and describe mechanism of production of normal heart sounds.
12. Classify and explain murmurs.
13. Draw and describe normal ECG.
14. Describe the regulation heart rate.
15. Describe heart blocks and classify various arrhythmias and its development.
16. Define and explain Myocardial Infarction and Angina Pectoris
17. Define and describe different types of blood pressures and their control.
18. Describe the lymphatic circulation
19. Describe the function of veins.
20. Describe hemodynamics of blood flow.
21. Describe peripheral resistance and its regulation.
22. Define and describe cardiac output and venous return.
23. Describe the factors affecting venous return and cardiac output.
24. Describe the Ficks method of determining cardiac output.
25. Describe juguar venous pulse
26. Describe the radial pulse.
27. Describe cutaneous, coronary, cerebral and pulmonary circulation.
28. Describe circulatory changes in muscular exercise
29. Define and describe different types of shocks.
30. Describe Triple response and cutaneous circulation
31. Describe Fetal circulation and circulatory changes at birth
24
Clinical Module
1. Clinical significance of cardiac cycle, correlation of ECG and heart sounds to cardiac
cycle
2. Clinical significance of cardiac cycle, interpretation of ischemia and arrhythmias
3. Effects of hypertension
4. Clinical significance of heart sounds
5. Effects of ischemia
6. Shock
Contents:
Cardiac Muscle
Heart valves
Cardiac output- definition, normal value, determinants. Stroke volume and its regulation
Arterial pulse, Blood pressure-definition, normal values, factors affecting blood pressure
25
2. Respiratory System
General Objectives
At the end of this unit the student should be able to:
Mechanics of respiration
Lung volumes and capacities
Pulmonary circulation, transport of respiratory gases
Factors affecting respiration
Regulation of respiration-neural regulation, voluntary control and chemical regulation
Cardio respiratory adjustments in health & disease
Exercise, high altitude, deep sea diving
Hypoxia, hypercapnia, hypocapnia, oxygen treatment
26
2. Gastro Intestinal System
1. Discuss the physiologic anatomy of gastrointestinal tract along with its general functions.
2. Describe Enteric nervous system and discuss electrical activity of GIT Smooth muscle.
3. Discuss the general principles of control of gastrointestinal motility and secretion.
4. Explain Mastication swallowing and their control.
5. Describe motility
6. Describe Enteric nervous system and discuss electrical activity of GIT Smooth muscle.
7. Discuss the general principles of control of gastrointestinal motility and secretion
8. Explain Functions, motility and of small and large intestine
9. Mechanism of vomiting and its control pathway.
10. Defecation and its control pathway
11. Discuss the composition and regulation of secretions of GIT (Saliva, stomach intestine
and pancreas).
12. Discuss the functions of liver and gall bladder.
13. Describe the digestive hormones (exocrine and endocrine functions of pancreas).
Content:
Organisation, Gastrointestinal secretions & their regulation , Motility of G.I. Tract, Functions of
Salivary glands, Liver & Gall Bladder, Pancreas, Functions of Liver & Stomach. Vomiting, GIT
hormones
DEMONSTRATIONS ON:
2. Electrocardiography
27
9. Spirometery to measure various lung capacities & volumes, Respiratory rate, Tidal volume,
IRV, IC, ERV, EC, residual volume on Spirometery.
10. Graphs
i] Skeletal muscle-properties
RECOMMENDED BOOKS
28
TABLE OF SPECIFICATIONS-PHYSIOLOGY I
1stYEAR DPT
Asst No. of
Topic K S A Total
Tools Items in theory
SAQ's 1 (SAQ)
Cell C210% - - 10% MCQ's 4(MCQ)
SAQ's 1.5 (SAQ)
MCQ's 7(MCQ)
Nerve Physiology C3 10% 4% 1% 15% Practicals
SAQ's 1.5 (SAQ)
MCQ's 7(MCQ)
Muscle Physiology C3 10% 4% 1% 15% Practicals
SAQ's 1(SAQ)
MCQ's 5(MCQ)
Blood C2 7% 2% 1% 10% Practicals
1(SAQ)
SAQ's 4(MCQ)
C37% 10% MCQ's
Heart Physiology 2% 1% Practicals
1(SAQ)
SAQ's 7(MCQ)
C310% 15% MCQ's
Circulatory System 3% 2% Practicals
1(SAQ)
SAQ's 7(MCQ)
C310% 15% MCQ's
Respiratory System 3% 2% Practicals
1(SAQ)
Gastrointestinal C210% - - 10% SAQ's 4(MCQ)
System MCQ's
TOTAL 100% MCQ 45 SEQ 09
29
KINESIOLOGY-I AND BIOMECHANICS
30
KINESIOLOGY-I
4. Explain and apply musculoskeletal forces, musculoskeletal torques, muscle and joint
interaction and musculoskeletal levers?
1. Define Joint, arthrology, synarthrosis, diarthrosis, ovoid, saddle, axis of rotation, and
instantaneous axis of rotations
2. Describe different classifications of joints and axis of rotation
3. Explain Histological organization and types of periarticular connective tissue.
4. Elaborate the structure and composition of bone.
5. Identify the effects of immobilization on bone and periarticular connective tissues.
6. Give a Brief overview of joint pathologies.
1. Describe the structural organization of skeletal Muscles, its morphology and architecture.
2. Explain generation of force and development of internal torque by muscle.
3. Explain the modulation of force through concentric or eccentric activation.
4. Discuss the process of muscle Activation via nervous system.
5. Briefly elaborate Introduction to EMG, its recording, analysis and amplitude during
muscle activation.
6. Elaborate the causes of fatigue in healthy person.
7. Explain the changes in muscle with strength training, disuse and advanced age.
31
CHAPTER-4STARTING POSITION
1. Define fundamental position, discuss the muscle work and uses of following fundamental
positions.
a. STANDING
b. Kneeling
c. Sitting
d. Lying
e. Hanging
CHAPTER-8 WRIST
32
CHAPTER-9 HAND
1. Explain the Osteology and arthrology of hand.
2. Explain the osteokinematics and arthrokinematics of hand.
3. Describe the innervation of muscles and joints of Hand.
4. Explain the Hand muscles and their actions.
33
Practical Training/ Lab Work
Evaluation of posture
Regional upper limb muscle testing as the region is covered in Anatomy I
Practical demonstrations of muscles work and its ranges
Practical demonstrations of various fundamental positions and posture analysis.
34
TABLE OF SPECIFICATIONS-KINESIOLOGY-I
1st YEAR DPT
35
Asst No. of
Topic K S A Total
Tools Items
36
Practical
TOTAL 100% MCQ 25 SEQ 05
37
BIOMECHANICS
Basic terminology
Biomechanics
Mechanics
Dynamics
Statics
Kinematics
Kinetics and anthropometries
Scope of scientific inquiry addressed by biomechanics
Difference between quantitative and qualitative approach for analyzing human movements
Biomechanics of human bone growth and development
Kinematic Concepts For Analyzing Human Motion
Common units of measurement for mass, force, weight, pressure, volume, density, specific
weight, torque and impulse
Different types of mechanical loads that act on human body.
Uses of available instrumentation for measuring kinetic quantities
Biomechanics of Tissues and Structures of the Musculoskeletal System
Biomechanics of Bone
Biomechanics of Articular Cartilage
Biomechanics of Tendons and Ligaments
Biomechanics of Peripheral Nerves and Spinal Nerve Roots
Biomechanics of Skeletal Muscles
Biomechanics of the Human Upper Extremity
Biomechanics of the Shoulder
Biomechanics of the Elbow
Biomechanics of the Wrist and Hand
Factors that influence relative mobility and stability of upper extremity articulation
Muscles that are active during specific upper extremity movements
Biomechanical contributions to common injuries of the upper extremity
Biomechanics of Human Lower Extremity
38
Biomechanics of the Hip
Biomechanics of the Knee
Biomechanics of the ankle and foot
Factors influencing relative mobility and stability of lower extremity articulations
Adaptation of lower extremity to its weight bearing functions
Muscles that are active in specific lower extremity movements
Biomechanical contribution to common injuries of the lower extremity
Basic biomechanics of musculoskeletal system By: Nordin & Frankel, 3rd edition.
Basic Biomechanics, By: Susan J. Hall 4th edition.
39
TOS-BIOMECHANICS1st YEAR DPT
No. of
Topic K S A Total AsstTools
Items
Introduction to C1 3% - - 5% MCQS 1MCQ
biomechanics C2 2%
Kinematic concepts for C1 2% - - 5% MCQS 2 MCQs
analyzing Human C2 3%
movement
Kinetic concepts for C1 2% - - 4% MCQS 2 MCQs
analyzing Human C2 2%
movement
Biomechanics of Human C2 15% - - 15% MCQS 2 MCQs
bone growth & SEQS 1 SEQs
development
Biomechanics of Human C1 7% - - 14% MCQS
skeletal articulations C2 7% SEQ 2 MCQs
40
BEHAVIOURAL SCIENCES &
INTRODUCTION TO COMPUTER
BEHAVIOURAL SCIENCES:
THEORY HOURS 50
TOTAL HOURS 50
COURSE DESCRIPTION:
This course is designed to increase awareness of psychosocial issues faced by individuals and
their significant reference groups at various points on the continuum of health and disability,
including factors that influence values about health promotion, wellness, illness and disability.
Personal and professional attitudes and values are discussed as they relate to developing
therapeutic relationships. Communication skills are emphasized for effective interaction with
clients, health-care professionals and others
41
TABLE OF SPECIFICATIONS- Behavioural Sciences
DPT
Communication Its types, modes and factors affecting it Non-verbal cues
Characteristics of a good communicator
Personality and Intelligence
Stages and characteristics of psychological growth and development
Personality and development theories of personality Factors affecting personality
development
Assessment of personality Influence of personality in determining reactions during health,
disease, hospitalization, stress, etc
Intelligence and its types Relevance of IQ and EQ Methods of enhancing EQ and effectively
using IQ Factors affecting intelligence and their assessment
42
Asst
Topic C1 C2 % No. ofItems
Tools
Behavioural Sciences and their importance in health 11% MCQ 05
Bio-Psycho-Social Model SEQ 01 ( from this or
Desirable attitudes,Roles of a doctor fromApplication of
Ethics and character building Behavioural Principles in
Health and Disease)
Understanding Behaviour 11% MCQ 05
Sensation, sense organs / special organs SEQ 02
Perception, Attention, Memory, thinking,
Cognition,Problem solving
Communication Its types, modes and factors
affecting it Non-verbal cues
Characteristics of a good communicator
Personality and Intelligence
Personality and development theories of
personality Influence of personality in
determining reactions during health, disease,
hospitalization, stress, etc
Intelligence and its types IQ and EQ
Stress Management 13% MCQ 06
Definition ,classification of stress and SEQ 02
stressors, Relationship of stress and stressors
with illness and health
Conflict and frustration
Adjustment and maladjustment
Patient anxiety / stress
Coping skills
Psychological defence mechanisms
pain perception and patients experience of
pain Treatment
adherence and compliance
Psychological techniques including hypnosis
Doctor Patient Relationship
Concept of boundaries and psychological
reactions in doctor patient relationship
(such as transference and counter
transference)
Communication Skills 11% MCQ 05
Principles of effective communication SEQ 01( from this or
Active listening frominterviewing)
43
Art of questioning
Good and bad listener
Counseling: steps, scope, indication and
contraindications
Dealing with real life crisis and conflict
situations in health settings
A practical method of communication
between the doctor and patient about
disease, drugs, prognosis etc
44
Psychological changes during adolescence and
old age and their clinical management
Impact of illness on a patients psychological
well being including the ability to cope and
understand the association between
psychological stress and physical well being
Role of doctor in patient reassurance and
allaying anxiety and fear
INTRODUCTION TO COMPUTER:
THEORY HOURS 50
TOTAL HOURS 50
COURSE DESCRIPTION:
This is an introductory course on Information and Communication Technologies. Topics include
ICT terminologies, hardware and software components, the internet and world wide web, and
ICT based applications.
45
Hardware: Computer Systems & Components
Storage Devices , Number Systems
Software: Operating Systems, Programming and Application Software
Introduction to Programming, Databases and Information Systems
Networks
Data Communication
The Internet, Browsers and Search Engines
The Internet: Email, Collaborative Computing and Social Networking
The Internet: E-Commerce
IT Security and other issues
Project Week
Review Week
Text Books/Reference Books:
Introduction to Computers by Peter Norton, 6th International Edition (McGraw HILL)
Using Information Technology: A Practical Introduction to Computer &
Communications by Williams Sawyer, 6th Edition (McGraw HILL)
Computers, Communications & information: A user's introduction by Sarah E.
Hutchinson, Stacey C. Swayer
Fundamentals of Information Technology by Alexis Leon, Mathewsleon Leon pres
46
ISLAMIC (ETHICS) AND PAKISTAN STUDIES
47
1) Verses of Surah Al-Baqra Related to Faith(Verse No-284-286)
2) Verses of Surah Al-Hujrat Related to Adab Al-Nabi (Verse No-1-18)
3) Verses of Surah Al-Mumanoon Related to Characteristics of faithful (Verse No-1-11)
4) Verses of Surah al-Furqan Related to Social Ethics (Verse No.63-77)
5) Verses of Surah Al-Inam Related to Ihkam(Verse No-152-154)
Study of Selected Text of Holly Quran
1) Verses of Surah Al-Ihzab Related to Adab al-Nabi (Verse No.6,21,40,56,57,58.)
2) Verses of Surah Al-Hashar (18,19,20) Related to thinking, Day of Judgment
3) Verses of Surah Al-Saf Related to Tafakar,Tadabar (Verse No-1,14)
Seerat of Holy Prophet (S.A.W) I
1) Life of Muhammad Bin Abdullah ( Before Prophet Hood)
2) Life of Holy Prophet (S.A.W) in Makkah
3) Important Lessons Derived from the life of Holy Prophet in Makkah
Seerat of Holy Prophet (S.A.W) II
1) Life of Holy Prophet (S.A.W) in Madina
2) Important Events of Life Holy Prophet in Madina
3) Important Lessons Derived from the life of Holy Prophet in Madina
Introduction To Sunnah
1) Basic Concepts of Hadith
2) History of Hadith
3) Kinds of Hadith
4) Uloom ul-Hadith
5) Sunnah & Hadith
6) Legal Position of Sunnah
Selected Study from Text of Hadith
Introduction to Islamic Law & Jurisprudence
1) Basic Concepts of Islamic Law & Jurisprudence
2) History & Importance of Islamic Law & Jurisprudence
3) Sources of Islamic Law & Jurisprudence
4) Nature of Differences in Islamic Law
5) Islam and Sectarianism
48
Islamic Culture & Civilization
1) Basic Concepts of Islamic Culture & Civilization
2) Historical Development of Islamic Culture & Civilization
3) Characteristics of Islamic Culture & Civilization
4) Islamic Culture & Civilization and Contemporary Issues
Islam & Science
1) Basic Concepts of Islam & Science
2) Contributions of Muslims in the Development of Science
3) Quranic & Science
Islamic Economic System
1) Basic Concepts of Islamic Economic System
2) Means of Distribution of wealth in Islamic Economics
3) Islamic Concept of Riba
4) Islamic Ways of Trade & Commerce
Political System of Islam
1) Basic Concepts of Islamic Political System
2) Islamic Concept of Sovereignty
3) Basic Institutions of Govt. in Islam
Islamic History
1) Period of Khlaft-E-Rashida
2) Period of Ummayyads
3) Period of Abbasids
Social System of Islam
1) Basic Concepts of Social System of Islam
2) Elements of Family
3) Ethical Values of Islam
49
Mulana Muhammad Yousaf Islahi,
Hussain Hamid Hassan, An Introduction to the Study of Islamic Law leaf Publication
Islamabad, Pakistan.
Ahmad Hasan, Principles of Islamic Jurisprudence Islamic Research Institute,
International Islamic University, Islamabad (1993)
Mir Waliullah, Muslim Jrisprudence and the Quranic Law of Crimes Islamic Book
Service (1982)
H.S. Bhatia, Studies in Islamic Law, Religion and Society Deep & Deep Publications
New Delhi (1989)
Dr. Muhammad Zia-ul-Haq, Introduction to Al Sharia Al Islamia Allama Iqbal Open
University, Islamabad (2001)
PAKISTAN STUDIES:
Objectives
Develop vision of historical perspective, government, politics, contemporary Pakistan,
ideological background of Pakistan.
Study the process of governance, national development, issues arising in the modern age
and posing challenges to Pakistan.
50
a. 1947-58
b. 1958-71
c. 1971-77
d. 1977-88
e. 1988-99
f. 1999 onward
3. Contemporary Pakistan
a. Economic institutions and issues
b. Society and social structure
c. Ethnicity
d. Foreign policy of Pakistan and challenges
e. Futuristic outlook of Pakistan
51
BOOKS RECOMMENDED
Burki, Shahid Javed. State & Society in Pakistan, The Macmillan Press Ltd 1980.
Akbar, S. Zaidi. Issue in Pakistans Economy. Karachi: Oxford University Press, 2000.
S.M. Burke and Lawrence Ziring. Pakistans Foreign policy: An Historical analysis.
Karachi: Oxford University Press, 1993.
Mehmood, Safdar. Pakistan Political Roots & Development. Lahore, 1994.
Wilcox, Wayne.The Emergence of Banglades., Washington: American Enterprise,
Institute of Public Policy Research, 1972.
Mehmood, Safdar. Pakistan Kayyun Toota, Lahore: Idara-e-Saqafat-e-Islamia, Club
Road, nd.
Amin, Tahir. Ethno -National Movement in Pakistan, Islamabad: Institute of Policy
Studies, Islamabad.
Ziring, Lawrence. Enigma of Political Development. Kent England: WmDawson & sons
Ltd, 1980.
Zahid, Ansar. History & Culture of Sindh. Karachi: Royal Book Company, 1980.
Afzal, M. Rafique. Political Parties in Pakistan, Vol. I, II & III. Islamabad: National
Institute of Historical and cultural Research, 1998.
Sayeed, Khalid Bin. The Political System of Pakistan. Boston: Houghton Mifflin, 1967.
Aziz, K.K. Party, Politics in Pakistan, Islamabad: National Commission on Historical
and Cultural Research, 1976.
Muhammad Waseem, Pakistan Under Martial Law, Lahore: Vanguard, 1987.
Haq, Noor ul. Making of Pakistan: The Military Perspective. Islamabad: National
Commission on Historical and Cultural Research, 1993.
52
SECOND PROFESSIONAL YEAR
1. ANATOMY II
2. PHYSIOLOGY-II
3. KINESIOLOGY-II& ERGONOMICS
4. BIOCHEMISTRY & GENETICS
5. MEDICAL PHYSICS
ANATOMY II
53
course. Dissection and identification of structures in the cadaver supplemented with the study of
charts, models, prosected materials and radiographs are utilized to identify anatomical landmarks
and configurations of embryology, head and neck, neuroanatomy and abdomen and pelvis.
Anatomy-II Total marks:200
Theory:
The examination in the subject of Anatomy-II shall consist of three hours duration and of
maximum 90 marks each. Internal assessment shall be of 10 marks each.
There will be 09 short essay questions in each paper from the subject of Anatomy-1 and there
will be no choice. Each short essay question will carry 05 marks.
There will be 45 MCQs in paper and each question will carry 01 marks.
Oral / practical examination in the subject of anatomy-1 will consist of maximum 90 marks.
Internal assessment shall be of 10 marks.
EMBRYOLOGY:
GENERAL
Male and female reproductive organs.
Cell division and Gametogenesis.
54
Fertilization, cleavage, blastocyst formation and implantation of the embryo. Stages of early
embryonic development in second and third week of intrauterine life
Foetal membrane (amniotic cavity, yolk sac, allantois, umbilical cord and Placenta).
Developmental defects .clinical aspects
SPECIAL:
Musculoskeletal system
Cardiovascular system
CNS
The face:
Sensory and motor nerves of the face
Name the Bones of the face and their locations.
Muscles of the face
Muscles of mastication with actions and nerve supply.
Mandible.
Hyoid bone.
Temporomandibular joint
The Skull:
Bones of skull
Anterior cranial fossa
Middle cranial fossa
Posterior cranial fossa
Base of skull.
Structures passing through foramina
Neuro Anatomy:
Central Nervous System: Disposition, Parts and Functions
Brain stem (Pons, Medulla, and Mid Brain)
Cerebrum its grey matter (functional areas of cerebrum).
Cerebellum its grey matter and white matter with clinical aspects.
Thalamus its nuclei, connections and functions.
Hypothalamus its nuclei, connections and functions.
Blood Supply of Brain and its clinical aspects.
Stroke and its types
55
Ventricles of Brain
CSF circulation and Hydrocephalus
Meninges of Brain
Cranial Nerves with special emphasis upon 3th, 4th,5th,7th,8th,9th and 12th (their course,
distribution, and clinical aspects).
Autonomic nervous system, its components
SPINAL CORD
Gross appearance
Structure of spinal cord
Grey and white matter
Meninges of spinal cord
Blood supply of spinal cord
Autonomic Nervous system
Neural pathways (Neural Tracts)
Functional significance of Spinal cord level
56
Pelvis
Brief description of bony pelvis and its types.
Pelvic diaphragm or pelvic floor muscles and its clinical aspects.
Sacrum & SI joints.
Pelvic viscera with special emphasis on female reproductive systems.
Brief description of perineum
Nerves of perineum.
Practical
During study of Gross Anatomy, emphasis should be given on applied aspect, radiological
anatomy, surface anatomy and cross-sectional anatomy of the region covered in the
respective semester /year
57
TABLE OF SPECIFICATIONS-ANATOMY-II
2nd YEAR DPT
Asst No. of
Topic K S A Total
Tools Items
58
PHYSIOLOGY II
59
DETAILED COURSE OUTLINE
1. NERVOUS SYSTEM
Specific Instructional Objectives:
60
21. Describe coverings and ventricle of CNS
22. Describe nervous tissue and Neuroglia.
23. Introduction to CNS, layers and divisions
24. Describe different components of CNS and their functions
25. Describe synapse and synaptic transmission.
26. Describe properties of synapse.
27. Discuss characteristics of synapse.
28. Classify the nerve fibers.
29. Explain the functions of neurotransmitters and neuropeptides.
30. Describe reflex action, reflex arc and classification of reflexes.
31. Discuss properties of reflex action.
32. Describe important reflexes
33. Describe the muscle spindle and explain muscle tone.
34. Classify sensory receptors and describe their features.
35. Describe properties of receptors.
36. Discuss general cutaneous sensations and describe touch and temperature.
37. Explain pain and referred pain.
38. Explain the analgesia system.
39. Describe the ascending tracts.
40. Describe sensory cortex.
41. Describe motor cortex.
42. Describe Descending (Pyramidal) tracts.
43. Describe motor cortex.
44. Describe Descending (Pyramidal) tracts.
45. Describe hemi section of spinal cord.
46. Describe complete section of spinal cord.
47. Describe cerebellum, its functional division, connections and functions.
48. Discuss cerebellar disease
49. Describe basal ganglia, its connections and functions.
50. Describe parkinsons disease and hyperkinetic disease of basal ganglia.
51. Describe basal ganglia, its connections and functions.
52. Describe parkinsons disease and hyperkinetic disease of basal ganglia.
53. Describe hypothalamic nuclei, its connections and functions.
54. Describe thalamus and thalamic syndrome.
55. Describe the functions of Reticular formation.
56. Describe Sleep.
57. Explain the Physiology of EEG.
Contents:
61
Receptor physiology-classification & properties
iii] Reflexes classification & properties (monosynaptic, polysynaptic, superficial, deep &withdrawal
reflex
iv] Sensory & Motor Tracts-effect of transection [complete & incomplete] at various levels
vii] Labyrinth
viii] Function of Basal Ganglia, Thalamus, Hypo-Thalamus, Pre-frontal lobe, Reticular Activating
System,
Cerebellum
ii. Limbic functions, sexual behaviour, fear & range, motivation Limbic system
2. EXCRETORY SYSTEM:
1. Describe the gross and microscopic structure of kidneys, nephrons, ureter and urinary
bladder
2. Identify and describe the histological structure of kidney, ureter and urinary bladder, and
their functions.
62
3. Explain Body fluids compartments of volumes, osmolalities of extra cellular fluids & ICF,
measurements of fluid volume, oedema.
4. Describe the formation of lymph and tissue fluid.
5. Explain control of water balance and role of kidney in maintenance of homeostasis
6. Describe renal plasma flow, glomerular filteration and its regulation.
7. ExplainTubular reabsorption and secretion along different parts of nephron and its
regulation
8. Discuss the processing of filtrate in Proximal, distil and collecting tubules.
9. Discuss Plasma clearance its determination, application & formation.
10. Describe the mechanism of formation of dilute &concentrated urine.
11. Describe Counter current multiplier and exchange mechanism.
12. Describe control of extra cellular fluid osmolality.
13. Describe renal regulation of pH & hydrogen secretion.
14. Describe the role of the kidney in blood pressure regulation.
15. Describe hormonal functions of the kidney.
Contents:
v) Renal circulation
4.TEMPERATURE REGULATION
63
Contents:
5. ENDOCRINOLOGY
Physiology of the endocrine glands Pituitary, Pineal Body, Thyroid, Parathyroid, Adrenal, Gonads,
Thymus, Pancreas. Hormones secreted by these glands, their classifications and functions.
7. Discuss the physiological effects of hypothalamic hormones and their role in various
feedback systems.
8. List the Hormones secreted by the anterior and posterior pituitary. Discuss the
-Hypothalamic hormones
Anterior Pituitary Hormones
-Growth Hormone
-PTH and Calcitonin.
-Mineralocorticoids
-Glucocorticoids
-Epinephrine/Norepinephrine
64
-Insulin
Glucagon and somatostatin.
