Therapeutic Skill Scenarios For Practical Examination

Therapeutic skill scenarios for practical examination Examination card: 1

You are a physiotherapist involved in the rehabilitation of a 60 year old female who has recently had a left hip arthroplasty. Demonstrate a simple post-operative exercise plan to prevent post-operative secondary complications and promote functional recovery (prior to the mobilization of the patient out of bed) Assist this patient to sit on the side of the bed, and then teach this patient how to use a walking frame. With an emphasis on both hips, analyse the components of movement taking place during one gait cycle.

Examination card: 2 You are working in a stroke/neurorehabilitation unit. A 65 year old gentleman with a right–sided hemiplegia needs to be transferred from a wheelchair to an adjustable plinth for therapy. Although the patient has asymmetry of posture, the patient can weight transfer in the sitting position and is able maintain their trunk over base of support. Standing does form part of the therapy. The right arm remains flaccid and the patient is slumped in the wheelchair. •

Demonstrate an appropriate transfer (to include a stand). A sitting position on the side of the plinth is the finish position.

•

With your patient safely positioned on the side of the plinth, facilitate the removal of this patient’s footwear

•

Analyse the activity occurring at the lumbar spine and hip joint as the patient removes the shoe from the unaffected leg.

Examination card: 3 •

Measure the proper fit of axillary crutches for a 40-year old female who can be discharged from in-patient care, but has been advised not to take weight through the right leg following open reduction and internal fixation of a fractured tibia and fibula.

•

Non-weight bearing of the right lower limb is advocated. Teach your patient to use the axillary crutches safely using an appropriate gait pattern. This also includes the ascent and descent of stairs.

•

With an emphasis on the hip, knee and ankle of the unaffected left limb analyse the activity of sit to stand.

Examination card: 4 You are working in an outpatient department. A 35 year old adult with a T12 complete spinal cord lesion uses a wheelchair for indoor/outdoor mobility. They are usually able to transfer independently from the wheelchair onto a bed/plinth. However, he /she has developed a stiff painful left shoulder and is finding this transfer difficult. The therapist decides to use a sliding transfer board. •

Demonstrate how you would transfer a patient from a wheelchair onto the side of the plinth using the transfer board and an assistant. This patient has some sitting ability.

•

Support him /her into an appropriate position in preparation for the application of a hot pack and then apply the hot pack to the patients left shoulder

•

Analyse the activity occurring in the right shoulder (glenohumeral joint) as the patient helps remove their top (over their head) in preparation for the application of the hot pack. Start position: arm by side, finish position, arm by side.

Examination card: 5 You are working in a ward setting. A patient who has had abdominal surgery on the previous day requires moving from a supine lying position into a supported sitting position in order to improve respiratory function. The patient is able to understand commands and can help a little. •

Demonstrate an appropriate move making use of the Philislide. You have an assistant to help.

•

Teach this patient a simple regime of leg exercises to reduce the danger of postoperative complications

•

Analysis of moving and handling principles. Using your models, articulate to the examiner the principles of safe and efficient moving and handling that have been incorporated into the various phases of the procedure you have just demonstrated. Reference should be made to biomechanical and ergonomic principles and should include both static and dynamic phases.

Examination card: 6 You are working on a medical ward. A patient has had a stroke with a flaccid left sided hemiplegia. When you arrive the patient is lying unsupported in a poor postural position on their right side. •

Using pillows/ towels and appropriate handling, demonstrate how you would position this patient so he/ she is lying in a supported position on their right side. The patient is conscious but unable to help

•

Using philislides then turn the patient onto their left side

•

From this sidelying position, analyse the activity occurring at the shoulder girdle/ shoulder complex , as the patient is encouraged to pick up a tissue from the bedside locker.

Examination card: 7 You are working in an outpatient clinic. Massage to right the lower limb has been advocated for a patient with an oedematous lower limb following soft tissue trauma. •

With your patient safely positioned on the plinth demonstrate appropriate massage techniques to reduce oedema in the lower limb

•

Teach this patient to use walking sticks (partial weight bearing gait pattern)

•

With an emphasis on pelvic activity (the lumbar region of the vertebral column and the hip joint) analyse the activity of sit to stand ( left-side)

Examination Card : 8 You are working in a rehabilitation unit; a patient needs to be hoisted from their wheelchair onto a plinth for therapy. This includes passive movements Examination card: 9

• Demonstrate how you would hoist this patient onto the plinth. The patient needs • to end up in a lying position ready for you to passively move the lower limbs Examination card: 9 • Demonstrate passive movements of both lower limbs With an on thea axial components the functional activity •• Teach theemphasis above patient method to relieve analyse weight from the buttock area. of rolling from supine to side-lying.

Examination card: 9 You are a physiotherapist working on a vascular surgical ward. A 65 year old gentleman has recently had a left below knee amputation as a result of peripheral vascular disease and diabetes mellitus. Demonstrate a post-operative physiotherapy management plan to prevent postoperative secondary complications and promote functional recovery of this patient (prior to out-of-bed mobilization) Teach this patient to transfer from the bed into a wheelchair With an emphasis on the shoulder(glenohumeral joint) and elbow of the leading arm analyse the above transfer.

Examination card: 10 A 25 year old female has soft tissue trauma to the lateral ligament of the ankle following a fall. Demonstrate how you would apply cryotherapy (an ice pack) to help manage tissue swelling Teach your patient how to use elbow crutches using a partial weight-bearing gait pattern. The ascent and descent of stairs should be included. Analyse the functional activity of step-up. Start position: both feet flat on stair one, finish position: both feet flat on stair two. Emphasis- both hips.

Examination card: 11 A 35 year old female with multiple sclerosis has weak lower limbs. She uses elbow crutches indoors and a wheelchair for outdoor mobility. •

Teach this patient a simple active/active assisted exercise regime (using a mat on the floor) to help maintain range of movement, flexibility and strength in the lower limb.(Focus on the hips and knees)

•

Assist the patient to get into the wheelchair from the floor and then teach a relative of the above patient how to ascend and descend a kerb with the wheelchair

•

Analyse the activity involved in self propelling the wheelchair, with particular emphasis on the left shoulder (glenohumeral joint) and the left elbow.