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SAN JOSE STATE UNIVERSITY

UNDERGRADUATEATHLETIC TRAINING

EDUCATION PROGRAM

CLINICAL EDUCATION MODULES

ATHLETIC TRAINING STUDENT GUIDE TO COMPETENCY COMPLETION IN

KIN 197A, 197B, 197C, 197D andALL REQUIRED ATHLETIC TRAINING COURSES

SAN JOSE STATE UNIVERSITYUNDERGRADUATE

ATHLETIC TRAINING EDUCATION PROGRAM CLINICAL EDUCATION MODULES

The Undergraduate Athletic Training Education Program at San Jose State University requires a series of clinical experiences consisting of competencies and proficiencies. Competencies and proficiencies will be obtained through a number of experiences in the classroom, lab, and clinical/internship setting. This manual is divided into 4 sections related to internship courses: 197A, 197B, 197C and 197D. In order to complete the Athletic Training Education Program, each student will need to have each competency evaluated in all 4 sections of this manual. Approved Clinical Instructors (ACI) are the only individuals who can evaluate competence in each skill. Skill evaluation will include practice in labs, demonstration of competence and either an experience in the field or a scenario. Students are responsible to spend time outside classroom and internship experiences to ensure skill competence.

Students may advance through the manual at their own rate. Successful practice and then competence of each task must be demonstrated prior to skill performance in the clinical setting. Demonstration of skill performance should coincide with course completion. In order to progress through the internship process (197A to 197B, etc.) students must complete the required (labeled REQUIRED) skills in each section. Although it is preferred that students complete all proficiencies for each course, it is understood that some field/scenario proficiencies may be difficult to obtain. Thus, students have 4 semesters (197A, 197B, 197C and 197D) to complete these sections of the proficiencies.

Progress to program completion requires that all evaluations be completed by Approved Clinical Instructors (ACI) and recorded by the program director as an exit requirement.

DEFINITIONS:

Practice: Skill taught in class or lab and practiced either 1-on-1 with an ACI or peer, or in small peer groups.

Competence: Student demonstration of skill proficiency in an oral practical setting. This may occur in class, lab or internship classroom with an ACI.

Field/Scenario Competence: Demonstration of skill proficiency in a field setting or during internship classroom through a scenario oral practical with an ACI only.

Required: Proficiencies labeled required must be completed during the specified internship course (i.e. 197A, 197B, 197C and 197D) in order to receive a grade and progress to the next course.

NR: Proficiencies labeled NR required completion by the end of KIN 197D in order to receive signature for the Board of Certification (BOC) examination. It is strongly recommended that students complete these during the specified internship course (i.e. 197A, 197B, 197C and 197D), but it is not required to receive a grade and progress to the next course.

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Student Name

Program Entry Date

Program Completion

Program Director Print Name Signature Date

Clinical Coordinator Print Name Signature Date

Advisor (If different from above) Print Name Signature Date

ACI Print Name Signature Date







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CLINICAL PROFICIENCIES

KIN 197Aand

KIN 188/189

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KIN 197A - Internship in Athletic Training I

Competency Evaluation Sheet

All skills must be viewed, dated and initialed. Peers can evaluate Practice elements, while an ACI must evaluate Competence and Field/Scenario elements.

Separate sheets are provided for evaluation skills of head injuries. Each evaluation should be completed for practice, competence, and field/scenario elements. You must have a rating of 4 or above on the competence and field/scenario elements to pass

REQUIREDCompetency Practice Competence Field/Scenario

TAPING and WRAPPING Medial Longitudinal Arch Great Toe

- Valgus support - Varus support - Hyperextension/flexion

Ankle- Closed Basketweave- Open Basketweave- Basic preventative –inversion/eversion- Compression wrap with horseshoes- Achilles

MTSS- Circumferential taping

Quadriceps/Hamstring wrapping Adductor/Groin wrapping Hip Flexor wrapping Knee

- Valgus support (MCL)- Varus support (LCL)- Hyperextension- Compression wrap

Thumb- Hyperextension- Abduction- Combination- Check rein

Fingers- Buddy taping- Hyperextension/Hyperflexion

Elbow- Hyperextension- Varus/valgus- Hyperflexion- Compression wrap

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Wrist/Hand Taping- Ulnar/Radial deviation- Hyperflexion/Hyperextension- Wrist/Hand combination- General compression taping

Shoulder- Glenohumeral Spica wrap- Acromioclavicular joint

Lumbar support/bracing Cervical support/bracing Rib/Thorax support/bracing

REQUIRED NRPADDING/SPLINTING Materials (foams, felts, etc.) Friction pad Bony prominence/donut pad Muscle contusion Soft playing cast (silicone, thermofoam) Hard immobilization splint or cast (thermoplastics, plaster, fiberglass) Pre-fabricated splints

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REQUIREDRISK MANAGEMENT Use and interpret weight charts

ENVIRONMENTAL CONDITIONS Assess the following conditions and make participation recommendations Heat/Cold Temperature Lightning Wind Humidity (Sling-psychrometer)

REQUIRED NREMERGENCY ASSESSMENT Emergency Plan understanding

- Demonstration of proper preparation - Knowledge of procedures- Proper blood borne pathogen disease

prevention and disposal CPR certification First Aid certification

Check surroundings for physical and/or environmental hazards Triage Patient Assessment

- Primary survey (ABCD)- Control of bleeding- Vital signs (HR/RR/BP)- Level of consciousness (oriented x 4)

Shock Pulse: Identify the signs and symptoms of the following cardiac rhythms

- Tachycardia- Bradycardia- Arrhythmia

Respirations: Identify signs and symptoms of the following breathing patterns

- Apnea- Tachypnea- Dyspnea- Bradypnea- Hyperventilation- Obstructed airway – conscious- Obstructed airway – unconscious

Temperature- Oral- Axillary- Tympanic

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Skin- Color- Temperature

Diabetic Emergencies- Diabetic Coma- Insulin Shock

Fractures/Dislocations- Proper “packaging” for transportation- Guidelines for splint application

Spinal Cord Injury - Proper spine board techniques- Proper stretcher/sport chair use- Proper stabilization techniques

Splint- Vacuum splint- Moldable splint (Sam splint)

Transportation of injured individual using- Spine board- Sport chair- Manual techniques

Open Wound Management- Open vs. closed wound- Control bleeding- Wound cleansing principles- Apply superficial skin closures- Apply appropriate dressings- Apply and remove gloves and other

protective equipment- Properly dispose of biohazardous

waste Environmental Conditions – Identify signs and symptoms of the following:

- Heat syncope- Heat cramps- Heat exhaustion - Heat stroke- Hypothermia- Frostbite

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REQUIREDPHYSICAL EVALUATION Snellen eye chart Height Weight Skin (blemishes, rashes, moles, etc.)

EQUIPMENT, PADDING & BRACING Crutch Fitting - Instruct patient on use of crutches Cane Fitting - Instruct patient on use of cane

GENERAL MEDICINE Personal hygiene and health principles and guidelines Infectious disease transmission and prevention principles and guidelines

You must have a rating of 4 or above on the competence and field/scenario elements to pass

Please mark below with the following rating system:5 = Superior - distinctly more than expected of an athletic training student4 = Good – above average – better than expected3 = Average – expected performance2 = Fair – satisfactory performance1 = Poor – unacceptable performance

Competence Rating Date and Initial

Field/Scenario Rating Date and Initial

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KIN 189 Practical Examinations: Your oral practical examinations must be submitted to your portfolio.

Date & Initial

Case Study: One case study on a Lower Extremity injury of your choice must be completed according to the green sheet and placed in your portfolio. Each case study must include the following information:

Introduction of injuryRelevant anatomy Signs and symptoms of injuryEvaluation of injuryTreatment of injurySurgery (if applicable)Standard rehabilitation (if applicable)Summary

Date & Initial

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KIN 197A - Internship in Athletic Training I

FIELD DECISIONS - UNCONSCIOUS ATHLETE


REQUIRED NRCompetency Practice Competence Field/Scenario

Evaluate scene for safety

Summon Help - activate EMS

HistoryWhat was the mechanism of injury?Was the person unconscious? For how long?Prior history of CNS injuries or difficulty?

Suspect/Assume Cervical Spine Injury · Immobilize head/cervical spine · Check ABCDs (primary survey)

- Begin rescue breathing/CPR if necessary- Transport to hospital

· If primary survey benign, move to abbreviated secondary survey · Vital signs to establish baseline

- Pulse/Respirations/Blood Pressure- Serial evaluations

· Pupil response - PEARL

· Attempt to arouse victim – will awaken to: - Name

- Patting/tapping - Pain (pinch, rub, etc.)

