Student Name and Number
Assessor’s Name
Passing Grad:
Physical Therapist Technician
PC 002 Final Clinical Assessment
Upper 1
Materials
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
Patient case study
Pen
Paper (checklist for assessor and blank for student)
Assessment materials:
I. Goniometer
II.
Reflex hammer
III.
Kleenex
Treatment materials:
I. Ultrasound machine
II.
Ultrasound head and wire
III.
Gel
Pillows
Towels
Plinth
Hand sanitizer
Simulated patient
Facility Instructions
This PC 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 PC: 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 5 minutes to prepare the room and equipment. They will then have 30
minutes to perform the given task(s). Student will complete this PC with due regard to all safety
procedures ensuring they ask about contraindications/precautions to which the simulated
patient will have none.
Student Name and Number
Assessor’s Name
Passing Grad:
Grading Scheme
This PC consists of a pass/fail checklist. The student must perform all points on the checklist to
successfully pass this PC. If they are not successful, they must be tested again.
Instructions For Simulated Patient
Subjective History Information:
Chief complaint is left elbow pain. Diagnosed with lateral epicondylitis by the doctor today. Has
been having left elbow pain for 4 months now. No specific trauma or event that caused the
pain. Intermittent pain is localized slightly below the lateral epicondyle and aggravated by
lifting, gripping and using a screwdriver. Pain is temporarily decreased to an ache with ceasing
the activity, resting the arm and stretching the forearm. The pain is sharp and throbbing and
sometimes radiate down the forearm to the wrist. On a scale of 1-10, pain is a 8/10 at its worse
and 2/10 at its best. Has tried taking NSAID and it does provide some mild relief. No previous
elbow issues or injuries. Occupation is a cook. Does a lot of chopping, cutting and stirring. Plays
tennis in his spare time. Consents to the objective exam.
Special Questions:
o Do symptoms change (better or worse) with any movements of the neck or shoulder?
o NO
o Does the elbow ever “slip out” or feel unstable?
o NO
o Does the pain change with gripping activities?
o YES- worse with gripping
o Do you ever experience numbness of tingling in the hand?
o NO
o Was the elbow hyper extended during the time of injury?
o NO
o Do you relate the symptoms to a throwing activity?
o NO
Red Flag Questions:
o Infection/Inflammation - NO
o Malignancy - NO
Student Name and Number
Assessor’s Name
o
o
o
o
o
o
Passing Grad:
Fracture/Dislocation - NO
Inflammatory Arthritides - NO
Abnormal Vitals- NO
Abnormal Vascular/Neurological Exam- NO
Heterotopic Ossification (Post-Surgical Consideration) - NO
Inappropriate progress from treatment made after surgery - NO
Objective Exam Information:
o Slight forward head posture with rounded shoulders
o On palpation, tenderness over lateral epicondyle and ++tenderness over wrist extensor
tendon origin
o Neck AROM: full and pain free
o Shoulder AROM: Full and pain free
o Wrist AROM: Full, pain with end range flexion
o Elbow AROM: Full, mild pain with ext’n
o Elbow strength testing: 5/5 flex and ext’n
o Neuro exam: Normal dermatomes, myotomes, reflexes
o Special test:
o –ve Middle finger test
o +ve Mill’s with pain throughout left forearm
o +ve Cozen’s with ++pain over lateral epicondyle
o –ve Chair lift test
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 5 minutes
to review the case and 30 minutes to perform the assessment and the treatment. All the
materials that you will need for the assessment will be provided for you.
Scenario 1
A 45 year old male is referred to physical therapy for left lateral epicondylitis. Perform the
subjective and objective examination. Then manage the patient’s condition with ultrasound
according to the following parameters:
-1mHz
-0.8 w/cm2
-Pulsed cycle at 50%
-5 minute treatment time
Student Name and Number
Assessor’s Name
Passing Grad:
Physical Therapist Technician
Subjective and Objective Assessment
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 (neck, axilla, chest wall,
shoulder, arm, carrying angle)
YES NO
COMMENTS
Student Name and Number
Assessor’s Name
Passing Grad:
4
Palpation (lateral and medial
epicondyles, radial head, wrist
extensors origin)
5 Screen C/S AROM (flex, ext’n, side
flex, and rotation)
6 Screens shoulder AROM (flex, ext’n,
ABD, ADD, IR, ER)
7 Screens wrist AROM (flex, ext’n,
pronation, supination, radial and
ulnar deviation)
8 Elbow AROM with goniometer (flex,
extension)
9 Isometric strength testing at elbow
(flex, ext’n)
10 Dermatomes C1-T1 (light touch)
11 Myotomes C5-T1
12 Reflexes x3 (biceps, triceps,
brachioradialis)
13 Special test: Middle finger
14 Special test: Mill’s test
15 Special test: Cozen’s test
16 Special test: Chair lift test
17 PTT records findings in the patient’s
chart
Overall Assessment:
PASS
Student’s Signature
Date:
FAIL
Assessor’s Signature
Student Name and Number
Assessor’s Name
Passing Grad:
Physical Therapist Technician
Treatment Administration
Clinical Assessment
CHECKLIST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Confirm patient identification and
diagnosis
Confirm patients chief complaint
Identify appropriate treatment plan
as per initial assessment
Confirm patient has no
contraindications
Identify any precautions to
treatment
Explain the benefits of the chose
therapy to the patient
Obtain patient consent
Use appropriate infection control
procedures for patient care (hand
washing and equipment cleaning)
Perform sensation testing
(hot/cold)
Appropriately position the patient
for treatment
Appropriately drape the patient for
treatment
Prepare the modality for treatment
(plug in, ensure working properly)
Correctly position the modality on
the patient for treatment
Select the correct modality settings
(frequency, intensity, time)
Instruct the patient on expected
sensations during treatment
Start modality and time
YES NO
COMMENTS
Student Name and Number
Assessor’s Name
Passing Grad:
17 Monitor the patient during
treatment
18 Turn off/remove the modality
19 Clean the patient’s treatment area
and the modality as required
20 Inspect patient’s skin for adverse
effects
21 Verify the patient’s response post
treatment
22 Provide patient with any advise and
instructions post-treatment
Overall Assessment:
PASS
Student’s Signature
Date:
FAIL
Assessor’s Signature