UNIVERSITY OF SCRANTON
DEPARTMENT OF PHYSICAL THERAPY
COURSE SYLLABUS
PT 350 INTRODUCTION TO THERAPEUTIC EXERCISE
— Fall 1999
COURSE TITLE
PT 350 Introduction to
Therapeutic Exercise
3 credits (2 hr.
lecture/wk; 2 hr. lab/wk for each student)
INSTRUCTORS
● Office hours as
posted
Laboratory Instructor –
Janet Caputo, PT. Office – Allied
Health System, 961-2242.
- Eric
Rollinson, PTA, 961-1142.
COURSE DESCRIPTION This course introduces
the concepts of fitness and exercise and prepares the student to design and
implement basic therapeutic exercise programs for clinical use. Expected responses to exercise (among
healthy individuals) and training and patient responses to traditional
therapeutic exercise programs are discussed.
Normal tissue response to exercise, and following surgical intervention
is discussed. The course investigates physical fitness as a function of the
following determinants: strength, endurance, flexibility, power, and
skill. Physiology of the neuromuscular
system as it relates to exercise is reviewed.
Energy metabolism and nutritional support for energy metabolism are
discussed. The effects of aging,
disuse, immobilization, denervation, and selected drugs on exercise performance
are discussed. Laboratory activities
include exposure to techniques for clinical assessment and improvement of
strength, flexibility, endurance, power, and skill (including manual muscle
testing and goniometry).
PROFESSIONAL BEHAVIOR
In keeping with the professional behavior that all
members of a health care team should uphold, each student in this course is
expected to conduct her/himself in a respectful and professional manner. This includes, but is not limited to:
Ø
being punctual and prepared for every class session
Ø respecting
his/her classmates and the instructor during class discussions
Ø working
independently when asked to do so
Ø working
in a positive and productive manner with classmates on group projects
Ø respecting
oneself by presenting his/her own ideas and opinions in a positive and
thoughtful manner that demands the attention and respect of classmates
Ø being
committed to a positive learning experience, latest edition, available at U of
S bookstore.
CLASS ATTENDANCE Consistent attendance
during scheduled class and lab times are considered to be a prime indicator of
mature and professional behavior.
Absences from lectures, laboratory sessions or clinical experiences are
only excusable under extenuating circumstances and/or previous notification of
the course instructors. Make up work
and/or exams are at the discretion of the course instructor. It should be noted that class participation
is 10 % of the final grade.
REQUIRED TEXTS
Berryman
Reese, N. Muscle and Sensory Testing, Philadelphia, W.B. Saunders,
1999. ISBN 0-7216-5958-6.
Kisner
C, and Colby L.A. Therapeutic Exercise: Foundations and Techniques,
Philadelphia, F.A. Davis Co, 1996.
Kosmahl,
E. Course Notes: Intro to Therapeutic Exercise PT 350
Kendall, F.P., McCreary,
E.K., and Provance, P.G. Muscle Testing and Function, 4th
ed., Baltimore, Williams & Wilkens, 1993. ISBN 0-683-0476-8.
Norkin, C.C., and White,
D.J. Measurement of Joint Motion: A guide to Goniometry, 2nd
edition, Philadelphia, F.A. Davis, 1995, ISBN 0-8036-6579-2.
***NOTE: The
information that is required for the goniometry portion of this course is
available at the course web site:
http://academic.uofs.edu/faculty/kosmahle1/courses/pt350/goniomet/gonpage1.htm
If you are comfortable
using the web as a reference source, there is no need to purchase the Norkin
and White textbook. Using the PT
Department Computer Lab to download a paper copy of the web materials is not allowed. If you wish to have a hard copy
reference (which will be referred to in lecture and lab), please purchase the
“N & W” textbook.
Mathiowetz V et al. Grip
and pinch strength. Normative data for
adults, Archives of Plhysical Medicine and Rehabilitation, 66, Feb 1985, pp.
69-74 *Presently not in library.
Williams-Andrews A, Thomas MW, Bohannon RW. Normative values for isometric muscle force measurements obtained with hand-held dynamometers, Physical Therapy, 76, March 1996, pp. 248-259
PT
350 Intro to Therapeutic Exercise Fall
1999
Kendall
Muscle Testing Videos
I.