· Nonverbal reaction to pain - Appropriate - Inappropriate - None

· Decerebrate/Decorticate Posturing

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REQUIRED NRFurther evaluation if awakens · Conscious and

- Oriented x four - Disoriented - Restless (inability to stay still)

· Speech - Clear - Rambling - Garbled - Combative - None

· Sensory/motor evaluation - Distal upper extremities - Distal lower extremities

You must have a rating of 4 or above on the competence and field/scenario elements to pass




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KIN 197A: Internship in Athletic Training I

FIELD DECISIONS - CONSCIOUS ATHLETE REMOVED TO ATHLETIC TRAINING ROOM

All skills must be viewed, dated, and initialed. Peers can evaluate Practice elements, while an ACI must evaluate Competence and Field/Scenario elements.


HistoryWhat was the mechanism of injury?Was the person unconscious? For how long?Prior history of CNS injuries or difficulty?

Baseline Information · Monitor vital signs - Normal values for vital signs and exercise considerations - Increasing pulse, decreasing BP = shock

- Increasing systolic/decreasing diastolic BP = increasing intercranial pressure

· Pain anywhere else/cervical spine injury? · Orientation x 4 (time, place, person, self) · Pupil response (PEARL) · Headache · Dizziness or vertigo · Facial expression (dazed, blank, etc.) · Nystagmus · Tinnitus · Amnesia

- retrograde defined/evaluated- anterograde defined/evaluated

· Cognitive function evaluation

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REQUIRED NRCranial Nerves

1. Olfactory - identify scent from each nostril2. Optic - visual acuity3. Occulomotor - constriction of pupil,

opening eyelid, eye adduction/downward roll

4. Trochlear – upward roll of eyes5. Trigmenial - clench teeth, palpate masseters,

facial sensation sharp vs. dull6. Abducens – lateral ocular movement7. Facial - raise eyebrows, close eyes tightly,

show teeth, frown, smiled, puff out cheeks8. Acoustic/Vestibulocochlear - test unilateral

hearing and balance

9. Glossopharangeal - say “ah”, swallow and watch for coordinated “curtain movement” of pharynx

10. Vagus - “gag” reflex11. Spinal accessory - upper trapezius/resisted shoulder shrug, sternomastoid/turn head against resistance12. Hypoglossal - stick out tongue, look for

asymmetry, deviation or atrophy

Palpation · Mastoid processes · Cervical spinous/transverse processes · Supraspinous ligament · Sternomastoids (O to I) · Trapezius (O to I) – upper/middle/lower fibers · Compare bilaterally

Ranges of Motion – Active, Passive and Resistive · Cervical flexion – chin to chest · Cervical extension – look straight above head · Lateral cervical flexion – approx. 45 degrees · Cervical rotation – chin/nose over acromion process · End feels for passive ranges · Strength grades for resistive ranges · Compare bilaterally

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REQUIRED NRNeurological Evaluation · Myotomes – C5-T1

- C5 - Shoulder abduction - C6 - Biceps curl/wrist extension - C7 - Triceps extension/wrist flexion - C8 - Finger flexion/grip strength- T1 - Finger abduction/adduction

· Dermatomes – C5-T1- C5 – Lateral arm- C6 – Lateral forearm, thumb, index finger- C7 – Posterior forearm, middle finger- C8 – Medial forearm, ring and little fingers- T1 – Medial arm

Circulatory Evaluation · Done previously by taking pulse · Skin color/temperature

Immediate First Aid · Ice · Support · Rest · ReferralFunctional Tests/Return to Play Considerations · Normal/pain-free ROM · Normal strength · Normal neurological function (sensory/motor) · Functional testing - movements specific to sport/position · Movements are fluid without an appearance of hesitation · Complete resolution of all symptoms of head injury

You must have a rating of 4 or above on the competence and field/scenario elements to pass.




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KIN 197B,KIN 191A and KIN 193

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KIN 197B: Internship in Athletic Training II



Separate sheets are provided for evaluation skills in the following areas. Each evaluation should be completed for practice, competence, and field/scenario. You must have a rating of 4 or above on the competence and field/scenario elements to pass.

History Hip Knee Ankle Foot Spine and Sacroiliac Joint


PROTECTIVE EQUIPMENT Football helmet fitting

- Types of helmets- Wet hair- Ear holes- Cheek pads- Forehead/eyebrow- Occiput- Bladder/padding conforming- Chinstrap- Facemask

Shoulder pads- Normal vs. cantilever style- Covers sternum- Covers acromion process/tip of

shoulder- Covers scapula- Anchors (straps/laces)

Rib brace/guard Mouthpieces

- OTC vs. custom Shoes

- Describe parts of shoe/how they work

- Fit (shoe types vs. foot types) Orthotics

- Types/Construction

TAPING and WRAPPING Patellar tracking (McConnell taping)

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Patellar support (patellar tendonitis)

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REQUIRED NRGENERAL MEDICINE

Recognize signs/symptoms of the following conditions- Hypertension- Hypertrophic cardiomyopathy- Hypotension- Migraine headache- Syncope

Recognize signs/symptoms of the following viral diseases- Infectious mononucleosis- Measles (rubeola)- German measles (rubella)- Mumps (parotitis)- Chicken pox (varicella)

Recognize signs/symptoms of the following systemic diseases- Iron-deficiency anemia- Sickle cell anemia- Lyme disease

ADMINISTRATION Record Keeping - Knowledge of and demonstrated ability to complete the following with confidentiality

- Injury reports (SOAP)- Daily record keeping/treatment log- Coaches reports- Progress notes - Rehabilitation charts- Emergency records- Insurance records- Physical examination records- Written/hard copies vs. electronic- Filing system/security

Insurance- Personal (professional liability)- University (primary vs. secondary

coverage)- Athlete (HMO/PPO/direct)- Procurement, claim processing

Appropriately stock an athletic trainer’s kit

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REQUIRED NRPHARMACEUTICAL Federal and State regulations

- Over the counter medications- Prescription medications

Proper storage and disposal Proper record keeping and inventory Analgesics use Anti-inflammatory use Anti-histamine use Antacid use Antiseptic and disinfectant use





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Each student must submit a professional resume and cover letter written to the affiliated clinical internship site to which you desire your KIN 197C placement. These must be returned to the course instructor, not to the affiliated clinical internship site supervisor (ACI).

The resume and cover letter will be placed in your portfolio. Date & Initial

Case Study: One case study on an Upper Extremity injury of your choice must be completed according to the green sheet and placed in your portfolio. Each case study must include:

Introduction of injuryRelevant anatomy Signs and symptoms of injuryEvaluation of injuryTreatment of injurySurgery (if applicable)Standard rehabilitation (if applicable)Summary

Date & Initial

All KIN 193 – All Administration and Organization in Athletic Medicine assignments/projects should be completed and placed in your portfolio.

Date & Initial

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KIN 197B - Internship in Athletic Training II

HISTORY OF INJURY

All skills must be viewed, dated and initialed. Peers can evaluate Practice, while an ACI must evaluate Competence and Field/Scenario elements.


Chief complaintTell me about your problem

History of the present problemWhen did you first notice the symptoms?Any prior history of this problem?Any family history of similar symptoms?Any recent change in your activity?Aware of any specific mechanism of injury?Any unusual sounds/sensations with injury?

Time sequenceSudden or gradual onset of symptoms?How long do the symptoms last?Constant or intermittent symptoms?When do the symptoms typically occur?

Location of symptomsPoint with one finger to area of most painAny other areas of pain/discomfort?

Characteristics of the painCharacterize the pain (dull, sharp, etc.)Does the pain radiate?What relieves the pain?What increases the pain?Do the symptoms affect your activity level?

Participation in sport/activitySport/activity?Position/event?Frequency and duration of practices?Could equipment be related to the injury?What is the playing environment?What type of warm-up pattern?

Personal managementHave you attempted any treatment?Have you taken any medication?Have you seen anyone else for the problem?Do you have any opinion as to your problem?

