pth240 su2015...a. muscle weakness or paralysis b. joint muscle rom limitation c. unequal leg length...

Reviewed by PTA Faculty 5/4/2015 1 Reviewed & Approved : GMLevicki, May 2015

Technical College of the Lowcountry Instructor: TBA 921 Ribaut Rd. Contact Information : TBA Beaufort, SC 29901

PTH240 Therapeutic Exercise/Application

SU2015

Course Description PTH 240 Therapeutic Exercises/Applications Credit: 5.0, Lecture: 4 (60 hrs – 10 hrs/wk) Lab: 3 (45 hrs - 7.5 hrs/wk) Prerequisites: PTH 101, PTH 202, PTH 205, BIO 211, ENG 102 Co-Requisites: PTH 242, PTH 252 Course Focus This course provides the practical application of therapeutic exercise, goniometry and manual muscle testing. The use of various therapeutic exercise and data collection techniques by the physical therapist assistant is presented and practiced within the context of the plan of care developed by a licensed physical therapist. Students practice concepts related to patient education, appropriate communication, and documentation of patient care activities. Text and References

1. Higgins, M. Therapeutic Exercise: from Theory to Practice. Philadelphia: F.A. Davis; 2011. 2. Graves, RA. Clinical Decision Making for the Physical Therapist Assistant. Philadelphia: FA Davis;

2013. 3. Clarkson, H. Musculoskeletal Assessment: Joint Motion and Muscle Testing, 3rd Ed. Philadelphia:

Lippincott Williams & Wilkins; 2013. 4. Lippert LS. Clinical Kinesiology and Anatomy. 5th ed. Philadelphia, PA: F. A. Davis Company; 2011. 5. Bar Chart Physical Therapy (in book store)

Course Objectives At the completion of this course, students will: General:

1. Read a research article that pertains to therapeutic exercise. 2. Write a summary of the research article published in a peer reviewed journal related to physical

therapy assessment. 3. Complete all tests and measures in the APTA Balance Score Sheet. 4. Apply knowledge of body mechanics, pain assessment, vital signs, and patient safety to

therapeutic exercise strategies. 5. Use the SOAP note format to document the provision of physical therapy interventions as

directed by the plan of care. 6. Educate others in therapeutic exercise programs.


7. Be able to identify swing and stance components of gait and the major muscle activity that occurs at each joint

UNIT 1: Gait Analysis

1. Define and utilize appropriate terminology relating to gait. 2. Describe key components (joint ROM and muscle action) that occur during the stance and swing phases of gait. 3. Review determinants that affect gait (displacement of center of gravity, width of base, lateral pelvic tilt, and arm swing). 5. Recognize key qualities of typical gait that occur both with young children and elderly adults. 6. Identify or describe common atypical gaits caused by the following:

a. Muscle weakness or paralysis b. Joint muscle ROM limitation c. Unequal leg length

UNIT 2: Introduction to Exercise Principles

1. Describe the elements of the physical therapy patient management process. 2. Recognize the role of the PTA in patient assessment. 3. Define terms related to exercise and muscle function. 4. State basic principles related to therapeutic exercise. 5. State basic principles related to motor learning. 6. Apply basic principles related to motor learning to patient situations. 7. Relate physical therapy practice to models of disablement. 8. Distinguish between pathology, impairment, functional limitation, and disability. 9. Recognize contextual factors (social determinants of health) that may influence outcomes. 10. Compare the Nagi and ICF Models of Disablement. 11. Relate rehabilitation to functional outcomes. 12. Identify strategies to enhance patient compliance.

UNIT 3: Aquatic Exercise

1. Define terms related to the properties of water. 2. Explain physiological responses to immersion in water. 3. Apply the properties of water to therapeutic exercise techniques. 4. List precautions and contraindications to aquatic exercise.* 5. Incorporate the use aquatic therapy with stretching techniques. 6. Incorporate the use of aquatic therapy with resistance training. 7. Differentiate uses of different aquatic exercise equipment. 8. State advantages and disadvantages of aquatic therapy. 9. Recognize indications for aquatic therapy

UNIT 4: ROM

1. Differentiate between passive ROM exercise, active assistive ROM exercise, active ROM exercise, and active resistive ROM exercise.