Trunk and Hip Muscles, Part I (Length Tests)
II.
Trunk and Hip Muscles Part II (Strength Tests)
III.
Shoulder Joint and Shoulder Girdle Muscles
IV.
Elbow, Forearm and Hand Muscles
V.
Lower Extremity Muscles
Hislop HJ, Montgomery J. Daniels’ and
Worthingham’s Muscle Testing: Techniques of Manual Examination, 6th
Edition, Philadelphia, W.B. Saunders, 1995.
McArdle, W.D., Katch, F.I., Katch, V.L. Exercise
Physiology: Energy, Nutrition, and Human Performance, Latest edition,
Philadelphia, Lea & Febiger.
1.
Define therapeutic exercise.
2.
Define fitness.
3.
Define the determinants of fitness including
strength, endurance, flexibility, power, and skill.
4.
Understand the content of a complete patient
evaluation including, subjective information, objective information (ROM, gross
motor strength, sensory testing, palpation), with development and
implementation of an exercise program.
5.
Define goniometry, and explain (and demonstrate)
the steps required performing a goniometric measurement.
6.
Identify the components of the standard goniometer:
body, stationary arm and moving arm.
Describe additional ROM measuring devices and techniques.
7.
Explain the concepts of validity, reliability
(intratester and intertester), positioning, stabilization and substitution and
how they relate to goniometry.
8.
Skillfully perform PROM and understand each type
and the specific “end feel” for each joint
Understand normal vs. abnormal “end feel”.
9.
Measure and document flexibility via goniometer and
via muscle length testing. A satisfactory goniometry measurement will include
a) correct positioning, b) appropriate stabilization, c) use of proper
landmarks, d) accurate reading of goniometer (and knowledge of “normal” ranges,
and e accurate recording of measurement.
10. Be
able to differentiate and explain the difference of osteokinematic and arthrokinematic
movements.
11. Discuss
the significance and some of the causes of excessive and limited ROM.
12. Define
manual muscle testing and identify the steps to perform an accurate MMT
including a) correct positioning of subject and part being tested, b) appropriate
application of resistance, c) palpation of muscle belly or tendon as
appropriate, d) proper selection of grades, e) accurate recording of grades.
PT
350 Intro to Therapeutic Exercise Fall
1999
13. Explain
the following concepts as they relate to manual muscle testing: validity,
reliability (intratester and intertester), positioning, stabilization,
substitution, test position, test movement, break test.
14. Define
active and passive insufficiency and provide examples of both.
15. Define
the following types of exercise/ROM: active, active-assistive, passive,
resisted, stretching.
16. Differentiate
between stretching and ROM exercises.
17. Identify
indications for, and contraindications and precautions for active,
active-assistive, passive, resisted and stretching exercises.
18. Understand
the physiology of soft tissue repair and apply this to exercise selection for
acute, subacute and chronic stages of healing.
19. Understand
exercise for post-surgical patients.
20. Understand
the principles of aerobic conditioning.
21. Design
and implement exercise training programs to improve flexibility via active,
active-assistive, passive, resistive and stretching exercises.
22. Understand
the principles of isometric, isotonic, and isokinetic exercise (including
manual muscle testing and hand held dynamometry).
23. Define
concentric and eccentric muscle contractions.
24. Develop
and perform an exercise program designed to improve strength using all of the
following exercise systems:
Isotonic Isokinetic
Isometric Manual
resistance
Concentric Eccentric
25. Define
fatigue and describe its influence on exercise.
26. Define
muscular power, and design an exercise program that emphasizes increasing
muscular power.
27. Define
endurance, MAX VO2, A-V O2
difference, oxygen deficit, oxygen dept, cardiac output, age predicted maximum
heart rate, MET.
28. Understand
the principles of aerobic conditioning.
29. Recognize
contraindications and precautions for endurance training and testing.
30. Design
and implement and exercise program intended to improve endurance and
cardiovascular fitness.
31. Define
perceptual-motor skill and coordination.
