Therapeutic Exercise III

Course Description

Therapeutic Exercise III includes the application of therapeutic exercises for clients with vascular problems, amputations, and stroke, along with gait training and analysis for these clients.

Within the SCNS taxonomy, PHT is the Physical Therapist Assistant prefix. Daytona State publishes this at 4 credits, giving approximately 60 contact hours at the PHT lecture convention. It is the third and final course of the therapeutic exercise sequence, taken with its corequisite laboratory PHT2235L.

The three populations named here have something in common that the earlier courses' populations did not: all three involve permanent change rather than recovery to a previous state. A patient with a vascular condition, an amputation, or a stroke is frequently learning to do things differently rather than regaining what they had — and that reframes the therapeutic goal, the patient's emotional experience, and the clinician's role substantially. It is the most demanding content in the programme for reasons that are only partly technical.

Learning Outcomes

Required Outcomes

• Describe peripheral vascular disease, both arterial and venous, and their presentations.
• Distinguish arterial and venous insufficiency and their differing exercise implications.
• Describe lymphedema, its stages, and its management principles.
• Describe the precautions and contraindications for exercise in vascular disease.
• Recognize signs of deep vein thrombosis and describe the required response.
• Describe wound care precautions relevant to vascular patients.
• Describe compression therapy and its role.
• Describe levels of amputation and their functional implications.
• Describe post-amputation management, including residual limb care and shaping.
• Describe prosthetic components and their selection considerations.
• Describe prosthetic training progression from donning through ambulation.
• Recognize prosthetic fit problems and describe the required response.
• Describe phantom limb sensation and pain and their management.
• Apply exercise interventions for the patient with an amputation.
• Describe stroke, its types, and its typical presentations by lesion location.
• Describe hemiplegia, tone abnormalities, and recovery patterns.
• Apply neuromuscular re-education and task-specific training after stroke.
• Describe hemineglect, aphasia, and cognitive sequelae and adapt intervention accordingly.
• Describe shoulder subluxation and its prevention.
• Analyze normal and pathological gait and identify deviations.
• Relate gait deviations to specific impairments in each population.
• Apply gait training with appropriate assistive devices and guarding.
• Describe orthotic devices and their role in gait.
• Progress intervention within an established plan of care and document response.

Optional Outcomes

• Describe body-weight-supported treadmill training.
• Describe constraint-induced movement therapy.
• Describe functional electrical stimulation in gait.
• Describe wheelchair mobility and seating for these populations.
• Describe community reintegration and driving assessment referral.
• Complete preparation for the NPTE-PTA.

Major Topics

Required Topics

• Peripheral vascular disease
• Arterial versus venous insufficiency
• Lymphedema
• Vascular exercise precautions
• Deep vein thrombosis recognition
• Wound care precautions
• Compression therapy
• Amputation levels and function
• Post-amputation management
• Prosthetic components
• Prosthetic training progression
• Prosthetic fit problems
• Phantom limb sensation and pain
• Exercise after amputation
• Stroke types and presentations
• Hemiplegia, tone, and recovery
• Neuromuscular re-education after stroke
• Neglect, aphasia, and cognitive sequelae
• Shoulder subluxation
• Gait analysis
• Deviations by population
• Gait training and assistive devices
• Orthotics in gait
• Progression and documentation

Optional Topics

• Body-weight-supported treadmill training
• Constraint-induced movement therapy
• Functional electrical stimulation in gait
• Wheelchair mobility and seating
• Community reintegration
• NPTE-PTA preparation