- Atrial natriuretic Peptide, Renin, erythropoientin and melatonin.
10.Describe Endocrine functions of Thymus, heart, kidney and pineal glands.
11.Describe endocrine functions of the pancreas and its hormones.
12. Discuss diabetes mellitus along with various hyperglycemic factors on basis of
sign/symptoms and data.
13. Discuss effects of lack of insulin on CHO, metabolism and glucose regulation.
14. Discuss effects of lack of insulin on fat & protein metabolism.
Male - Male Spermatogenesis, Functions of testes, pubertal changes in males, testosterone - Functions &
regulations of secretion.
Female - Functions of ovaries and uterus, pubertal changes, menstrual cycle and related hormones,
Functions of estrogens and progesterone and their regulation, Menopause.
1. Discuss the role of hormones in puberty, menarche, menopause, pregnancy, lactation and
parturition.
3. Explain the physiological changes during pregnancy in the mother with particular
reference to pattern of changes in blood levels of hormones such as LH, FSH, estrogen
& progesterone during different phases of the menstrual & ovarian cycles.
65
7. SPECIAL SENSES
Clinical/Applied Concepts
1. Clinical Importance of Tuning fork tests and their interpretation to distinguish conductive and
nerve deafness.
2. Hearing loss and audiometry.
3. Explain Nystagmus&test related to vestibular apparatus
4. Ageusia and Anosmia
7. EXERCISE PHYSIOLOGY
Contents
Introduction
Definition of physical exercise and exercise physiology
Classification of exercise/sports events
Control of internal environment
Homeostasis
Control systems of the body
Nature of the control system
Examples of homeostatic control
Exercise : A test of homeostatic control
Neuromuscular changes in exercise
Physiological effects of strength training and endurance training on skeletal muscles
Muscle metabolic systems in exercise
Definition of muscle strength, power and endurance
Fatigue mechanisms during exercise
Muscle hypertrophy/Hyperplasia/Atrophy/Muscle soreness
Mechanisms of increasing muscle strength during exercise
67
Circulatory responses to exercise (brief revision):
Overview of organization of the circulatory system and heart
Changes in oxygen delivery to muscle during exercise
Circulatory responses to exercise
Cardiovascular adjustments to exercise training
VO2 max: Arterio-venous oxygen difference during exercise
Cardiovascular adaptations with strength and endurance training
Concept and basic differences between pressure loaded & volume loaded exercise
Respiration during exercise (brief revision)
Overview of organization of respiratory system
Pulmonary ventilation
Pulmonary volumes and capacities
Diffusion of gases
Blood flow to the lungs
Ventilation-perfusion relationships
O2 and CO2 transport in blood
Ventilation and acid base balance
Ventilatory and blood-gas responses to exercise
Control of ventilation
O2 debt
Temperature regulation
68
Overview of heat balance during exercise
Overview of heat production/heat loss
Bodys thermostat-hypothalamus
Thermal events during exercise
Exercise in the heat
Exercise in cold environment
RECOMMENDED BOOKS
TABLE OF SPECIFICATIONS-PHYSIOLOGY-II
2ndYEAR DPT
Asst No. of
Topic K S A Total
Tools Items in theory
69
Physiological Basis of Medical Practice by John B. West and Taylor,12th Ed.
Exercise Physiology- Theory and Application to Fitness and Performance by: Scott K.
Powers, Edward T. Howley.
Exercise physiology, A thematic Approach By: Tudor Hale, University College
Chichester, UK
Additional study material as assigned by the tutor
70
KINESIOLOGY-II AND ERGONOMICS
THEORY HOURS 200
PRACTICAL HOURS 100
TOTAL HOURS 300
COURSE DESCRIPTION:
This course covers the definition of kinesiology as well as its importance in physical therapy. It
identifies the scope of kinesiology and studies its application. It covers the types of human
motions as well as plane and relative axis of motion. It also explains the inter-relationship among
kinematic variables and utilizes this knowledge to describe and analyze motion.
This course additionally covers the classification of the joints and muscles along their
distinguishing characteristics; group action of muscles arthrokinematics and osteokinematics of
human movement.
The Ergonomics component of this course will also help to gain an understanding of basic
theoretical concepts, principles and techniques of ergonomics as well as an introduction to
fundamental ergonomic measurement tools for assessment of physical workload, posture,
occupational exposure, and stress.
Kinesiology-II and Ergonomics Total marks: 200
Theory:
The examination in the subject of Kinesiology-II and Ergonomics shall consist of three hours
duration and of maximum 90 marks each. Internal assessment shall be of 10 marks each.
There will be 09 short questions in each paper from the subject of kinesiology-II and Ergonomics
and there will be no choice. There will be 6 question from kinesiology-II course outline and 3
questions from ergonomics course. Each short essay question will carry 05 marks.
There will be 45 MCQs in each paper and each question will carry 01 mark. There will be 25
MCQs from kinesiology-II course outline and 20 MCQs from ergonomics course.
Oral / practical examination in the subject of kinesiology-II and Ergonomics will consist of
maximum 90 marks. Internal assessment shall be of 10 marks.
71
KINESIOLOGY-II
1. Describe the innervation of the muscles and joints within the trunk and craniocervical
regions.
2. Explain the muscles of trunk including their anatomy and functional interaction.
3. Explain the muscles of craniocervical region including their anatomy and functional
interaction.
4. Discuss the biomechanical issues of lifting
PART 1: MASTICATION
1. Explain the osteology related to mastication.
2. Explain the arthrology of temporomandibular joint.
3. Explain theOsteokinematics and arthrokinematics of TM joint.
4. Discuss the muscle and joint interaction related to mastication.
PART 2: VENTILATION
1. Explain the arthrology related to ventilation.
2. Explain the muscular action during ventilation.
3. Discuss the influence of posture on the potential stress on the temporomandibular joint.
72
CHAPTER-17 KINESIOLOGY OF WALKING
CHAPTER-18 POSTURE
73
Practical demonstrations of the techniques of active, movements
Practical demonstrations gait analysis
74
TABLE OF SPECIFICATIONS-KINESIOLOGY-II
2ndYEAR DPT
Asst No. of
Topic K S A Total
Tools Items
75
ERGONOMICS
ANTHROPOMETRY
76
COGNITIVE AND BEHAVIORAL OCCUPATIONAL DEMANDS OF WORK
77
78
COMPUTERS AND ASSISTIVE TECHNOLOGY
Describe the epidemiology of cumulative trauma disorder and apply the dose response model
to determine risk factors causing cumulative trauma disorder.
Identify different risk factors in using a video display terminal (VDT).
Apply ergonomic principles and recommendations to enhance workstation design for
reducing the risks associated with prolonged use.
ERGONOMICS FOR CHILDREN AND YOUTH IN THE EDUCATIONAL
ENVIRONMENT
Describe musculoskeletal symptoms and complaints which students encounter while carrying
school bags.
Explain what postures are comfortable and ideal for study/sports at school and home.
ERGONOMICS OF AGING
Explain how physiologic, biologic, psychological, and sociologic theories of aging combine
to explain the aging process.
Describe what changes can the ergonomist brings to minimize the effects of aging.
Apply knowledge of aging processes to address ergonomic concerns of older workers.
ERGONOMICS IN DISABILITY MANAGEMENT
Define the participatory ergonomics process, Primary, secondary and tertiary prevention.
List the return-to-work process.
List the return to work process.
Describe a process of reflective analysis when implementing ergonomics in disability
management.
ERGONOMICS OF PLAY AND LEISURE
Identify how ergonomic principles apply to activities of leisure and sport.
Identify risk factors for quilting, golf, and gardening and apply the same concepts to other
leisure activities.
Identify strategies to improve effort and efficiency in leisure tasks using ergonomic
principles.
Enlist various characteristics of an ideal tool.
BIOMECHANICS OF HUMAN SPINE
Define and explain how anatomical structure affects movement capabilities of the spine.
Identify factors influencing the relative mobility and stability of different regions of the
spine.
Explain the ways in which the spine is adapted to carry out its biomechanical functions.
Explain the relationship between muscle location and the nature and effectiveness of muscle
action in the trunk.
79
Describe the biomechanical contributions to common injuries of the spine.
80
Practical Training / Lab Work
Biomechanical assessment of Upper extremity
Biomechanical assessment of Lower Extremity
Biomechanical assessment of Gait
Reflective case assignment related to biomechanics of various regions of the body
Measurement of angles of joints
Biomechanical study of deformities
Recommended text books
Basic biomechanics of musculoskeletal system By: Nordin & Frankel, 3rd edition.
Basic Biomechanics, By: Susan J. Hall 4th edition.
Additional study material as assigned by the tutor.
Ergonomics for the therapist by Karen Jacobs 3rd edition mosby and Elsevier publishers
81
TABLE OF SPECIFICATIONS-ERGONOMICS
2ndYEAR DPT
Asst No. of
Topic K S A Total
Tools Items
Ergonomics and Therapy: An C1 2% - - 2% MCQS MCQ=1
Introduction
A Client-Centered Framework for C13% - - 5% MCQS MCQ=1
Therapists in Ergonomics C2 2% SEQ SEQ= 1
82
BIOCHEMISTRY & GENETICS
`
THEORY HOURS 200
TOTAL HOURS 200
COURSE DESCRIPTION:
This course provides the knowledge and skills in fundamental organic chemistry and
introductory biochemistry that are essential for further studies It covers basic biochemical,
cellular, biological and microbiological processes, basic chemical reactions in the prokaryotic
and eukaryotic cells, the structure of biological molecules, introduction to the nutrients i.e.
carbohydrates, fats, enzymes, nucleic acids and amino acids. The nutritional biochemistry
concludes the course.
Biochemistry and Genetics Total marks: 20
Theory:
The examination in the subject of Biochemistry and Genetics consist of three hours duration and
of maximum 90 marks each. Internal assessment shall be of 10 marks each.
There will be 09 short questions in each paper from the subject of Biochemistry and Genetics
and there will be no choice. Each short essay question will carry 05 marks.
There will be 45 MCQs in each paper and each question will carry 01 mark.
Oral / practical examination in the subject of kinesiology-II and Ergonomics will consist of
maximum 90 marks. Internal assessment shall be of 10 marks.
Describe the biochemical structure of cell membrane & enlist its functions
Enumerate the components of cytoskeleton and infer the importance of these components
(microfilaments, microtubules, & intermediate filaments)
BODY FLUIDS
83
Define and enumerate weak acids & bases
Define pH & pK
Classify amino acids (according to R-side chain, nutritional importance, & metabolic end
products)
Briefly describe the hierarchy of protein structure and enumerate the bonds responsible for
primary, secondary, tertiary and quaternary structure
Describe the structure and function of fibrous proteins (collagen & elastin)
Describe the structure and function of globular proteins (hemoglobin) to understand various
clinical problems
Enlist the functions and state the clinical importance of plasma proteins (albumin,
immunoglobulins, fibrinogen, transferrin, and alpha-1 antitrypsin)
Understand the nutritional importance of proteins and relate this information to protein
energy malnutrition (PEM). Compare and contrast the salient features of kwashiorkor and
marasmus.
CHEMISTRY OF CARBOHYDRATES
Define and classify carbohydrates. Enlist their biochemical functions.
84
Clearly differentiate between D and L isomers, and anomers, and aldo and keto isomers.
Define epimers and enumerate important epimers of glucose.
Illustrate the structure & functions of monosaccharides (glucose, galactose, fructose and
mannose), disaccharides (maltose, lactose, sucrose and lactulose) & oligosaccharides
Illustrate the structure & functions of homopolysaccharides (starch, glycogen and cellulose)
Enlist the types of dietary fibers and state their sources and functions. Appraise the role of
dietary fiber in health and disease
Define glycemic index and evaluate the impact of various dietary carbohydrates on blood
sugar level and appraise their clinical significance
CHEMISTRY OF LIPIDS
Define & classify lipids
Illustrate the structure of fatty acids (saturated and unsaturated fatty acids)
Quote the sources and evaluate the health effects of saturated fats, monounsaturated fats, -3
fatty acids, -6 fatty acids, essential fatty acids, trans fats and cholesterol
85
ENZYMOLOGY
Define enzymes
Classify enzymes according to IUMB system: Briefly discuss six major classes & give one
example of each class
Define isoenzymes and apply the knowledge of isoenzymes to diagnose various clinical
problems (Isoenzymes of CK & LDH)
Briefly discuss the effect of following factors on enzyme activity (pH, temperature, substrate
concentration, enzyme concentration, & enzyme inhibitors)
Enlist principal serum enzymes used in clinical diagnosis along with their major diagnostic
use (AST, ALT, ALP, amylase, & acid phosphatase)
NUTRITIONAL BIOCHEMISTRY
Minerals & trace elements
Define and classify minerals according to their daily requirement
Enumerate sources and quote RDA of sodium, potassium, calcium & phosphorus. Enlist their
major biochemical functions and interpret their clinical significance
Enumerate sources and quote RDA of iron. Enlist its major biochemical functions. Describe
its metabolism & interpret the clinical significance
86
Vitamins
Define and classify vitamins
Enumerate sources and quote RDA of fat soluble vitamins (A, D, E & K). Enlist their major
biochemical functions. Interpret their clinical significance in the light of biochemical
functions
Enumerate sources and quote RDA of water soluble vitamins (B-complex and vitamin C).
Enlist their major biochemical functions. Interpret their clinical significance in the light of
biochemical functions
TISSUE BIOCHEMISTRY
Briefly describe the biochemical composition and enumerate the functions of extracellular
matrix (ECM)
Recognise the importance of ECM and its components in health and various diseases
Describe the biochemical structure of bone and interpret various metabolic and genetic
disorders related to the bone (rickets and osteomalacia, osteogenesis imperfecta,
osteoporosis, osteopetrosis, osteoarthritis and achondroplasia)
METABOLISM
Bioenergetics
Infer the meaning of redox potential and explain how it can be used to predict the direction of
flow of electrons in biologic systems
87
Enumerate the four protein complexes of electron transport chain (ETC) involved in the
transfer of electrons through the respiratory chain and illustrate their organization and
reactions
Briefly describe the structure of ATP synthase complex and indicate its role in the
generation of ATP with special reference to chemiosmotic hypothesis
Identify the site/ mechanism of action of amytal, rotenone, antimycin A, cyanide, carbon
monoxide, sodium azide, oligomycin and uncoupling proteins (UCPs)
Metabolism of carbohydrates
Outline the steps involved in the process of digestion & absorption of carbohydrates and
apply this knowledge to explain the biochemical mechanism underlying the clinical features
of lactose intolerance
Enlist the seven major types of GLUTs along with their functions
Define glycolysis and enumerate its two major types. Outline the reactions of glycolysis
(aerobic and anaerobic glycolysis) mentioning the regulatory enzymes. Interpret the
significance of aerobic and anaerobic glycolysis. Calculate the amount of ATP produced
under aerobic and anaerobic conditions. Apply the knowledge of glycolysis to interpret the
clinical manifestations of pyruvate kinase deficiency.
Outline the reactions of citric acid cycle mentioning the regulatory enzymes. Calculate the
amount of ATP produced and infer the significance of this cycle.
Outline the reactions of glycogenesis and glycogenolysis. Infer the significance of these
pathways. Apply this knowledge to interpret the clinical manifestations of glycogen storage
diseases (Type Ia, Type II and Type V)
88
Outline the reactions of pentose phosphate pathway. Infer the significance of this pathway.
Apply this knowledge to interpret the clinical manifestations of glucose-6-phosphate
dehydrogenase deficiency.
Metabolism of lipids
Outline the steps involved in the process of digestion & absorption of lipids and apply this
knowledge to explain the biochemical mechanism underlying the clinical features of cystic
fibrosis
Outline the reactions involved in the biosynthesis and oxidation (only oxidation) of fatty
acids. Infer the significance of these pathways.
Outline the reactions involved in the biosynthesis and degradation of triacylglycerols. Infer
the significance of these pathways.
Outline the reactions involved in biosynthesis and utilization of ketone bodies. Predict the
metabolic consequences of starvation and uncontrolled diabetes mellitus.
Outline the reactions involved in the biosynthesis of cholesterol. Identify the regulatory
enzyme of cholesterol biosynthesis and apply this knowledge to infer the cholesterol
lowering effect of statin drugs. Identify the degradation products of cholesterol (bile acids
/bile salts) and their role during health and disease (cholelithiasis)
Classify eicosanoids. Outline the steps involved in their biosynthesis. Appraise the role of
various eicosanoids in health and disease. Evaluate the clinical uses of corticosteroids, COX-
1 and COX-2 inhibitors.
89
Outline the steps involved in the process of digestion & absorption of proteins and apply this
knowledge to explain the biochemical mechanism underlying the clinical features of Hartnup
disease and gluten enteropathy.
Illustrate transamination & oxidative deamination of amino acids and infer the significance
of these reactions in the metabolism of amino acids
Enlist the sources of ammonia. Briefly describe transport of ammonia
Outline the reactions of urea cycle mentioning its regulation. Apply this knowledge to infer
the causes and consequences of hyperammonemia (hereditary and acquired)
Briefly describe the structure of heme and outline the reactions involved in the degradation of
heme along with the clinical interpretation of the conjugated and un-conjugated
hyperbilirubinemia
(Biosynthesis of heme not required)
Metabolism of purines & pyrimidines
Enumerate major nitrogenous bases. Illustrate their structure mentioning the sources of
individual atoms of the rings. Differentiate between nucleosides and nucleotides. Apply the
principles of nomenclature to name major nucleosides and nucleotides. State the functions of
important nucleotides (ATP, GTP, UDP, SAM, & PAPS)
Outline the reactions involved in the degradation of purines. Apply this knowledge to infer
the causes and consequences of hyperuricemia (hereditary and acquired) and adenosine
deaminase deficiency. Apply the knowledge of purine degradation pathway to infer the
serum uric acid lowering effect of allopurinol.
Brief description of degradation of pyrimidines and enumerate the degradation products
90
Briefly illustrate the process of DNA transcription (in both prokaryotes and eukaryotes) and
infer its significance
Define genetic code and codons. Infer the consequences of altering the nucleotide sequence
(silent mutation, missense mutation, nonsense mutation, trinucleotide repeat expansion,
splice- site mutations and frame-shift mutations). Apply this knowledge to understand the
molecular basis of diseases (Huntington disease, fragile X syndrome, myotonic dystrophy)
Briefly describe the pre-requisites (components) and steps of protein synthesis (in both
prokaryotes and eukaryotes) & repair. Apply this knowledge to understand how the drugs
like streptomycin, tetracyclins, puromycin, chloramphenicol, and erythromycin exert their
antibiotic effects.
Define restriction endonucleases, vectors, probes. Briefly describe the recombinant DNA
technology and enlist its applications.
Outline the steps of polymerase chain reaction (PCR) and enlist advantages and applications
of this technique.
ENDOCRINOLOGY
Describe the chemistry of receptors
Classify hormones according to their chemical nature and mechanism of action. Briefly
describe the mechanism of action of group I and group II hormones
Outline the steps involved in the biosynthesis of adrenal cortical hormones (glucocorticoids
and mineralocorticoids, and adrenal androgens). Briefly describe how the secretion of these
hormones is regulated? Enlist functions of glucocorticoids and mineralocorticoids. Apply this
knowledge to interpret the clinical features of the related disorders (congenital adrenal
hyperplasia, Cushings syndrome, Addisons disease, primary and secondary aldosteronism)
Outline the steps involved in the biosynthesis of pancreatic hormones (insulin & glucagon).
Briefly describe how the secretion of these hormones is regulated? Enlist functions of insulin
91
& glucagon. Apply this knowledge to interpret the clinical features and complications of
Type I and type II diabetes mellitus
92
TABLE OF SPECIFICATIONS-BIOCHEMISTRY
2nd YEAR DPT
Asst No. of
Topic K S A Total
Tools Items
93
SEQ 0
Viva 1
Molecular biology & genetics - - MCQ 3
SEQ 1
Viva 2
Endocrinology - - MCQ 0
SEQ 0.5
Viva 2
TOTAL 100% MCQ 45 SEQ 09
94
MEDICAL PHYSICS
STATIC ELECTRICITY
Define capacitors
Charging by Conduction capacitors
Types of capacitors
Arrangment of capacitors
Demonstrate charging and discharging of capacitor
Oscillating Discharge of Capacitors
95
CURRENT ELECTRICITY
Define ohms law, resistance and its types
Explain chemical and thermal effects of current on Human body
Explain Types of cells and battries (Wet and Lechlanche cells)
Combination of cell in series and parallel
Define electronic tubes
Define ionization of gases and thermionic emission
Electricel components and its units,
Diodes and Triodes,
Electrolysis and Electrolytic burns
ELECTROMAGNETISM:
Define moleculer theory of magnetism
Define laws of magnetism
Magnetic effects of current
Moving iron type, hotwire, thermocouple type , meter,voltmeter , ammeter
Demonstrate Measurement tools of High and low frequency currents
FaradyLaw,
Lenses,
Mutual and Self induction
Eddys Current,
Explain Transformer, construction, types, static and auto transformer
Dynamo, Construction, A.C, D.C. dynamo
ELECTRO MECHANICS:
Define rectification and Rectificationion of AC
Demonstrate types of rectification (full and half waves) ,valve rectification circuits and
metal Rectifier
Define surging of current (Lewis and valve surger)
Demonstrate reverser, metronomic interrupter, reverse jones motor interrupter and
multivibratorscircut
SOUND WAVES
Describe range of sound waves (Normal hearing band, infrasonic, ultrasonic)
Refraction and Reflection of sound waves,
96
Characteristics of tone, resonance and beats,
Characteristics of sound waves and their velocities
Method of application
Illustrate the indication and contraindication of sound waves
HEAT
Explain Heat therapy
Explain Mode of transfer
Elaborate Effect of heating
Explain scales of temperature, nature of Heat and Specific Heat
Effect of impurities on melting and boiling point
ELECTROMAGNETIC RADIATION
Explain electromagnetic radiation and its penetration
Explain Basic concept of physics (relationship b/w freq and wavelength)
Law of reflection, absorption and refraction
Demonstrate concave-convex mirrors and reflectors
Define lens and prisms
Electromagnetic spectrum,
Explain Infrared rays, radio waves, visible rays, ultravoilet rays, x-rays & nuclear waves
Explain Total internal Reflection, cosine law and inverse Square law
RADIATION PROTECTION
Define ionizing and non ionizing radiations
Demonstrate properties, units, quantities, dangers and preventive measures from its
dangers
Effect of ionizing and non ionizing,
Internal and External hazards,
Main principal to control external hazards
Distance and shielding
97
PRACTICAL
To verify the ohms Law
To find the specific resistance by using the potential divider
To verify the joules law of electrical methods
To calibrate a thermo couple and an unknown temperature
To find the acceleration due to gravity by simple pendulum
To verify the law of reflection of light
To verify the law of refraction of light
To verify the refraction index of glass using rectangular slab.
98
TOS-MEDICAL PHYSICS2nd YEAR DPT
Asst No. of
Topic K S A Total
Tools Items
Electricity and 5% 0% 0% 5% MCQ 2 MCQ
magnetism
99
HEALTH AND WELNESS
THEORY HOURS 50
TOTAL HOURS 50
COURSE DESCRIPTION:
This course includes discussion on the theories of health and wellness, including motivational
theory, locus of control, public health initiative, and psycho-Social, spiritual and cultural
consideration. Health risks, screening, and assessment considering epidemiological principles are
emphasized. Risk reduction strategies for primary and secondary prevention, including programs
for special populations are covered.
100
Fitness Training:
Physical Activities Readiness Questionnaire
Physical Activities Pyramid
Exercise Programs
Evidence-Based Practice
Screening for Health, Fitness, and Wellness:
Distinguishing Screening, Examination, and Evaluation
Interviewing for Health, Fitness and Wellness
Vital Signs, 3-minute Step Test, and Borg perceived Scale of Exertion
Seven Dimensions of Wellness
Physical Health Screening
Health, Fitness, and Wellness Issues during Childhood and Adolescence:
Structure and Function
Recognizing and Reporting Child abuse
Denver II Developmental Screening
Special Concerns in Pediatrics
Program for Prevention of Obesity
Health, Fitness, and Wellness During Adulthood:
Tasks of Adulthood
Adult Health and Wellness Risks
Screening Tools for Adulthood
Adult Educational Materials
Women's Health Issues: Focus on Pregnancy:
Screening for Womens Health
Womens Heart Disease
Female Athlete Triad
Educational Material for Women
Prepartum and Postpartum Exercises
Prevention Practice for Older Adults :
Ageism
101
Anatomical and Physiological Changes with Aging
Common Health Problems of Older Adults
Screening Older Adult for Health Fitness and Wellness
Fitness for Older Adults
Resources to Optimize Health and Wellness:
Chronic Illness
Nutrition
Progressive Relaxation
Time management
Spirituality
Health Protection:
Infection Control
Injury Prevention during Childhood
Injury prevention during Adolescence
Injury Prevention during Adulthood
Injury Prevention during Older Adulthood
Prevention Practice for Musculoskeletal Conditions:
Musculoskeletal, Changes in Childhood and Adolescence
Musculoskeletal Changes with Aging
Ergonomics
Workplace Screening for Musculoskeletal Risk
102
Prevention Practice for spinal Cord Injury
Prevention Practice for Parkinsons disease
Prevention practice for Multiple Sclerosis
Prevention Practice for Integumentary Disorders:
Lifespan Changes of the integumentary System
Skin Care
Prevention Practice for Individuals with Developmental Disabilities:
Defining Developmental Disabilities
Misconceptions about Disabilities
Promoting Health for Individuals with Developmental Disabilities
Quality of life for Individuals with Developmental Disabilities
Marketing Health and Wellness:
Definition of Marketing
Marketing Strategies for health and wellness Centers
RECOMMENDED BOOK:
A Physical Therapists Guide to Health, Fitness, and Wellness
By Catherine R Thompson, PhD, MS, PT
PATHOLOGY& MICROBIOLOGY
104
LEARNING OUTCOMES OF GENERAL PATHOLOGY
At the end of the session, students will be able to:
1: Define and discuss briefly cell injury and apoptosis. Enlist causes of cell injury.