2. Identify techniques used to perform self-ROM. 3. State normal ROM values for the joints of the upper and lower extremities. 4. Identify functional ROM for the joints of the upper and lower extremities. 5. Recognize patterns of substitution used to simulate increased ROM.


6. Review & identify normal joint end-feels. 7. State the goals of ROM exercises. 8. State contraindications to ROM exercises.* 9. Demonstrate PROM utilizing correct hand placement and body mechanics.

UNIT 5: Data Collection Techniques: Goniometry

1. State the purpose of goniometry in physical therapy. 2. Explain the principles of goniometry. 3. Define reliability and validity with regards to assessment instruments. 4. Sate reliability values for the universal goniometer. 5. Identify techniques and practices used to increase reliability of goniometric measurements. 6. Demonstrate correct alignment the goniometer when measuring joint ROM. 7. Demonstrate effective stabilization techniques during goniometric measurements. 8. Accurately perform goniometric measurements of the shoulder, elbow, wrist, hip, knee and ankle.* 9. Correctly document the results of goniometry assessment.

UNIT 6: Data Collection Techniques: Manual Muscle Testing

1. State the purpose of manual muscle testing in physical therapy. 2. Explain the principles of manual muscle testing. 3. Describe concepts related to the reliability and validity of manual muscle testing. 4. Define muscle test grades. 5. Demonstrate correct positioning and grading when performing manual muscle tests. 6. Demonstrate effective stabilization techniques when preforming manual muscle tests. . 7. Accurately perform manual muscle tests of the shoulder, elbow, wrist, hip, knee and ankle.* 8. Correctly document MMT assessment.

UNIT 7: Increasing Flexibility

1. Define terms related to muscle flexibility. 2. Relate hypomobility to soft tissue shortening. 3. Explain the physiological responses to stretching exercises. 4. List the contraindications and precautions to muscle stretching.* 5. Devise age appropriate muscle stretching techniques 6. Evaluate various techniques used to increase muscle flexibility. 7. Demonstrate effective muscle stretching techniques utilizing correct hand placement and body

mechanics. 8. Effectively incorporate the use of cold and heat to a muscle stretching intervention. 9. Incorporate interventions to increase muscle flexibility into a physical therapy session as directed by

the plan of care. UNIT 8: Principles of Resistance Training

1. Define terms related to resistance training. 2. Explain basic concepts related to the force of muscle contraction. 3. Explain the clinical implications of slow twitch and fast twitch muscle fibers. 4. Explain physiological responses to resistance training. 5. Assess patient responses to resistance training. 6. Describe the effects of aging on muscle strength. 7. Determine methods to progress resistance training programs.


8. Compare isometric, isotonic and isokinetic forms of resistance training. 9. Compare open-chain versus closed-chain resistance training. 10. State appropriate treatment parameters for different types of resistance exercise. 11. Evaluate different equipment used for resistance training including elastic bands, free weights, and

resistance machines. 12. Compare progressive resistance training protocols including Delorme, Oxford, and DAPRE. 13. Identify contraindications and precautions to the use of resistance training.* 14. Recognize issues pertaining to patient safety during resistance training. 15. Apply basic physical principles related to the use of resistance training as a physical therapy

intervention including stabilization, positioning, and posture. 16. Provide basic patient education related to resistance training. 17. Relate therapeutic exercise to functional outcomes. 18. Demonstrate strengthening exercise techniques using elastic bands, free weights, body parts or

household items in open and close chain for the UE & LE. 19. Incorporate interventions to increase muscle strength into a physical therapy session as directed by

the plan of care. UNIT 9: Balance Assessment and Exercise

1. Define key terms related to balance. 2. Explain the role of different sensory systems in balance control 3. Assess balance using the Berg Balance Test, Functional Reach Test, and Timed Up and Go Test. 4. Recognize strategies used to maintain balance. 5. Identify causes of impaired balance. 6. Describe the effects of aging on balance. 7. Devise age appropriate balance programs. 8. Describe intervention techniques used to treat balance impairments 9. Determine methods to progress balance training programs. 10. List fall prevention strategies for home safety. 10. Demonstrate patient monitoring during intervention activities related to balance training.* 11. Incorporate interventions to improve balance into a physical therapy session as directed by the plan

of care. 12. Appropriately document balance to accurately reflect the provision of physical therapy intervention

as directed by the plan of care. UNIT 10: Aerobic Conditioning and Re-Conditioning

