Student Name and Number Assessor’s Name Passing Grad: Physical Therapist Technician Management of Pelvis, Hip and Thigh Conditions Clinical Assessment Materials a) b) c) d) e) f) g) h) Patient case study Pen Paper (checklist for assessor and blank for student) Assessment materials: I. Goniometer II. Reflex hammer III. Kleenex Pillows Plinth Hand sanitizer Simulated patient Facility Instructions This EC shall be completed in one of two settings: a) The physical therapy clinic at the Polyclinic; or b) The physical therapy classroom at the AFAMS school house once the equipment on order has arrived and has been set up for student use. Arrangements and Procedures Practical EC: The student will enter the assessment room where there will be the assessor and a simulated patient in a chair. The assessor will read the scenario from a piece of paper to the student and will then make it accessible for the student to reference during the assessment. Students shall receive 2 minutes to prepare the room and equipment. They will then have 30 minutes to perform the given task(s). Student will complete this EC with due regard to all safety procedures ensuring they ask about contraindications/precautions to which the simulated patient will have none. Grading Scheme This EC consists of a pass/fail checklist. The student must perform all points on the checklist to successfully pass this EC. If they are not successful, they must be tested again. Student Name and Number Assessor’s Name Passing Grad: Instructions For Simulated Patient Subjective History Information: Chief complaint is left anterior hip pain. Examined by the doctor today who diagnosed her with osteoarthritis of the hip joint. Pain started about over 10 years ago and has gotten progressively worse over the years. Had a serious motor vehicle accident 15 years ago where she dislocated and fractured her left hip. Received some minor treatment but has always had pain and stiffness since. During the past few years the pain has increased in intensity and has started to affect her function more. Pain is mainly localized to the anterior left hip area but can radiate around laterally. Pain is a constant dull ache to the left hip and can sometimes be an intermittent sharp pain with certain activities. Aggravated by prolonged sitting and walking, rising from sitting, first thing in the morning, squatting, and stairs. Pain is slightly decreased with sitting or lying, heat, elevation and resting. On a scale of 1-10, pain is a 7/10 at its worse and 2/10 at its best. Regularly takes Tylenol which provides some relief. Patient is a mother and grandmother to over 10 children. Her activities of daily living include a lot of cleaning and housework as well as she is the primary care giver for the children. Consents to the objective exam. Special Questions: o o o o o Any trauma? If so what was the mechanism of injury? NO Any locking, catching, clunking or clicking? YES, cracking and clicking Any urinary incontinence? NO Able to lie on the affected side? YES, for short periods of time Location of pain? Anterior, posterior, or lateral? Anterior and sometimes lateral Red Flag Questions: o Bowel or bladder disturbances? NO o History of a fall from a standing position? NO o Unexplained weight loss? NO o History of long-term corticosteroid use? NO o 5-8 year old boys with groin/thigh pain? NO o A shortened and externally rotated lower extremity? NO o Pain in groin, and/or scrotum in males? NO o Groin aching exacerbated with weight-bearing? NO o Involved leg held in external rotation? NO o Unwillingness to weight bear on or move the involved hip? NO Student Name and Number Assessor’s Name Passing Grad: Objective Exam Information: o Decreased weight bearing on left in standing, decreased stance phase on left during gait, difficultly with rising from sitting with pain, left leg slightly externally rotated in standing o On palpation, tenderness over anterior left hip joint, left great trochanter and left PSIS o Lumbar AROM: full all directions, mild pain with end range flexion o Hip AROM: o Normal flexion, ABD, ADD, ER o ++ Decreased left IR with ++ hip pain o Slightly decreased left ext’n with moderate hip pain o Hip PROM: o Decreased IR with ++pain o Slight decrease extension with some pain o Hip strength testing: o 5/5 flex, ABB, ADD, ER, Ext’n o 4/5 IR with pain o Neuro exam: o Normal dermatomes o Normal myotomes o Normal reflexes o Special test: o +ve FABER’s on left producing left hip pain Student Name and Number Assessor’s Name Passing Grad: Trainee Instructions The assessor will read a scenario and then provide a copy for reference. You will have 2 minutes to review the case and prepare for the assessment and 30 minutes to perform the assessment. All the materials that you will need for the assessment will be provided for you. Scenario 1 A 50 year old female is referred to physical therapy for left hip osteoarthritis. Perform the subjective and objective examination. Student Name and Number Assessor’s Name Passing Grad: Physical Therapist Technician Management of Pelvis, Hip and Thigh Conditions Clinical Assessment CHECKLIST SUBJECTIVE ASSESSMENT 1 2 3 Confirm patient identification and diagnosis Confirm patients chief complaint 5 Inquire about the patient’s history of present illness (OPQRST) Inquire about the patient’s pain (location, duration, type, frequency) Ask about past medical history 6 Ask about current medications 7 Inquire about the patient’s social status and occupation Inquire about any previous treatments for the condition Ask special questions 4 8 9 10 Ask red flag questions 11 Obtain consent to perform objective exam OBJECTIVE ASSESSMENT 1 2 3 Use appropriate infection control procedures for patient care (hand washing and equipment cleaning) Remove any clothing that is obstructing the area to be assessed Inspection (Posture, spinal curves, transfers, gait, tilt of the pelvis, muscle atrophy, bruising, swelling) YES NO COMMENTS Student Name and Number Assessor’s Name 4 5 6 7 8 9 Passing Grad: Palpation (iliac crests, ASIS, PSIS, ischial tuberosity, greater trochanter and bursae, SI joint, pubic symphysis) Screen lumbar spine AROM (flex, ext’n, rotation, side flexion) Hip AROM with goniometer (flex, ext’n, ABD, ADD, IR, ER) Hip PROM (IR, Ext’n) Hip strength testing (flex, ext’n, ABD, ADD, IR, ER) Dermatomes L2-S2 (light touch) 10 Myotomes L2-S1 11 Reflexes x2 (patellar, Achilles) 12 Special test: FABER’s 17 PTT records findings in the patient’s chart Overall Assessment: PASS Student’s Signature Date: FAIL Assessor’s Signature