2: Define Necrosis and brief dscription of caseous, liquefactive, coagulative and gangrenous
necrosis.
3: Define and briefly discuss with examples Hyperplasia, Hypertrophy, Atrophy, Metaplasia.
4: Define acute inflammation and discuss briefly its vascular events and cellular events and enlist
the chemical mediators of acute inflammation.
5: Define and briefly discuss granulomatous and non- granulomatous chronic inflammation with
examples.
6: Briefly discuss the processes of primary and secondary healing and tabulate the differences
between primary and secondary healing. Briefly discuss factors affecting healing.
7: Define and briefly discuss the following hemodynamic disorders
a. Edema
b. Hyperemia / congestion
c. Hemorrhage
d. Thrombosis
e. Embolism
f. Infarction
g. Shock
8: Tabulate the differences between benign and malignant tumors with examples in context of
nomenclature of Tumors.
9: Discuss briefly
Antigen
Antibodies
T & B cells
Autoimmunity
10: Define and briefly discuss Hypersensitivity reactions with examples.
LEARNING OUTCOMES OF SPECIAL PATHOLOGY
105
2: Define and Classify endocarditis and write down the diagnostic criteria for endocarditis.
3: Define and Classify cardiomyopatheies and enlist their various causes.
THE RESPIRATORY SYSTEM
At the end of the session, students will be able to:
1: Define obstructive pulmonary diseases and discuss briefly etiology and pathogenesis of
emphysema, chronic bronchitis and bronchiectasis.
2: Define and classify interstitial lung diseases. Briefly discuss their causes.
3: Define and classify pneumonia and enlist their causes.
4: Briefly discuss the etiology and causes of lung abscess, pleural effusion and acute respiratory
distress syndrome.
5: Briefly discuss etiology and pathogenesis of TB.
THE INTEGUMENTARY SYSTEM
At the end of the session, students will be able to:
1: Define macule, papule, nodule, plaque, vesicle, bulla, blister, pustule, ulceration,
hyperkeratosis, acanthosis and erosion.
2: Enlist the names and discuss briefly acute and chronic inflammatory dermatoses.
3: Define the thermal injuries of skin and discuss briefly their causes.
THE NEUROMUSCULAR SYSTEM
At the end of the session, students will be able to:
1: Define and classify diseases of peripheral nerves.
2: Define and classify muscular dystrophies and briefly discuss etiology and pathogenesis of
Duchenne and Becker muscular dystrophies.
3: Define and classify Myopathies.
4: Define Myasthenia gravis and briefly discuss its pathogenesis and clinical course.
BONES AND JOINTS
At the end of the session, students will be able to:
1: Define Osteoporosis, osteomalacia, rickets, pagets disease and osteomyelitis and briefly
discuss the causes and pathogenesis of each of these condition.
2: Classify bone tumors. Discuss briefly giant cell tumor and osteogenic sarcoma.
3: Define and briefly discuss etiology, pathogenesis, morphology and clinical features of:
A: Rheumatoid arthritis, Osteoarthritis
B: Gouty arthritis, Pseudogout.
C: Infectious arthritis
D: Seronegative arthritis
CNS:
At the end of the session, students will be able to:
1: Classify infectious diseases of brain (bacterial, viral, prions). Briefly discuss their etiology and
brief pathogenesis.
2: Define and classify degenerative and demyelinating diseases of CNS and briefly discuss the
etiology, pathogenesis and clinical feature of:
106
Amyotrophic Lateral Sclerosis
Alzheimer's Disease, Alzheimer's Dementia, and Variants
Dystonia
Huntington's Disease
Multiple Sclerosis
Parkinsonism and Parkinson's Disease
3: Define, classify and briefly discuss cerebrovascular diseases.
4: Classify CNS tumors.
MICROBIOLOGY
GENERAL BACTERIOLOGY:
At the end of the session, students will be able to:
1: Tabulate important components of bacterial cell and their functions.
2: Classify and enlist important groups of bacteria on the basis of staining and use of oxygen.
3: Draw and label bacterial growth curve
4: Tabulate the differences between exotoxins and endotoxins.
5: Define sterilization and disinfection. Enlist methods of sterilization along with their uses and
principles. Enlist important disinfectants used in clinical practice along with their uses.
SPECIAL BACTERIOLOGY:
At the end of the session, students will be able to discuss the basic characteristics, brief
laboratory diagnosis and diseases caused by:
1. Staphylococcus aureus and epidermidis
2. Streptococci (S. pyogenes, S. aglactiae, pneumococcus and S. viridians)
3. Gonococuss and Meningococcus
4. Clostridia (C. tetani. C. botulinum and C. perfringens )
5. Mycobacterium Tuberculosis.
6. Treponemes (T. pallidum & Borrelia burgdorferi).
BASIC VIROLOGY:
At the end of the session, students will be able to:
1. Briefly discuss viral structure.
2. Briefly classify viruses.
RECOMMENDED BOOKS:
1: PATHOLOGIC BASIS OF DISEASE BY ROBBINS AND COTRAN (9 th EDITION)
2: REVIEW OF MEDICAL MICROBIOLOGY AND IMMUNOLOGY BY WARREN
LEVINSON (12th EDITION)
PRACTICAL EXAMINATION
TOTAL MARKS: 90 + 10 (internal assessment) = 100 marks
VIVA VOCE =40 marks PRACTICAL EXAMINATIONS= 45marks PRACTICAL
COPY= 5 marks
107
MICROBIOLOGY: (LIST OF PRACTICALS:)
1: STUDY OF MICROSCOPE
2: CULTURE MEDIA (BLOOD AGAR, CHOCOLATE AGAR, NUTRIENT AGAR, L J)
3: GRAM STAINING
4: ZN STAINING
5: STERILIZATION
108
PATHOLOGY:
SLIDES AND SPECIMENS:
1. LIPOMA
2. LEIOMYOMA
3. GRANULOMA
4. CASEOUS NECROSIS
5. ACUTE APPENDICITIS
6. CHRONIC CHOLYCYSTITIS
7. GIANT CELL TUMOR OF BONE
8. OSTEOGENIC SARCOMA
109
TOPICS % MCQ SEQ
CVS 10% 1 3 4 1 C1
Integumentary system 7% 1 1 2 1 C1
Neuromuscular 10% 1 3 4 1 C2
system
Bones & Joints 16% 3 6 9 1 C2
CNS 10% 1 3 4 1 C2
Microbiology 20% 4 4 8 2 1 = C1
1 = C2
Total 100% 45 9 ( 9X5) =
45 marks 45 marks
TOPICS % MCQ SEQ
CVS 10% 1 3 4 1 C1
Integumentary system 7% 1 1 2 1 C1
Neuromuscular 10% 1 3 4 1 C2
system
Bones & Joints 16% 3 6 9 1 C2
CNS 10% 1 3 4 1 C2
Microbiology 20% 4 4 8 2 1 = C1
1 = C2
Total 100% 45 9 ( 9X5) =
45 marks 45 marks
110
PHARMACOLOGY
111
3. Psychosis,
4. Depression,
5. Epilepsy
6. Parkinsonism,
7. Anagesics ( NSAIDs & opioids)
8. Drugs for Rheumatoid Arthritis & osteoarthritis
DRUGS AFFECTING MUSCULOSKELETAL MUSCLE;
Skeletal Muscle Relaxants
Drugs for Rheumatoid Arthritis & osteoarthritis
Drugs for osteoporosis
AUTONOMIC PHARMACOLOGY
Introduction to ANS
Brief concept including classification, mode of action, uses & adverseeffects of different
classes of autonomic drugs (activating or blocking both cholinergic & adrenergic
systems.
CARDIOVASCULAR PHARMACOLOGY
Brief concept including classification, mode of action, uses & adverseeffects of drugs used in
1. Hypertension
2. Angina Pectoris
3. Cardiac Arrhythmias
4. Congestive Heart Failure
5. Coagulants & anticoagulants
6. Hyperlipidemia
7. Anemias
RESPIRATORY AND GASTROINTESTINAL PHARMACOLOGY;
Brief concept including classification, mode of action, uses & adverseeffects of drugs used in
1. Bronchial asthma
2. Acid peptic disease
3. Vomiting
4. Constipation
5. diarrhea
112
ENDOCRINE PHARMACOLOGY;
Brief concept of classes ofdrugs that affect the endocrine system like
Adrenocorticosteroids
Male and Female hormones
Thyroid and antithyroid Drugs
Agents affecting bone mineralization
Drugs used for Diabetes Mellitus
Recommended Textbook:
Pharmacology in Rehabilitation (3rd Edition)By Charles D. Ciccone
Pharmacology ,Richard A, Harvey ,2nd Edition ,Lippincott
Trevors pharmacology
Multi-author text book of Pharmacology and Therapeutics ,M.Cheema,Avol 1 and Vol
113
TABLE OF SPECIFICATIONS-PHARMACOLOGY
3RD YEAR DPT
TOPIC K S A TOTAL ASST- NO.ITEMS
TOOLS
Basic Principles C1 - - 10% MCQs, 7
SEQs 1
Autonomic Pharmacology C1 - - 15% MCQs 8
SEQs 1
Cardiovascular C1 10% MCQs 5
Pharmacology SEQs 1
Pharmacology Of Central C1 15% MCQs 5
Nervous System SEQs 1
Respiratory Pharmacology C1 2.5% MCQs 1
SEQs 0.5
Gastrointestinal C1 2.5% MCQs 1
Pharmacology SEQs 0.5
Endocrine Pharmacology C1 5% MCQs 3
SEQs 1
Chemotherapeutic agents C1 15% MCQs 5
SEQs 1
Drugs used to treat pain C2 10% MCQs 5
inflammation SEQs 1
Drugs acting on C3 15% MCQs 5
musculoskeletal system SEQs I
TOTAL 100% MCQs 45, SEQs 9
114
PHYSICAL AGENTS & ELECTROTHERAPY
115
Define ultraviolet rays, infrared rays, paraffin bath, cryotherapy
Demonstrate techniques of general and local application
Explain physiological and therapeutic effects
Identify indications, contraindications, dangers and precautions
ELECTRICAL ENERGY MODALITIES(ELECTRICAL STIMULATING CURRENTS,
IONTOPHORESIS, BIOFEEDBACK,TENS)
Categorize various waveforms and pulse characteristics.
Explain current flow through various types of biologic tissue.
Explain muscle, nerve and nonexcitatory cell responses to electrical stimulation.
Describe how current flows through biologic tissue.
Discuss the various treatment parameters including frequency, intensity, duration, and
polarity that must be considered with electrical stimulating currents.
Differentiate between iontophoresis and phonophoresis.
Explain the basic mechanisms of ion transfer.
Establish specific iontophoresis application procedures and techniques.
Identify the different ions most commonly used in iontophoresis.
Choose the appropriate clinical applications for using an iontophoresis technique.
Establish precautions and concerns for using iontophoresis treatment.
Define biofeedback and identify its uses in a clinical setting.
Explain physiologically how the electrical activity generated by a muscle contraction can be
measured using an electromyograph (EMG).
Outline the equipment setup and clinical applications for biofeedback.
SOUND ENERGY MODALITIES (ULTRASOUND)
Analyze the transmission of acoustic energy in biologic tissues relative to waveforms,
frequency, velocity, and attenuation.
Break down the basic physics involved in the production of a beam of therapeutic
ultrasound.
Compare both the thermal and nonthermal physiologic effects of therapeutic ultrasound.
Evaluate specific techniques of application of therapeutic ultrasound and how they may be
modified to achieve treatment goals.
Choose the most appropriate and clinically effective uses for therapeutic ultrasound. Explain
the technique and clinical application of phonophoresis.
Identify the contraindications and precautions that should be observed with therapeutic
ultrasound.
ELECTROMAGNETIC ENERGY MODALITIES (LASER, SHORTWAVE
DIATHERMY, MICROWAVE DIATHERMY)
Identify the different types of lasers.
Analyze the therapeutic applications of lasers in wound and soft-tissue healing, edema
reduction, inflammation, and pain.
Demonstrate the application techniques of low power lasers.
116
Incorporate the safety considerations in the use of lasers.
Be aware of the precautions and contraindications for low-power lasers.
Evaluate how the diathermies may best be used in a clinical setting.
Explain the physiologic effects of diathermy.
Compare treatment techniques for continuous shortwave and pulsed shortwave diathermy.
Demonstrate the equipment setup and treatment technique for microwave diathermy.
Discuss the various clinical applications and indications for using continuous short-wave,
pulsed shortwave, and microwave diathermy.
Identify the treatment precautions for using the diathermies.
Analyze the rate of heating and how long muscle retains the heat generated from a shortwave
diathermy treatment.
Compare and contrast diathermy and ultrasound as deep-heating agents
MECHANICAL ENERGY MODALITIES (COMPRESSION DEVICES, SPINAL
TRACTION)
Define external compression and its effects
Demonstrate application technique
Identify contraindications and precautions of external compression
Differentiate between intermittent or sequential compression pumps
Outline the setup procedure for intermittent external compression.
Recognize the effects that changing a parameter might have on edema reduction.
Review the clinical applications for using intermittent compression devices.
Analyze the physical effects and therapeutic value of traction on bone, muscle, ligaments,
joint structures, nerve, blood vessels, and intervertebral disks.
Explain the setup procedures and treatment parameter considerations for using mechanical
lumbar traction.
Demonstrate the setup procedure for mechanical traction techniques for the cervical spine.
AQUATIC EXERCISE
Define Aquatic exercise.
Explain the goals, indications, precautions and contraindications of aquatic exercises.
Describe the properties of water and special equipment used for aquatic exercises.
Describe different pools, temperature regulation, and pool care and safety.
Describe different treatment techniques.
Practical Training/ Lab Work
The practical training will be practiced in physiotherapy treatment ward under the supervision of
qualified physiotherapists
Location of motor points
Faradic & I.D.C test
Strength duration curve, determination of Rheobase and Chronaxie
117
Accomodity test
Electromyography
Definition, method, value, uses of E.M.G, Electromyography & temperature, feedback
technique
Practical application of TENS in physical therapy treatment ward
Reflective clinical case studies
Iontophoresis
Practical application of Infra red rays
Practical application of ultrasound including Phonophoresis
Supervised application of Ultraviolet rays including determination of test dosage
Practical application of cold packs
Practical application of traction
Paraffin Wax bath application
Demonstration of techniques during practical classes, later on techniques practiced by
students on patients attending the department under supervision of trained physiotherapists.
Note:
The students are expected to make a record of his/her achievements in the log book. The log
book is a collection of evidence that learning has taken place. It is a reflective record of
achievements. The log book shall also contain a record of the procedures which student would
have performed/observed.
Recommended books:
118
119
TABLE OF SPECIFICATIONS-PHYSICAL AGENTS &ELECTROTHERAPY
3rd YEAR DPT
Asst No. of
Topic K S A Total
Tools Items
120
THERAPEUTIC EXEDRCISES &TECHNIQUES
COURSE DESCRIPTION:
This course presents anatomical and physiological principles to allow students to develop
integrated therapeutic exercise interventions. Students have the opportunity to develop an
acquired understanding of physiological responses to various types of training and develop skills
in prescription, implementation, and modeling of exercise programs. Exercise components of
strength, aerobic/ anaerobic conditioning, flexibility, balance and stage of healing/rehabilitation
are examined. Evidence of appropriate, safe and effective exercise design and proper exercise
biomechanics and prescription parameters are addressed with all interventions. Exercise
considerations for special populations and across the age span are covered. Concepts are
presented in lecture and practiced in the laboratory.
GENERAL CONCEPTS
Define therapeutic exercise, key terms of physical function, types of exercise intervention
and Disablement.
Describe and explain the process, models and classification of disablement in physical
therapy.
Describe and explain how evidence based management and clinical decision making impacts
on patient management in physical therapy.
Explain the strategies a physical therapist should use for effective exercise and task specific
instruction.
121
122
Prevention, Health, and Wellness
Define Health, wellness, prevention and types of prevention.
Describe behavioral change theories in determining readiness to change in patient/client.
Describe the steps to develop and implement prevention, health, wellness and fitness
program.
Define functional excursion, active insufficiency and passive insufficiency, range of motion,
passive ROM, active ROM, and active assisted ROM.
Describe Indications, limitations, precautions and contraindication of ROM exercises.
Explain the principles, procedures, and applications of ROM.
Perform various ROM and self-assisted ROM techniques.
Describe continuous passive motion, its benefits and guidelines.
Stretching for Impaired Mobility
123
Describe the principles, indications, precautions and contraindications of resistance exercises.
Describe manual and mechanical resistance exercises.
Perform manual resistance exercises on various body regions.
Describe principles of PNF techniques.
Perform PNF techniques on body.
Describe various resistance training regimens.
Recognize the various equipment used for resistance training.
Principles of Aerobic Exercise
PRINCIPLES OF INTERVENTION
Soft Tissue Injury, Repair, And Management
Define and explain different soft tissue lesions.
Explain the management of soft tissue lesions in acute, sub-acute and chronic stage.
Explain cumulative trauma disorder
Joint, Connective Tissue, And Bone Disorders And Management
Define and explain arthritis and arthrosis including osteoarthritis and rheumatoid arthritis.
Explain and differentiate fibromyalgia and myofascial pain syndrome.
Explain osteoporosis.
Describe fractures also explain rehabilitation after fractures.
Surgical Interventions And Postoperative Management
Describe indications and contraindications of surgical interventions.
Describe the guidelines for preoperative and postoperative management.
124
TABLE OF SPECIFICATIONS-THERAPEUTICS
3rdYEAR DPT
Describe common orthopedic surgeries and their postoperative management.
Therapeutics Exercises and Technique, By: Carolyn Kisner & Lynn Allen Colby 4th 5th
edition.
Therapeutics Exercises: Techniques for Intervention By: William D.Banddy
Clinical decision making in therapeutic exercise By: Patricia e. Sullivan & prudence d.
Markos, Appleton & Lange Norwalk, Connecticut
125
Asst No. of
Topic K S A Total
Tools Items
126
TEACHING METHODOLOGY & COMMUNITY
MEDICINE
THEORY HOURS 100
TOTAL HOURS 100
COURSE DESCRIPTION:
The course is organized to introduce the concept of health care and management issues in Health
Services. It will help them in assuming a leadership role in their profession and assume the
responsibility of guidance. It will help them assume wider responsibilities at all levels of health
services. It will help them in improving their performance through better understanding of the
total function of the institution.
DETAILED COURSE OUTLINE
TEACHING METHODOLOGY
127
COMMUNITY MEDICINE
COURSE DESCRIPTION:
This course is designed for the physiotherapists in order to develop strong knowledge
background regarding the community health and well being. It also gives knowledge about issues
in community health and policies and procedures for their effective management..
129
HISTORY TAKING
PRACTICAL HOURS 100
TOTAL HOURS 100
COURSE DESCRIPTION:
During this supervised clinical practice, students are responsible for learning the art of history
taking, the first interaction with patient. Students learn the skills under supervision of trained
physical therapists. Students become familiar with performance of these skills in all settings
(inpatient and outpatient) as well as on all types of patients (surgical, non-surgical, pediatric,
geriatric, etc.)
The emphasis is placed on general history taking skills as well as its pertinence to all systems
(musculoskeletal, Integumentary, cardiovascular, pulmonary, and neurological.) Student is
required to keep a performance record of all listed competencies and successfully perform on
real patients during the final evaluation of the course.
Clinical Competencies:
Review pertinent medical records and conduct an interview which collects the following data:
Past and current patient/client history
Demographics
General health status
Chief complaint
Medications
Medical/surgical history
Social history
Present and pre-morbid functional status/activity
Social/health habits
Living environment
Employment
Growth and development
Lab values
Imaging
130
Consultations
Documentation of the history
SYSTEMS REVIEW
PRACTICAL HOURS 100
TOTAL HOURS 100
COURSE DESCRIPTION:
During this supervised clinical practice, students are responsible for learning the skills of systems
review and validate the need for physical therapy services. Students learn to objectively review
each system under the supervision of trained physical therapists. Students become familiar with
performance of these skills in all settings (inpatient and outpatient) as well as on all types of
patients (surgical, non-surgical, pediatric, geriatric, etc.) Student is required to keep a
performance record of all listed competencies and successfully perform on real patients during
the final evaluation of the course.
Clinical Competencies:
Perform review of systems to determine the need for referral or for physical therapy
services.
Systems review screening includes the following:
General Health Condition (GHC)
Fatigue
Malaise
Fever/chills/sweats
131
Nausea/vomiting
Dizziness/lightheadedness
Unexplained weight change
Numbness/Paresthesia
Weakness
Cognition
Cardiovascular System (CVS)*
Dyspnea
Orthopnea
Palpitations
Pain/sweats
Syncope
Peripheral edema
Cough
Pulmonary System (PS)*
Dyspnea
Onset of cough
Change in cough
Sputum
Hemoptysis
Clubbing of nails
Stridor
Wheezing
Gastrointestinal System (GIS)
Difficulty with swallowing
Heartburn, indigestion
Change in appetite
Change in bowel function
Urinary System (US)
Frequency
132
Urgency
Incontinence
Genital Reproductive System (GRS)
Male
Describe any sexual dysfunction, difficulties, or concerns
Female
Describe any sexual or menstrual dysfunction, difficulties, or problems
RECOGNITION OF RED AND YELLOW FLAGS
Initiate referral when positive signs and symptoms identified in the review of systems
are beyond the specific skills or expertise of the physical therapist or beyond the scope
of physical therapist practice.
Consult additional resources, as needed, including other physical therapists, evidence-
based literature, other health care professionals, and community resources.
Screen for physical, sexual, and psychological abuse.
Cardiovascular and Pulmonary Systems
Conduct a systems review for screening of the cardiovascular and pulmonary system
(heart rate and rhythm, respiratory rate, blood pressure, edema).
Read a single lead EKG.
Integumentary System
Conduct a systems review for screening of the integumentary system, the assessment of
pliability (texture), presence of scar formation, skin color, and skin integrity.
Musculoskeletal System
Conduct a systems review for screening of musculoskeletal system, the assessment of gross
symmetry, gross range of motion, gross strength, height and weight.
Neurological System
Conduct a systems review for screening of the neuromuscular system, a general assessment
of gross coordinated movement (e.g., balance, gait, locomotion, transfers, and transitions)
and motor function (motor control and motor learning).
133
FOURTH PROFESSIONAL YEAR
1. MEDICINE
2. SURGERY
3. PT-I: MUSCULOSKELETAL, NEUROLOGICAL PHYSICAL
THERAPY
4. RADIOLOGY & DIAGNOSTIC IMAGING
5. EMERGENCY PROCEDURES AND PRIMARY CARE
6. BIOSTATISTICS & EVIDENCE BASED PRACTICE
7. SUPERVISED CLINICAL PRACTICE III, IV
134
MEDICINE
CARDIOVASCULAR DISEASES
Cardiac Diseases:
Chest pain
Dyspnoea
Palpitation
Peripheral edema
Syncope
Cardiac failure
Acute pulmonary edema
Cardiogenic shock
Systemic hypertension
Ischemic heart disease
Angina pectoris
Unstable angina
Myocardial infarction
135
Rheumatic fever
Valvular heart diseases
Congenital heart diseases
Ventricular septic defect
Atrial septal defect
pulmonary heart disease
Pericardial disease
Pulmonary hypertension
Cardiac arrhythmias and heart in pregnancy
Vascular Diseases:
Arteriosclerosis
Acute & Chronic ischemia of leg
Aortic aneurysm
Buergers disease
Raynauds disease
Varicose veins
Venous thrombosis
RHEUMATOLOGY AND BONE DISEASES
Arthritis
Osteoarthritis
Rheumatoid arthritis
Connective tissue diseases
Arthritis in elderly
Arthritis in children,
Seronegative spondyloarthropathies
Crystals deposition disease
Arthritis associated with other diseases
Back Pain
Back Pain due to serious disease
Inflammatory Back Pain
136
Disc disease
Mechanical problems
Soft tissues problems
Psychogenic Back Pain
Nonspecific Back Pain
Neck pain
Soft Tissue Rheumatism
Bone diseases
Pagets disease
Infections of bones
Neoplastic disease
Skeletal dysplasia
Other hereditary diseases
RESPIRATORY DISEASES
Diseases of Upper respiratory tract
Common cold
Sinusitis
Rhinitis
Pharangitis
Acute laryngeo-trcheobronchitis
Influenza
Inhalation of the foreign bodies
Disease of Lower Respiratory tract
Acute & chronic Bronchitis
Bronchiectasis
Cystic fibrosis
Asthma
Emphysema
Pneumonias
137
Tuberculosis
Pulmonary fibrosis
Radiation damage
Common tumors of the lungs
Respiratory failure
Adult distress respiratory syndrome
Disorders of chest wall and pleura
Chest trauma
Deformities of rib cage
Dry pleurisy
Pleural effusion
Empyema
Pneumothorax
Dermatology
Introduction to disorders and diseases
Acne vulgaris
Psoriasis
Boils
Carbuncles
Alopecia
Mycosis fungoides
Polymorphic light eruptions
Vitilogo
Pityriasis
Hyperhydrosis
Diseases of Brain and Spinal Cord:
Common neurological symptoms
Neurological examination
The brain death
Stroke, types of stroke
138
Parkinsons disease
Epilepsy
Multiple Sclerosis
Infective and Inflammatory diseases
Intracranial tumors
Hydrocephalus
Headache
Migraine
Facial pain
Head injury
Motor neuron disease
Diseases of spinal cord
Diseases of Cranial nerves
Peripheral nerve lesions
Diseases of voluntary muscles and of neuromuscular junction
Sleep
Unconsciousness and Comma
Renal diseases
Glomerulonephritis
Acute nephritic syndrome
Nephrotic syndrome
Urinary tract infection
Renal hypertension
Renal failure
Benign enlargement of prostate gland
Prostatic carcinoma
Diseases of the Blood:
Anemia
Brief description of types of Anemia
139
Brief description of Bleeding and Coagulation, only Haemophilia and Thrombosis is
described in detail
Miscellaneous Diseases:
Brief description of Diabetes Mellitus and its complications
Detailed description of Diabetic Neuropathy and Diabetic foot
Steroid induced Myopathy
140
SURGERY
COURSE DESCRIPTION:
This course intends to familiarize students with principles orthopedic surgery along with
familiarization with terminology and abbreviations for efficient and effective chart reviewing
and documentation. It also explores various orthopedic conditions needing surgical attention,
focusing on epidemiology, pathology, as well as primary and secondary clinical characteristics
and their surgical management. The purpose of this course is to make physiotherapy students
aware of various surgical conditions so these can be physically managed effectively both pre as
well as postoperatively.