32. Measure
and appropriately document gross and fine motor coordination and balance.
33. Develop
and perform an appropriate exercise program to improve gross and fine motor
coordination and balance.
34. Describe
the structure and function of skeletal, cardiac and smooth muscle.
35. Describe
the structure and function of the various skeletal muscle fiber types.
36. Describe
the structure and function of the motor unit.
37. Explain
how the basic nutritional components are metabolized for energy.
38. Differentiate
which energy metabolism systems are utilized to supply energy for each of the
components of physical fitness.
39. Monitor
clinical responses to measurement and exercise training procedures to insure
patient safety.
PT 350 Intro to Therapeutic Exercise Fall
1999
40. Describe
the effect of exercise training programs designed to improve strength,
endurance, flexibility, power, and skill on; skeletal muscle, the motor unit,
the cardiovascular system, the peripheral vascular system, and connective
tissue.
41. Explain
the effects of aging, disuse, immobilization, denervation and selected drugs on
skeletal muscle, the motor unit, the cardiovascular, and connective tissue.
42. Describe
acute and chronic vascular disorders that affect the arterial, venous and
lymphatic systems.
43. Design
and implement an exercise program (noting the contraindications) for patients
with vascular disorders.
44. Identify
contraindications and precautions for childbirth preparation exercises.
45. Develop
and implement an exercise program for childbirth preparation.
COURSE EVALUATION OF STUDENT PERFORMANCE
A.
Attendance and classroom/laboratory participation
(10 % of lab and lecture final grade)
1.
Classroom
a.
Because of the competency-based nature of the
Physical Therapy Curriculum, attendance at all sessions is mandatory. Please see or
call the instructor(s) if attendance is not possible.
b.
Students are expected to be on time for class and participate in class discussion (e.g. be
prepared to answer and/or ask questions relevant to the subject matter
presented throughout the curriculum.
Students are responsible for previous course information).
2.
Laboratory Sessions
a.
Students are expected to be on time and wearing appropriate laboratory attire, as designated by
your faculty (e.g., nametag, shorts, tee shirt, socks and
sneakers). Students must be prepared to expose necessary areas of
the body. Women must wear bathing suit
or halter-top under tee shirt (course instructor will inform students when
bathing suit tops are necessary). It is the discretion of the laboratory
instructor to dismiss the student from lab if the student is not properly
dressed.
b.
You are to perform the assigned tasks.
c.
You are prepared to answer/ask questions pertinent
to the lab assignment.
d.
Utilize your laboratory time to the fullest. Practice
is vital, and expected to also occur outside of laboratory sessions.
B. Teaching methods Lecture,
lab, question and answer, discussion, student case presentations, videotape
articles, computer-assisted instruction.
PT 350 Intro to Therapeutic Exercise Fall 1999
Grading Criteria: The
lecture and laboratory components of this course are intended to support each
other. The student is expected to be
able to incorporate information from both lecture and lab for all written
exams, performance exams, presentations and assignments, etc.
A. Lecture
a) Attendance
and participation (as stated above). 10%
b)
Two homework cases 20%
c)
Exams (two one hour exams (20% each, comprehensive final exam) 70%
B. Laboratory
a)
Attendance and participation (as stated above) 10%
b)
One case presentation 22.5%
c)
Three performance exams 67.5%
Students are expected to work independently on the cases and present their findings in written form. Grades will be based on accuracy, thoroughness, and how well your thoughts are conveyed.
Prepare a Short
report (two pages or less), typewritten double-spaced, that includes the
following:
Ø
Your name, date
Ø
Problem type (PROM, AROM, isotonic, isometric…)
Ø
Problem number (re-type the problem)
Ø
Summary of important facts and findings – explain
consequences of diagnosis, injury, patient circumstances, that may alter
patient progress and require refinement of treatment.
Ø
List treatment goals with expected time of
achievement of each goal.
Ø
Treatment plan, including clinic exercises, home
exercises, patient education, precautions, and briefly discuss the use of
therapeutic modalities (as the semester progresses, the depth and thoroughness
of treatment should increase).