Resources & Tools

• Therapeutic Exercise: Foundations and Techniques (Kisner & Colby) — the reference for this sequence, and the book PTAs keep.
• Physical Rehabilitation (O'Sullivan, Schmitz & Fulk) — the comprehensive clinical reference.
• Daniels and Worthingham's Muscle Testing — the manual muscle testing standard.
• Measurement of Joint Motion: A Guide to Goniometry (Norkin & White) — the goniometry standard.
• Kinesiology of the Musculoskeletal System (Neumann) — carried forward from PHT1128; the exercise rationale rests on it.
• APTA (apta.org) and its clinical practice guidelines — student membership is inexpensive and the guidelines are the evidence base.
• Shirley Ryan AbilityLab Rehabilitation Measures Database — free; the fastest lookup for any outcome measure.
• FSBPT (fsbpt.org) — free NPTE-PTA content outline; therapeutic exercise is the most heavily weighted domain.
• CAPTE (capteonline.org) — free accreditation lookup and programme pass rates.
• A goniometer, a gait belt, and a practice partner — the working kit, and the partner matters most.
• Model Systems Knowledge Translation Center (msktc.org) — free patient and family education materials on stroke, limb loss, and related conditions; genuinely usable with real families.
• Amputee Coalition (amputee-coalition.org) — free resources and peer support information.

Career Pathways

• Physical therapist assistant — SOC 31-2021.
• Outpatient orthopaedic clinics — the largest PTA setting, and where therapeutic exercise is the daily work.
• Skilled nursing and long-term care — a very large Florida sector.
• Inpatient rehabilitation and acute care.
• Home health — frequently the best-paid PTA setting.
• Cardiac and pulmonary rehabilitation — a defined setting where this content applies directly.
• Sports and performance settings.
• Aquatic therapy — Florida has many facilities.
• Paediatric and school-based practice.
• Travel PTA work — higher pay for mobility.
• ⚠ Becoming a physical therapist requires a doctoral degree, and PTA coursework generally does not transfer into it.

Special Information

⚠⚠ Vascular patients: the precautions are the content

• Arterial and venous insufficiency require opposite handling in some respects, and confusing them is a genuine clinical error. Compression is central to venous management and can be harmful in significant arterial disease.
• Know the presentations. Arterial disease produces claudication, diminished pulses, pallor on elevation, and painful distal ulcers; venous disease produces oedema, hemosiderin staining, and less painful ulcers at the medial malleolus.
• Deep vein thrombosis is the emergency. Unexplained calf pain with swelling, warmth, and redness means stop, do not massage or exercise the limb, and escalate immediately — a dislodged thrombus causes pulmonary embolism.
• Exercise is beneficial in arterial disease but must be prescribed to symptom tolerance, and claudication-limited walking programmes have real evidence behind them.
• Check the skin every session. These patients have impaired healing and frequently impaired sensation, and a small injury becomes a serious wound.
• Diabetes is frequently comorbid, bringing neuropathy, impaired healing, and foot ulceration risk — and Florida's large diabetic population makes this combination extremely common in practice here.
• Footwear and foot inspection matter and are legitimate patient education within scope.
• Report skin changes and non-healing wounds to the supervising PT and the team promptly.

⚠ Amputation and stroke: the psychological dimension is part of the clinical picture

• Both populations are experiencing loss, and grief, depression, and altered identity are common and clinically relevant rather than incidental.
• Depression after stroke is common and under-recognized, and it substantially affects participation and outcome. Noticing it and reporting it is within your role; treating it is not.
• Phantom limb sensation is normal and nearly universal after amputation; phantom limb pain is different and is a genuine clinical problem. Telling a patient their sensation is imaginary is both wrong and harmful.
• Body image and identity change. How a clinician speaks about a residual limb or an affected side matters more than clinicians usually realize.
• Language matters. "The patient with left hemiparesis" rather than "the left CVA in room 4," and never discussing a patient as though they cannot hear — patients with aphasia frequently understand far more than they can express.
• Families are part of the picture, and they are frequently exhausted, frightened, and receiving a great deal of information from many professionals.
• Set expectations honestly but stay in scope. The PTA does not deliver prognosis — refer those conversations to the supervising PT or physician.
• Motivation is a treatment variable. Meaningful goals produce effort, and effort produces the repetitions that drive recovery.