A. ORTHOPEDIC SURGERY
FRACTURES
141
DISLOCATION AND SUBLUXATION
After completion the student should be able to:
a. Difference between Dislocation and subluxation
b. Principles of management of Dislocation and subluxation
c. Types of Dislocation and subluxation along with management of shoulder, AC joint,
elbow, hip and knee joint
142
vii. Psoriatic arthritis
b. Assess Psoriatic arthritis, OA/ spondylosis / spondylolysis / spondylolisthesis /
ankylosing spondyltis.
c. Understand operative / non operative management of all the above conditions
143
Understand Causes, Classification of congenital and acquired deformities, Physical and
clinical and radiological features, their Complications, Principles of medical and surgical
management of the following deformities:
(i) Spine:
Torticolis
Scoliosis
Kyphosis
Lordosis
flat back
(ii) Lower Limb
CDH
coxa vera
coxa valga
anteversion
Retroversion
Genu valgum
Genu varum
Genu recurvatum
Talipes calcaneous equines, varus & valgus
Talipes calcaneovarus
Talipes calcaneovalgus
Talipes equinovarus
Pes cavus
Pes planus
Hallux valgus & varum,
Hallux rigidus and hammer toe
(iii) Shoulder and upper limb
Sprengels shoulder
Cubitus varum
Cubitus valgum
Deputryns contracture
144
B. GENERAL SURGERY
1.BASICS OF SURGERY
After completion the student should be able to:
a) Describe indications for surgery, types of incisions, bandages and dressings
b) Understand trauma and metabolic response to trauma, hemorrhage, homeostasis and
blood transfusions
c) Describe in detail chest and abdominal trauma
d) Understand classification of shock, fluid and electrolyte imbalance, classification of body
fluid changes, pre-intra and postoperative fluid therapy
e) Understand wounds, their types, wound healing and factors affecting wound healing,
wound care, bandages and dressing
f) Understand ulcers, sinus and fistula
g) Describe burns. types and classification and management of burns, complication and their
management
h) Understand grafts, types of grafts, prognosis and possible complication and their
management
i) Understand preoperative assessment and preparation, postoperative treatment,
complication and their management
j) Understand types of anesthesia (local, regional and general), intravenous anesthetic
agents, muscle relaxants, inhalational anesthetic agents, anesthesia associated diseases
and complication of anesthesia as well as recovery from anesthesia, postoperative pain
management and care
k) Understand indications of transplantation (kidney, liver, heart), complication and
postoperative care
2. THORACIC SURGERY
2.1 Pulmonary surgery
After completion the student should be able to
(a) Describe the following:
i. Types of incision
ii. Types of operation
iii. complications of pulmonary surgery
iv. drains , tubes
v. pneumonectomy, lobectomy , thoracoplasty
vi. Operations on pleura
vii. Chest injuries
145
(b) Understand Indication for pulmonary surgery in:
i. Diseases of chest wall and pleura
ii. Diseases of bronchi
iii. Tumors of lung
iv. Lung abscess
v. Hydatid disease of lung
vi. Pulmonary embolism
vii. Mediastinal masses
viii. Problems related to diaphragm
2.2 Cardiac surgery
At the end of this chapter, student should be able to:
Describe Cardiac Surgery indications
Perform Cardiorespiratory resuscitation
Understand Special investigation procedures in cardiac surgery, Basic techniques in cardiac
surgery, Types of incision, Types of operation, Complications of cardiac surgery, Lines,
drains and tubes
Describe briefly the indications for cardiac surgery in:
i. Congenital heart diseases
ii. Acquired heart diseases
iii. Diseases of the pericardium
iv. Cardiac transplantation
3.VASCULAR SURGERY
At the end of this chapter, student should be able to:
Understand Investigation in vascular disease types of operation
Describe Indications & complications of vascular surgery.
Describe briefly
i. Arterial occlusion
ii. Gangrene
iii. Amputation
iv. Aneurysm
146
v. Burgers disease
vi. Raynauds disease and syndrome
vii. Varicose veins
viii. Superficial and deep venous thrombosis
ix. Venous hemorrhage
x. Lymph edema
xi. Lymph adenitis and lymphomas
4. NEUROSURGERY
4.1 Cranial surgery
At the end of this chapter, student should be able to:
a. Describe Special investigations in brain diseases and traumas
b. Understand types of operations, indications and complications of cranial surgery
c. Describe briefly:
147
148
Recommended Text Books:
Short practice of surgery by Baily and Loves
Text Book of Surgery by Ijaz Ahsan
Outline of Fractures by david hamblen, Hamish Simpsons
Outline of orthopedics. by david hamblen, Hamish Simpsons
Apleys systems of orthopedics and fractures by Louis Solomon 9th ed , publisher holder
Arnold
149
TABLE OF SPECIFICATIONS-SURGERY
4TH YEAR DPT
Asst No. of
Topic K S A Total
Tools Items
150
PHYSIOTHERAPY TREATMENT-I
Course Description:
This course includes a study of anatomy and physiology of the musculoskeletal system and
pathological changes of the system and function, including diagnostic tests and measurements.
Relevant testes and measures for determining impairment and differentiating the diagnosis based
on the specificity and sensitivity of the assessment instruments as related to patients with
musculoskeletal conditions are discussed. The use of evidence-based physical therapy
intervention for musculoskeletal conditions is emphasized. Topics will focus on medical
terminology, clinical examination, evaluation, comparing contemporary, traditional interventions
and the impact of evolving technology in this area.
OBJECTIVES:-
151
3. Documentation in SOAP notes format .
4. Practice Evidence based musculoskeletal Physical Therapy Treatment protocols.
5. Describe Posture and Biomechanical Influences, Alignment, Stability,Impaired
posture,Etiology of pain,Common faulty postures: characteristics and
Impairments,Management of impaired posture, General management guidelines, Tension
headache/cervical headache.
6. Review the structure and function of the spine .
7. Describe pathology of intervertebral disc, pathomechanical relationships of intervertebral
disc and facet joint. ,Pathology of the zygapophyseal (facet) , Pathology of muscle and soft
tissue injuries: strains, tears, and contusions .
8. Interpret Principles of management for the Spine , Management guidelinesnon-weight-
bearing bias, Management guidelinesextension bias,Management guidelinesflexion bias,
Management guidelinesstabilization , Management guidelinesmobilization, Management
guidelinessoft tissue injuries,Management GuidelinesTemporomandibular Joint
Dysfunction.
9. Explain Basic concepts of spinal management with exercise, Fundamental interventions,
Patient education,General exercise guidelines, Kinesthetic awareness, Elements of
kinesthetic trainingfundamental techniques,Progression to active and habitual control of
Posture , Mobility/flexibility, Cervical and upper thoracic, Regionstretching techniques,
Mid and lower thoracic and lumbar.
10. Practice Regionsstretching techniques, Muscle performance: stabilization, muscle
endurance, and strength training, Stabilization trainingfundamental techniques and
Progressions , Isometric and dynamic exercises , Cardiopulmonary endurance , Common
aerobic exercises and effects on the spine , Functional activities , Early functional training
fundamental techniques , Preparation for functional activitiesbasic exercise Techniques ,
Body mechanics and environmental adaptations , Intermediate to advanced exercise
techniques for Functional training , Education for prevention.
11. Illustrate and practice Examination, evaluation and assessment of shoulder joint ,Referred
pain and nerve injury , Management of shoulder disorders and surgeries , Joint
Hypomobility: nonoperative management , Glenohumeral joint surgery and postoperative
management , Painful shoulder syndromes (rotator cuff disease, impingement syndromes,
shoulder instabilities): , Nonoperative management , Painful shoulder syndromes: surgery
and postoperative management , Shoulder dislocations: nonoperative management
,Shoulder instabilities: surgery and postoperative management , Exercise interventions for
the shoulder , Girdle Exercise Techniques During Acute And Early Subacute Stages of
tissue healing , Exercise techniques to increase flexibility and range of motion , Exercises
to develop and improve muscle performance and functional control.
12. Illustrate and practice Examination, evaluation and assessment of elbow and forearm
complex, Referred pain and nerve injury in the elbow region , Management of elbow and
forearm disorders and surgeries , Joint Hypomobility: nonoperative management , Joint
surgery and postoperative management , Myositis ossificans , Overuse syndromes:
repetitive trauma syndromes , Exercise interventions for the elbow and Forearm , Exercise
techniques to increase flexibility and range of Motion , Exercises to develop and improve
muscle performance And functional.
152
13. Illustrate and practice Examination, evaluation and assessment of wrist and hand ,Major
nerves subject to pressure and trauma at the Wrist and hand ,Management of wrist and
hand disorders And surgeries , Joint Hypomobility: nonoperative management , Joint
surgery and postoperative management , Repetitive trauma syndromes/overuse ,Traumatic
lesions in the wrist and hand,Exercise interventions for the wrist and Hand, Techniques for
musculotendinous mobility, Exercise techniques to increase flexibility and range Of motion
,Exercises to develop and improve muscle Performance, neuromuscular control, and
coordination.
14. Illustrate and practice Examination, evaluation and assessment of hip joint ,The hip and
gait , Referred pain and nerve injury , Management of hip disorders and surgeries ,Joint
Hypomobility: nonoperative management , Joint surgery and postoperative management,
Fractures of the hipsurgical and postoperative management , Painful hip
syndromes/overuse syndromes: nonoperative management , Exercise interventions for the
hip region , Exercise techniques to increase flexibility and range of motion , Exercises to
develop and improve muscle performance and functional control.
15. Illustrate and practice Examination, evaluation and assessment of knee joint , Referred
pain and nerve injuries , Management of knee disorders and surgeries , Joint Hypomobility:
nonoperative management , Joint surgery and postoperative management , Patellofemoral
dysfunction: nonoperative management , Patellofemoral and extensor mechanism
dysfunction: Surgical and postoperative management , Ligament injuries: nonoperative
management , Ligament injuries: surgical and postoperative Management , Meniscal tears:
nonoperative management , Meniscal tears: surgical and postoperative management ,
Exercise interventions for the knee , Exercise techniques to increase flexibility and range of
motion , Exercises to develop and improve muscle performance and functional control.
16. Illustrate and practice Examination, evaluation and assessment of ankle and foot joint ,
Referred pain and nerve injury , Management of foot and ankle disorders and surgeries ,
Joint Hypomobility: nonoperative management , Joint surgery and postoperative
management , Overuse (repetitive trauma) syndromes: nonoperative management ,
Ligamentous injuries: nonoperative management , Traumatic soft tissue injuries: surgical
and postoperative management ,Joint Hypomobility: nonoperative management ,Joint
surgery and postoperative management , Overuse (repetitive trauma) syndromes:
nonoperative management , Ligamentous injuries: nonoperative management.
153
DETAILED COURSE OUTLINE
Impaired posture
Etiology of pain
Common faulty postures: characteristics and Impairments
154
MANAGEMENT GUIDELINES BASED ON IMPAIRMENTS
Principles of management for the Spine
Management guidelinesnon-weight-bearing bias
Management guidelinesextension bias
Management guidelinesflexion bias
Management guidelinesstabilization
Management guidelinesmobilization
Management guidelinessoft tissue injuries
Management GuidelinesTemporomandibular Joint Dysfunction
155
Shoulder dislocations: nonoperative management
Shoulder instabilities: surgery and postoperative management
Exercise interventions for the shoulder
Girdle Exercise Techniques During Acute And Early Subacute Stages of tissue healing
Exercise techniques to increase flexibility and range of motion
Exercises to develop and improve muscle performance and functional control
THE HIP
Examination, evaluation and assessment of hip joint
The hip and gait
Referred pain and nerve injury
Management of hip disorders and surgeries
Joint Hypomobility: nonoperative management
Joint surgery and postoperative management
Fractures of the hipsurgical and postoperative management
Painful hip syndromes/overuse syndromes: nonoperative management
Exercise interventions for the hip region
Exercise techniques to increase flexibility and range of motion
Exercises to develop and improve muscle performance and functional control
156
THE KNEE
Examination, evaluation and assessment of knee joint
Referred pain and nerve injuries
Management of knee disorders and surgeries
Joint Hypomobility: nonoperative management
Joint surgery and postoperative management
Patellofemoral dysfunction: nonoperative management
Patellofemoral and extensor mechanism dysfunction: Surgical and postoperative
management
Ligament injuries: nonoperative management
Ligament injuries: surgical and postoperative Management
Meniscal tears: nonoperative management
Meniscal tears: surgical and postoperative management
Exercise interventions for the knee
Exercise techniques to increase flexibility and range of motion
Exercises to develop and improve muscle performance and functional control
Practical Training
The practical training will be sought in physiotherapy treatment based settings. Keeping in view
therapeutic principles, management of various pre and post operative conditions will be practiced
under supervision and later independently by the students, the practical work might include:
Therapeutic Management of conditions of spine
Therapeutic Management of conditions of extremities
Therapeutic Management of vascular disorders
Therapeutic Management of pulmonary conditions
Therapeutic Management of gynaecological conditions
Reflective clinical case studies
Supervised and independent Practical application of therapeutic techniques on patients in
outdoor and indoor physiotherapy treatment settings.
157
Note:
The students are expected to make a record of his/her achievements in the log book. The log
book is a collection of evidence that learning has taken place. It is a reflective record of
achievements. The log book shall also contain a record of the procedures which student would
have performed/observed.
158
NEUROLOGICAL PHYSICAL THERAPY
COURSE DESCRIPTION:
This course provides an in-depth exploration of the assessment and intervention procedures used
with persons with various neurological pathologies. The focus of this course will be on
neurological problems acquired in adulthood. Theories of motor control and motor learning will
be studied and applied to assessment and treatment. Laboratories will be used to strengthen
evaluation and intervention skills, especially the analysis of movement as well as planning,
practicing, and modifying treatment. The format of this course includes lectures, discussions,
laboratory experiences, problem-based learning activities, community based experiences, and
patient-centred case study learning activities.There will also be contact with persons with
neurological dysfunction as part of this course. Clinical competence in the evaluation and
treatment of persons with neurological impairments is to be developed. Topics will focus on
medical terminology, clinical examination, evaluation, comparing contemporary, traditional
interventions and the impact of evolving technology in this area.
NEUROLOGICAL EXAMINATION:
Explain History Taking
Explain System review
Demonstrate Test and measures
INTERVENTIONS:
Introduction to Theories of Neurological Rehabilitation
Explain Remediation & facilitation approaches
Define Bobath-NDT
Define Motor relearning program(MRP)
Define Kabat, Knott, Voss (PNF)
DefineConstraint induced movement therapy (CIMT)
Explain Motor Control / Motor Learning Approach
Define Neural plasticity/ adoptability
Define Balance
Explain Role of sensory system
159
Explain Skill acquisition
Define Postural Control
Explain Mobility Function
Explain Task-Related Training Approach
Explain Compensatory Training Approach
Define Normal Reach, Grasp and Manipulation
NEUROLOGICAL DYSFUNCTIONS
Explain CVA (Stroke)
Explain Traumatic Brain Injury (TBI)
Explain Spinal Cord Injury (SCI)
Describe Degenerative Diseases (Progressive CNS disorders)
Explain Multiple Sclerosis (MS)
Explain Parkinsons Disease (PD)
Explain Post Polio Syndrome (PPS)
Explain Cerebellar Disorders
Explain Vestibular Disorders
Explain Cranial Nerves Disorders
Explain polyneuropathies
160
161
162
NEUROMUSCULAR DISORDERS &CASE HISTORIES
Explain Principles of assessment and outcome measures
Describe Documentation in SOAP notes format
Demonstrate Evidence based neurological Physical Therapy Treatment protocols
In the laboratory sessions, neurological physiotherapy skills will be demonstrated and practiced.
Various reflective case studies related to the neurological rehabilitation will be assigned to the
students.
Note:
The students are expected to make a record of his/her achievements in the log book. The log
book is a collection of evidence that learning has taken place. It is a reflective record of
achievements. The log book shall also contain a record of the procedures which student would
have performed/observed. This log book will be an integral part of the Physiotherapy in Practice
I and Physiotherapy in Practice II.
163
TABLE OF SPECIFICATIONS-PHYSIOTHERAPY TREATMENT-I
4TH YEAR DPT
Asst No. of
Topic K S A Total
Tools Items
Musculoskeletal 2 2 1 5% VIVA 0
evaluation OSPE 0
Spine 5 3 2 10% MCQS 6
SEQS 2
VIVA
OSPE
Shoulder 3 3 1 7% MCQS 6
SEQS 1
VIVA,
OSPE
Elbow &Forearm 2 2 1 5% MCQS, 3
SEQS 1
VIVA,
OSPE
Wrist &Hand 1 1 1 3% MCQS 2
SEQS 0
VIVA,
OSPE
Hip 5 3 2 10% MCQS, 5
SEQS 1
VIVA,
OSPE
Knee 5 3 2 10% MCQS 7
SEQS 1
VIVA
OSPE
Ankle &Foot 2 2 1 5% MCQS, 2
SEQS 0
VIVA,
OSPE
Anatomy & physiology 3 0 0 3% MCQS, 2
of nervous system SEQS 0
VIVA
Neurological 2 2 1 5% MCQS, 0
Examination SEQS 0
VIVA
Interventions 7 7 1 15% MCQS, 5
SEQS 1
VIVA,
OSPE
Neurological 7 7 1 15% MCQS, 5
164
Dysfunction SEQS 2
VIVA,
OSPE
Neuromuscular 2 2 0 4% MCQS, 2
disorders SEQS 0
VIVA,
OSPE
Case Histories 1 1 1 3% VIVA, 0
OSPE 0
TOTAL 100% MCQ 45 SEQ 09
165
RADIOLOGY & DIAGNOSTIC IMAGING
166
FLUOROSCOPY:
What is Fluoroscopy?
Equipment used for fluoroscopy
Indications and Contra indications
How it helps in diagnosis
The Findings in Fluoroscopy
Benefits versus Risks and Costs
COMPUTED TOMOGRAPHY (CT):
What is Computed Tomography?
Equipment used for Computed Tomography
Indications and Contra indications
How it helps in diagnosis
The Findings in Computed Tomography
Benefits versus Risks and Costs
MAGNETIC RESONANCE IMAGING (MRI)
What is MRI?
Equipment used for MRI
Indications and Contra indications
How it helps in diagnosis
The Findings in MRI
Benefits versus Risks and Costs
Functional MRI
ULTRASOUND:
What is Ultrasound?
Equipment used for Ultrasound
Indications and Contra indications
How it helps in diagnosis
The Findings in Ultrasound
Benefits versus Risks and Costs
167
ENDOSCOPY:
What is Endoscopy?
Equipment used for Endoscopy
Indications and Contra indications
How it helps in diagnosis
The Findings in Endoscopy
Benefits versus Risks and Costs
NUCLEAR MEDICINE:
What is Nuclear Medicine?
Equipment used for Nuclear Medicine
Indications and Contra indications
How it helps in diagnosis.
Benefits versus Risks and Costs
INTERVENTIONAL RADIOLOGY
168
EMERGENCY PROCEDURES
&PRIMARY CARE IN PHYSICAL THERAPY
THEORY HOURS 50
TOTAL HOURS 50
COURSE DESCRIPTION:
This course provides the student with all of the skills necessary to take appropriate action in an
emergency in any practice setting. Basic life support, advanced cardiac life support, and first aid
and emergency preparedness are the content areas of this course. The course is designed to
provide knowledge and skill in emergency techniques and in the application of appropriate
action necessary to take care of the patient/client.
169
Vital signs
AIRWAY MANAGEMENT
Air way anatomy
Air way compromise
Oxygen therapy
Advanced airway devices
SUDDEN CARDIAC DEATH
Incidence and etiology of sudden death in general population
Sudden cardiac arrest in athletes
Screening and recognition of cardiac warning signs
Preparation for cardiac emergencies
Management of sudden cardiac arrest
HEAD INJURIES
Pathomechanics of brain injuries
Types of pathology
Classification of cerebral concussion
Cerebral contusion
Cerebral hematoma
Second impact syndrome
Initial on site assessment
Sideline assessment
Special tests for assessment of coordination
Special tests for assessment of cognition
Other tests
Medications
Wake ups and rest
EMERGENCY CARE OF CERVICAL SPINE INJURIES
Anatomy
Mechanism of injuries
Injuries to the spinal cord
170
Assessment
Management
EMERGENT GENERAL MEDICAL CONDITIONS
Sudden death
Exercise induced anaphylaxis
Acute asthma
Diabetes mellitus
Mononucleosis
Sickle cell traits
Hypertension
ENVIRONMENT-RELATED CONDITIONS
Heat related emergencies and their prevention
Cold related injuries
Lightning
Altitude related emergencies
ORTHOPEDIC INJURIES
Basic emergency medical care
Fundamentals of skeletal fractures
Splinting techniques
Fractures and dislocations of upper extremity
Fractures and dislocations of lower extremity
Fractures and dislocations of spine
ABDOMINAL INJURIES
Initial evaluation
Specific injuries: abdominal wall contusions, splenic injuries, liver injuries, renal
injuries, intestinal injuries, pancreatic injuries
Non-traumatic abdominal injuries: Appendicitis, ectopic pregnancy
THORACIC INJURIES
Assessment
171
Management of different Types of injuries: fractures, Pneumothorax, hemothorax,
pulmonary embolism
SPINE BOARDING IN CHALLENGING ENVIRONMENTS
The soft foam pit in gymnastics
The pole vault pit
The swimming pole and diving well
The ice hockey rink
THE PSYCHOLOGICAL AND EMOTIONAL IMPACT OF EMERGENCY
SITUATIONS
Defining psychological trauma
Psychological interventions in crisis situations
Psychological trauma in athletic environment
The psychological emergency response team
Internal team members
External team members
The psychological interventions recommendations.
PRIMARY CARE
FOUNDATION
Primary care: physical therapy modles1
Evidence - Based examination of diagnostic information
Cultural competence: An essential of primary health care
Pharmacologic considerations for the physical therapist
The patient interview: the science behind the art
EXAMINATION/EVALUATION
Prologue
Symptoms investigation, Part I: Chief complaint by body region
Symptoms investigation, Part II: Chief complaint by symptom
Patient health history including identifying health risk factor
Review of systems
172
Patient interview: the physical examination begins
Review of cardiovascular and pulmonary systems and vital signs
Upper quadrant screening examination
Lower quadrant screening examination\
Diagnostic imaging
Laboratory tests and values
SPECIAL POPULATIONS
The Pediatric and adolescent population
The obstetric client
The geriatric population
Health and wellness perspective in primary care
173
Recommended Text Books:
Emergency Care in Athletic Training by: Keith M.Gorse, Robert O. Blanc,
Francis Feld, Matthew Radelet, 1st edition, 2010, FA Davis Company
Acute care hand book for Physical Therapists by: Jaime C paz, Michelle P West,
2nd edition, 2002,Butterworth Heinemann
174
No Learning Outcomes Topic Knowledge Skill Atti
C1 C2 C3
175
4 Define computed tomography. Radiology C10.5% Not N
Applic App
Enumerate the equipment used for computed C20.5% able b
Computed
tomography
Tomography
Enumerate the indications and contra C2 1%
Imaging.
C2 1%
Describe the Benefits, Risks and Costs of
Magnetic Resonance Imaging. C20.5%
176
7 Define Endoscopy and enumerate the Radiology C10.5% Not N
Applic App
equipment used for Endoscopy. able b
Endoscopy
Enumerate the indications and contra
C20.5%
indications of Endoscopy.
C20.5%
Discuss Findings in Endoscopy.
Describe the Benefits, Risks and Costs of
C20.5%
Endoscopy.
10 Define and describe the organization and Emergency care C11% Not N
administration of emergency care. Applic App
Organization and
Describe briefly emergency team, initial patient able b
assessment care, emergency communication, administration of C21%
emergency equipment and supplies, emergency emergency care
care facilities.
11 Define and describe scene assessment and safety, Emergency care C1 1% C2 2% Not N
body substance isolation precautions, primary Applic App
Physical examination
survey, secondary survey, vital signs. able b
of the critically
injured
patient/athlete
177
12 Define and describe airway anatomy, airway Emergency care C1 1% C2 2% Not N
compromise, oxygen therapy, advanced airway Applic App
devices. able b
Airway management
13 Describe Incidence and etiology of sudden death in Emergency care C20.5% Not N
general population. Applic App
Sudden cardiac
Describe Sudden cardiac arrest in athletes. C20.5% able b
Describe Screening and recognition of cardiac death C20.5%
warning signs
Describe Preparation for cardiac emergencies. C20.5%
15 Describe the anatomy of spinal cord and cervical Emergency care C20.5% Not N
spine. Applic App
Describe the mechanism of injuries and types of Emergency care of
C20.5% able b
injuries of spinal cord. cervical spine
Describe the assessment of spinal cord injuries. injuries
C20.5%
Describe the management of spinal cord injuries.