1) Prepare
a short, typewritten handout, in outline form, that includes the
following:
Ø
Names of students in your presentation group
(groups will be assigned, approximately four in a group), date
Ø
Problem type (PROM, AROM, soft-tissue disruption,
isotonic, isokinetic…)
Ø
Problem number, re-type the problem
PT
350 Intro to Therapeutic Exercise Fall 1999
Ø
Summary of important facts and findings – explain
consequences of diagnosis, injury, patient circumstances, that may alter
patient progress and require refinement of treatment.
Ø
Treatment goals with estimated time of attainment
of each goal (if your case calls for evaluation only, list the test you will be
using, and the normal values for these tests).
Ø
Treatment plan (if your case calls for evaluation
only, list test results that you would expect for this patient at this point in
his/her rehabilitation, and explain why you believe these test results would be
appropriate.
2)
Make enough copies for distribution to the
student and instructors in the lab (the PT
secretaries will assist you with this).
3)
Give a
short (10 minutes or less) presentation discussing your case. Discuss the
important issues
concerning the case. Demonstrate at
least one of each: (test, examination, and treatment technique that you would
use with this case).
4) Allot
five minutes for questions from the class and instructors.
DEPARTMENT GRADE SCALE
A 95 C+ 80
A- 92 C 77* Note: Course
and/or Unit, and individual
B+ 89 C- 74 performance
exam grades below 77%
B 86 D+ 71 are
unacceptable for progression
B- 83 D 68 through
the curriculum and will initiate
F 67
and lower the
probation policy — See Student
Handbook.
PT 350 – Introduction to Therapeutic Exercise- Peter M. Leininger, MSPT, OCS
COURSE CONTENT OUTLINE/SCHEDULE
|
WEEK |
LECTURE |
LAB |
|
1 – Aug. 30 |
Wednesday-Introduction
to therapeutic exercise and the concepts of fitness, assessing patient,
developing exercise program. Muscle
length tests. Friday-
ROM and Stretching – READ Kisner & Colby CH 2 & 5 (handout). |
Goniometry and Manual Muscle Testing (MMT)
introduction. READ (Norkin
& White CH 1, 2) &/or http://academic.uofs.edu/faculty/kosmahle1/courses/pt350/goniomet/gonpage1.htm
Berryman CH 1,6 pp. 378-389. Williams-Andrews A, Thomas MW, Bohannon RW article (in
library). |
|
2 – Sept. 6 |
Wednesday-Resistance
exercise (strength). READ Kisner & Colby CH 3. Friday-Acute,
subacute and chronic pathology of the spine and exercises for the spine and
trunk. Read Kisner & Colby CH 14, 15
(handout). |
Goniometry (ROM) and strength testing of the spine,
trunk, and TMJ. READ
goniometry web site for spine and TMJ (Norkin & White CH 10-12), Berryman
CH 3. *Expectations of knowledge of “normal” ROM for selected
joints and “end-feel” and capsular pattern for each joint will be discussed.
Kendall MMT video #1-3. |
|
3 – Sept. 13 |
Wednesday-Exercises
for the spine and trunk (including HEP’s). Friday-Neuromuscular
implications with exercise regime (strengthening and ROM). *Homework
due (Isometrics, isotonics…) |
Continued flexibility and strength testing of the spine,
trunk and TMJ. See above readings. |
|
4 – Sept. 20 |
Wednesday-Muscle
physiology and histology. Friday-Cont.
physiology and histology and Rx of soft tissue, bony and postsurgical
problems. |
Practice implementing exercises for the spine and trunk
(from K & C CH 14 & 15 and HEP handouts). *
Case presentation # 1 (Goniometry and MMT evaluation for the spine, trunk and
TMJ). |
|
5 – Sept. 27 |
Wednesday-Nutrition
& energy metabolism (exercise physiology review). Friday-Cont.