⚠ Gait analysis is the culminating skill of the whole programme

• Gait training with these populations brings together everything — kinesiology, neuroscience, patient handling, therapeutic exercise, and orthotic and prosthetic knowledge.
• Deviations point to impairments, and the impairment determines the intervention. A Trendelenburg gait indicates hip abductor weakness; a steppage gait indicates dorsiflexor weakness; circumduction indicates a clearance problem — reading the deviation backward is the diagnostic skill.
• Prosthetic gait deviations frequently indicate fit or alignment problems rather than patient impairment, and recognizing that is what gets the patient back to the prosthetist rather than practising a compensation.
• Hemiplegic gait has characteristic patterns, and understanding which are compensations worth allowing and which are patterns worth retraining is genuine clinical judgement.
• Guard properly. These patients fall, and gait training is where it happens. Gait belt, correct side, and a planned route with a chair.
• Weight-bearing status and precautions are absolute and must be confirmed before every session.
• Orthoses change gait deliberately. An ankle-foot orthosis controlling drop foot alters the whole pattern, and checking fit and skin under it is a required step.
• Video is free and revealing. Slowing a recording shows what full-speed observation misses, and it is useful for patient education too.

⚠⚠ Safe patient handling and exercise safety

• Musculoskeletal injury from patient handling is the leading occupational injury in rehabilitation, and body mechanics alone are not sufficient protection — no amount of correct technique makes manually lifting an adult safe. Use the equipment.
• Never catch a falling patient. Guide a controlled descent and protect the head.
• Guard with a gait belt during any activity where balance is challenged, and position yourself on the appropriate side.
• Clear the environment before mobility or balance work — cords, rugs, wet floors, and furniture cause falls unrelated to the patient's ability.
• Know your stop criteria. Abnormal vital sign response, chest pain, disproportionate dyspnoea, dizziness, new neurological symptoms, or unusual pain all mean stop and notify.
• Monitor rather than assume. A patient's tolerance varies by day, by time of day, and by medication.
• Report injuries and near misses, including your own.

⚠⚠ PTA scope: you may not evaluate, establish, or alter the plan of care

• Physical therapy is licensed in Florida under Chapter 486, Florida Statutes. Both physical therapists and physical therapist assistants are licensed.
• The physical therapist evaluates, interprets, and establishes the plan of care. The PTA implements it. A PTA may not perform an initial evaluation, may not independently modify the plan, and may not discharge a patient.
• Progressing an exercise within the plan is different from changing the plan. That distinction is the everyday application of scope in these courses, and it is worth getting precise about.
• Data collection is within scope; interpretation is not. Measuring range of motion, grading strength, and reporting response is your job; deciding what it means for the plan is not.
• Report changes to the supervising PT promptly. A patient whose condition has changed needs re-evaluation.
• Supervision requirements are set by rule and differ by setting and payer, and Florida's differ from other states'.
• Documentation must support the billed service and demonstrate skilled care; therapy over-utilization has been a major federal enforcement area, particularly in Florida skilled nursing, and a PTA has personal exposure.
• CAPTE accreditation gates the pathway to NPTE-PTA eligibility and Florida licensure — verify before enrolling anywhere.
• Rule 11 applies — verify current requirements with the Board and the payer.

How Florida course levels affect transfer

The first digit of an SCNS number denotes the year of offering, not transferability. Courses at the 1000 and 2000 levels transfer transparently between Florida public institutions, and 3000 to 4000 is unproblematic since both are upper division. The boundary that actually matters is 2000 to 3000, where lower-division credit generally cannot satisfy an upper-division requirement.

PHT2235 is 4 credits and approximately 60 contact hours, with the corequisite laboratory PHT2235L — distinct SCNS numbers, both required. The catalog does not state the lecture's term of offering; the laboratory is published for fall, so confirm the schedule with the programme.

It completes the therapeutic exercise sequence and, with it, the classroom portion of the PTA programme before the terminal clinical rotations — see this repository's PHT2810 and PHT2820 guides.