C20.5%
16 Describe emergency management of following: Emergency care C10.5% C21.5% Not N
sudden death, exercise induced anaphylaxis, acute Applic App
Emergent general
asthma, diabetes mellitus, mononucleosis, sickle able b
cell traits, and hypertension. medical conditions
178
17 Describe heat related emergencies and their Emergency care C20.5% Not N
prevention. Applic App
Environment-related
Describe cold related injuries. conditions
C20.5% able b
Describe emergency treatment of lightening related C20.5%
injuries.
Describe altitude related emergencies C20.5%
19 Describe the initial evaluation and assessment of Emergency care C20.5% Not N
abdominal and thoracic injuries. Applic App
ABDOMINAL and
Describe specific abdominal injuries: abdominal able b
wall contusions, splenic injuries, liver injuries, thoracic INJURIES C21%
renal injuries, intestinal injuries, pancreatic
injuries.
Describe non traumatic abdominal injuries: C20.5%
Appendicitis, ectopic pregnancy.
Describe management of different thoracic injuries:
C2 1%
fractures, flail chest, Pneumothorax, hemothorax,
pulmonary embolism.
20 Describe the historic events that have helped shape Primary Care: C10.5% Not N
the current practice of primary care medicine. Applic App
Introduction to
Provide an overview of primary care medicine able b
from a physician perspective. primary care C20.5%
Describe examples of current physical therapy medicine
primary care practice models.
Provide strategies for facilitating a patient consult C20.5%
or referral to another health care provider.
C20.5%
179
depression, domestic violence, chemical C2 1%
dependency, and cancer.
22 Describe the types of patient data that fall under the PRIMARY CARE C2 1% Not N
category of symptom investigation, including the Applic App
Symptom
information that constitutes a red flag requiring able b
investigation
physician contact.
Summarize symptoms/signs associated with
medical disorders that may result in patient pain C2 1%
syndromes common to the practice of physical
therapy.
Describe medical-screening questionnaires and
incorporate them into an examination scheme for C2 1%
patients with common pain syndromes
23 Create checklists for general health and for each of PRIMARY CARE C10.5% Not N
the body organ systems. Applic App
Describe strategies for determining whether a able b
yes answer to any checklist item is a red flag C20.5%
Review of
or a yellow flag.
Discuss the types of patients and the patient visits systems C2 1%
(initial or follow-up) for which each of the
checklists is appropriate.
Describe strategies to efficiently integrate the C2 1%
review of systems checklists into a patient
examination scheme.
24 Provide a rationale for the need to measure, PRIMARY CARE C10.5% Not N
monitor, and record vital signs at rest, during Applic App
Review of
activity, and during recovery from activity. able b
Provide a rationale for the need to measure, cardiovascular and C20.5%
monitor, and record body mass index. pulmonary systems
Define blood pressure, heart rate, ventilator rate,
and heart and breath sounds. Describe accurate, and vital signs C2 1%
reliable, and valid clinical tests for each of these
measurements.
Describe the expected normal and potential C2 1%
abnormal changes in blood pressure, heart rate,
ventilator rate, and heart and breath sounds at rest
and in response to short- or long-term exercise.
25 Describe the primary objectives of the upper PRIMARY CARE C2 1% Not N
quarter screening examination related to the Applic App
Upper quarter
differential diagnosis process. able b
Describe the specific examination elements making screening
up the upper quarter screening examination. C2 1%
Explain the relevance of each of the specific
examination elements as they relate to the
differential diagnosis process, including C2 2%
180
identification of clinical red flags that would result
in a patient referral or consultation.
28 Provide an overview of the role laboratory tests PRIMARY CARE C20.5% Not N
and reported values play in patient management. Applic App
Laboratory tests and
Describe the clinical practice implications of able b
values associated with commonly used laboratory values
tests. C20.5%
Tot
al
181
182
BIOSTATISTICS & EVIDENCE BASED MEDICINE
BIOSTATISTICS
COURSE DESCRIPTION:
To provide the students with the necessary concepts of statistics to enable them to realize a
research project in the field of Physiotherapy. It involves selection of appropriate statistical
techniques to address questions of medical relevance; select and apply appropriate statistical
techniques for managing common types of medical data; use various software packages for
statistical analysis and data management; interpret the results of statistical analyses and critically
evaluate the use of statistics in the medical literature; communicate effectively with statisticians
and the wider medical community, in writing and orally through presentation of results of
statistical analyses; explore current and anticipated developments in medical statistics. It is
designed to teach entry-level physical therapy students the fundamentals of reading and
understanding research methods, design, and statistics.
PRESENTATION OF DATA
Introduction, basic principles of classification and Tabulation, Constructing of a frequency
distribution, Relative and Cumulative frequency distribution, Diagrams, Graphs and their
Construction, Bar charts, Pie chart, Histogram, Frequency polygon and Frequency curve,
183
Cumulative Frequency Polygon or Ogive, Historigram, Ogive for Discrete Variable. Types of
frequency curves. Exercises.
MEASURES OF DISPERSION
Introduction, Absolute and relative measures, Range, The semi-Inter-quartile Range, The Mean
Deviation, The Variance and standard deviation, Change of origin and scale, Interpretation of the
standard Deviation, Coefficient of variation, Properties of variance and standard Deviation,
Standardized variables, Moments and Moments ratios. Exercises.
HYPOTHESIS TESTING
Introduction, Statistical problem, null and alternative hypothesis, Type-I and Type-II errors, level
of significance, Test statistics, acceptance and rejection regions, general procedure for testing of
hypothesis. Exercises.
184
TESTING OF HYPOTHESES-TWO OR MORE POPULATIONS
Introduction, Testing of hypothesis and confidence intervals about the difference of population
means and proportions for small and large samples, Analysis of Variance and ANOVA Table.
Exercises
RECOMMENDED BOOKS
Walpole, R. E. 1982. Introduction to Statistics, 3rd Ed., Macmillan Publishing Co., Inc.
New York. Muhammad, F. 2005.
Statistical Methods and Data Analysis, Kitab Markaz, Bhawana Bazar Faisalabad
185
EVIDENCE BASED PRACTICE
Course Description:
This course introduces the concept of evidence-based practice in physical therapy including the
formulation of answerable clinical questions, methods of obtaining peer-reviewed evidence to
those clinical questions, and how to critically appraise evidence once located. This course is a
lecture and seminar course that will focus on developing the skills need for evaluating,
critiquing, and consuming the literature germane to physical therapy practice. Current journal
articles, texts, and online resources will be used in the course to develop critical reading and
writing skills.
Evidence-Based Physiotherapy
An introduction about evidence-based Physiotherapy:
What do we mean by high quality clinical research?
What do we mean by patient preferences?
What do we mean by practice knowledge?
Additional factors
The process of clinical decision-making
Importance of evidence-based Physiotherapy:
For patients
For physiotherapists and the profession
For funders of physiotherapy services
History of Evidence-Based Health Care
Steps for practicing evidence-based Physiotherapy
What do we need to know?
Relevant clinical questions
Refining your question
Effects of intervention
186
Experiences
Prognosis
Diagnosis
What constitutes evidence?
Evidence about effects of interventions
Different forms of evidence
Different sources of evidence
Hierarchy of evidence
Research study design
Finding the Evidence
Search Strategies
The World Wide Web
Selecting search terms AND and OR
Finding Evidence of Effects of Interventions
PEDro
The Cochrane Library
Finding Evidence of Prognosis and Diagnostic Tests
Finding Evidence of Experiences
CINAHL
Pub Med
Getting full text
Finding evidence of advances in clinical
Practice (Browsing)
Trust upon Evidence
A process for critical appraisal of evidence
Critical appraisal of evidence about the Effects of intervention
Randomized trials
Systematic reviews of randomized trials
Critical appraisal of evidence about experiences
Critical appraisal of evidence about prognosis
187
Individual studies of prognosis
Systematic reviews of prognosis
Critical Appraisal of Evidence about Diagnostic Tests
Individual studies of diagnostic tests
Systematic reviews of diagnostic tests
Clinical Guidelines as a Resource for Evidence-Based Physiotherapy
What are clinical guidelines?
History of clinical guidelines and why they are important
Where can I find clinical guidelines?
How do I know if I can trust the recommendations in a clinical Guideline?
Scope and purpose
Stakeholder involvement
Rigor of development
Clarity and presentation
Applicability
Editorial independence
What do the results of the critical appraisal mean for my practice?
Legal Implications of Clinical Guidelines
Clinical guidelines or reasonable care: which do the courts consider more important?
Documenting the use of a clinical guideline in practice: legal implications
Reflections on the Future of Guideline Development
Who should develop clinical guidelines?
Collaboration in guideline development
Uniprofessional or multiprofessional guideline development
Critical Thinking
The Benefit of Asking the Right Questions
What Are the Issue and the Conclusion?
What Are the Reasons?
What Words or Phrases Are Ambiguous?
What Are the Value Conflicts and Assumptions?
What Are the Descriptive Assumptions?
188
Are There Any Fallacies in the Reasoning?
How Good Is the Evidence: Intuition, Personal Experience?
Testimonials, and Appeals to Authority?
How Good Is the Evidence: Personal Observation, Research?
Studies, Case Examples, and Analogies
Are There Rival Causes?
Are the Statistics Deceptive?
What Significant Information Is Omitted?
What Reasonable Conclusions Are Possible?
Practice and Review
The Tone of Your Critical Thinking
Strategies for Effective Critical Thinking
PRACTICAL
Identify the different sources of evidence
Critically appraised topics (CAT)
How to evaluate web page
Ways of searching strategies for different databases
Selection of search terminology
Retrieving of articles from data bases
Practical Evidence based physiotherapy By, Rob Herbert, Gro Jamtdvedt, Judy
Mead& Kare Birger Hagen.
Asking the right question-A guide to critical thinking, 8th Edition By,
M.Neil.Browne& Stuart M Keeley
Additional reading material as assigned.
189
TOS Evidence Based Practice 4th YEAR DPT
SR KNOWLED S A TOT
.N Learning outcomes TOPIC GE AL ATs
O: C C C
1 2 3
1 1. Define Evidence based physical Evidence 1% - - 10% MCQS
therapy, High quality evidence, patient Based SEQS
preferences, practice knowledge. Physiotherapy
2. Describe the importance of EBP for 4%
patient, for physical therapist and the
profession.
3. Describe the steps of EBP. 5%
2 1. Describe the types of research designs, What is 4% - - 8% MCQS
including primary and secondary evidence?
research designs.
2. Describe the hierarchies of evidence. 2%
3. Discuss the rationale behind the
creation of different hierarchies for 2%
evidence about diagnostic tests,
prognostic factors, and interventions.
190
explain how external validity of an
evidence about the effects of
intervention can be appraised.
3. Explain how results about an evidence 5%
of effects of intervention can be
appraised.
191
9 1. Define clinical practice guidelines Critical 1% 7% MCQS
(CPG)/critical appraised topics (CAT). appraisal of
2. Describe the resources where we could clinical 2%
possibly find evidence about clinical practice
practice guidelines. guidelines
3. Explain the critical appraisal of CPGs. (CPGs) 4%
192
193
SUPERVISED CLINICAL PRACTICE III
Musculoskeletal
Competencies:
Examination:
Based on best available evidence select examination tests and measures that are appropriate
for the patient/client.
Perform posture tests and measures of postural alignment and positioning.*
Perform gait, locomotion and balance tests including quantitative and qualitative measures
such as*:
o Balance during functional activities with or without the use of assistive, adaptive,
orthotic, protective, supportive, or prosthetic devices or equipment
194
o Balance (dynamic and static) with or without the use of assistive, adaptive, orthotic,
protective, supportive, or prosthetic devices or equipment
o Gait and locomotion during functional activities with or without the use of assistive,
adaptive, orthotic, protective, supportive, or prosthetic devices or equipment to
include:
Bed mobility
Transfers (level surfaces and floor)*
Wheelchair management
Uneven surfaces
Safety during gait, locomotion, and balance
o Perform gait assessment including step length, speed, characteristics of gait, and
abnormal gait patterns.
Characterize or quantify body mechanics during self-care, home management, work,
community, tasks, or leisure activities.
Characterize or quantify ergonomic performance during work (job/school/play)*:
o Dexterity and coordination during work
o Safety in work environment
o Specific work conditions or activities
o Tools, devices, equipment, and workstations related to work actions, tasks, or
activities
Characterize or quantify environmental home and work (job/school/play) barriers:
o Current and potential barriers
o Physical space and environment
o Community access
Observe self-care and home management (including ADL and IADL)*
Measure and characterize pain* to include:
o Pain, soreness, and nociception
o Specific body parts
Recognize and characterize signs and symptoms of inflammation.
Perform musculoskeletal system tests and measures including:
A. Accessory movement tests
195
B. Anthropometrics
(1) Limb length
(2) Limb girth
(3) Body composition
C. Functional strength testing
D. Joint integrity*
E. Joint mobility*
F. Ligament laxity tests
G. Muscle length*
H. Muscle strength* including manual muscle testing, dynamometry, one repetition max
I. Palpation
J. Range of motion* including goniometric measurements
Perform orthotic tests and measures including*:
A. Components, alignment, fit, and ability to care for orthotic, protective, and supportive devices
and equipment.
B. Evaluate the need for orthotic, protective, and supportive devices used during functional
activities.
C. Remediation of impairments in body function and structure, activity limitations, and
participation restrictions with use of orthotic, protective, and supportive device.
D. Residual limb or adjacent segment, including edema, range of motion, skin integrity and
strength.
E. Safety during use of orthotic, protective, and supportive device.
Perform prosthetic tests and measures including*:
A. Alignment, fit, and ability to care for prosthetic device.
B. Prosthetic device use during functional activities.
C. Remediation of impairments in body function and structure, activity limitations, and
participation restrictions, with use of prosthetic device.
D. Evaluation of residual limb or adjacent segment, including edema, range of motion, skin
integrity, and strength.
E. Safety during use of the prosthetic device.
Perform tests and measures for assistive and adaptive devices including*:
196
A. Assistive or adaptive devices and equipment use during functional activities.
B. Components, alignment, fit, and ability to care for the assistive or adaptive devices and
equipment.
C. Remediation of impairments in body function and structure, activity limitations, and
participation restrictions with use of assistive or adaptive devices and equipment.
D. Safety during use of assistive or adaptive equipment.
Evaluation:
Clinical reasoning
Clinical decision making
1. Synthesize available data on a patient/client expressed in terms of the International
Classification of Function, Disability and Health (ICF) model to include body functions and
structures, activities, and participation.
2. Use available evidence in interpreting the examination findings.
3. Verbalize possible alternatives when interpreting the examination findings.
4. Cite the evidence (patient/client history, lab diagnostics, tests and measures and scientific
literature) to support a clinical decision.
Diagnosis:
1. Integrate the examination findings to classify the patient/client problem in terms of body
functions and structures, and activities and participation (i.e., practice patterns in the Guide)
2. Identify and prioritize impairments in body functions and structures, and activity limitations
and participation restrictions to determine specific body function and structure, and activities and
participation towards which the intervention will be directed.*
Prognosis:
1. Determine the predicted level of optimal functioning and the amount of time required to
achieve that level.*
2. Recognize barriers that may impact the achievement of optimal functioning within a predicted
time frame including*:
A. Age
197
B. Medication(s)
C. Socioeconomic status
D. Co-morbidities
E. Cognitive status
F. Nutrition
G. Social Support
H. Environment
Plan of Care:
Goal setting
Coordination of Care
Progression of care
Discharge
Design a Plan of Care
1. Write measurable functional goals (short-term and long-term) that are time referenced with
expected outcomes.
2. Consult patient/client and/or caregivers to develop a mutually agreed to plan of care.*
3. Identify patient/client goals and expectations.*
4. Identify indications for consultation with other professionals.*
5. Make referral to resources needed by the patient/client (assumes knowledge of referral
sources).*
6. Select and prioritize the essential interventions that are safe and meet the specified
functional goals and outcomes in the plan of care* (i.e., (a) identify precautions and
contraindications, (b) provide evidence for patient-centered interventions that are identified
and selected, (c) define the specificity of the intervention (time, intensity, duration, and
frequency), and (d) set realistic priorities that consider relative time duration in conjunction
with family, caregivers, and other health care professionals).
7. Establish criteria for discharge based on patient goals and current functioning
and disability.*
Coordination of Care
1. Identify who needs to collaborate in the plan of care.
198
2. Identify additional patient/client needs that are beyond the scope of physical therapist
practice, level of experience and expertise, and warrant referral.*
3. Refer and discuss coordination of care with other health care professionals.*
4. Articulate a specific rational for a referral.
5. Advocate for patient/client access to services.
Progression of Care
1. Identify outcome measures of progress relative to when to progress the patient further.*
2. Measure patient/client response to intervention.*
3. Monitor patient/client response to intervention.
4. Modify elements of the plan of care and goals in response to changing patient/client status,
as needed.*
5. Make on-going adjustments to interventions according to outcomes including
environmental factors and personal factors and, medical therapeutic interventions.
6. Make accurate decisions regarding intensity and frequency when adjusting interventions in
the plan of care.
Discharge Plan
1. Re-examine patient/client if not meeting established criteria for discharge based on the
plan of care.
2. Differentiate between discharge of the patient/client, discontinuation of service, and
transfer of care with re-evaluation.*
3. Prepare needed resources for patient/client to ensure timely discharge, including follow-up
care.
4. Include patient/client and family/caregiver as a partner in discharge.*
5. Discontinue care when services are no longer indicated.
6. When services are still needed, seek resources and/or consult with others to identify
alternative resources that may be available.
7. Determine the need for equipment and initiate requests to obtain.
Interventions:
Safety, Emergency Care, CPR and First Aid
Standard Precautions
Body Mechanics and
199
Positioning
Categories of Interventions
o Safety, Cardiopulmonary Resuscitation Emergency Care, First Aid
Ensure patient safety and safe application of patient/client care.*
Perform first aid.*
Perform emergency procedures.*
Perform Cardiopulmonary Resuscitation (CPR).*
Precautions
1. Demonstrate appropriate sequencing of events related to universal precautions.*
2. Use Universal Precautions.
3. Determine equipment to be used and assemble all sterile and non-sterile materials.*
4. Use transmission-based precautions.
5. Demonstrate aseptic techniques.*
6. Apply sterile procedures.*
7. Properly discard soiled items.*
Body Mechanics and Positioning
1. Apply proper body mechanics (utilize, teach, reinforce, and observe).*
2. Properly position, drape, and stabilize a patient/client when providing physical therapy.*
Interventions
1. Coordination, communication, and documentation may include:
A. Addressing required functions:
(1) Establish and maintain an ongoing collaborative process of
decision-making with patients/clients, families, or caregivers prior
to initiating care and throughout the provision of services.*
(2) Discern the need to perform mandatory communication and
reporting (e.g., incident reports, patient advocacy and abuse
reporting).
(3) Follow advance directives.
B. Admission and discharge planning.
C. Case management.
D. Collaboration and coordination with agencies, including:
200
(1) Home care agencies
(2) Equipment suppliers
(3) Schools
(4) Transportation agencies
(5) Payer groups
E. Communication across settings, including:
(1) Case conferences
(2) Documentation
(3) Education plans
F. Cost-effective resource utilization.
G. Data collection, analysis, and reporting of:
(1) Outcome data
(2) Peer review findings
(3) Record reviews
H. Documentation across settings, following APTAs Guidelines for Physical Therapy
Documentation, including:
(1) Elements of examination, evaluation, diagnosis, prognosis, and
Intervention
(2) Changes in body structure and function, activities and
participation.
(3) Changes in interventions
(4) Outcomes of intervention
I. Interdisciplinary teamwork:
(1) Patient/client family meetings
(2) Patient care rounds
(3) Case conferences
J. Referrals to other professionals or resources.*
K. Patient/client-related instruction may include:
A. Instruction, education, and training of patients/clients and caregivers regarding:
(1) Current condition, health condition, impairments in body structure
and function, and activity limitations, and participation restrictions)*
201
(2) Enhancement of performance
(3) Plan of care:
a. Risk factors for health condition, impairments in body structure and
function, and activity limitations, and participation restrictions.
b. Preferred interventions, alternative interventions, and alternative modes
of delivery
c. Expected outcomes
(4) Health, wellness, and fitness programs (management of risk factors)
(5) Transitions across settings
202
(3) Task-specific performance training
E. Strength, power, and endurance training for pelvic floor:
(1) Active (Kegel)
F. Strength, power, and endurance training for ventilatory muscles:
(1) Active and resistive
G. Manual therapy techniques may include:
A. Passive range of motion
B. Massage:
(1) Connective tissue massage
(2) Therapeutic massage
C. Manual traction*
D. Mobilization/manipulation:
(1) Soft tissue* (thrust and nonthrust*)
(2) Spinal and peripheral joints* (thrust and nonthrust*)
Functional training in self-care and home management may include*:
Functional training in work (job/school/play), community, and leisure integration or
reintegration may include*:
o Activities of daily living (ADL) training:
(1) Bed mobility and transfer training*
(2) Age appropriate functional skills
o Barrier accommodations or modifications*
o Device and equipment use and training:
(1) Assistive and adaptive device or equipment training during ADL (specifically
for bed mobility and transfer training, gait and locomotion, and dressing)*
(2) Orthotic, protective, or supportive device or equipment training during self-
care and home management*
(3) Prosthetic device or equipment training during ADL (specifically for bed
mobility and transfer training, gait and locomotion, and dressing)*
o Functional training programs*:
(1) Simulated environments and tasks*
(2) Task adaptation
203
o Injury prevention or reduction:
(1) Safety awareness training during self-care and home management*
(2) Injury prevention education during self-care and home management
(3) Injury prevention or reduction with use of devices and equipment
Prescription, application, and, as appropriate, fabrication of devices and equipment
may include*:
o Adaptive devices*:
(1) Hospital beds
(2) Raised toilet seats
(3) Seating systems prefabricated
o Assistive devices*:
(1) Canes
(2) Crutches
(3) Long-handled reachers
(4) Static and dynamic splints prefabricated
(5) Walkers
(6) Wheelchairs
o Orthotic devices*:
(1) Prefabricated braces
(2) Prefabricated shoe inserts
(3) Prefabricated splints
o Prosthetic devices (lower-extremity)*
o Protective devices*:
(1) Braces
(2) Cushions
(3) Helmets
(4) Protective taping
o Supportive devices*:
(1) Prefabricated compression garments
(2) Corsets
(3) Elastic wraps
204
(4) Neck collars
(5) Slings
(6) Supplemental oxygen - apply and adjust
(7) Supportive taping
Electrotherapeutic modalities may include:
A. Biofeedback*
B. Electrotherapeutic delivery of medications (e.g., iontophoresis)*
C. Electrical stimulation*:
(1) Electrical muscle stimulation (EMS)*
(2) Functional electrical stimulation (FES)
(3) High voltage pulsed current (HVPC)
(4) Neuromuscular electrical stimulation (NMES)
(5) Transcutaneous electrical nerve stimulation (TENS)
Physical agents and mechanical modalities may include: Physical agents:
A. Cryotherapy*:
(1) Cold packs
(2) Ice massage
(3) Vapocoolant spray
B. Hydrotherapy*:
(1) Contrast bath
(2) Pools
(3) Whirlpool tanks*
C. Sound agents*:
(1) Phonophoresis*
(2) Ultrasound*
D. Thermotherapy*:
(1) Dry heat
(2) Hot packs*
(3) Paraffin baths*
Mechanical modalities:
A. Compression therapies (prefabricated)*
205
(1) Compression garments
Skill Category Description of Minimum Skills
(2) Vasopneumatic compression devices*
(3) Taping
(4) Compression bandaging (excluding lymph edema)
B. Gravity-assisted compression devices:
(1) Standing frame*
(2) Tilt table*
C. Mechanical motion devices*:
(1) Continuous passive motion (CPM)*
D. Traction devices*:
(1) Intermittent
(2) Positional
(3) Sustained
206
SUPERVISED CLINICAL PRACTICE IV
Neurological
Course Description:
During this supervised clinical practice, students are responsible for successful execution of
examination, evaluation, and interventions relating to neurological disorders. Students become
familiar with performance of these skills in all settings (inpatient and outpatient) as well as on all
types of conditions (surgical, non-surgical, pediatric and geriatric.) Students learn to objectively
perform these skills under the supervision of trained physical therapists. Student is required to
keep a performance record of all listed competencies and successfully perform on real patients
during the final evaluation of the course.
Competencies:
Examination:
Based on best available evidence select examination tests and measures that are appropriate
for the patient/client.
Perform posture tests and measures of postural alignment and positioning.*
Perform gait, locomotion and balance tests including quantitative and qualitative measures
such as*:
o Balance during functional activities with or without the use of assistive, adaptive,
orthotic, protective, supportive, or prosthetic devices or equipment
207
o Balance (dynamic and static) with or without the use of assistive, adaptive, orthotic,
protective, supportive, or prosthetic devices or equipment
o Gait and locomotion during functional activities with or without the use of assistive,
adaptive, orthotic, protective, supportive, or prosthetic devices or equipment to
include:
Bed mobility
Transfers (level surfaces and floor)*
Wheelchair management
Uneven surfaces
Safety during gait, locomotion, and balance
o Perform gait assessment including step length, speed, characteristics of gait, and
abnormal gait patterns.
Characterize or quantify body mechanics during self-care, home management, work,
community, tasks, or leisure activities.
Characterize or quantify ergonomic performance during work (job/school/play)*:
o Dexterity and coordination during work
o Safety in work environment
o Specific work conditions or activities
o Tools, devices, equipment, and workstations related to work actions, tasks, or
activities
Characterize or quantify environmental home and work (job/school/play) barriers:
o Current and potential barriers
o Physical space and environment
o Community access
Observe self-care and home management (including ADL and IADL)*
Measure and characterize pain* to include:
o Pain, soreness, and nociception
o Specific body parts
Recognize and characterize signs and symptoms of inflammation.