1. Define terms related to aerobic conditioning and re-conditioning. 2. Differentiate between aerobic and anaerobic activities. 3. Explain physiological and psychological responses to aerobic exercise programs. 4. Describe physiological adaptations to aerobic conditioning. 5. Assess patient reactions to aerobic exercise.* 6. State the ACSM recommended activity level for adults and children. 7. Employ recommended parameters of exercise related to the use of aerobic conditioning and re-

conditioning. 8. Recognize different levels of activity as defined by MET. 9. Practice aerobic conditioning exercises. 10. State contraindications and precautions to the use of aerobic conditioning and re-conditioning

exercises.*


11. Incorporate interventions to increase aerobic conditioning into a physical therapy sessions as directed by the plan of care.

12. Utilize select data collection measurements to correctly assess aerobic condition and response to exertion.

UNIT 11: Relaxation Exercises

1. Describe different relaxation techniques. 2. Explain the theories of physiological relaxation responses. 3. Identify physical indicators of a relaxed state 4. Identify precautions to relaxation exercises* 5. Recognize modalities used to aid in muscle relaxation

Student Contributions Each student is required to actively participate in laboratory sessions by practicing the application of various skills on fellow classmates. Appropriate and professional behavior is expected at all times in the laboratory setting. Shorts and a T-shirt are the required attire for all laboratory activities. A sweatshirt or sweatpants may be worn over these if such clothing does not interfere with the laboratory activities. Clothing must allow access to various parts of the body during specified laboratory activities. Course Schedule Lecture: TBA Lab: TBA Graded Materials Midterm Exam 100 points Cumulative Final Exam 200 points Midterm Practical Exam 100 points Final Practical Exam 100 points Article Review 50 points 5 Lab Quizzes @ 10 pts each 50 points Case Study Questions 65 points Competency Skills Check 60 points (15 points each) (MMT/ROM/Therex/Flexibility) SOAP Note (MMT/ROM/Therex/Flexibility) 40 points (10 points each) Total 765 points GRADING POLICY

Grading scale

90% - 100% A 82% - 89% B 75% - 81% C 70% - 74% D Below 70% F

W withdraw WP withdraw with passing grade WF withdraw with failing grade I Incomplete

Refer to addendum for further grading information pertaining to this course. Grading Methodology. For the didactic portion, order to pass the class and progress in the program, the

student must pass the final examination with a grade of 75.00% or above AND the final grade must be


75.00% or more. Rounding will not be used to assess or determine the final grade. If a student fails the

final examination a second attempt will be given. The highest score a student can achieve on the second

attempt is 75% and the final grade for the examination only will be a C. If the student fails the final

examination on the second attempt, the student will not pass the course, and therefore will not be able

to progress in the program. Students absent from an examination/test/quiz or presentation will receive

a “0” grade for the examination/test/quiz unless other arrangements are made with the individual

instructor prior to the examination/test/quiz or presentation day or on the examination/test/quiz or

presentation day before the examination/test/quiz/presentation is scheduled to be given. It is the

responsibility of the student to contact the appropriate instructor to arrange to make up the

examination. Arrangements may be completed by telephone. If the instructor is not available, a

message should be left on the instructor’s voice mail AND with another member of the faculty or

administrative assistant. The instructor will decide the time and method of make-up

examination/test/quiz/presentation on an individual basis. Messages sent by other students are

unacceptable. The student is responsible for notifying the instructor of the reason for the absence.

Grades are posted on Blackboard within one week of administration of tests and examinations.

Each student must demonstrate safety and competence in required laboratory skills. Students are

responsible for insuring that laboratory skills are checked off by the instructor. All laboratory skills must

be passed with a minimum score of 75% in order to pass the course and progress in the program.

Students will be given two opportunities to pass each skill check. The highest score a student can

achieve on the second attempt is 75% and the final grade for the skill check only will be 75%. In

addition, the student must pass the final practical examination (score 75% or greater) in order to pass

the course. Should the student fail the final practical examination, the student will be given one

opportunity to retake the final practical examination. If the student fails the final practical examination

on the second attempt, the student will not pass the course, and therefore will not be able to progress

in the program. The highest possible score on retaking the final practical examination is 75.00%. Non-

compliance with a critical safety criterion will result in an automatic failure on skills checks as well as

practical examinations.