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HIP AND THIGH EVALUATION



History - Refer to history page Observation/Inspection · Observe in shorts (Use discretion) · Deformity - Genu recurvatum - Genu valgum/varum - Anteversion/retroversion · Discoloration · Scars · Bleeding · Swelling · Observe gait or ability to walk · Compare bilaterally

Palpation · Illiac Crests · Pubic Symphysis · Ischial Tuberosities · Greater Trochanter/Trochanteric Bursa · PSIS · ASIS · Sacroilliac joint · Femoral Triangle (contents/borders) · Sartorius · Adductor longus · Gluteus Medius · Gluteus Maximus · Hamstrings - Semimembranosis - Semitendinosis - Biceps femoris · Rectus Femoris · Vastus lateralis/medialis

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REQUIRED NRRange of Motion – Active, Passive and Resistive · Hip internal · Hip external rotation · Hip flexion · Hip extension · Hip adduction · Hip abduction · End feels for passive ranges · Strength grades for resistive ranges · Compare bilaterally

Stress Tests · Trendelenburg · Ober test · Leg length (true vs. apparent) · Thomas test · Straight leg raise test · Compare bilaterally

Neurological · Peripheral nerves (sensory/motor function) - Obturator - Femoral

- Tibial- Superior gluteal

- Inferior gluteal · Nerve root levels - L1-S2 dermatomes - L1-S2 myotomes

Circulation · Skin temperature/color · Capillary refill · Popliteal pulse · Posterior tibial pulse · Femoral pulseImmediate First Aid · Ice · Elevation · Compression · Rest (crutches) · Referral

REQUIRED NRFunctional Tests/Return to Play Considerations

· Weight Bearing · Gait

· Heel strike · Toe-off

· Walk on toes · Walk on heels

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· Hop on both feet · Hop on injured foot · Straight line jog ½ speed · Straight line jog ¾ speed · Straight line jog full speed · Full speed and come to stop over a 2-3 yard distance · Full speed to a dead stop · Large figure eight and make progressively smaller and faster · Carioca to left/right · Full sprint and cut 90 degrees to left/right · Movements specific to sport · All movements must be pain free/no limp





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KNEE EVALUATION



History - Refer to history page Observation/Inspection · Observe in shorts (use discretion) · Deformity - Genu recurvatum (hyperextension) - Genu varum/valgum · Discoloration · Swelling · Bleeding · Scars · Observe gait/ability to walk · Compare bilaterally

Palpation · Patella - Superior pole - Inferior pole - Medial/lateral undersurface/borders - Alignment considerations (medial, lateral, baja, alta, tilt, rotation) · Fibular head · Tibial tuberosity · Medial femoral condyle · Medial tibial plateau · Lateral femoral condyle · Lateral tibial plateau · Medial collateral ligament · Lateral collateral ligament · Joint line (menisci)

· Anterior superior tibiofibular ligament · Quadriceps (vastus lateralis/medialis) · Patellar tendon (infra. vs.supra patellar) · Infrapatellar fat pad · Gastrocnemius (medial/lateral head) · Hamstrings (biceps femoris, - Biceps femoris tendon - Semimembranosis - Semitendinosis · Iliotibial band/insertion (Gerdy’s tubercle) · Pes anserine muscles/insertion

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· Popliteal fossa (borders, contents)

REQUIRED NRRange of Motion – Active, Passive and Resistive · Knee flexion · Knee extension · Ankle plantar flexion · End feels for passive ranges · Strength grades for resistive ranges · Compare bilaterally

Stress Tests · Tinel sign (behind fibular head) · Menisci - Check ROM full flexion/extension - Apley’s compression/distraction - Bounce home - Deep squat/duck walk - McMurray’s test - thumb/index finger on joint line, internal/external rotation with varus/valgus force application · Joint effusion

- Ballotable patella - Suprapatellar pouch

- Differentiate from prepatellar bursitis · Ligaments

- Varus at 0 degrees and 15-30 degrees - Valgus at 0 degrees and 15-30 degrees - Anterior drawer

- Posterior drawer - Lachman/modified Lachman - Posterior sag sign (Godfrey’s sign)

· Compare bilaterally

Neurological · Peripheral nerves (sensory/motor function)

- Obturator- Femoral- Tibial

- Superior gluteal- Inferior gluteal

· Nerve root levels - L1-S2 dermatomes - L1-S2 myotomes

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REQUIRED NRCirculation · Skin temperature/color · Capillary refill · Popliteal pulse · Posterior tibial pulse · Dorsal pedal pulseImmediate First Aid · Ice · Elevation · Compression · Rest (crutches) · Referral

Functional Tests · Weight Bearing · Foot gait cycle


· Walk on toes · Walk on heels · Hop on both feet · Hop on injured foot · Straight line jog ½ speed · Straight line jog ¾ speed · Straight line jog full speed · Full speed and come to stop over a 2-3 yard distance · Full speed to a dead stop · Large figure eight and make progressively smaller and faster · Carioca to left/right · Full sprint and cut 90 degrees to left/right · Movements specific to sport · All movements must be pain free/no limp




Field/Scenario

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Rating Date and Initial

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ANKLE EVALUATION



History - Refer to history page Observation/Inspection · Remove shoes/socks bilaterally · Deformity · Bleeding · Swelling · Discoloration · Scars · Observe gait/ability to walk · Compare bilaterally

Palpation · Shaft of tibia · Fibula · Medial malleolus · Dome of talus · Lateral Malleolus · Calcaneus · Sustentaculum tali · Deltoid ligament · Anterior talofibular ligament · Calcaneofibular ligament · Posterior talofibular ligament · Anterior inferior tibiofibular ligament · Posterior inferior tibiofibular ligament · Tibialis posterior tendon · Flexor digitorum longus tendon · Flexor hallicus longus tendon · Tibialis Anterior · Extensor hallicus longus tendon · Extensor digitorum longus tendon · Peroneus longus/brevis tendons · Achilles tendon · Extensor digitorum brevis · Sinus tarsi · Calcaneal and retrocalcaneal bursa

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REQUIRED NRRange of Motion – Active, Passive and Resistive · Ankle inversion · Ankle eversion · Ankle dorsiflexion · Ankle plantarflexion · End feels for passive ranges · Strength grades for resistive ranges · Compare bilaterally

Stress Tests · Anterior drawer · Posterior drawer · Eversion · Inversion - Foot in neutral position - Foot in plantar flexed position · Kleiger’s test (dorsiflexion/external rotation) · Torsion/compression on malleoli · Thompson test · Heel tap test

Neurological · Peripheral nerves (sensory/motor function) - Deep peroneal - Superficial peroneal - Tibial - Sural - Saphenous · Nerve root levels - L4-S2 dermatomes - L4-S2 myotomes

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REQUIRED NRCirculation · Skin temperature/color · Capillary refill · Dorsal pedal pulse · Posterior tibial pulseImmediate First Aid · Ice · Elevation · Compression · Rest (crutches) · Referral








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FOOT EVALUATION



History - Refer to history page Observation/Inspection · Remove shoes/socks bilaterally · Deformity · Pes planus (flat feet) · Pes Cavus (high arch) · Forefoot varus/valgus · Rearfoot varus/valgus · Hallux valgus (bunion) · Swelling · Discoloration · Bleeding · Callous pattern · Observe gait/ability to walk · Observe wear on shoes · Compare bilaterally

Palpation · Medial malleolus · Lateral malleolus · Talar head · Neck/dome of talus · Sinus tarsi · Calcaneus · Sustenaculum tali · Peroneal tubercle · Navicular (tubercle) · Cunieforms (1st, 2nd, 3rd) · Cuboid · Intertarsal joints · Tarsometatarsal joints · Metatarsal heads/shafts/bases · Styloid process of 5th metatarsal · Phalanges (proximal/middle/distal) · Metatarsophalangeal joints · Proximal/distal interphalangeal joints · Sesamoid bones

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REQUIRED NR · Longitudinal arches (medial/lateral) · Transverse metatarsal arch · Plantar fascia · Achillles tendon · Peroneus longus/brevis · Tibialis posterior · Flexor digitorum longus/brevis · Flexor hallicus longus · Tibialis anterior · Extensor digitorum longus/brevis · Extensor hallicus longus · Calcaneal bursa · Calcaneal fat pad

Range of Motion – Active, Passive and Resistive · Toe/great toe flexion · Toe/great toe extension · Ankle dorsiflexion · Ankle plantarflexion · Ankle inversion · Ankle eversion · End feels for passive ranges · Strength grades for resistive ranges · Compare bilaterally

Stress Tests · Stress metatarsals longitudinally (false joint) · Toe tap test for FX · Distraction test · Compression of metatarsal heads · Stress interosseous membrane between metatarsals · Varus/valgus stress at MP/PIP/DIP joints · Toe hyperextension (stress plantar fascia)

Neurological · Peripheral nerves - Deep peroneal - Superficial peroneal - Tibial - Sural - Saphenous · Nerve root levels - L4-S2 dermatomes - L4-S2 myotomes

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REQUIRED NRCirculation · Skin temperature/color · Capillary refill · Dorsal pedal pulse · Posterior tibial pulseImmediate First Aid · Ice · Elevation · Compression · Rest (crutches) · Referral







Field/Scenario

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Rating Date and Initial

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SPINE AND SACROILIAC JOINT EVALUATION



