Skill Check Techniques

Manual Contact

On a neuromuscular level, motor responses are heavily influenced by pressure receptors. Therefore, appropriate pressure is a necessary component for influencing the direction of motion and facilitating a maximal response. Manual contact should impart a feeling of security and should not be painful. Proper body positioning and mechanics are preliminaries for appropriate application of pressure.

NDT and PNF are specific for an open hand approach to facilitating movement: there is no grasping the patient to facilitate optimal alignment or movement.

With NDT, contact is very light initially and allows for a graded increase in pressure depending on the stimulus needs of the patient.

Appropriate Resistance

Appropriate resistance is that amount of manual resistance which facilitates a maximal response while still allowing a smooth and coordinated contraction. Maximal resistance facilitates irradiation and overflow from stronger components to those that are weaker. Emphasis should be placed on avoiding the valsalva maneuver.

Resistance during PNF is dependent on the desired outcome of the intervention. For example resistance applied to build stability will differ in speed and force than resistance applied to produce a stretch

Body Mechanics and Safety

Gross motor skills are task-specific: physical therapy providers need to be able to work in and at the bedside, on hi-low mats, in parallel bars (sitting/standing) and in functional environments (bathroom, kitchen, car). Principles of good body mechanics (center of gravity, base of support, flexibility) must be observed during skill check and clinical activities.

Safety for you and your patient is the key to a successful treatment and career. Follow your clinical site's policy on use of a gait belt. In some cases, you will not be covered under Workmen's Compensation if you are injured during patient care and DID NOT follow safety policies and procedures, including correct use of a gait belt. When in doubt, put on the belt!

Verbal Cueing

Cueing should be simple, concise, audible. Depending on the condition and patient status, the patient should be given ample time to respond volitionally to the motor command. PNF cueing emphasizes the desired response (e.g. "hold" vs. "don't let me move you")

PNF Rhythmic Stabilization

Alternate isometric resistance to various manual contact points to enhance balance. Direction of pressure and hand positions are altered smoothly, increasing and decreasing resistance slowly, so that the patient continues to maintain a stabilizing contraction