In summary, to pass the course and progress in the program the student must meet all 4 criteria:

1. pass the final examination with a grade of 75.00% or above 2. pass the final practical examination with a grade of 75.00% or above 3. pass All competency skill checks with a grade of 75.00% or above 4. the final grade for all course evaluation methods must equate to a grade of 75.00% or above


TEST REVIEW Tests will be reviewed in class and discussion will be limited to the right answer. Students will not be allowed to take any written notes, use electronic devices to take notes or make an image of the tests. All items have to be removed from the desk/table top during the test review. For any discussion beyond the right answer, set up an appointment with the instructor to further discuss. Prior to the final exam, test review will be done during the last class of the semester. All items have to be removed from desk/table top during the test review. No notes can be taken and no electronic devices can be used to take notes or make images of the tests. This is an opportunity to ask questions about concepts that you do not understand. If individualized time is need for test review, an appointment can be made with the instructor, but not during exam week and the time limit will be 10 minutes. All tests will be reviewed under the supervision of an instructor. Students cannot bring any class notes with them. ADA STATEMENT The Technical College of the Lowcountry provides access, equal opportunity and reasonable accommodation in its services, programs, activities, education and employment for individuals with disabilities. To request disability accommodation, contact the counselor for students with disabilities at (843) 525-8219 or (843) 525-8242 during the first ten business days of the academic term. ATTENDANCE

1. The College’s statement of policy indicates that students must attend ninety percent of total class hours or they will be in violation of the attendance policy.

2. Students not physically attending class during the first ten calendar days from the start of the semester must be dropped from the class for NOT ATTENDING.

3. Students taking an online/internet class must sign in and communicate with the instructor within the first ten calendar days from the start of the semester to indicate attendance in the class. Students not attending class during the first ten calendar days from the start of the semester must be dropped from the class for NOT ATTENDING.

4. Reinstatement requires the signature of the division dean. a. In the event it becomes necessary for a student to withdraw from the course OR if a student

stops attending class, it is the student’s responsibility to initiate and complete the necessary paperwork. Withdrawing from class may have consequences associated with financial aid and time to completion.

b. When a student exceeds the allowed absences, the student is in violation of the attendance policy. The instructor MUST withdrawal the student with a grade of “W”, “WP”, or “WF” depending on the date the student exceeded the allowed absences and the student’s progress up to the last date of attendance or

c. under extenuating circumstances and at the discretion of the faculty member teaching the class, allow the student to continue in the class and make-up the work. This exception must be documented at the time the allowed absences are exceeded.

d. Absences are counted from the first day of class. There are no "excused" absences. All absences are counted, regardless of the reason for the absence.

5. A student must take the final exam or be excused from the final exam in order to earn a non-withdrawal grade.


6. Students are expected to be in class on time. Arrival to class after the scheduled start time or leaving class prior to dismissal counts as a tardy. Three tardies and/or early departures are considered as one absence unless stated otherwise. Instructor must be notified prior to start of class by call, text or email if the student is going to be late.

7. It is the student's responsibility to sign the roll sheet (if used) or verify attendance with instructor upon entering the classroom. Failure to sign the roll/verify attendance results in a recorded absence. In the event of tardiness, it is the student’s responsibility to insure that attendance is marked. The student is responsible for all material/ announcements presented, whether present or absent.

8. Continuity of classroom and laboratory (which includes clinical experiences) is essential to the student’s progress in providing safe and competent patient care. Students are expected to use appropriate judgment for participating in clinical activities. To evaluate the student’s knowledge and skills, it is necessary for the student to be present for all classroom, laboratory and clinical experiences. If absence does occur, the designated instructor, other core faculty, or the Division of Health Sciences administrative assistant (in that order), must be notified by telephone no later than 30 minutes prior to the start of class, lab or clinical experiences. The Division of Health Sciences telephone number is 843-525-8267.