History - Refer to history page Observation/Inspection · Observe in shorts/underwear (use discretion) · Observe fluidity of movement (example: onto table or into room) · Abdominal muscles/tone · Posture - Lordosis - Scoliosis - Kyphosis

- Balance of hips · Scars · Discoloration · Bleeding · Swelling · Atrophy · Posture (cervical, thoracic, lumbar curves) · Hairy patches · Leg lengthtrue vs. apparent) · Observe gait · Hips, knees, feet (varus, valgus, recurvatum Patella malalignment, arches) · Compare bilaterally

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REQUIRED NRPalpation · Tops of iliac crests - between L4/L5 spinous processes · PSIS – level of S2 spinous process · Lumbar/sacral spinous processes · Visible/palpable presence of any sacral or lumbar spinous process “step off” · SI joint (static and dynamic motion) · PSIS · ASIS · Pubic symphysis · Greater trochanter · Ischial tuberosities · Sacral triangle · Paraspinal/erector spinae muscles · Gluteal maximus/medius · Quadratus lumborum · Abdominal muscles

Ranges of Motion - Active, Passive and Resistive · Trunk flexion · Trunk extension · Trunk rotation · Trunk lateral bending · Proper stabilization of movements · End feels for passive ranges · Strength grades for resistive ranges · Compare bilaterally

Stress Tests · Spring test for ligamentous mobility · Valsalva maneuver · Milgram test · Kernig test · Slump test · Straight leg raise/Well straight leg raise · SI compression/distraction · Gaenslen’s test · Patrick’s/FABER test · Long sit test

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REQUIRED NRNeurological · Peripheral nerves (sensory/motor function)

- Femoral- Obturator- Tibial- Common peroneal- Superior gluteal- Inferior gluteal

· Nerve root levels- L1-S2 dermatomes- L1-S2 myotomes

· Reflexes-Patellar tendon (L3-L4)-Achilles tendon (S1-S2)

REQUIRED NRSpecific Muscular Testing · Erector Spinae (spinalis,longissimus, iliocostalis

evauated as a group) · Quadratus Lumborum · Psoas and illiacus

Circulation · Skin temperature/color · Capillary refill · Femoral pulse

Functional Tests · Weight Bearing · Foot gait cycle · Heel strike · Toe-off · Walk on toes · Walk on heels · Hop on both feet · Hop on injured foot · Straight line jog ½ speed · Straight line jog ¾ speed · Straight line jog full speed · Full speed and come to stop over a 2-3 yard

distance · Full speed to a dead stop · Large figure eight and make progressively

smaller and faster · Carioca to left/right · Full sprint and cut 90 degrees to left/right · Movements specific to sport · All movements must be pain free/no limp

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Comprehensive Oral Practical: You will select one item out of a hat from all the Oral Practical evaluations you have done to this point and be evaluated on that item.

The oral practical chosen was:





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KIN 197C,KIN 191B and KIN 195

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KIN 197C: Internship in Athletic Training III



Separate sheets are provided to demonstrate appropriate modality use for the following. Each evaluation should be completed for practice, competence, and field/scenario elements.

Ice Modalities Heat Modalities Ultrasound Electrical Stimulation Traction


GENERAL MEDICINE Otoscope - Demonstrate appropriate use Chemstrips - Measure urine values Skin diseases - recognize signs and symptoms associated with

- Poison ivy/sumac/oak- Ringworm- Warts- Impetigo- Herpes

Disordered eating - recognize signs and symptoms associated with

- Anorexia- Bulimia- Obesity

Ears, Eyes, Nose, Throat - recognize signs and symptoms associated with

- Common cold/rhinovirus- Conjunctivitis- Laryngitis- Pharyngitis- Rhinitis- Sinusitis- Tetanus- Tonsillitis

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Case Study: One case study on a general medicine illness/disease of your choice must be completed according to the green sheet and placed in your portfolio. Each case study must include:

Introduction of illness/diseaseSigns and symptoms of illness/diseaseEvaluation of illness/diseaseTreatment of illness/diseaseSurgery (if applicable)Standard Rehabilitation (if applicable)Summary

Date & Initial

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KIN 197C – Internship in Athletic Training III

ABDOMEN AND THORAX EVALUATION



History - Refer to history page

Observation/Inspection · Expose area (use discretion) · Scars · Atrophy/hypertrophy · Discoloration · Abdominal rigidity · Bleeding · Deformity · Signs and symptoms of shock · Difficulty breathing · Cyanosis · Ability to move/sit/stand · Compare bilaterally

Palpation · Start in quadrant furthest from pain · Quadrants/contents - Upper right - Upper left - Lower right - Lower left · Ribs (true/false/floating) · Sternum/manubrium/xiphoid process · Intercostal muscles/space · Costochondral joints · Chondrosternal joints · Crepitus · Rebound pain · Rigidity

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REQUIRED NRRange of Motion – Active, Passive and Resistive · Trunk flexion · Trunk extension · Trunk rotation · Trunk lateral bending · End feels for passive ranges · Strength grades for resistive ranges · Pelvic tilt

Stress Tests · Rib cage squeeze · Tap test Neurological · Referred pain sites/associated organs/structures

Circulation · Skin temperature/color · Capillary refill · Radial pulse · Brachial pulse

Immediate First Aid · Ice · Referral

Bladder Injury

Mechanism · Severe blow to lower pelvic regionSigns and symptoms · Pain and discomfort in lower abdomen · Signs of Shock · Hematuria · Abdominal rigidity · Desire but inability to urinate · Nausea · Uses stethoscope to determine bowel sounds Management · Physician referral

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REQUIRED NR Splenic Injury

Mechanism · Severe blow to upper left quadrantSigns and symptoms · Abdominal pain · Signs of Shock · Vomiting · Abdominal rigidity · Kerr’s sign · NauseaManagement · Physician referral

Kidney Injury

Mechanism · Severe blow mid-back area/flankSigns and symptoms · Rigidity of back muscles · Signs of Shock · Vomiting · Hematuria · Nausea · Referred pain in mid-thoracic region posteriorly, radiating forward around trunk into lower abdominal regionManagement ·Physician referral

Blow to Solar Plexus:

Mechanism · Severe blow to substernal areaSigns and symptoms · Respirations stop due to temporary diaphragm paralysisManagement · Help athlete overcome apprehension · Loosen belt and clothing around abdomen · Encourage relaxation with inhalation through nose exhalation through the mouth

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REQUIRED NRLiver Injury

Mechanism · Severe blow to upper right quadrantSigns and symptoms · Rigidity of abdominal muscles · Signs of Shock · Vomiting · Nausea · Pain and discomfort in area of blow · Referred pain below right scapula and chestManagement · Physician referral

Contusion/Strain of Rectus Abdominis

Mechanism · Severe blow or exertion of abdominal musclesSigns and symptoms · Rigidity · Pain/tightness in abdominal area · Pain with trunk flexion or extensionManagement · Ice · Compression

Pneumothorax: (traumatic vs. spontaneous)

Defined · Pleural cavity filled with airMechanism · Blunt force trauma · Penetration of rib fracture or other implement · Idiopathic (unknown) origin - spontaneousSigns and symptoms · Pain · Difficulty breathing · Signs of Shock · Anoxia (loss of oxygen) · Uses stethoscope to determine chest sounds (auscultation)Management · Immediate physician referral

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REQUIRED NRHemothorax

Defined · Blood in pleural cavityMechanism · Blunt force trauma · Penetration of rib fracture or other implementSigns and symptoms · Pain · Difficulty breathing · Signs of Shock · Cyanosis · Uses stethoscope to determine chest sounds (auscultation)Management · Immediate physician referral

Lung Hemorrhage

Mechanism · Violent blow or compression of chest with/without accompanying rib fractureSigns and symptoms · Pain with breathing · Dyspnea (painful, labored breathing) · Signs of Shock · Coughing of frothy blood · Uses stethoscope to determine chest soundsManagement · Physician referral

Rib Fracture

Mechanism · Kick or direct blow to rib cage · General compression of rib cage (indirect)Signs and symptoms · Pain on inspiration · Point tenderness · Swelling · Crepitus · Paradoxical motion/flail chestSpecial tests · Compression of rib cage · tap testManagement · Physician referral · Rib support (belt)

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REQUIRED NRSternal Fracture

Mechanism · Direct blow to sternum · Violent compressive posterior force · Hyperflexion of trunkSigns and symptoms · Sharp chest pain localized over sternum with inhalation · Position of head and shoulders dropped forward · Swelling · Displaced fragments possible (significant if

posterior)Management · Physician referral





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KIN 197C - Internship in Athletic Training III