Perform neurological tests and measures including:
208
1. Perform arousal, attention and cognition tests and measures to characterize or quantify
(including standardized tests and measures)*:
A. Arousal
B. Attention
C. Orientation
D. Processing and registration of information
E. Retention and recall
F. Communication/language
2. Perform cranial and peripheral nerve integrity tests and measures*:
A. Motor distribution of the cranial nerves (e.g., muscle tests, observations)
B. Motor distribution of the peripheral nerves (e.g., dynamometry, muscle tests,
observations, thoracic outlet tests)
C. Response to neural provocation (e.g. tension test, vertebral artery compression tests)
D. Response to stimuli, including auditory, gustatory, olfactory, pharyngeal, vestibular,
and visual (e.g., observations, provocation tests)
3. Perform motor function tests and measures to include*:
A. Dexterity, coordination, and agility
B. Initiation, execution, modulation and termination of movement patterns and voluntary
postures
4. Perform neuromotor development and sensory integration tests and measures to characterize
or quantify*:
A. Acquisition and evolution of motor skills, including age-appropriate development
B. Sensorimotor integration, including postural responses, equilibrium, and righting reactions
5. Perform tests and measures for reflex integrity including*:
A. Deep reflexes (e.g., myotatic reflex scale, observations, reflex tests)
B. Postural reflexes and reactions, including righting, equilibrium and protective
reactions
C. Primitive reflexes and reactions, including developmental
D. Resistance to passive stretch
E. Superficial reflexes and reactions
F. Resistance to velocity dependent movement
209
6. Perform sensory integrity tests and measures that characterize or quantify including*:
A. Light touch
B. Sharp/dull
C. Temperature
D. Deep pressure
E. Localization
F. Vibration
G. Deep sensation
H. Stereognosis
I. Graphesthesia
Evaluation:
Clinical reasoning
Clinical decision making
1. Synthesize available data on a patient/client expressed in terms of the International
Classification of Function, Disability and Health (ICF) model to include body functions and
structures, activities, and participation.
2. Use available evidence in interpreting the examination findings.
3. Verbalize possible alternatives when interpreting the examination findings.
4. Cite the evidence (patient/client history, lab diagnostics, tests and measures and scientific
literature) to support a clinical decision.
Diagnosis:
1. Integrate the examination findings to classify the patient/client problem in terms of body
functions and structures, and activities and participation (i.e., practice patterns in the Guide)
2. Identify and prioritize impairments in body functions and structures, and activity limitations
and participation restrictions to determine specific body function and structure, and activities and
participation towards which the intervention will be directed.*
210
Prognosis:
1. Determine the predicted level of optimal functioning and the amount of time required to
achieve that level.*
2. Recognize barriers that may impact the achievement of optimal functioning within a predicted
time frame including*:
A. Age
B. Medication(s)
C. Socioeconomic status
D. Co-morbidities
E. Cognitive status
F. Nutrition
G. Social Support
H. Environment
Plan of Care:
Goal setting
Coordination of Care
Progression of care
Discharge
Design a Plan of Care
1. Write measurable functional goals (short-term and long-term) that are time referenced with
expected outcomes.
2. Consult patient/client and/or caregivers to develop a mutually agreed to plan of care.*
3. Identify patient/client goals and expectations.*
4. Identify indications for consultation with other professionals.*
5. Make referral to resources needed by the patient/client (assumes knowledge of referral
sources).*
6. Select and prioritize the essential interventions that are safe and meet the specified
functional goals and outcomes in the plan of care* (i.e., (a) identify precautions and
contraindications, (b) provide evidence for patient-centered interventions that are identified
211
and selected, (c) define the specificity of the intervention (time, intensity, duration, and
frequency), and (d) set realistic priorities that consider relative time duration in conjunction
with family, caregivers, and other health care professionals).
7. Establish criteria for discharge based on patient goals and current functioning
and disability.*
Coordination of Care
1. Identify who needs to collaborate in the plan of care.
2. Identify additional patient/client needs that are beyond the scope of physical therapist
practice, level of experience and expertise, and warrant referral.*
3. Refer and discuss coordination of care with other health care professionals.*
4. Articulate a specific rational for a referral.
5. Advocate for patient/client access to services.
Progression of Care
1. Identify outcome measures of progress relative to when to progress the patient further.*
2. Measure patient/client response to intervention.*
3. Monitor patient/client response to intervention.
4. Modify elements of the plan of care and goals in response to changing patient/client status,
as needed.*
5. Make on-going adjustments to interventions according to outcomes including
environmental factors and personal factors and, medical therapeutic interventions.
6. Make accurate decisions regarding intensity and frequency when adjusting interventions in
the plan of care.
Discharge Plan
1. Re-examine patient/client if not meeting established criteria for discharge based on the
plan of care.
2. Differentiate between discharge of the patient/client, discontinuation of service, and
transfer of care with re-evaluation.*
3. Prepare needed resources for patient/client to ensure timely discharge, including follow-up
care.
4. Include patient/client and family/caregiver as a partner in discharge.*
5. Discontinue care when services are no longer indicated.
212
6. When services are still needed, seek resources and/or consult with others to identify
alternative resources that may be available.
7. Determine the need for equipment and initiate requests to obtain.
Interventions:
Safety, Emergency Care, CPR and First Aid
Standard Precautions
Body Mechanics and
Positioning
Categories of Interventions
o Safety, Cardiopulmonary Resuscitation Emergency Care, First Aid
Ensure patient safety and safe application of patient/client care.*
Perform first aid.*
Perform emergency procedures.*
Perform Cardiopulmonary Resuscitation (CPR).*
Precautions
1. Demonstrate appropriate sequencing of events related to universal precautions.*
2. Use Universal Precautions.
3. Determine equipment to be used and assemble all sterile and non-sterile materials.*
4. Use transmission-based precautions.
5. Demonstrate aseptic techniques.*
6. Apply sterile procedures.*
7. Properly discard soiled items.*
Body Mechanics and Positioning
1. Apply proper body mechanics (utilize, teach, reinforce, and observe).*
2. Properly position, drape, and stabilize a patient/client when providing physical therapy.*
Interventions
1. Coordination, communication, and documentation may include:
A. Addressing required functions:
(1) Establish and maintain an ongoing collaborative process of
decision-making with patients/clients, families, or caregivers prior
to initiating care and throughout the provision of services.*
213
(2) Discern the need to perform mandatory communication and
reporting (e.g., incident reports, patient advocacy and abuse
reporting).
(3) Follow advance directives.
B. Admission and discharge planning.
C. Case management.
D. Collaboration and coordination with agencies, including:
(1) Home care agencies
(2) Equipment suppliers
(3) Schools
(4) Transportation agencies
(5) Payer groups
E. Communication across settings, including:
(1) Case conferences
(2) Documentation
(3) Education plans
F. Cost-effective resource utilization.
G. Data collection, analysis, and reporting of:
(1) Outcome data
(2) Peer review findings
(3) Record reviews
H. Documentation across settings, following APTAs Guidelines for Physical Therapy
Documentation, including:
(1) Elements of examination, evaluation, diagnosis, prognosis, and
Intervention
(2) Changes in body structure and function, activities and
participation.
(3) Changes in interventions
(4) Outcomes of intervention
I. Interdisciplinary teamwork:
(1) Patient/client family meetings
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(2) Patient care rounds
(3) Case conferences
J. Referrals to other professionals or resources.*
K. Patient/client-related instruction may include:
A. Instruction, education, and training of patients/clients and caregivers regarding:
(1) Current condition, health condition, impairments in body structure
and function, and activity limitations, and participation restrictions)*
(2) Enhancement of performance
(3) Plan of care:
a. Risk factors for health condition, impairments in body structure and
function, and activity limitations, and participation restrictions.
b. Preferred interventions, alternative interventions, and alternative modes
of delivery
c. Expected outcomes
(4) Health, wellness, and fitness programs (management of risk factors)
(5) Transitions across settings
215
(3) Movement pattern training
(4) Neuromuscular education or reeducation*
o Functional training in self-care and home management may include*:
o Functional training in work (job/school/play), community, and leisure integration or
reintegration may include*:
Activities of daily living (ADL) training:
(1) Bed mobility and transfer training*
(2) Age appropriate functional skills
Barrier accommodations or modifications*
Device and equipment use and training:
(1) Assistive and adaptive device or equipment training during ADL
(specifically for bed mobility and transfer training, gait and locomotion, and
dressing)*
(2) Orthotic, protective, or supportive device or equipment training during
self-care and home management*
(3) Prosthetic device or equipment training during ADL (specifically for bed
mobility and transfer training, gait and locomotion, and dressing)*
o Functional training programs*:
(1) Simulated environments and tasks*
(2) Task adaptation
o Injury prevention or reduction:
(1) Safety awareness training during self-care and home management*
(2) Injury prevention education during self-care and home management
(3) Injury prevention or reduction with use of devices and equipment
Prescription, application, and, as appropriate, fabrication of devices and equipment
may include*:
o Adaptive devices*:
(1) Hospital beds
(2) Raised toilet seats
(3) Seating systems prefabricated
o Assistive devices*:
216
(1) Canes
(2) Crutches
(3) Long-handled reachers
(4) Static and dynamic splints prefabricated
(5) Walkers
(6) Wheelchairs
o Orthotic devices*:
(1) Prefabricated braces
(2) Prefabricated shoe inserts
(3) Prefabricated splints
o Prosthetic devices (lower-extremity)*
o Protective devices*:
(1) Braces
(2) Cushions
(3) Helmets
(4) Protective taping
o Supportive devices*:
(1) Prefabricated compression garments
(2) Corsets
(3) Elastic wraps
(4) Neck collars
(5) Slings
(6) Supplemental oxygen - apply and adjust
(7) Supportive taping
Electrotherapeutic modalities may include:
A. Biofeedback*
B. Electrotherapeutic delivery of medications (e.g., iontophoresis)*
C. Electrical stimulation*:
(1) Electrical muscle stimulation (EMS)*
(2) Functional electrical stimulation (FES)
(3) High voltage pulsed current (HVPC)
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(4) Neuromuscular electrical stimulation (NMES)
(5) Transcutaneous electrical nerve stimulation (TENS)
Physical agents and mechanical modalities may include: Physical agents:
A. Cryotherapy*:
(1) Cold packs
(2) Ice massage
(3) Vapocoolant spray
B. Hydrotherapy*:
(1) Contrast bath
(2) Pools
(3) Whirlpool tanks*
C. Sound agents*:
(1) Phonophoresis*
(2) Ultrasound*
D. Thermotherapy*:
(1) Dry heat
(2) Hot packs*
(3) Paraffin baths*
Mechanical modalities:
A. Compression therapies (prefabricated)*
(1) Compression garments
Skill Category Description of Minimum Skills
(2) Vasopneumatic compression devices*
(3) Taping
(4) Compression bandaging (excluding lymph edema)
B. Gravity-assisted compression devices:
(1) Standing frame*
(2) Tilt table*
C. Mechanical motion devices*:
(1) Continuous passive motion (CPM)*
D. Traction devices*:
218
(1) Intermittent
(2) Positional
(3) Sustained
219
220
PHYSIOTHERAPY TREATMENT-II
At the end of the final year DPT students should be able to:
1. Describes the structure and function of cardiovascular and respiratory systems
2. Define and describes the Ischemic Cardiac Condition and its pathophysiology
3. Define and describes Cardiac Muscle Dysfunction and its pathophysiology
4. Define and describes Restrictive Lung Dysfunction and its pathophysiology
5. Define and describes Chronic Obstructive Pulmonary Diseases and its pathophysiology
6. Describe Cardiopulmonary Implications of Specific Diseases
7. Describe various Cardiovascular and pulmonary diagnostic Tests and procedures
8. Describe the various Cardiovascular and Thoracic surgical interventions
9. Describe the Monitoring and Life-Support Equipment after cardiopulmonary surgery
10. Describe and identify various cardiovascular and pulmonary medications
11. Describes the assessment procedures and treatment of different Cardiopulmonary
Conditions
12. Describe Therapeutic Interventions of Cardiac and pulmonary rehabilitation
13. Describe Outcome Measures use in cardiopulmonary assessment
14. Assess critically ill patient in the intensive care unit
15. Describe Mechanical ventilation and identify implications for physiotherapy
16. Identify and describe Musculoskeletal problems in ICU patient
17. Identify Patient groups with specific needs in ICU
18. Define and describe Systemic inflammatory response syndrome (SIRS) and sepsis
19. Define and describe Acute respiratory distress syndrome (ARDS)
20. Define and describe Disseminated intravascular coagulation (DIC)
21. Define and describe Inhalation burns and trauma
22. Identify neurological conditions requiring intensive care
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23. Describe physiotherapy techniques and identifyemergency situations in Intensive care
for the critically ill adults
24. Define pulmonary rehabilitation and describe aims and benefits of pulmonary
rehabilitation
25. Describe the implications , setting and resources for pulmonary rehabilitation
26. Describe the selection criteria and assessment before implicating pulmonary
rehabilitation
27. Describe the structure , Pulmonary rehabilitation team , Exercise component and
Outcome measures used in pulmonary rehabilitation
28. Define cardiac rehabilitation and describe goals , team of cardiac rehabilitation and what
is the role of physiotherapist in cardiac rehabilitation
29. Describe the rationale for cardiac rehabilitation ,identify the time of ambulation of a
patient , describe exercise training and organizesecondary prevention and patient
education program for cardiac rehabilitation
30. Comprehend and describe ischemic heart disease and clinical condition associated with
it: Cardiac arrest , Angina pectoris and Myocardial infarction
31. Describe common cardiac surgeries
32. Identify drugs to control cardiovascular system
33. Describe physiotherapy Assessment, Recording and Treatment strategies in
cardiopulmonary rehabilitation
34. Describe outcome evaluation during and after cardiac rehabilitation and complications of
exercise
35. Describe and identify special consideration for older patients
36. Define and describe cardiac failure, valvular heart disease and congenital heart disease
37. Evaluate patient compliance, Cost-effectiveness and Legal aspects of cardiopulmonary
rehabilitation
38. Define and describe cardiopulmonary transplantation and its process including patient
assessment , operative procedures , post-operative care, Rejection of the transplanted
organs, immunosuppression , infections, its management and Special considerations for
the physiotherapist
39. Define and describe hyperventilation including its sign and symptoms, its causes and
different breathing patterns
40. Describe the assessment criteria and diagnostic test used in patients with hyperventilation
41. Explain the treatment plan , breathing education and re-education , Compensatory
procedures in the short term, Planned rebreathing, Speech, Home program, Exercise and
fitness program and Group therapy for patients with hyperventilation
42. Define and describe bronchiectasis , its evaluation and medical and physiotherapy
management
43. Define and describe primary ciliary dyskinesia , its evaluation and medical and
physiotherapy management
222
44. Define and describe cystic fibrosis with its evaluation , Medical and Physiotherapy
management
223
DETAILED COURSE OUTLINE
INTRODUCTION
Patho-physiology
Ischemic Cardiac Condition
Cardiac Muscle Dysfunction
Restrictive Lung Dysfunction
Chronic Obstructive Pulmonary Diseases
Cardiopulmonary Implications of Specific Diseases
Pharmacology
Cardiovascular Medications
Pulmonary Medications
The needs of specific patientsandIntensive care for the critically ill adult
Assessment of the critically ill patient in the intensive care unit (ICU)
Mechanical ventilation - implications for physiotherapy
Musculoskeletal problems
Patient groups with specific needs
Systemic inflammatory response syndrome (SIRS) and sepsis
Acute respiratory distress syndrome (ARDS)
Disseminated intravascular coagulation (DIC)
224
Inhalation burns
Trauma
Neurological conditions requiring intensive care
Physiotherapy techniques
Emergency situations
Pulmonary rehabilitation
Definition and aims of pulmonary rehabilitation
Benefits of pulmonary rehabilitation
Setting up pulmonary rehabilitation
Resources
Selection of patients
Patient assessment for pulmonary rehabilitation
Structure of pulmonary rehabilitation
Pulmonary rehabilitation team
Exercise component
Outcome measures
Cardiac rehabilitation
Introduction
Goals of cardiac rehabilitation
Cardiac rehabilitation team
Role of the physiotherapist
Cardiac surgery
Drugs to control the cardiovascular system
Physiotherapy
Assessment
Recording
Treatment
Outcome evaluation
Complications of exercise
225
Other considerations
The older patient
Cardiac failure
Valvular heart disease
Congenital heart disease
Compliance
Cost-effectiveness
Legal aspects
Cardiopulmonary transplantation
Introduction
Assessment
The transplantation process
Donors
Operative procedures
Postoperative care
Rejection of the transplanted organs
Immunosuppression
Infections
Special considerations for the physiotherapist
Denervation of the heart/lungs
Immunosuppression
Infection/rejection
Physiotherapy management
Hyperventilation
Introduction
Signs and symptoms
Causes of hyperventilation
Personality
Diagnostic tests
Breathing patterns
Treatment
The assessment
Treatment plan
Breathing education
Breathing pattern re-education
Compensatory procedures in the short term
Planned rebreathing
Speech
Home programme
Exercise and fitness programmes
Group therapy
Bronchiectasis, primary ciliary dyskinesia and cystic fibrosis
Bronchiectasis
226
Medical management
Physiotherapy
Evaluation of physiotherapy
Cystic fibrosis
Medical management
Physiotherapy
Evaluation of physiotherapy
Continuity of care
OBJECTIVES:-
At the end of four year students should be able to:-
1. Describe Medical Terminology Regarding gynecology, obstetrics and womens
health , Anatomy, Physiology of pregnancy, Physical and physiological changes of
labour and the peurperium, The antenatal period, Relieving the discomforts of pregnancy
227
, Preparation of labour, Postnatal period, The climacteric , Common gynecological
conditions , Gynecological surgery , Urinary function and dysfunction, Bowel and
anorectal function and dysfunction.
2. Estimate the Management of breast cancer , Management of lymph odema.
3. Comprehend Special Topic problems related to Female athletes, Exercise issues and
aging , Aquatic therapy services in women health.
4. Illustrate and practice Physical therapy management for women with long term physical
disabilities.
Physiotherapy in Obstetrics and Gynecology By: Jill Mantle, Jeanette Haslam, Sue Barton,
2nd edition.
Textbook of Physiotherapy for Obstetricic and Gynaecological Conditions (Paperback) By
(author) G.B. Madhur
MANUAL THERAPY
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COURSE DESCRIPTION: Through the utilization of instruction, demonstration, practical
exercises, research article critical review and case study discussions and presentations this course
will provide an introduction to the best evidence in state of the art advanced manual therapy. A
BRIEF overall review of all Manual Therapy techniques, along with manual therapy techniques
covering spine and Temporo- Mandibular joint, will take place. Techniques briefly covered are:
advanced myofascial trigger point therapy, Proprioceptive training, muscle energy combination
techniques, strain counter 203 strain, neuromobilization combination techniques and
mobilization, manipulation techniques with emphasis on thrust manipulation. Thorough
evaluation, assessment and technique brief overview of selection training will take place utilizing
evidence based models such as APTAs Open Door and Hooked in Evidence programs. All
skills will be introduced through on-site demonstration and hands-on practice. Students will also
get exposure in critical review of research articles pertaining to application of manual therapy
techniques. Case review, discussion and case presentations are an important component of this
course
OBJECTIVES
At the end of year students should be able to:
1. Illustrate and practice (ORTHOPEDIC MANUAL THERAPY) KALTENBORN-
EVJENTH CONCEPT History, Special features , Overview PRINCIPLES SPINAL
MOVEMENT , The mobile segment . Spinal range of movement , Joint positioning for
evaluation and treatment, Three-dimensional joint positioning Resting position
Actual resting position Nonresting positions, Joint locking , Bone and joint
movement ,Rotations of a vertebral bone Standard bone movements Combined
bone movements Coupled movements Noncoupled movements , Joint roll-gliding
associated with bone rotations Joint roll-gliding Abnormal roll-gliding,
Translation of vertebral bone , Joint play associated with bone translation .
2. Interpret TRANSLATORIC JOINT PLAY ,The Kaltenbom Treatment Plane,
Translatoric Joint Play Movements, Determining the direction of restricted gliding , Glide
test, Kaltenbom Convex-Concave Rule ,Grades of translatoric movement , Normal grades
of translatoric movement (Grades I - III) Palpating resistance to normal movement ,
Pathological grades of translatoric movement , Using translatoric grades of movement.
3. Interpret TESTS OF FUNCTION , Principles of function testing , Assessing quantity
of movement Measuring rotatoric movement with a device Manual grading of
rotatoric movement ( - scale) , Assessing quality of movement Quality of movement
to the first stop End-feel: Quality of movement after the first stop , Elements of
function testing , Active and passive rotatoric movements Testing rotatoric movement
Localization tests Differentiating articular from extra-articular dysfunction
Differentiating muscle shortening from muscle spasm , Translatoric joint play tests ,
Resisted movements , Passive soft tissue movements , Additional tests.
4. Comprehend , Goals of the OMT evaluation , Physical diagnosis , Indications and
contraindications , Measuring progress , Elements of the OMT evaluation, Screening
exam Detailed exam History inspection Tests of function Palpation
229
Neurologic and vascular tests Medical diagnostic studies, diagnosis and trail
treatment.
5. Comprehend and practice Goals of joint mobilization , Mobilization techniques , Pain
relief mobilization Pain-relief traction mobilization (Grade I -IISZ) Vibrations
and oscillations ,Relaxation mobilization Relaxation-traction mobilization (Grade I -
II), Stretch mobilization Stretch-traction mobilization (Grade III) Stretch-glide
mobilization (Grade /), Manipulation .
6. Explain A voiding high-risk manual treatment Rotation mobilization Joint
compression, If traction exacerbates symptoms.
7. Practice Elements of OMT, Treatment to relieve symptoms Immobilization
Thermo-Hydro-Electric (T-H-E) therapy Pain-relief mobilization Special
procedures for pain relief ,Treatment to increase mobility Soft tissue mobilization
Passive soft tissue mobilization Active-facilitated soft tissue mobilization
Muscle stretching principles Joint mobilization to increase mobility Neural
tissue mobilization ,Specialized exercise to increase mobility ,Treatment to limit
movement, To inform, instruct and train , Research.
8. Explain SPINAL SYNDROMES SPINAL SYNDROMES , Notes on spinal
syndromes,Cervical syndromes , Thoracic syndromes, Lumbar syndromes, Neurologic
evaluation of nerve root syndromes ,Sensory innervation of the skin , Sensory innervation
of deep structures , Motor innervation ,Common nerve root syndromes.
9. Illustrate and practice The Maitlands and Mulligan concept ,Subjective examination,
Physical examination, Examination of the temporomandibular joint , Examination of the
upper cervical spine , Examination of the cervicothoracic spine , Examination of the
thoracic spine , Examination of the lumbar spine .
10. Illustrate and practiceTHE SUBJECTIVE EXAMINATION STEP BY STEP
Introduction, Body chart B,ehavior of symptoms, Special questions ,History of the
present condition (HPC), Past medical history (PM H) , Social and family history (SH,
FH), Plan of the physical examination, Case scenarios , Counterfeit clinical presentations
11. Illustrate and practicePHYSICAL EXAMINATION STEP BY STEP , Introduction ,
Observation, Joint tests , Muscle tests ,Neurological tests , Special tests 208 , Functional
ability,Palpation , Accessory movements , Completion of the physical examination
12. Illustrate and practice TECHNIQUES TECHNIQUE PRINCIPLES , Learning
manual techniques, Applying manual techniques, Objective, Starting position
Patient's position Therapist's position, Hand placement and fixation/stabilization
Grip Therapist 's stable hand Therapist's moving hand ,Procedure Joint
pre-positioning Mobilization technique Symbols ,Recording , Identifying an
intervertebral segment, The Star Diagram PELVIS , Functional anatomy and movement ,
Notes on evaluation and treatment. Pelvis tests and mobilizations.
13. Illustrate and practice LUMBAR SPINE , Functional anatomy and movement , Notes
on evaluation and treatment, Lumbar tests and mobilizations.
230
14. Illustrate and practiceTHORACIC SPINE AND RIBS , Functional anatomy and
movement , Notes on evaluation and treatment , Thoracic tests and mobilizations .
15. Illustrate and practice CERVICAL SPINE , Functional anatomy and movement ,
Notes on evaluation and treatment , Cervical tests and mobilizations
16. Illustrate and practice UPPER CERVICAL SPINE , Functional anatomy and
movement , Notes on evaluation and treatment, Upper cervical tests and mobilizations
17. Illustrate and practice JAW , Functional anatomy and movement , Jaw examination
scheme,Jaw tests and mobilizations
18. Illustrate and practice SPINAL MOBILIZATIONS THE CERVICAL AND UPPER
THORACIC SPINES , NAGS, REVERSE NAGS , SNAGS , SELF SNAGS, Spinal
Mobilization with arm Movement , Other mobilization with movement techniques
(MWMS) for the Cervical and Upper Thoracic Spines .
19. Illustrate and practice THE UPPER CERVICAL SPINE SPECIAL TECHNIQUES
, The acute Wry Neck , Headaches,Vertigo, Nausea and other vertebral artery Signs
20. Illustrate and practice THE LUMBAR SPINE, SNAGS , SELF SNAGS
21. Illustrate and practice THE SACROILIAC JOINTS ( S/I) JOINTS THE
THORACIC SPINE THE RIB CAGE INTEGRATIVE MANUAL THERAPY ,
Postural Compensations of the spine, Muscle Energy and 'Beyond' Technique for the
spine , Treatment of spine Hypertonicity for Synergic Pattern ,Release with Strain and
Counter strain Technique, Myofascial Release , Tendon Release Therapy for Treatment
of Tendon Tissue Tension with Advanced Strain and Counter strain Technique ,
Ligaments: a Tensile Force Guidance System: Treatment with Ligament Fiber Therapy ,
Procedures and Protocols to correct spinal Dysfunction with Integrative Manual Therapy.