A copy of TCL’s STATEMENT OF POLICY NUMBER: 3-1-307 CLASS ATTENDANCE (WITHDRAWAL) is on file in the Division Office and in the Learning Resources Center. HAZARDOUS WEATHER In case weather conditions are so severe that operation of the College may clearly pose a hardship on students and staff traveling to the College, notification of closing will be made through the following radio and television stations: WYKZ 98.7, WGCO 98.3, WGZO 103.1, WFXH 106.1, WWVV 106.9, WLOW 107.9, WGZR 104.9, WFXH 1130 AM, WLVH 101.1, WSOK 1230 AM, WAEV 97.3, WTOC TV, WTGS TV, WJWJ TV, and WSAV TV. Students, faculty and staff are highly encouraged to opt in to the Emergency Text Message Alert System. www.tcl.edu/textalert.asp ACADEMIC MISCONDUCT There is no tolerance at TCL for academic dishonesty and misconduct. The College expects all students to conduct themselves with dignity and to maintain high standards of responsible citizenship. It is the student’s responsibility to address any questions regarding what might constitute academic misconduct to the course instructor for further clarification. The College adheres to the Student Code for the South Carolina Technical College System. Copies of the Student Code and Grievance Procedure are provided in the TCL Student Handbook, the Division Office, and the Learning Resources Center. Health care professionals hold the public trust. Academic misconduct by health science students calls that trust into question and academic integrity is expected. It is a fundamental requirement that any work presented by students will be their own. Examples of academic misconduct include (but are not limited to):

1. copying the work of another student or allowing another student to copy working papers, printed output, electronic files, quizzes, tests, or assignments.

2. completing the work of another student or allowing another student to complete or contribute to working papers, printed output, electronic files, quizzes, tests, or assignments.

http://www.tcl.edu/textalert.asp


3. viewing another student’s computer screen during a quiz or examinations. 4. talking or communicating with another student during a test. 5. violating procedures prescribed by the instructor to protect the integrity of a quiz, test, or

assignment. 6. plagiarism in any form, including, but not limited to: copying/pasting from a website,

textbook, previously submitted student work, or any instructor-prepared class material; obvious violation of any copyright-protected materials.

7. knowingly aiding a person involved in academic misconduct. 8. providing false information to staff and/or faculty. 9. entering an office unaccompanied by faculty or staff. 10. misuse of electronic devices.

If academic misconduct is suspected student will be referred to Dean of Students which may result in a zero for the grade pending due process. Additional Instructors Lab: TBA


PTH 240 Therapeutic Exercise/Application Laboratory Skills Achievement List

1. Goniometry, Manual Muscle Testing, Stretching Shoulder Abduction Flexion/extension Int/Ext rotation Elbow Flexion/extension Forearm Pronation/supination Wrist Flexion/extension Radial/Ulnar deviation

Hip Flexion/extension Abduction/adduction Int/Ext rotation Knee Flexion/extension Ankle Dorsiflexion/plantar flexion Foot Inversion/Eversion

2. Therapeutic exercise program for a major muscle groups causing the motion at joints above Review Surface Anatomy at the beginning of each chapter for shoulder, elbow, wrist & hand; hip, knee, ankle & foot in the Coleman book as well as muscle OIAN within the chapter. .

11 Reviewed by PTA Faculty 5/4/2015 Reviewed & Approved : GMLevicki, May 2015

Course Schedule may need to be adapted to the availability of the instructor for SU2015 semester.

Date Lecture Topic Readings Assignments Labs

5/26 T 1-430pm

Review Syllabus 1:00-1:30 Gait: Analysis

Lippert Chapter 22 pp.339-352

Gait Lab

5/27 W Unit 2: Exercise Principles Part 1

Higgins Chapter 1

Unit 2 #8 Via Case Studies Unit 2 #13

5/28 Th Unit 2: Exercise Principles Part 2

Higgins Chapter 1 8:30am-9:30am

5/28 Th Unit 3: Aquatics Higgins Chapter 12 At the Y: 9:50 am-12 noon

5/29 F Unit 4: ROM UE Higgins Chapter 4 Clarkson pp.6-11; 133-139;171-179; 249-259 (fxnl ROM) Clarkson pp.66-67;

Unit 4 #4 ppt Handout from Lippert UE ROM: Clarkson pp.73-88; 145-148; 190-194; 201; 204; 206; 208

6/1 M Unit 4: ROM LE Higgins Chapter 4 Clarkson pp.12-31 310-315;339-343; 395398 (fxnl ROM)

Unit 4 #s 5 & 9 Clarkson 266-268; 270-271; 273; 274; 322;350-351;357;360; 362;364;366; 368