FACE EVALUATION




Observation/Inspection · Deformity

- Bite - Ability to move eyes - Squinting

· Swelling · Atrophy · Hyphema · Conjunctivitis · Pupil reaction to light/size · Observe motions (smile, frown, etc..) · Signs of head injury · Panda bear eyes · Depressed cheekbone · Battles sign · Scars · Discoloration · Bleeding · Compare bilaterally

Palpation · Maxilla · Mandible · frontal bone · temporal bone · Zygomatic arch · Orbit · Nasal bone/septum · TMJ

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REQUIRED NRCranial Nerves

1. Olfactory - identify scent from each nostril

2. Optic - visual acuity3. Occulomotor - constriction of pupil,

opening eyelid, eye adduction/downward roll

4. Trochlear – upward roll of eyes5. Trigmenial - clench teeth, palpate

masseters, facial sensation sharp vs. dull6. Abducens – lateral ocular movement7. Facial - raise eyebrows, close eyes

tightly, show teeth, frown, smiled, puff out cheeks

8. Acoustic/Vestibulocochlear - test unilateral hearing and balance

9. Glossopharangeal - say “ah”, swallow

and watch for coordinated “curtain movement” of pharynx

10. Vagus - “gag” reflex11. Spinal accessory - upper

trapezius/resisted shoulder shrug, sternomastoid/turn head against resistance12. Hypoglossal - stick out tongue, look for

asymmetry, deviation or atrophy

Muscle Testing · Jaw (open/close) · Facial expressions · Tongue movement · Eye movements · Compare bilaterallyCirculation · Skin temperature/color

Immediate First Aid · Ice · Rest · Referral

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54


SHOULDER EVALUATION




Observation/Inspection · Observe without shirt or in tank top · Differentiate between scoliosis and habitual overhead motion · Deformity - Arm position - Depressed/dropped shoulder - Scoliosis

- Protracted shoulder due to tight pectoralis major muscles - Winged scapula - Step-off of acromioclavicular joint

· Muscle atrophy · Scars · Discoloration · Bleeding · Observe posture - Anterior view - Posterior view - Lateral view · Scapular rhythm – 2:1 ratio · Compare Bilaterally

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REQUIRED NRPalpation · Scapula - Spine of scapula – level of T3 spinous process - Acromion process - Coracoid process - Inferior angle - Superior angle - Medial/vertebral border - Lateral/axillary border · Clavicle - Sternal/medial/proximal end - Middle 1/3 – “s-curve” - Acromial/lateral/distal end · Humerus - Humeral head - Bicipital/intertubercular groove - Greater tuberosity - Lesser tuberosity - Deltoid tuberosity · Sternoclavicular joint/ligaments · Coracoclavicular ligaments · Acromioclavicular joint/ligaments · Muscles

- Supraspinatus- Infraspinatus

- Teres minor- Subscapularis- Teres major- Latissimus dorsi- Trapezius (upper/middle/lower fibers)- Deltoid (anterior/middle/posterior

fibers)- Pectoralis major (sternal/clavicular

heads)- Biceps brachii (long/short heads)- Triceps brachii (long/medial/lateral

heads)- Serratus anterior

· Axilla – lymph nodes · Compare bilaterally

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REQUIRED NRRange of Motion - Active, Passive and Resistive · GH extension · GH flexion · GH horizontal abduction · GH horizontal adduction · GH internal rotation · GH external rotation · GH abduction · GH adduction · Scapular depression · Scapular elevation · Scapular protraction · Scapular retraction · Cervical flexion · Cervical extension · Cervical lateral bending · Cervical rotation · End feels for passive ranges · Strength grades for resistive ranges · Compare bilaterally

REQUIRED NRSpecial Tests · Piano Key (AC sprain) · Biceps tests

- Speed’s test - Yergason’s test - Lundington’s test · Impingement/rotator cuff tests - Hawkins-Kennedy test - Neer test - Empty can test - Drop arm test - Painful arc · Thoracic outlet syndrome tests

- Adson’s test- Allen’s test

· GH instability tests- Apprehension test- Posterior apprehension test- Relocation test- Anterior/posterior translation/glide tests- Sulcus sign

· Labrum tests- Labral grind test- Clunk test

· Compare Bilateral

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Neurological · Peripheral nerves (sensory/motor function) - Axillary - Musculocutaneous - Median - Ulnar - Radial · Nerve root levels - C5-T1 dermatomes - C5-T1 myotomes · Reflexes - Triceps (C7-C8) - Biceps (C5-C6) - Brachioradialis (C5-C6)

Circulation · Skin temperature/color · Radial Pulse · Brachial pulse · Capillary refill

Immediate First Aid · Ice · Rest (sling and swath) · Compression · Referral · Elevation

Functional Tests/Return to Play Considerations · Normal, pain-free ranges of motion · Normal strength, neuromuscular control · Movements specific to sport/position





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ELBOW/ARM EVALUATION




Observation/Inspection ·Deformity

- Carrying angle (cubitus valgus) - Gunstock deformity (cubitus varus)

·Swelling ·Atrophy ·Isosceles triangle · Observe motion ·Compare bilaterally ·Scars ·Discoloration ·Bleeding ·Olecranon bursitis

Palpation · Olecranon process · Lateral epicondyle · Medial epicondyle · Radial head · Annular ligament · Ulna · Medial/ulnar collateral ligament · Lateral/radial collateral ligament · Cubital tunnel

· Wrist flexors (palm on medial elbow reference) - Pronator teres - Flexor carpi radialis

- Palmaris longus - Flexor carpi ulnaris - Flexor digitorum superficialis

· Biceps brachii tendon · Triceps brachii · Wrist extensors

- Extensor digitorum - Extensor pollicis longus - Brachioradialis

- Supinator · Antecubital space (borders and contents)

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REQUIRED NRRange of Motion – Active, Passive and Resistive

- Elbow flexion- Elbow extension- Forearm supination- Forearm pronation- End feels for passive ranges- Strength grades for resistive ranges- Compare bilaterally

Stress Tests · Valgus with slight flexion · Varus with slight flexion · Tinel sign (cubital tunnel) · Tennis elbow (elbow extended vs. flexed) · Tap test · Compare bilaterally

Neurological · Peripheral nerves (sensory/motor function)

- Axillary - Musculoceutaneous

- Median - Ulnar - Radial

· Nerve root levels - C5-T1 dermatomes - C5-T1 myotomes - C4 dermatome/myotome

Circulation · Skin temperature/color · Radial pulse · Brachial pulse · Capillary refill

Immediate First Aid ·Ice ·Elevation ·Compression ·Rest (sling/swath) ·Referral


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HAND/THUMB EVALUATION




Observation/Inspection · Deformity - Fist/metacarpal heads (Boxer’s fx)

- MP flexion (all fingers point to lunate) - Dislocation (DIP/PIP/MP) · Swelling · Scars · Discoloration · Bleeding · Atrophy (thenar/hypothenar eminence) · Observe position and function · Compare bilaterally

Palpation · Radial styloid process · Ulnar styloid process · Anatomic snuff box · Thenar eminence · Hypothenar eminence · Carpal bones (proximal and distal rows) · Metacarpals (heads/shaft/bases) · Phalanges (proximal/middle/distal) · MP joints · PIP joints · DIP joints · Extensor pollicis longus · Abductor pollicis longus · Extensor pollicis brevis · 1st dorsal interossei · Palmaris longus · Flexor digitorum superficialis · Flexor digitorum profundus · Extensor digitorum

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REQUIRED NRRange of Motion – Active, Passive and Resistive · Finger abduction · Finger adduction · MP joint flexion · MP joint extension · PIP joint flexion · PIP joint extension · DIP joint flexion · DIP joint extension · Thumb flexion · Thumb extension · Thumb abduction · Thumb adduction · Thumb opposition · End feels for passive ranges · Strength grades for resistive ranges · Compare bilaterally

Stress Tests · Tap test · Phalens · Tinel sign · Valgus/varus test for MP/PIP/DIP · Stress the metacarpals/phalanges longitudinally (false joints) · Finkelstein test · Compare bilaterally

Neurological · Peripheral nerves (sensory/motor function) - Median - Ulnar - Radial · Nerve root levels - C5-T1 dermatomes - C5-T1 myotomes

Circulatory · Skin temperature/color · Capillary refill · Radial pulse

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REQUIRED NRImmediate First Aid · Ice · Elevation · Compression · Rest (splint) · Referral