231
Joint roll-gliding associated with bone rotations Joint roll-gliding Abnormal roll-
gliding
Translation of vertebral bone
Joint play associated with bone translation
TESTS OF FUNCTION
Principles of function testing
Assessing quantity of movement Measuring rotatoric movement with a device
Manual grading of rotatoric movement ( - scale)
Assessing quality of movement Quality of movement to the first stop End-feel:
Quality of movement after the first stop
Elements of function testing
Active and passive rotatoric movements Testing rotatoric movement Localization
tests Differentiating articular from extra-articular dysfunction Differentiating muscle
shortening from muscle spasm
Translatoric joint play tests
Resisted movements
Passive soft tissue movements
Additional tests
OMT EVALUATION
Goals of the OMT evaluation
Physical diagnosis
Indications and contraindications
Measuring progress
Elements of the OMT evaluation
Screening exam
Detailed exam History inspection Tests of function Palpation Neurologic
and vascular tests
Medical diagnostic studies
Diagnosis and trial treatment
OMT TREATMENT
Elements of OMT
Treatment to relieve symptoms Immobilization Thermo-Hydro-Electric (T-H-E)
therapy Pain-relief mobilization Special procedures for pain relief
Treatment to increase mobility Soft tissue mobilization Passive soft tissue
mobilization Active-facilitated soft tissue mobilization Muscle stretching principles
Joint mobilization to increase mobility Neural tissue mobilization
Specialized exercise to increase mobility
Treatment to limit movement
To inform, instruct and train
Research
SPINAL SYNDROMES
Notes on spinal syndromes
Cervical syndromes
Thoracic syndromes
Lumbar syndromes
Neurologic evaluation of nerve root syndromes
Sensory innervation of the skin
Sensory innervation of deep structures
Motor innervation
Common nerve root syndromes
233
THE SUBJECTIVE EXAMINATION STEP BY STEP
Introduction
Body chart
Behavior of symptoms
Special questions
History of the present condition (HPC)
Past medical history (PM H)
Social and family history (SH, FH)
Plan of the physical examination
Case scenarios
Counterfeit clinical presentations
PHYSICAL EXAMINATION STEP BY STEP
Introduction
Observation
Joint tests
Muscle tests
Neurological tests
Special tests
Functional ability
Palpation
Accessory movements
Completion of the physical examination
PELVIS
Functional anatomy and movement
Notes on evaluation and treatment
Pelvis tests and mobilizations
LUMBAR SPINE
Functional anatomy and movement
Notes on evaluation and treatment
Lumbar tests and mobilizations
234
THORACIC SPINE AND RIBS
Functional anatomy and movement
Notes on evaluation and treatment
Thoracic tests and mobilizations
CERVICAL SPINE
Functional anatomy and movement
Notes on evaluation and treatment
Cervical tests and mobilizations
JAW
Functional anatomy and movement
Jaw examination scheme
Jaw tests and mobilizations
THE SACROILIAC JOINTS (S/I) JOINTS THE THORACIC SPINE THE RIB CAGE
INTEGRATIVE MANUAL THERAPY
Postural Compensations of the spine
Muscle Energy and 'Beyond' Technique for the spine
Treatment of spine Hypertonicity for Synergic Pattern
Release with Strain and Counter strain Technique
235
Myofascial Release
Tendon Release Therapy for Treatment of Tendon Tissue Tension with Advanced Strain and
Counter strain Technique
Ligaments: a Tensile Force Guidance System: Treatment with Ligament Fiber Therapy
Procedures and Protocols to correct spinal Dysfunction with Integrative Manual Therapy
In the laboratory sessions, Supervised evaluation and manual therapy treatment techniques will
be demonstrated and practiced, including joint and soft-tissue mobilization, manipulations, and
posture and movement retraining in the physiotherapy clinic/Ward and Orthopaedic clinic/Ward,
Indoor as well as outdoor. Various reflective case studies related to manual therapy of the spine
and TM joint will be assigned to the students. Note: The students are expected to make a record
of his/her achievements in the log book. The log book is a collection of evidence that learning
has taken place. It is a reflective record of achievements. The log book shall also contain a record
of the procedures which student would have performed/observed.
Manual Mobilization of the Joints The Kaltenborn Method of Joint Examination and
Treatment Volume I The Extremities By: Freddy M. Kaltenbom in collaboration with Olaf
Evjenth, Traudi Baldauf Kaltenbom, Dennis Morgan, and Eileen Vollowitz ,OPTP
Minneapolis, Minnesota, USA.
Manual Therapy By: Ola Grimsby, the Ola Grimsby institute San Diego.
Integrative Manual therapy for the upper and lower extremities By: Sharon weiselfish, North
Atlantic books Berkeley, California.
Orthopedic manual therapy an evidence-based approach by: Chad Cook
Orthopaedic Manual Therapy Diagnosis Spine and Temporomandibular Joints By: Aad van
der Translatoric Spinal Manipulation By: John R. Krauss, Olaf Evjenth, and Doug
Creighton John R. Krauss A Lakeview Media L. L.C. Publication
Neuromusculoskeletal Examination and Assessment A Handbook for Therapists By: Nicola J
Petty, Ann P Moore &G D Maitland, Second Edition Churchill Livingstone
Myofascial Manipulation Theory and Clinical Application, Second Edition By: Robert I.
Cantu, Alan J. Grodin an Aspen Publication Aspen Publishers, Inc. Gaithersburg, Maryland
2001
Maitland's Vertebral Manipulation Seventh Edition By: Geoffrey D. Maitland
Musculoskeletal manual medicine, diagnosis and treatment by Jiri Dovark, Vaclav
Dovaropik, Werneir Schneider etc
Manual therapy, NAGS, SNAGS, MWMS etc by Brian R Mulligan fifth edition
236
TABLE OF SPECIFICATIONS-PHYSIOTHERAPY TREATMENT-II
5TH YEAR DPT
Asst No. of
Topic K S A Total
Tools Items
237
Tissues of function 2% 0.5% 0.5% 3% MCQS,SEQS 3 MCQs
VIVA,OSPE
OMT evaluation 2% 1% 1% 4% VIVA,OSPE
Spinal joint 2% 2% 1% 5% MCQS,SEQS 2 MCQs
mobilizations VIVA,OSPE
OMT treatment 2% 2% 1% 5% VIVA,OSPE
Spinal syndromes 3% 2% 1% 6% MCQS,SEQS 3 MCQs
VIVA,OSPE
Manual therapy 3% 4% 1% 7% VIVA,OSPE 4 SEQs
assessment
Techniques 3% 4% 1% 7% VIVA,OSPE
Spinal mobilizations 2% 1% 1% 4% VIVA,OSPE
Integrative manual 2% 1% 1% 4% MCQS,SEQS 3 MCQs
therapy VIVA,OSPE
TOTAL 100% MCQ 45 SEQ 09
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CLINICAL DECISION MAKING
& DIFFERENTIAL DIAGNOSIS
COURSE DESCRIPTION:
The course will cover the principles and methods of clinical screening in physical therapy
practice. A basic format for musculoskeletal, neuromuscular, Integumentary, and
cardiopulmonary screening in physical therapy will be presented, with a focus on differential
diagnosis within the scope of physical therapy practice, and incorporation of the role of the
physical therapist as it interfaces with the role of the physician. A clarification of red-flags that
differentiate a systemic condition from a neuromusculoskeletal condition will be a continuing
theme throughout the course. Decision-making skills related to physical therapy will be
emphasized through the use of patient case scenarios with a focus on when to treat, and when to
refer. Strategies to effectively and appropriately communicate with health care colleagues and
patients regarding medical diagnostic information and medical status will be introduced.
240
Describe Cardiovascular Disorders, Laboratory Values, effects of cardiovascular
medications and Physician Referral.
7. SCREENING FOR PULMONARY DISEASE
After completion of this course, the student should be able to:
Understand Signs and Symptoms of Pulmonary Disorders, Inflammatory/Infectious
Disease, Genetic Disease of the Lung, Occupational Lung Diseases
Describe Pleur-opulmonary Disorders and Physician Referral
8. SCREENING FOR GASTROINTESTINAL DISEASE
After completion of this course, the student should be able to:
Understand Signs and Symptoms of Gastrointestinal Disorders, Gastrointestinal
Disorders and Physician Referral
9. SCREENING FOR HEPATIC AND BILIARY DISEASE
After completion of this course, the student should be able to:
Understand Hepatic and Biliary Signs and Symptoms, Hepatic and Biliary
Pathophysiology, Gallbladder and Duct Diseases and Physician Referral
10. SCREENING FOR UROGENITAL DISEASE
After completion of this course, the student should be able to:
Understand Signs and Symptoms of Renal and Urological Disorders,The Urinary
Tract, Renal and Urological Pain, Renal and Urinary Tract Problems and Physician
Referral
11. SCREENING FOR ENDOCRINE AND METABOLIC DISEASE
After completion of this course, the student should be able to:
Understand, Introduction to Metabolism, Endocrine Pathophysiology.and Physician
Referral
Describe Associated Neuromuscular and Musculoskeletal Signs and Symptoms.
12. SCREENING FOR IMMUNOLOGIC DISEASE
After completion of this course, the student should be able to:
Understand immunological system using the Screening Model, Immune System
Pathophysiology and Physician Referral
Understand Screening for Cancer, Cancer StatisticsRisk Factor Assessment and
Cancer Prevention
241
Describe Major Types of Cancer, Metastases, Clinical Manifestations of Malignancy,
Oncologic Pain, Side Effects of Cancer Treatment, Cancers of the Musculoskeletal
System, Primary Central Nervous System Tumors, Cancers of the Blood and Lymph
System and Physician Referral
13. SCREENING THE HEAD, NECK, AND BACK
After completion of this course, the student should be able to:
Describe how to Evaluate the Head, Neck, or Back,Using the Screening Model
Explain Location of Pain and Symptoms, Sources of Pain and Symptoms
Understand Screening for Oncologic Causes of Back Pain, Screening for Cardiac
Causes of Neck and Back Pain, Screening for Peripheral Vascular Causes of Back
Pain, Screening for Pulmonary Causes of Neck and Back Pain, Screening for Renal
and Urologic Causes of Back Pain,Screening for Gastrointestinal Causes of Back
Pain, Screening for Liver and Biliary Causes of Back Pain, Screening for
Gynecologic Causes of Back Pain, Screening for Male Reproductive Causes of Back
Pain, Screening for Infectious Causes of Back Pain and Physician Referral
14. SCREENING THE SACRUM, SACROILIAC, AND PELVIS
After completion of this course, the student should be able to:
Explain The Sacrum and Sacroiliac Joint, The Coccyx, The Pelvis and Physician
Referral.
15. SCREENING THE LOWER QUADRANT: BUTTOCK, HIP, GROIN, THIGH,
AND LEG
After completion of this course, the student should be able to:
Evaluate the Lower Quadrant using the screening model, Trauma as a Cause of Hip,
Groin, or Lower Quadrant Pain
Understand Screening for Systemic Causes of Sciatica, Screening for Oncologic
Causes of Lower Quadrant Pain, Screening for Urologic Causes of Buttock, Hip,
Groin, or Thigh Pain, Screening for Male Reproductive Causes of Groin Pain,
Screening for Infectious and Inflammatory Causes of Lower Quadrant Pain,
Screening for Gastrointestinal Causes of Lower Quadrant Pain, Screening for
Vascular Causes of Lower Quadrant Pain, Screening for Other Causes of Lower
Quadrant Pain and Physician Referral
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TABLE OF SPECIFICATIONS- CDM & DD
5thYEAR DPT
16. SCREENING THE CHEST, BREASTS, AND RIBS
After completion of this course, the student should be able to:
Understand how to Evaluate the Chest, Breasts, or Ribs, Screening for Oncologic
Causes of Chest or Rib Pain, Screening for Cardiovascular Causes of Chest, Breast,
or Rib Pain, Screening for Pleuropulmonary Causes of Chest, Breast, or Rib Pain,
creening for Gastrointestinal Causes of Chest, Breast, or Rib Pain, Screening for
Breast Conditions that Cause Chest or Breast Pain, Screening for Other Conditions as
a Cause of Chest, Breast, or Rib Pain, Screening for Musculoskeletal Causes of
Chest, Breast, or Rib Pain, Screening for Neuromuscular or Neurologic Causes of
Chest, Breast, or Rib Pain Using the Screening Model and Physician Referral
17. SCREENING THE SHOULDER AND UPPER EXTREMITY
After completion of this course, the student should be able to:
Understand how to Evaluate Shoulder and Upper Extremity, Screening for Pulmonary
Causes of Shoulder Pain, Screening for Cardiac Causes of Shoulder Pain, Screening
for Gastrointestinal Causes of Shoulder Pain, Screening for Liver and Biliary Causes
of Shoulder Pain, Screening for Rheumatic Causes of Shoulder Pain, Screening for
Infectious Causes of Shoulder Pain, Screening for Oncologic Causes of Shoulder
Pain, Screening for Gynecologic Causes of Shoulder Pain by Using the Screening
Model and Physician Referral
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Topic K S A Total Assessment
Tools
MCQ SEQ
244
SCIENTIFIC INQUIRY, RESEARCH METHODOLOGY
& RESEARCH PROJECT
COURSE DESCRIPTION:
This course includes discussion on basic quantitative methods and designs, including concepts of
reliability and validity, interpretation of inferential statistics related to research designs, co
relational statistic & designs, interclass correlation coefficients, and critical appraisal of the
literature.
DETAILED COURSE OUTLINE
Research Fundamentals:
Rehabilitation Research
Theory in Rehabilitation Research
Research Ethics
Research Design:
Research Problems, Questions, and Hypotheses
Research Paradigms
Design Overview
Research Validity
Experimental Designs:
Group Designs
Single-System Design
Non experimental Research:
Overview of Non experimental Research
Clinical Case Reports
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Qualitative Research
Epidemiology
Outcomes Research
Survey Research
Measurement:
Measurement Theory
Methodological Research
Data Analysis:
Statistical Reasoning
Statistical Analysis of Differences; The basics
Statistical Analysis of Differences; Advanced and special Techniques
Statistical Analysis of Relationships; The basics
Statistical Analysis of Relationships; Advanced and special Techniques
Being a Consumer
Locating the Literature
Evaluating Evidence One Article at a time
Synthesizing Bodies of Evidence
Implementing Research:
Implementing a Research Project
Publishing and Presenting Research
PRACTICAL
Literature review
Preparation, presentation and defense of research proposal
Poster presentation
RECOMMENDED TEXTBOOK:
Essentials of clinical research By Stephan P. Glasser
Rehabilitation Research (Principles and Applications) 3rd Edition By Elizabeth Domholdt
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PROFESSIONAL PRACTICE IN PHYSICAL THERAPY
THEORY HOURS 50
TOTAL HOURS 50
COURSE DESCRIPTION:
The course will discuss the role, responsibility, ethics administration issues and accountability of
the physical therapists. The course will also cover the change in the profession to the doctoral
level and responsibilities of the professional to the profession, the public and to the health care
team. The topic of health care system in Pakistan with comparison with current health system
abroad will be discussed too.
LEARNING OUTCOMES
1.The physical therapist as professional:
After completion of this chapter the student must be able to Understand:
What does professional mean?
Preliminary definitions of profession and professional
Sociological perspective
Structural approach
Processual approach
Characteristics of professions cited in the literature
Power approach
Dimensions of occupation & profession
Autonomy, self-regulation of ethical standards, and accountability
Privileges of autonomous practice in 2020
Self-regulation of ethical standards
Accountability of professionals
Individual professionalismprofessionalism without professions?
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The history of a profession
Professional recognition
2. Contemporary practice issues.
After completion of this chapter the student must be able to describe:
A vision for the future
The doctorate in physical therapy
Perspective of the profession
Perspective of the practitioner
Direct access issue
Selected curriculum requirements from evaluative criteria for physical therapist
Plan of care
Social responsibility
Career development
Physical therapy practice patterns
Components of a practice pattern
Important factors that affect health
3. The five roles of the physical therapist
3.1. The physical therapist as patient/client manager:
After completion of this chapter the student must be able to explain:
evaluation and diagnosis
Prognosis
Discharge planning and discontinuance of care
Outcomes
Clinical decision making
Referral relationships
Interpersonal relationships
Ethical and legal issues
Informed consent
Managed care and fidelity
3.2. The physical therapist as consultant
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After completion of this chapter the student must be able to explain:
Physical therapy consultation
Building a consulting business
The consulting process
The skills of a good consultant
Trust in the consultant/client relationship
Ethical and legal issues in consultation
Components of a consulting agreement
3.3. The physical therapist as critical inquirer:
After completion of this chapter the student must be able to explain:
History of critical inquiry
Evidence-based medicine
Outcomes research
Whose responsibility is research?
Roles of the staff physical therapist in critical inquiry
Collaboration in clinical research
Ethical and legal issues in critical inquiry
3.4. The physical therapist as educator;
After completion of this chapter the student must be able to explain:
History of physical therapy education
Contemporary educational roles of the physical therapist
Teaching opportunities in continuing education
Academic teaching opportunities
Theories of teaching and learning in professional education
Ethical and legal issues in physical therapy education
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TABLE OF SPECIFICATIONS- Professional practice
5th YEAR DPT
Patient/client management
First-line management
Midlevel managers and chief executive officers
Leadership
Ethical and legal issues
4. Professional development, competence, and expertise;
After completion of this chapter the student must be able to explain:
Lifelong process of skill enhancement
The professional development continuum: from competence to expertise
Activities that promote professional development
Evaluation of competence and professional development
Professional development planning
Possible evaluators of professional achievement
Career advancement
Organizational impact on professional development
5. Future challenges in physical therapy:
After completion of this chapter the student must be able to describe:
Physical therapys moral mission
The future in three realms, individual, institutional& societal.
Professionalism and the physical therapist
Recommended Books:
Professionalism in Physical Therapy: History, Practice, & Development, Lisa L. Dutton,
PT, PhD
APTA. Guide to Physical Therapy Practice: Revised second edition. Alexandria, VA:
American Physical Therapy Association; 2003. ISBN: 978-1-887759-85-
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Topic/ Learning Outcomes C1 C2 C3 Total Assessment
Tools
MCQ
1.The physical therapist as professional 15% 05
Define profession and professional. 1%
Describe professionalism from sociologic
3%
perspective.
Describe the characteristics of a profession. 3%
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Describe the role of physical therapist as an
10%
administrator.
4. Professional development, competence, and 15% 7%
expertise;
Describe the activities that promote 3%
professional development.
Describe the method of evaluation of
4%
competence and professional development.
Understand professional development
4%
planning.
Understand the possible evaluators of
4%
professional achievement.
252
253
PHYSIOTHERAPY TREATMENT-III
COURSE DESCRIPTION:
This course addresses both the medical and rehabilitation management of the pediatric patient.
Foundation lectures on normal development and psychological issues provide the students with a
model to use when learning about pediatric pathologies, assessments and interventions. This
course also involves the examination and treatment of the pediatric population using an interdisciplinary
approach. The etiology and clinical features of common diseases/ disorders observed in the pediatric
population will be emphasized. Lab: Methods for examination, goal setting, and intervention are
emphasized. Students will participate in interdisciplinary case studies and an interdisciplinary evaluation
project.Topics will focus on medical terminology, clinical examination, evaluation, comparing
contemporary, traditional interventions and the impact of evolving technology in this area.
COURSE DESCRIPTION:
This course addresses both the medical and rehabilitation management of the pediatric patient.
Foundation lectures on normal development and psychological issues provide the students with a
model to use when learning about pediatric pathologies, assessments and interventions. This
course also involves the examination and treatment of the pediatric population using an
interdisciplinary approach. The etiology and clinical features of common diseases/ disorders
observed in the pediatric population will be emphasized. Lab: Methods for examination, goal
setting, and intervention are emphasized. Students will participate in interdisciplinary case
studies and an interdisciplinary evaluation project. Topics will focus on medical terminology,
clinical examination, evaluation, comparing contemporary, traditional interventions and the
impact of evolving technology in this area.
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Learning Outcomes:
Describe History and Examination / Pediatric Examination
Define Assessment and outcome measurement
Explain Theories of Development
Describe Medical Care of Children with Disabilities
Explain Psychological Assessment in Pediatric Rehabilitation
Describe Approaches to working with children
Explain Normal Developmental Milestones
Describe Language Development in Disorders of Communication and Oral Motor
Function Adaptive Sports and Recreation
Illustrate Orthotic and Assistive Devices
Define Electrodiagnosis in Pediatrics
Define Motor Learning& Principles of Motor Learning
ExplainThe Child Parents and Physiotherapist
Demonstrate Aging With Pediatric Onset Disability and Diseases
Demonstrate The Assessment of Human Gait, Motion, and Motor Function
Explain Psychosocial Aspects of Pediatric Rehabilitation
Describe Pediatric and Neonatal Intensive Therapy
explain Disorders of Respiratory System
define and explain Cystic Fibrosis Duchene Muscular
define and explain Hemophilia
Lower Limb Deformities
Orthopedics and Musculoskeletal
Define and explain Talipes Equino Varus
Define and explain Torticolis
Define and explain Pediatric Limb Deficiencies
Neuromuscular Diseases
Define and explain Myopathies
Define and explain Traumatic Brain Injury
Define and explain Cerebral Palsy
Define and explain Spinal Cord Injuries
Define and explain Spina Bifida
Define and explain Oncology and palliative care
COURSE DESCRIPTION:
The course covers normal aging process, physiological and psychological changes and their
effects on daily living activities (ADL) and instrumental daily living activities (IADL).Relevant
testes and measures for determining impairment and differentiating the diagnosis based on the
specificity and sensitivity of the assessment instruments as related to patients with geriatric
conditions are discussed. The use of evidence-based physical therapy intervention for geriatric
conditions is emphasized. Topics will focus on comparing contemporary and traditional
interventions and the impact of evolving technology in this area. Topics will focus on medical
terminology, clinical examination, evaluation, comparing contemporary, traditional interventions
and the impact of evolving technology in this area.
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Learning Outcomes:
PSYCHOLOGICAL CHANGES:
Explain The 3 Ds and Suicide in Older Adults
Define Delirium
Define Dementia
Define Depression
257
EFFECTS OF AGE:
Define Task Complexity,
Demonstrate Exercise
Explain Ambulation.
GERONTOLOGY
Define gerontology and describe Types of gerontology
Explain Social aspect of aging regarding gerontology
Explain Psychological aspect of aging regarding gerontology
Explain Biological aspect of aging regarding gerontology
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SPORTS PHYSICAL THERAPY
COURSE DESCRIPTION:
The main focus of this course is related to the understanding of the role that physical therapists
play in both the industrial continuum and sports physical therapy. Emphasis is placed on acute
management of traumatic injuries and/or sudden illness. In addition, injury prevention with an
emphasis on the advanced clinical competencies related to the practice of sports physical therapy
will also be covered.
259
20. Classify and explain different forms of ankle injuries in sports with their management
strategies
21. Classify and explain different forms of foot injuries in sports with their management
strategies
22. Describe and classify the Drugs commonly used in sport injuries
23. Explain ethical issue in Sports Medicine
COURSE DESCRIPTION:
The main focus of this course is related to the understanding of the role that physical therapists
play in both the industrial continuum and sports physical therapy. Emphasis is placed on acute
management of traumatic injuries and/or sudden illness. In addition, injury prevention with an
emphasis on the advanced clinical competencies related to the practice of sports physical therapy
will also be covered.
Recommended Books
Sports Rehabilitation and Injury Prevention by:Paul Comfort &Earle Abrahamson, 1st
Edition, 2010,Wiley Blackwell Publishers
Clinical Sports Medicine by: Brukner & Khan, 4ed, McGraw-Hill Publishers
A guide to sports and injury management by: Mike Bundy & Andy Leaver, 1st edition, 2010,
Churchill Livingstone.
COURSE DESCRIPTION:
This course intends to study prosthetic and orthotic management as applied to a variety of patient
populations across a life span. It also addresses the considerations of various pathologies and
medical, surgical management to formulate appropriate patient examinations, evaluation,
diagnosis, prognosis and intervention that are consistent with physical therapy practice
guidelines. Principles of normal biomechanics, pathomechanics, physiology and
Pathophysiology will be a major focus for evaluation, intervention and education of the vascular,
neuromuscular, and / or musculoskeletal compromised patient who may utilize prosthetic or
orthotic devices. Basic principles of mechanical physics and material characteristics will be
applied.
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DETAILED COURSE OUTLINE
ORTHOTICS
INTRODUCTION TO ORTHOTICS
Define Basic Terminology
Explain Historical Background
Describe Factors In Prescription Orthotics
Illustrate Nomenclature of Orthotics
Explain Biomechanical Principles
Explain Materials Used in Orthotics Manufacturing
Demonstrate Methods of Construction
FOOT ORTHOSES
illustrate Shoe Style
explain Parts of Shoes
illustrate Special Purpose Shoes
demonstrate Foot Examination
explain Orthotics Interventions
describe Fabrication Options
describe Pediatric Foot Orthoses
explain Guideline for Prescription Foot Orthoses
262
ORTHOSES FOR PARAPLEGIA AND HIP DISORDERS
Define Paraplegia
Expalin Standing Frames
Describe Orthoses Designed For Ambulation
Demonstrate Functional Electrical Stimulation
Demonstrate Specific Devices for Paraplegia
Explain Hip Orthoses
Guidelines for Prescription
263
PROSTHETICS
EARLY MANAGEMENT
Describe Clinic Team Approach to Rehabilitation
Explain Amputation Surgery: Osteomyoplastic Reconstructive Technique
Describe Postoperative Management
Define Pain Management
Explain Skin Disorders and Their Management
Describe Psychological Consequences of Amputation
264
Asst No. of
Topic K S A Total
Tools Items
265
HUMAN GROWTH, DEVELOPMENT &COMMUNITY BASED
REHABILITATION
THEORY 50
HOURS
TOTAL 50
HOURS
COURSE DESCRIPTION:
This course intends to give the physiotherapy students basic knowledge about various types of
disabilities existing in special children. The knowledge ranges from physically handicapped to
intellectually disabled children. It also gives information about various existing approaches for
the effective rehabilitation and teaching methods
INTRODUCTION
Understand primary health care and community based rehabilitation.