6/2 T Lab Quiz 1: Units 1-4 ROM Competency Skill Check

6/3 W Unit 5: Goniometry Higgins Chapter 4 SOAP Note for ROM due 6/3 8a

Unit 5 #6, #7, 8 UE UE Goni: Clarkson 89-93; 149-154;195-200; 201-203; 205;207; 209;210

6/4 Th Unit 5: Goniometry Higgins Chapter 4 Unit 5 # 8 LE LE Goni: Clarkson 269;272; 273;275-277; 278-285; 323; 327-331; 352-354; 358-359;361; 363;365; 367; 369; 370-372

6/5 F Unit 6: MMT Clarkson pp.32-51 MMT UE Unit 6 #7 Clarkson 94-132; 155-170; 211-248

6/8 M Unit 6: MMT MMT UE/LE Unit 6 #7

6/9 T Lab Quiz 2: Units 5-6 (MMT UE) MMT LE Unit 6 #7 Clarkson 288-309; 333-338; 376-394

6/10 W Unit 7: Flexibility Higgins Chapter 5 MMT Competency Skill Check UE: 717 Hip, Knee, Ankle: 435-437 Hip: 491-497 Knee: 379-383 Ankle: 303-308

6/11 Th Unit 7: Flexibility Higgins Chapter 5 SOAP Note for MMT due 6/11 8a

Unit 7#7


6/12 F Unit 7 & Review Unit 7 #7

6/15 M Midterm Exam Units 1-7 Flexibility Competency Skill Check

6/16 T Midterm Practical: SOAP Note for Flexibility due 6/16 1p

6/17 W Unit 8: Resistance Training Higgins Chapter 7, 10 Article Review Due 5:30pm

Unit 8 #15 UE: 718-729

6/18 Th Unit 8: Resistance Training Higgins Chapter 7-8 Unit 8 #15 Core: 165-180 Clarkson 475-482 Clarkson 483-489 (fxnl ROM)

6/19 F Unit 8: Resistance Training Higgins Chapter 9 Unit 8 #15 LE - Hip 500-509

6/22 M Unit 8: Resistance Training Higgins Chapter 10 Unit 8 #15 LE - Knee 445-449

6/23 T Lab Quiz 3: Unit 8 Therex Training Competency Skill Check

6/24 W Unit 9: Balance Assessment & Ex

Higgins Chapter 13 SOAP Note for Therex due 6/24 8a

Unit 9 #3 Knee: 394-398 Ankle: 312-315

6/25 Th Unit 9: Balance Assessment & Ex

Higgins Chapter 13 Review Balance Sheet Handout & Bring to Class

Unit 9 #3

6/26 F Unit 10: Aerobic Conditioning

Higgins Chapter 13 Aerobic Exercise Activities Unit 10 # 9 & 11

6/29 M Unit 10: Aerobic Conditioning

Higgins Chapter 13 Aerobic Exercise Activities Unit 10 # 12

6/30 T Lab Quiz 4: Units 9-10

7/1 W Unit 11: Relaxation Guest Lecture Denise Van Nostran

Relaxation Techniques

7/2 Th Ex Program: Devising & Progressing

Clarkson pp.55-62 UE

7/3 F School Closed for July 4th Holiday

7/6 M Ex Program: Devising & Progressing

LE

7/7 T Lab Quiz 5: Unit 11 & exercise progression

Case Study Questions Due 4:30p

Adult Fitness Examination Review as a class 4p-4:30p

7/8 W No Classes: Prepare for Exams

7/9 Th Final Exam 8:30-10:30

7/10 F Cumulative Final Practical Thurs 11:30a -12:30p & Friday 8:30a-11a


Technical College of the Lowcountry Division of Health Sciences Physical Therapist Assistant Program

Course Syllabus and /or Addendum Acknowledgement I __________________________________________ indicate by signing this document

that I have received a copy of the syllabus and/or addendum (if applicable) for PTH 240

for Summer 2015. I have also read the PTA Program Handbook, and Division

Handbook. My signature indicates that I understand and I have had an opportunity to

review and ask questions regarding the content of the syllabus and or addendum(s), if

applicable. I understand that this syllabus and/or addendum (if applicable), does not

constitute a contract and is subject to change without adequate notification.

_______________________________________ ____________________________

Student Signature Date

pth240 su2015...a. muscle weakness or paralysis b. joint muscle rom limitation c. unequal leg length...

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