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ICE BAGS



Set-up and Application 1. Place patient in a comfortable position 2. Fill plastic bag with enough ice to last the

duration of the treatment 3. Use enough bags to cover the area being

treated 4. Remove excess air from bags 5. Apply one layer of a wet elastic wrap or

towel around the area to be treated (optional) 6. Place ice bag on area being treated 7. Secure ice bag in place with toweling or an

elastic bandage/plastic wrap 8. Check for frostbite during treatment 9. Watch for neuropathy over large superficial

nerves10. Treatment time is 20 minutesIndications 1. Acute injury or inflammation 2. Acute or chronic pain 3. Postsurgical pain and edemaContraindications 1. Some cardiac/respiratory conditions 2. Uncovered open wounds 3. Circulatory insufficiency 4. Cold allergy and/or hypersensitivity 5. Neurological sensory deficit

You must have a rating of 4 or above on the competence and field/scenario elements to pass.Please mark below with the following rating system:

5 = Superior - distinctly more than expected of an athletic training student4 = Good – above average – better than expected3 = Average – expected performance2 = Fair – satisfactory performance1 = Poor – unacceptable performance



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Cryostretch – Vapocoolant Spray



Set-up and Application1. Place patient in a comfortable position so that

the muscle group may be easily stretched2. If spraying near the face, cover the patient’s

eyes, nose and mouth3. Hold container upside down 12-18 inches

from the skin 4. Hold the bottle at a 30-45 degree angle from

the skin5. Spray (sweep) the entire length of the muscle

in one direction only from distal to proximal6. Do not frost the skin7. Begin passive stretching as you start spraying

the area8. Allow tissue to re-warm between sweeps9. Repeat 2-3 times or until desired stretch

occurs10. Monitor for frostbite

Indications1. Trigger points2. Muscle spasm3. Decreased range of motion

Contraindications1. Allergy to spray2. Uncovered open wounds3. Acute and/or post-surgical injury4. Contraindications relating to cold application5. Contraindications relating to passive

stretching6. Use around eyes/nose/mouth (protect from

spray)

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67


Controlled Cold Therapy Units (Cryocuff)



Set-up and Application 1. Fill cooling unit with ice as indicated 2. Add cold water to “fill” mark 3. Allow water to chill for 5-10 minutes 4. Select appropriate appliance for body part 5. Fasten distal strap snugly (Do not restrict

blood flow) 6. Fasten proximal strap loosely 7. Connect appliance to cooler using hose

provided 8. Open air vent to allow water to flow into the

appliance 9. Elevate cooler above body part10. Remove air-bleed cap to force trapped air out

of appliance11. Disconnect hose12. Check for frostbite during treatment13. Check for neuropathy over large superficial

nerves14. Treatment time is up to 72 hours

continuously

Indications 1. Acute injury or inflammation 2. Acute or chronic pain 3. Post-surgical pain and edema

Contraindications 1. Some cardiac/respiratory conditions 2. Uncovered open wounds 3. Circulatory insufficiency 4. Cold allergy and/or hypersensitivity 5. Neurological sensory deficit

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69


Ice Immersion/Cold Whirlpool



Set-up and Application 1. If using whirlpool, verify GFCI operation 2. Prepare bucket/whirlpool with cold water

and ice (50-60º F) 3. Place neoprene caps on patient if necessary

to insulate fingers/toes 4. Immerse body part in bucket/whirlpool 5. If desired, turn on whirlpool, adjust amount and direction of turbulence 6. Instruct patient not to turn whirlpool on or

off or touch any electrical connections while in the whirlpool or while body is wet

7. Check patient regularly for nerve palsy 8. Watch patient’s level of consciousness

during treatment 9. Do not allow patient to continually withdraw

body part from water10. Treatment time is 10-20 minutes11. Wrap and elevate body part after treatment

Indications 1. Acute injury or inflammation 2. Acute or chronic pain 3. Post-surgical pain and edema

Contraindications 1. Some cardiac/respiratory conditions 2. Open wounds – must be dedicated treatment 3. Circulator insufficiency 4. Cold allergy and/or hypersensitivity 5. Neurological sensory deficit 6. Absolute inability to tolerate the cold

temperature

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71


Warm Whirlpool



Set-up and Application 1. Verify GFCI operation 2. Fill whirlpool with hot water (100-110º F) 3. Add disinfectant (optional) 4. Place patient in a comfortable position using

a high chair or bench 5. Immerse body part in water 6. Turn turbine on and adjust amount and

direction of turbulence 7. Instruct patient not to turn whirlpool on or

off or touch any electrical connections while in the whirlpool or while body is wet

8. Treatment time is 15-20 minutes Indications 1. Subacute or chronic inflammation 2. Peripheral vascular disease 3. Decreased range of motion 4. Neurological sensory deficit

Contraindications 1. Acute conditions in which water turbulence

would further irritate injured areas or in which the limb is placed in a gravity dependent position

2. Patient’s requiring postural support during treatment

3. Skin conditions/infections unless dedicated whirlpool

4. Fever

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73


Paraffin BathAll skills must be viewed, dated and initialed. Peers can evaluate Practice elements, while an ACI must evaluate Competence and Field/Scenario elements.


Set-up/Application - Immersion Method 1. Thoroughly clean body part to be treated

with soap and water. After drying, use alcohol to remove soap residue.

2. Have patient dip the body part into the paraffin and remove.

3. Allow wax to dry (it will turn a dull shade of white).

4. Repeat dipping in was 6-12 more times while allowing drying in between each dip.

5. Place body part back in wax for duration of treatment.

6. Have patient avoid touching the sides or bottom of the unit because burns may result.

7. Do not allow patient to move joints, this may crack dried wax and allow fresh paraffin to touch the skin, increasing risk of burns.

8. Monitor for comfort and mottling of skin. 9. Treatment time is 15-20 minutes.10. After treatment have patient scrape off

paraffin back into heating unit

Set-up/Application – Pack/Glove Method 1. Thoroughly clean body part to be treated

with soap and water. After drying, use alcohol to remove soap residue.

2. Have patient dip the body part into the paraffin and remove.

3. Allow wax to dry (it will turn a dull shade of white).

4. Repeat dipping in wax 6-12 more times. 5. Place body part in plastic bag, aluminum foil

or wax paper. 6. Wrap and secure a terry cloth towel or

glove/oven mitt around body part. 7. Elevate body part if indicated. 8. Monitor for comfort and mottling of skin.

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9. Treatment time is 15-20 minutes.10. After treatment have patient scrape off

paraffin back into heating unit.

Indications 1. Subacute or chronic inflammation 2. Limitation of motion after immobilization

Contraindications 1. Open wounds 2. Skin infections 3. Neurological sensory deficit 4. Peripheral vascular disease





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Moist Heat PacksAll skills must be viewed, dated and initialed. Peers can evaluate Practice elements, while an ACI must evaluate Competence and Field/Scenario elements.


Set-up and Application 1. Remove pack carefully from hydrocollator

using tongs. 2. Cover pack with a commercial terry cloth

covering or wrap pack with layers of toweling.

3. Place patient in a comfortable position. 4. Place the pack on the patient. Do not let the

patient lie on the pack. Do not allow the pack to come into direct contact with the skin.

5. Completely cover any infected area of skin with sterile gauze.

6. Check patient after first five minutes for comfort and mottling and recheck patient regularly.

7. Treatment time is 15-20 minutes. 8. Return pack to hydrocollator and allow 30-

45 minutes for it to reheat before reusing it. 9. Remove contaminated gauze if used and

wash toweling or commercial cover.

Indications 1. Subacute or chronic inflammation 2. Reduction of subacute or chronic pain 3. Subacute or chronic muscle spasm 4. Decreased range of motion 5. Hematoma resolution 6. Reduction of joint contractures

Contraindications 1. Acute injuries 2. Peripheral vascular disease 3. Impaired circulation 4. Poor thermoregulatory system 5. Neurological sensory deficit

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77


Cervical TractionAll skills must be viewed, dated and initialed. Peers can evaluate Practice elements, while an ACI must evaluate Competence and Field/Scenario elements.


Set-up and Application 1. Establish that no contraindications are

present by questioning the patient. 2. Determine the patient’s weight. 3. The cervical musculature may be pretreated

with moist heat to decrease muscle spasm. 4. Instruct the patient to remove any earrings,

glasses, or other clothing that may interfere with the placement of the halter.

5. Lay the patient on the treatment table in the supine position.

6. Place a pillow or two under the patient’s knees.

7. Position the unit so that the line of pull is aligned with the midline of the body (i.e., so that the head is not laterally flexed).

8. Secure the halter to the cervical region according to the manufacturer’s instructions. Normally the pressure points are the occipital processes and, to a lesser degree, the chin.