from wed. |
*Performance
Exam # 1 –The spine, trunk, TMJ Goniometry,
MMT, flexibility and strength testing. See
sign-up sheets and criteria for grading. |
|
6 – Oct. 4 |
Wednesday-Aerobic
Exercise (endurance and fatigue). READ Kisner
& Colby CH 4. **Thursday
Written Exam # 1 (3:00 - 5:00 L1006)
Weeks 1-5. Friday-Continue
with endurance, fatigue. |
Practice applications of isometrics, isotonics and
isokinetics in lab. Review section in
Kisner & Colby CH 3. Students are
expected to practice being a “patient” and “therapist” on the Biodex. |
|
7 – Oct. 11 |
Wednesday-Exercises
of the hip and common pathologies of the hip. READ
Kisner & Colby CH 11(handout). Friday-Exercises
for the knee and common pathologies. READ K
& C CH 12 (handout). |
*Case
presentation # 2 (Strengthening applications, isometric, isotonic,
isokinetic…). Continue practice with isokinetics (become proficient
with setting up for various extremities). |
|
8 - Oct. 18 |
Wednesday-Exercises
for the ankle & foot and common pathologies. READ
Kisner & Colby CH 13 (handout). Friday-Review
lower extremity therapeutic exercises and pathologies. |
Lower extremity goniometry, MMT, flexibility and
therapeutic exercises. READ
goniometry web site for lower extremity (Norkin & White CH 7,8,9.
Berryman CH 4. Kisner & Colby CH
11,12,13. Kendall MMT video #5. |
|
9 – Oct. 25 |
Wednesday-Introduction
to Proprioceptive Neuromuscular Facilitation, HR to ROM, K
& C pp. 159-164 (PNF) – handout. Friday-Muscular
power development. READ Kisner
& Colby pp. 58 & 59. Review. |
Manual resistance exercises to lower extremities and
basic PNF applications (including HR…).
READ Kisner
& Colby pp. 80-83. *Case
presentation # 3 – Lower extremity. |
|
10 – Nov. 1 |
Wednesday-Skill,
balance and coordination (measurement and exercises to improve). READ Kisner & Colby pp. 20, 21
and handout. Friday-Continue with above topic. |
**Performance Exam # 2 – Lower extremity goniometry, MMT, manual
resistance, manual resistance, manual stretching & ROM exercises. See
sign-up sheet and grading criteria. |
|
11 – Nov. 8 |
Wednesday-The
effects of aging, disuse, neural implications, drugs (legal and illegal) on
physical status. Friday-Continue
with above topic. |
Exercises to evaluate, develop/improve, skill,
coordination and balance. Overview of upper extremity goniometry, MMT and therapeutic
exercises. |
|
12 – Nov. 15 |
Wednesday-Exercises
for the shoulder and common pathologies. READ
Kisner & Colby CH 8 (handout). Thursday-
**Written Exam #2 (3:00-5:00 L1006). Friday-Exercises
for the elbow and common pathologies.
READ Kisner
& Colby CH 9. |
Upper Extremity goniometry, MMT, flexibility and
therapeutic exercises. READ
goniometry web site for upper extremity, (Norkin & White CH 4,5,6),
Berryman CH 2, Kendall MMT videos # 3,4, Kisner & Colby CH 8,9,10, and
Mathiowetz V et al. Grip and pinch strength: Normative data for adults, Arch
of Phys Med and Rehab, 66, Feb. 1985, pp. 69-74. |
|
13 – Nov. 22 |
Wednesday-
Thanksgiving Break Friday-
Thanksgiving Break |
THANKSGIVING BREAK |
|
14 – Nov. 29 |
Wednesday-Exercises
for the wrist and hand and common pathologies. READ Kisner
& Colby CH 10 (handout). Friday-Peripheral
vascular disease. READ
Kisner & Colby CH 18 (handout). |
Upper extremity manual resistance exercise (review Kisner
& Colby pp. 72-80, and UE PNF exercises. *Case
presentation #4 – Upper extremity. |
|
15 – Dec. 6 |
Wednesday-Exercise
for the obstetric patient. READ Kisner
& Colby CH 17. Friday-Study
day. Final
Exam – Comprehensive (40 % fg). Time
and location TBA. |
**Performance
Exam # 3 – Upper extremity goniometry, MMT, manual resistance,
manual stretching and therapeutic exercise. **Friday’s
lab will need to be moved up to Wednesday or Thursday. |