Describe how primary health care are linked to community based rehabilitation.
266
1. Describe how society embraces disability.
2. Describe the disability movement.
3. Describe the models of disability including the medical model and social model.
4. Understand the international standards of human rights.
267
Recommended books:
Introduction to Special Education By: Allen and Beacon,(1992), A Simon & Superter
Comp.Needham Heights
Exceptional Children, Howard, W.l. (1988); Columbus, Merill.
Exceptional Children and Adults, Patton, J.R. (1991); Boston Scott Foresmen and Co.
Exceptional Children in Focus by: Patton J.R. (1991); New York, Macmillan pub. Co
Community based rehabilitation worker manual, marion loveday, global health publication
268
269
TOS Community Based Rehabilitation 5thYEAR DPT
270
5 4. Describe the models of rehabilitation. 5% - - 15% MCQS
5. Describe the provision of rehabilitation Health 5%
and physical therapy.
services
6. Assess the local needs and resource 5%
analysis of community. Delivery
TOTAL 100%
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SUPERVISED CLINICAL PRACTICE V
Course Description:
During this supervised clinical practice, students are responsible for successful execution of
examination, evaluation, and interventions relating to cardiovascular and pulmonary disorders.
Students become familiar with performance of these skills in all settings (inpatient and
outpatient) as well as on all types of conditions (surgical, non-surgical, pediatric and geriatric,.)
Students learn to objectively perform these skills under the supervision of trained physical
therapists. Student is required to keep a performance record of all listed competencies and
successfully perform on real patients during the final evaluation of the course.
Competencies:
Examination:
Based on best available evidence select examination tests and measures that are appropriate
for the patient/client.
Perform posture tests and measures of postural alignment and positioning.*
Perform gait, locomotion and balance tests including quantitative and qualitative measures
such as*:
272
o Balance during functional activities with or without the use of assistive, adaptive,
orthotic, protective, supportive, or prosthetic devices or equipment
o Balance (dynamic and static) with or without the use of assistive, adaptive, orthotic,
protective, supportive, or prosthetic devices or equipment
o Gait and locomotion during functional activities with or without the use of assistive,
adaptive, orthotic, protective, supportive, or prosthetic devices or equipment to
include:
Bed mobility
Transfers (level surfaces and floor)*
Wheelchair management
Uneven surfaces
Safety during gait, locomotion, and balance
o Perform gait assessment including step length, speed, characteristics of gait, and
abnormal gait patterns.
Characterize or quantify body mechanics during self-care, home management, work,
community, tasks, or leisure activities.
Characterize or quantify ergonomic performance during work (job/school/play)*:
o Dexterity and coordination during work
o Safety in work environment
o Specific work conditions or activities
o Tools, devices, equipment, and workstations related to work actions, tasks, or
activities
Characterize or quantify environmental home and work (job/school/play) barriers:
o Current and potential barriers
o Physical space and environment
o Community access
Observe self-care and home management (including ADL and IADL)*
Measure and characterize pain* to include:
o Pain, soreness, and nociception
o Specific body parts
Recognize and characterize signs and symptoms of inflammation.
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Perform cardiovascular/pulmonary tests and measures including:
A. Heart rate
B. Respiratory rate, pattern and quality*
C. Blood pressure
D. Aerobic capacity test* (functional or standardized) such as the 6-minute walk test
E. Pulse Oximetry
F. Breath sounds normal/abnormal
G. Response to exercise (RPE)
H. Signs and symptoms of hypoxia
I. Peripheral circulation (deep vein thrombosis, pulse, venous stasis,
lymph edema)*
Evaluation:
Clinical reasoning
Clinical decision making
1. Synthesize available data on a patient/client expressed in terms of the International
Classification of Function, Disability and Health (ICF) model to include body functions and
structures, activities, and participation.
2. Use available evidence in interpreting the examination findings.
3. Verbalize possible alternatives when interpreting the examination findings.
4. Cite the evidence (patient/client history, lab diagnostics, tests and measures and scientific
literature) to support a clinical decision.
Diagnosis:
1. Integrate the examination findings to classify the patient/client problem in terms of body
functions and structures, and activities and participation (i.e., practice patterns in the Guide)
2. Identify and prioritize impairments in body functions and structures, and activity limitations
and participation restrictions to determine specific body function and structure, and activities and
participation towards which the intervention will be directed.*
Prognosis:
1. Determine the predicted level of optimal functioning and the amount of time required to
achieve that level.*
274
2. Recognize barriers that may impact the achievement of optimal functioning within a predicted
time frame including*:
A. Age
B. Medication(s)
C. Socioeconomic status
D. Co-morbidities
E. Cognitive status
F. Nutrition
G. Social Support
H. Environment
Plan of Care:
Goal setting
Coordination of Care
Progression of care
Discharge
Design a Plan of Care
1. Write measurable functional goals (short-term and long-term) that are time referenced with
expected outcomes.
2. Consult patient/client and/or caregivers to develop a mutually agreed to plan of care.*
3. Identify patient/client goals and expectations.*
4. Identify indications for consultation with other professionals.*
5. Make referral to resources needed by the patient/client (assumes knowledge of referral
sources).*
6. Select and prioritize the essential interventions that are safe and meet the specified
functional goals and outcomes in the plan of care* (i.e., (a) identify precautions and
contraindications, (b) provide evidence for patient-centered interventions that are identified
and selected, (c) define the specificity of the intervention (time, intensity, duration, and
frequency), and (d) set realistic priorities that consider relative time duration in conjunction
with family, caregivers, and other health care professionals).
7. Establish criteria for discharge based on patient goals and current functioning
and disability.*
275
Coordination of Care
1. Identify who needs to collaborate in the plan of care.
2. Identify additional patient/client needs that are beyond the scope of physical therapist
practice, level of experience and expertise, and warrant referral.*
3. Refer and discuss coordination of care with other health care professionals.*
4. Articulate a specific rational for a referral.
5. Advocate for patient/client access to services.
Progression of Care
1. Identify outcome measures of progress relative to when to progress the patient further.*
2. Measure patient/client response to intervention.*
3. Monitor patient/client response to intervention.
4. Modify elements of the plan of care and goals in response to changing patient/client status,
as needed.*
5. Make on-going adjustments to interventions according to outcomes including
environmental factors and personal factors and, medical therapeutic interventions.
6. Make accurate decisions regarding intensity and frequency when adjusting interventions in
the plan of care.
Discharge Plan
1. Re-examine patient/client if not meeting established criteria for discharge based on the
plan of care.
2. Differentiate between discharge of the patient/client, discontinuation of service, and
transfer of care with re-evaluation.*
3. Prepare needed resources for patient/client to ensure timely discharge, including follow-up
care.
4. Include patient/client and family/caregiver as a partner in discharge.*
5. Discontinue care when services are no longer indicated.
6. When services are still needed, seek resources and/or consult with others to identify
alternative resources that may be available.
7. Determine the need for equipment and initiate requests to obtain.
Interventions:
Safety, Emergency Care, CPR and First Aid
276
Standard Precautions
Body Mechanics and
Positioning
Categories of Interventions
o Safety, Cardiopulmonary Resuscitation Emergency Care, First Aid
Ensure patient safety and safe application of patient/client care.*
Perform first aid.*
Perform emergency procedures.*
Perform Cardiopulmonary Resuscitation (CPR).*
Precautions
1. Demonstrate appropriate sequencing of events related to universal precautions.*
2. Use Universal Precautions.
3. Determine equipment to be used and assemble all sterile and non-sterile materials.*
4. Use transmission-based precautions.
5. Demonstrate aseptic techniques.*
6. Apply sterile procedures.*
7. Properly discard soiled items.*
Body Mechanics and Positioning
1. Apply proper body mechanics (utilize, teach, reinforce, and observe).*
2. Properly position, drape, and stabilize a patient/client when providing physical therapy.*
Interventions
1. Coordination, communication, and documentation may include:
A. Addressing required functions:
(1) Establish and maintain an ongoing collaborative process of
decision-making with patients/clients, families, or caregivers prior
to initiating care and throughout the provision of services.*
(2) Discern the need to perform mandatory communication and
reporting (e.g., incident reports, patient advocacy and abuse
reporting).
(3) Follow advance directives.
B. Admission and discharge planning.
277
C. Case management.
D. Collaboration and coordination with agencies, including:
(1) Home care agencies
(2) Equipment suppliers
(3) Schools
(4) Transportation agencies
(5) Payer groups
E. Communication across settings, including:
(1) Case conferences
(2) Documentation
(3) Education plans
F. Cost-effective resource utilization.
G. Data collection, analysis, and reporting of:
(1) Outcome data
(2) Peer review findings
(3) Record reviews
H. Documentation across settings, following APTAs Guidelines for Physical Therapy
Documentation, including:
(1) Elements of examination, evaluation, diagnosis, prognosis, and
Intervention
(2) Changes in body structure and function, activities and
participation.
(3) Changes in interventions
(4) Outcomes of intervention
I. Interdisciplinary teamwork:
(1) Patient/client family meetings
(2) Patient care rounds
(3) Case conferences
J. Referrals to other professionals or resources.*
K. Patient/client-related instruction may include:
A. Instruction, education, and training of patients/clients and caregivers regarding:
278
(1) Current condition, health condition, impairments in body structure
and function, and activity limitations, and participation restrictions)*
(2) Enhancement of performance
(3) Plan of care:
a. Risk factors for health condition, impairments in body structure and
function, and activity limitations, and participation restrictions.
b. Preferred interventions, alternative interventions, and alternative modes
of delivery
c. Expected outcomes
(4) Health, wellness, and fitness programs (management of risk factors)
(5) Transitions across settings
Therapeutic exercise may include performing:
A. Aerobic capacity/endurance conditioning or reconditioning*:
(1) Gait and locomotors training*
(2) Increased workload over time (modify workload progression)
(3) Movement efficiency and energy conservation training
(4) Walking and wheelchair propulsion programs
(5) Cardiovascular conditioning programs
B. Relaxation:
(1) Breathing strategies*
(2) Movement strategies
(3) Relaxation techniques
C. Airway clearance techniques may include*:
A. Breathing strategies*:
(1) Active cycle of breathing or forced expiratory techniques*
(2) Assisted cough/huff techniques*
(3) Paced breathing*
(4) Pursed lip breathing
(5) Techniques to maximize ventilation (e.g., maximum inspiratory hold, breath
stacking, manual hyperinflation)
279
B. Manual/mechanical techniques*:
(1) Assistive devices
C. Positioning*:
(1) Positioning to alter work of breathing
(2) Positioning to maximize ventilation and perfusion
o Functional training in self-care and home management may include*:
o Functional training in work (job/school/play), community, and leisure integration or
reintegration may include*:
o Activities of daily living (ADL) training:
(1) Bed mobility and transfer training*
(2) Age appropriate functional skills
o Barrier accommodations or modifications*
o Device and equipment use and training:
(1) Assistive and adaptive device or equipment training during ADL (specifically
for bed mobility and transfer training, gait and locomotion, and dressing)*
(2) Orthotic, protective, or supportive device or equipment training during self-
care and home management*
(3) Prosthetic device or equipment training during ADL (specifically for bed
mobility and transfer training, gait and locomotion, and dressing)*
o Functional training programs*:
(1) Simulated environments and tasks*
(2) Task adaptation
o Injury prevention or reduction:
(1) Safety awareness training during self-care and home management*
(2) Injury prevention education during self-care and home management
(3) Injury prevention or reduction with use of devices and equipment
Prescription, application, and, as appropriate, fabrication of devices and equipment may
include*:
o Adaptive devices*:
(1) Hospital beds
(2) Raised toilet seats
280
(3) Seating systems prefabricated
o Assistive devices*:
(1) Canes
(2) Crutches
(3) Long-handled reachers
(4) Static and dynamic splints prefabricated
(5) Walkers
(6) Wheelchairs
o Orthotic devices*:
(1) Prefabricated braces
(2) Prefabricated shoe inserts
(3) Prefabricated splints
o Prosthetic devices (lower-extremity)*
o Protective devices*:
(1) Braces
(2) Cushions
(3) Helmets
(4) Protective taping
o Supportive devices*:
(1) Prefabricated compression garments
(2) Corsets
(3) Elastic wraps
(4) Neck collars
(5) Slings
(6) Supplemental oxygen - apply and adjust
(7) Supportive taping
Electrotherapeutic modalities may include:
A. Biofeedback*
B. Electrotherapeutic delivery of medications (e.g., iontophoresis)*
C. Electrical stimulation*:
(1) Electrical muscle stimulation (EMS)*
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(2) Functional electrical stimulation (FES)
(3) High voltage pulsed current (HVPC)
(4) Neuromuscular electrical stimulation (NMES)
(5) Transcutaneous electrical nerve stimulation (TENS)
Physical agents and mechanical modalities may include: Physical agents:
A. Cryotherapy*:
(1) Cold packs
(2) Ice massage
(3) Vapocoolant spray
B. Hydrotherapy*:
(1) Contrast bath
(2) Pools
(3) Whirlpool tanks*
C. Sound agents*:
(1) Phonophoresis*
(2) Ultrasound*
D. Thermotherapy*:
(1) Dry heat
(2) Hot packs*
(3) Paraffin baths*
Mechanical modalities:
A. Compression therapies (prefabricated)*
(1) Compression garments
Skill Category Description of Minimum Skills
(2) Vasopneumatic compression devices*
(3) Taping
(4) Compression bandaging (excluding lymph edema)
B. Gravity-assisted compression devices:
(1) Standing frame*
(2) Tilt table*
C. Mechanical motion devices*:
282
(1) Continuous passive motion (CPM)*
D. Traction devices*:
(1) Intermittent
(2) Positional
(3) Sustained
INTEGUMENTARY
Course Description:
During this supervised clinical practice, students are responsible for successful execution of
examination, evaluation, and interventions relating to Integumentary, gynecology and obstetrics,
sports and metabolic disorders. Students become familiar with performance of these skills in all
settings (inpatient and outpatient) as well as on all types of conditions (surgical, non-surgical,
pediatric, geriatric, obstetrics & gynecology, sports etc.) Students learn to objectively perform
these skills under the supervision of trained physical therapists. Student is required to keep a
283
performance record of all listed competencies and successfully perform on real patients during
the final evaluation of the course.
Competencies:
Examination:
Based on best available evidence select examination tests and measures that are appropriate
for the patient/client.
Perform posture tests and measures of postural alignment and positioning.*
Perform gait, locomotion and balance tests including quantitative and qualitative measures
such as*:
o Balance during functional activities with or without the use of assistive, adaptive,
orthotic, protective, supportive, or prosthetic devices or equipment
o Balance (dynamic and static) with or without the use of assistive, adaptive, orthotic,
protective, supportive, or prosthetic devices or equipment
o Gait and locomotion during functional activities with or without the use of assistive,
adaptive, orthotic, protective, supportive, or prosthetic devices or equipment to
include:
Bed mobility
Transfers (level surfaces and floor)*
Wheelchair management
Uneven surfaces
Safety during gait, locomotion, and balance
o Perform gait assessment including step length, speed, characteristics of gait, and
abnormal gait patterns.
Characterize or quantify body mechanics during self-care, home management, work,
community, tasks, or leisure activities.
Characterize or quantify ergonomic performance during work (job/school/play)*:
o Dexterity and coordination during work
o Safety in work environment
o Specific work conditions or activities
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o Tools, devices, equipment, and workstations related to work actions, tasks, or
activities
Characterize or quantify environmental home and work (job/school/play) barriers:
o Current and potential barriers
o Physical space and environment
o Community access
Observe self-care and home management (including ADL and IADL)*
Measure and characterize pain* to include:
o Pain, soreness, and nociception
o Specific body parts
Recognize and characterize signs and symptoms of inflammation.
Perform integumentary integrity tests and measures including*:
A. Activities, positioning, and postures that produce or relieve trauma to the skin.
B. Assistive, adaptive, orthotic, protective, supportive, or prosthetic devices and
equipment that may produce or relieve trauma to the skin.
C. Skin characteristics, including blistering, continuity of skin color, dermatitis, hair
growth, mobility, nail growth, sensation, temperature, texture and turgor.
D. Activities, positioning, and postures that aggravate the wound or scar or that produce
or relieve trauma.
E. Signs of infection.
F. Wound characteristics: bleeding, depth, drainage, location, odor, size, and color.
G. Wound scar tissue characteristics including banding, pliability, sensation, and texture.
Evaluation:
Clinical reasoning
Clinical decision making
1. Synthesize available data on a patient/client expressed in terms of the International
Classification of Function, Disability and Health (ICF) model to include body functions and
structures, activities, and participation.
2. Use available evidence in interpreting the examination findings.
3. Verbalize possible alternatives when interpreting the examination findings.
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4. Cite the evidence (patient/client history, lab diagnostics, tests and measures and scientific
literature) to support a clinical decision.
Diagnosis:
1. Integrate the examination findings to classify the patient/client problem in terms of body
functions and structures, and activities and participation (ie, practice patterns in the Guide)
2. Identify and prioritize impairments in body functions and structures, and activity limitations
and participation restrictions to determine specific body function and structure, and activities and
participation towards which the intervention will be directed.*
Prognosis:
1. Determine the predicted level of optimal functioning and the amount of time required to
achieve that level.*
2. Recognize barriers that may impact the achievement of optimal functioning within a predicted
time frame including*:
A. Age
B. Medication(s)
C. Socioeconomic status
D. Co-morbidities
E. Cognitive status
F. Nutrition
G. Social Support
H. Environment
Plan of Care:
Goal setting
Coordination of Care
Progression of care
Discharge
Design a Plan of Care
1. Write measurable functional goals (short-term and long-term) that are time referenced with
expected outcomes.
2. Consult patient/client and/or caregivers to develop a mutually agreed to plan of care.*
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3. Identify patient/client goals and expectations.*
4. Identify indications for consultation with other professionals.*
5. Make referral to resources needed by the patient/client (assumes knowledge of referral
sources).*
6. Select and prioritize the essential interventions that are safe and meet the specified
functional goals and outcomes in the plan of care* (i.e., (a) identify precautions and
contraindications, (b) provide evidence for patient-centered interventions that are identified
and selected, (c) define the specificity of the intervention (time, intensity, duration, and
frequency), and (d) set realistic priorities that consider relative time duration in conjunction
with family, caregivers, and other health care professionals).
7. Establish criteria for discharge based on patient goals and current functioning
and disability.*
Coordination of Care
1. Identify who needs to collaborate in the plan of care.
2. Identify additional patient/client needs that are beyond the scope of physical therapist
practice, level of experience and expertise, and warrant referral.*
3. Refer and discuss coordination of care with other health care professionals.*
4. Articulate a specific rational for a referral.
5. Advocate for patient/client access to services.
Progression of Care
1. Identify outcome measures of progress relative to when to progress the patient further.*
2. Measure patient/client response to intervention.*
3. Monitor patient/client response to intervention.
4. Modify elements of the plan of care and goals in response to changing patient/client status,
as needed.*
5. Make on-going adjustments to interventions according to outcomes including
environmental factors and personal factors and, medical therapeutic interventions.
6. Make accurate decisions regarding intensity and frequency when adjusting interventions in
the plan of care.
Discharge Plan
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1. Re-examine patient/client if not meeting established criteria for discharge based on the
plan of care.
2. Differentiate between discharge of the patient/client, discontinuation of service, and
transfer of care with re-evaluation.*
3. Prepare needed resources for patient/client to ensure timely discharge, including follow-up
care.
4. Include patient/client and family/caregiver as a partner in discharge.*
5. Discontinue care when services are no longer indicated.
6. When services are still needed, seek resources and/or consult with others to identify
alternative resources that may be available.
7. Determine the need for equipment and initiate requests to obtain.
Interventions:
Safety, Emergency Care, CPR and First Aid
Standard Precautions
Body Mechanics and
Positioning
Categories of Interventions
o Safety, Cardiopulmonary Resuscitation Emergency Care, First Aid
Ensure patient safety and safe application of patient/client care.*
Perform first aid.*
Perform emergency procedures.*
Perform Cardiopulmonary Resuscitation (CPR).*
Precautions
1. Demonstrate appropriate sequencing of events related to universal precautions.*
2. Use Universal Precautions.
3. Determine equipment to be used and assemble all sterile and non-sterile materials.*
4. Use transmission-based precautions.
5. Demonstrate aseptic techniques.*
6. Apply sterile procedures.*
7. Properly discard soiled items.*
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Body Mechanics and Positioning
1. Apply proper body mechanics (utilize, teach, reinforce, and observe).*
2. Properly position, drape, and stabilize a patient/client when providing physical therapy.*
Interventions
1. Coordination, communication, and documentation may include:
A. Addressing required functions:
(1) Establish and maintain an ongoing collaborative process of
decision-making with patients/clients, families, or caregivers prior
to initiating care and throughout the provision of services.*
(2) Discern the need to perform mandatory communication and
reporting (e.g., incident reports, patient advocacy and abuse
reporting).
(3) Follow advance directives.
B. Admission and discharge planning.
C. Case management.
D. Collaboration and coordination with agencies, including:
(1) Home care agencies
(2) Equipment suppliers
(3) Schools
(4) Transportation agencies
(5) Payer groups
E. Communication across settings, including:
(1) Case conferences
(2) Documentation
(3) Education plans
F. Cost-effective resource utilization.
G. Data collection, analysis, and reporting of:
(1) Outcome data
(2) Peer review findings
(3) Record reviews
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H. Documentation across settings, following APTAs Guidelines for Physical Therapy
Documentation, including:
(1) Elements of examination, evaluation, diagnosis, prognosis, and
Intervention
(2) Changes in body structure and function, activities and
participation.
(3) Changes in interventions
(4) Outcomes of intervention
I. Interdisciplinary teamwork:
(1) Patient/client family meetings
(2) Patient care rounds
(3) Case conferences
J. Referrals to other professionals or resources.*
K. Patient/client-related instruction may include:
A. Instruction, education, and training of patients/clients and caregivers regarding:
(1) Current condition, health condition, impairments in body structure
and function, and activity limitations, and participation restrictions)*
(2) Enhancement of performance
(3) Plan of care:
a. Risk factors for health condition, impairments in body structure and
function, and activity limitations, and participation restrictions.
b. Preferred interventions, alternative interventions, and alternative modes
of delivery
c. Expected outcomes
(4) Health, wellness, and fitness programs (management of risk factors)
(5) Transitions across settings
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A. Debridement*nonselective:
(1) Enzymatic debridement
(2) Wet dressings
(3) Wet-to-dry dressings
(4) Wet-to-moist dressings
B. Dressings*:
(1) Hydro gels
(2) Wound coverings
C. Topical agents*:
(1) Cleansers
(2) Creams
(3) Moisturizers
(4) Ointments
(5) Sealants
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(2) Task adaptation
o Injury prevention or reduction:
(1) Safety awareness training during self-care and home management*
(2) Injury prevention education during self-care and home management
(3) Injury prevention or reduction with use of devices and equipment
Prescription, application, and, as appropriate, fabrication of devices and equipment may
include*:
o Adaptive devices*:
(1) Hospital beds
(2) Raised toilet seats
(3) Seating systems prefabricated
o Assistive devices*:
(1) Canes
(2) Crutches
(3) Long-handled reachers
(4) Static and dynamic splints prefabricated
(5) Walkers
(6) Wheelchairs
o Orthotic devices*:
(1) Prefabricated braces
(2) Prefabricated shoe inserts
(3) Prefabricated splints
o Prosthetic devices (lower-extremity)*
o Protective devices*:
(1) Braces
(2) Cushions
(3) Helmets
(4) Protective taping
o Supportive devices*:
(1) Prefabricated compression garments
(2) Corsets
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(3) Elastic wraps
(4) Neck collars
(5) Slings
(6) Supplemental oxygen - apply and adjust
(7) Supportive taping
Electrotherapeutic modalities may include:
A. Biofeedback*
B. Electrotherapeutic delivery of medications (e.g., iontophoresis)*
C. Electrical stimulation*:
(1) Electrical muscle stimulation (EMS)*
(2) Functional electrical stimulation (FES)
(3) High voltage pulsed current (HVPC)
(4) Neuromuscular electrical stimulation (NMES)
(5) Transcutaneous electrical nerve stimulation (TENS)
Physical agents and mechanical modalities may include: Physical agents:
A. Cryotherapy*:
(1) Cold packs
(2) Ice massage
(3) Vapocoolant spray
B. Hydrotherapy*:
(1) Contrast bath
(2) Pools
(3) Whirlpool tanks*
C. Sound agents*:
(1) Phonophoresis*
(2) Ultrasound*
D. Thermotherapy*:
(1) Dry heat
(2) Hot packs*
(3) Paraffin baths*
Mechanical modalities:
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A. Compression therapies (prefabricated)*
(1) Compression garments
Skill Category Description of Minimum Skills
(2) Vasopneumatic compression devices*
(3) Taping
(4) Compression bandaging (excluding lymph edema)
B. Gravity-assisted compression devices:
(1) Standing frame*
(2) Tilt table*
C. Mechanical motion devices*:
(1) Continuous passive motion (CPM)*
D. Traction devices*:
(1) Intermittent
(2) Positional
(3) Sustained
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