9. Connect the halter to the spreader bar.

10. Align the unit so that the angle of pull places the cervical spine in approximately 25 degrees of flexion.

11. Remove any slack in the pulley cable.12. Reset all controls to zero and turn unit on.13. Adjust the RATIO to the appropriate on-off

sequence, normally a 3:1 or 4:1 ratio.14. Adjust the TENSION to approximately 10

percent of the person’s body weight. If this is the patient’s first exposure to intermittent cervical traction, or if the person is displaying apprehension about the treatment, the TENSION can be initiated at its lowest value.

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15. Instruct the patient as to what to expect during the treatment and to inform you if any discomfort is experienced. Explain that the force of the pull is felt at the occiput and not at the chin.

16. Set the appropriate treatment DURATION, and initiate the treatment.

17. Allow the unit to cycle through its first

tension cycle. The TENSION maybe gradually increased during subsequent cycles. If pain is experienced at any time during the treatment, decrease the amount of force or discontinue the treatment.

18. Instruct the patient to remain relaxed during both the on and off cycles.

19. If the pressure placed on the mandible causes discomfort in the teeth or TMJ joint, gauze or a mouthpiece may be placed between the teeth to dissipate the force.

20. The treatment should last 10-20 minutes for most injuries, 5-10 minutes for a herniated disk.

21. If the traction unit does not automatically shut off, gradually reduce the TENSION over a period of three or four cycles.

22. Gain some slack in the cable and turn unit off

23. Remove the SPREADER BAR and HALTER.

24. Question the patient regarding any perceived benefit or complications derived from the treatment.

25. Have the patient remain sitting or lying supine for 5 minutes after the conclusion of the treatment.

26. Record the pertinent information (tension, duration, duty cycle) in the patient’s medical file.

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Indications 1. Cervical or lumbar muscle spasm 2. Certain degenerative disk diseases 3. Herniated or protruding intervertebral disc 4. Nerve root compression 5. Osteoarthritis 6. Capsulitis of the vertebral joints 7. Pathology of the anterior or posterior

longitudinal ligaments

Contraindications 1. Unstable spine 2. Diseases affecting the vertebra or spinal

cord, including cancer and meningitis 3. Vertebral fractures 4. Extruded disk fragmentation 5. Spinal cord compression 6. Conditions in which vertebral flexion and/or

extension is contraindicated 7. Conditions that worsen after traction

treatments 8. Osteoporosis 9. Conditions that have not been evaluated by a

physician





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Ultrasound All skills must be viewed, dated and initialed. Peers can evaluate Practice elements, while an ACI must evaluate Competency and Field/Scenario elements.


Set-up/Application - Water Immersion 1. Establish that no contraindications are

present by questioning the patient. 2. Place the patient in a comfortable position. 3. Inspect body part to be treated (check for

rashes, infections, open wounds) 4. Fill plastic, ceramic or rubber tub with water 5. Clean area to be treated to remove any body

oils, dirt, etc. 6. Immerse body part in water. 7. Select appropriate sound head size. 8. Determine and set frequency (1Mhz-3 Mhz). 9. Set duty cycle (20% – 100%).10. Set treatment duration according to

determined frequency and duty cycle.11. Place sound head in the water facing the

body part to be treated and begin slowly moving the sound head approximately one inch from the area being treated. Move the sound head parallel to the body part.

12. Press start.13. Adjust intensity to appropriate level while

keeping the sound head moving. (Intensity may need to be set prior to pressing start on some machines.)

14. Move sound head continuously at a moderate

speed (4cm/sec.) 15. If bubbles accumulate on the sound head

during treatment, quickly wipe them away with your finger.

16. At the end of the treatment, turn all dials to zero and remove sound head from water.

17. Dry body part.18. Record treatment parameters.

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Indications 1. Joint contractures 2. Muscle spasm 3. Neuroma 4. Scar tissue 5. Trigger areas 6. Postacute reduction of myositis ossificans 7. Acute inflammatory conditions (pulsed

output) 8. Chronic inflammatory conditions (pulsed or

continuous output) 9. Body part to be treated is smaller than the

diameter of the sound head or has irregular surfaces

Contraindications 1. Acute conditions 2. Ischemic areas 3. Tendency to hemorrhage 4. Areas around the eyes, heart, skull, or

genitals 5. Pregnancy when used over the pelvic or

lumbar areas 6. Over cancerous tumors (therapeutic doses

applied over tumors have been shown to increase mass and weight of the tumor.)

7. Over the spinal cord or large nerve plexus in high doses

8. Neurological sensory deficit 9. Over a fracture site before healing complete10. Stress fracture sites11. Over sites of active infection12. Over the pelvic or lumbar area in

menstruating female patients13. Areas of impaired circulation

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Set-up/Application – Bladder Method 1. Establish that no contraindications are


rashes, infections, open wounds) 4. Fill bladder (balloon or plastic bag) with

water. Can also use a bladder filled with gel or silicone.

5. Make sure that all air pockets are removed from bladder before sealing.

6. Apply coupling medium to body part being treated.

7. Coat both sides of bladder with coupling medium.

8. Place bladder on body part being treated. 9. Select appropriate sound head size.10. Determine and set frequency (1Mhz-3 Mhz).11. Set duty cycle (20% – 100%).12. Set treatment duration according to

determined frequency and duty cycle.13. Place sound head on bladder and begin

slowly moving the sound head over the bladder.

14. Press start.15. Adjust intensity to appropriate level while


16. Move sound head continuously at a moderate speed (4cm/sec.)

17. At the end of the treatment, turn all dials to zero and remove sound head from bladder.

18. Remove gel from patient’s skin.19. Dispose of used bladder.20. Record treatment parameters.

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Indications – Bladder Method 1. Joint contractures 2. Muscle spasm 3. Neuroma 4. Scar tissue 5. Trigger areas 6. Postacute reduction of myositis ossificans 7. Acute inflammatory conditions (pulsed


continuous output) 9. Irregular surfaces or surfaces that can not be

immersed in water

Set-up/Application – Direct Method 1. Establish that no contraindications are


rashes, infections, open wounds) 4. Place toweling around area to be treated. 5. Clean area to be treated to remove any body

oils, dirt, etc. 6. Apply coupling medium to area. 7. Select appropriate sound head size. 8. Determine and set frequency (1Mhz-3 Mhz). 9. Set duty cycle (20% – 100%).10. Set treatment duration according to

determined frequency and duty cycle.11. Begin slowly moving the sound head over

the medium, maintaining contact at all times.12. Press start.13. Adjust intensity to appropriate level while


14. Move sound head continuously at a moderate speed (4cm/sec.) using overlapping strokes or circles with firm pressure.

15. At the end of the treatment, turn all dials to zero. Remove sound head from treated area.

16. Remove gel from patient’s skin.17. Record treatment parameters.

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Contraindications – Direct Method 1. Acute conditions 2. Ischemic areas 3. Tendency to hemorrhage 4. Areas around the eyes, heart, skull, or


lumbar areas 6. Over cancerous tumors (Therapeutic doses



8. Neurological sensory deficit 9. Over a fracture site before healing is

complete10. Stress fracture sites11. Over sites of active infection12. Over the pelvic or lumbar area in

menstruating female patients13. Areas of impaired circulation

Indications – Direct Method 1. Joint contractures 2. Muscle spasm 3. Neuroma 4. Scar tissue 5. Trigger areas 6. Postacute reduction of myositis ossificans 7. Acute inflammatory conditions (pulsed


continuous output)

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Contraindications – Direct Method 1. Acute conditions 2. Ischemic areas 3. Tendency to hemorrhage 4. Areas around the eyes, heart, skull, or





8. Neurological sensory deficit 9. Over a fracture site before healing is

complete10. Stress fracture sites11. Over sites of active infection12. Over the pelvic or lumbar area in menstruating female patients13. Areas of impaired circulation

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Set-up/Application - Phonophoresis 1. Establish that no contraindications are

present by questioning the patient. 2. Place the patient in a comfortable position

encouraging circulation to the area. 3. Inspect body part to be treated (check for

rashes, infections, open wounds) 4. Place toweling around area to be treated. 5. Clean area to be treated to remove any body

oils, dirt, etc. 6. Make sure skin is well moistened and

relatively hairless. 7. Apply medication to skin and rub in, then

apply coupling medium to area, or, apply medicated ultrasound transmission media.

8. Select appropriate sound head size. 9. Determine and set frequency (1Mhz -3Mhz).10. Set duty cycle (20% – 100%).11. Set treatment duration according to

determined frequency and duty cycle.12. Slowly move the sound head over the

medium, maintaining contact at all times.13. Press start.14. Adjust intensity to appropriate level while


15. Move sound head continuously at a moderate speed (4cm/sec.) using overlapping stokes or circles with firm pressure.

16. At the end of the treatment, turn all dials to zero and remove sound head from the area being treated.

17. Cover remaining medication with an occlusive dressing.

18. Record treatment parameters.

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Indications - Phonophoresis 1. Joint contractures 2. Muscle spasm 3. Neuroma 4. Scar tissue 5. Trigger areas 6. Postacute reduction of myositis ossificans 7. Acute inflammatory conditions (pulsed


continuous output)

Contraindications - Phonophoresis 1. Acute conditions 2. Ischemic areas 3. Tendency to hemorrhage 4. Areas around the eyes, heart, skull, or





8. Neurological sensory deficit 9. Over a fracture site before healing is complete 10. Stress fracture sites 11. Over sites of active infection 12. Over the pelvic or lumbar area in

menstruating female patients 13. Areas of impaired circulation

You must have a rating of 4 or above on the competence and field/scenario elements to pass.Please mark below with the following rating system:

5 = Superior - distinctly more than expected of an athletic training student4 = Good – above average – better than expected3 = Average – expected performance2 = Fair – satisfactory performance1 = Poor – unacceptable performance



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Electrical Stimulation

All skills must be viewed, dated and initialed. Peers can “check off” Practice, an ACI must check off Competency and Field/Scenario.


HVPS, IFC, TENS, MENS

Set-up/Application - Principles 1. Establish that no contraindications are


rashes, infections, open wounds) 4. Clean the electrodes to remove any residual

gels or skin oils or use new electrodes 5. Clean the point to be stimulated with alcohol

to remove any body oils, lotions, dirt, etc. 6. Connect the leads to the unit and to the

electrodes. 7. If using carbon-impregnated rubber

electrodes, wet the sponge or apply gel to electrodes. If using self-adhesive electrodes, apply to patient

8. Determine the electrode placement technique to be used.

9. If a monopolar technique is being used, attach the dispersive electrode to a large body mass (Do NOT cross the spinal cord, or place over the abdomen or torso).

10. Secure electrodes in place if not self-adhesive.

11. Explain the sensations to be expected from the treatment, and advise against any unnecessary movement during the treatment.

12. Turn the unit on - Activate the POWER switch.

13. Reset out put parameters - Fully reduce the INTENSITY control and depress the RESET button.

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14. Select output parameters A. Select modeB. Set the Pulse or phase duration (width)C. Adjust the pulse (or beat) frequency (rate)D. Select polarity (HVPS)E. Select sweep frequency (IFC)F. Select phase intervalH. Vector depth (according to the depth of

the tissue)I. Vector Speed

15. Set treatment duration.16. Begin treatment by pressing the start button17. Slowly increase the intensity control until the

appropriate current level is obtained.18. If necessary or applicable, adjust the balance

control to maximize comfort19. If the unit does not shut off automatically,

gradually decrease the intensity and/or depress the STOP button.

20. Remove the electrodes from the body, and wipe away any residual gel.

21. Check the treatment area for burns, skin irritation, or discoloration.

22. Conduct an interview with the patient immediately following the treatment to ascertain the effectiveness of the parameters used.

23. Record treatment parameters and patient’s comments.

Indications - (HVPS) 1. Reeducation of peripheral nerves 2. Delay of denervation and disuse atrophy by

stimulating muscle contractions 3. Reduction of post-traumatic edema 4. Maintenance of range of motion 5. Reduction of muscle spasm 6. Reeducation of partially denervated muscle 7. Facilitation of voluntary motor function 8. Increase in local blood circulation

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Contraindications - HVPS 1. Cardiac disability 2. Demand-type pacemakers 3. Pregnancy – over pelvic area 4. Menstruation – over pelvic area 5. Cancerous lesions 6. Sites of infections 7. Exposed metal implants 8. Over the carotid sinus, esophagus, larynx,

pharynx, on or around the eyes, the upper thorax, the temporal region

9. Severe obesity10. Areas of the skin irritated by the use of gel,

adhesive, or current flow

Indications - (TENS)1. Control of chronic pain2. Management of post-surgical pain3. Reduction of post-traumatic acute pain

Contraindications - (TENS)All of the above listed for HVPS and:1. Pain of central origin 2. Pain of unknown origin

Indications – Interferential/IFC1. Acute pain2. Chronic pain3. Muscle spasm

Contraindications – Interferential/IFCAll of the above listed for HVPS and TENS

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Indications - MENS1. Acute and chronic pain2. Acute and chronic inflammation3. Reduction of edema4. Sprains5. Strains6. Contusions7. Temporomandibular joint dysfunction 8. Carpal tunnel syndrome9. Superficial wound healing10. Scar tissue11 Neuropathies

Contraindications - MENSAll of the above listed for HVPS and:1. Pain or other symptoms of unknown origin2. Osteomyelitis

General Principles – Electrical StimulationStudent demonstrates the ability to select theappropriate parameters for:- Pain relief – gate control theory- Pain relief – endogenous opiate theory- Muscle re-education- Electrode placement technique





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Comprehensive Oral Practical: You will select one item out of a hat from the Oral Practicals you have done to this point and be evaluated on that item.






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KIN 197D,KIN 193 and KIN 194

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KIN 197D: Internship in Athletic Training IV




PHARMACEUTICAL Epinephrine Injection

- Identify indications- Demonstrate proper

verbal/nonverbal instructions- Identify signs/symptoms of an

allergic reaction or overdose of epinephrine

- Demonstration of proper storage- Demonstration of proper disposal of

injection system Bronchodilator (inhaler)

- Identify indications - Demonstrate proper verbal

nonverbal instructions- Identify signs/symptoms of an

allergic reaction or overdose of bronchodilator

- Demonstration of proper storage

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REQUIRED NRRanges of Motion - demonstrate instruction of the following Passive ROM exercises

- Lower extremity- Upper extremity- Trunk- Cervical spine

Active ROM exercises- Lower extremity- Upper extremity- Trunk- Cervical spine

Active-assisted ROM exercises- Lower extremity- Upper extremity- Trunk- Cervical spine

Exercise to Improve Speed - demonstrate ability to instruct and knowledge of concepts

- Upper extremity- Lower extremity

- Sprint work - Fartlek training

Exercise to Improve Agility - demonstrate ability to instruct and knowledge of concepts

- Carioca- Cross-over- Figure-eight- Zig-zag- Cutting maneuvers- V-cuts

Exercise to Improve Strength/Endurance - demonstrate ability to instruct and knowledge of concepts - Cardiovascular

- Aquatic- UBE- Stationary bike- Physioballs (upper and lower body)- Stairmaster- Treadmill- Elliptical trainer

- Muscular- Free weight- Cuff weights- Machine weights

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Exercise to Improve Power - demonstrate ability to instruct and knowledge of concepts

- Plyometric training- Olympic lifts- Stretch-shortening cycle- Amoritization period

REQUIRED NRExercise to Improve Neuromuscular Control - demonstrate ability to instruct and perform - PNF patterns - Upper Extremity D1 - Upper Extremity D2 - Lower Extremity D1

- Lower Extremity D2- PNF techniques

- Contract/relax- Hold/relax- Quick reversal- Slow reversal- Rhythmic stabilization

- Propcioception/kinesthetic awareness - Wobble board or balance apparatus/BAPS - Incline board - Single-leg balancing (stable vs. unstable surface) - Weighted-ball rebounding - Plyoballs - Trampoline

Sport-Specific Skill Instruction and Improvement

- Running- Throwing- Catching- Striking- Biking- Other specific skills

Core Stabilization Activities- Stabilization- Postural control- Functional spine position- “Dead bug” activities- “Cat/camel” activities- Physioballs- Other activities _______________

Joint Mobilization- Upper extremity distraction- Upper extremity glides - Lower extremity distraction

- Lower extremity glides - Explain the convex/concave rules

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REQUIRED NREvaluation Base Line Information

- Goniometric measurements- Circumferential measurements

Compression- Circumferential- Intermittent- Sequential

Treatment Applications Traction

- Table (lumbar/cervical)- Manual- Wall/mounted - Gravitational (ex: Codman’s)

Massage- Pre-event- Post-event- Friction- Tapotement- Petrissage- Effleurage- Acupressure

Case Study: Two rehabilitation case studies, one lower and one upper extremity injury of your choice, must be completed according to the green sheet and placed in your file. Each case study must include:

Introduction of injuryRelevant anatomy General information about the injurySurgery (if applicable)Rehabilitation:

Phases of rehabilitation (goals, objectives and criteria to progress)Specific exercises (include for example sets & reps, and positioning of patient)Specific Modalities (include all settings)Approximate timeframe for rehabilitationSummary

Date & Initial

Completion of Mock National Certification Examination Score (%) Date & Initial

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Comprehensive Oral Practical - You will pick one item at random from all the Oral Practical evaluations you have done to this point. You will then perform the oral practical evaluation.






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