Therapeutic Exercise III Lab

Course Description

Therapeutic Exercise III Lab 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 and the L suffix marks a laboratory-only course, paired with the PHT2235 lecture. Daytona State publishes this at 2 credits with a $9 lab fee, offered fall, giving approximately 60 contact hours at the DSC physical therapist assistant laboratory convention.

This is the final laboratory of the programme, and it is the one closest to what a PTA actually does in an inpatient rehabilitation or skilled nursing setting. The patients are complex, the handling is demanding, and the margin for error in guarding is small — which is exactly why it comes last, immediately before the terminal clinical rotations.

Learning Outcomes

Required Outcomes

• Screen for precautions and contraindications specific to vascular, amputee, and stroke patients.
• Recognize signs of deep vein thrombosis and respond appropriately.
• Inspect skin and wounds and report findings.
• Apply exercise interventions for patients with vascular conditions.
• Apply compression and positioning techniques where indicated.
• Perform residual limb care techniques, including wrapping and shrinker application.
• Position a patient after amputation to prevent contracture.
• Instruct and supervise pre-prosthetic exercise.
• Instruct prosthetic donning and doffing.
• Progress prosthetic gait training from parallel bars to community ambulation.
• Recognize prosthetic fit and alignment problems and report them.
• Apply exercise and positioning interventions after stroke.
• Handle a hemiplegic patient safely, including positioning and transfers.
• Protect a subluxed or at-risk shoulder during handling and exercise.
• Apply neuromuscular re-education and task-specific training.
• Adapt instruction for aphasia, neglect, and cognitive impairment.
• Apply appropriate cueing strategies for patients with perceptual deficits.
• Perform gait analysis and identify deviations in each population.
• Apply gait training with appropriate assistive devices.
• Guard safely during gait training, including on stairs and uneven surfaces.
• Fit and check orthotic devices and inspect the skin beneath them.
• Instruct patients and caregivers in home programmes and safe handling.
• Document intervention, response, and observations accurately.
• Apply safe patient handling principles throughout.

Optional Outcomes

• Use body-weight-supported treadmill equipment.
• Apply functional electrical stimulation during gait.
• Perform wheelchair mobility training.
• Administer standardized functional outcome measures.
• Practise caregiver training scenarios.
• Prepare for practical examination and clinical readiness assessment.

Major Topics

Required Topics

• Population-specific screening
• Deep vein thrombosis recognition
• Skin and wound inspection
• Vascular exercise application
• Compression and positioning
• Residual limb care and wrapping
• Post-amputation positioning
• Pre-prosthetic exercise
• Prosthetic donning and doffing
• Prosthetic gait progression
• Prosthetic fit problem recognition
• Post-stroke exercise and positioning
• Hemiplegic handling
• Shoulder protection
• Neuromuscular re-education and task-specific training
• Adapting for aphasia, neglect, and cognition
• Cueing for perceptual deficits
• Gait analysis
• Gait training with devices
• Guarding on stairs and uneven surfaces
• Orthotic fitting and skin checks
• Home programme and caregiver instruction
• Documentation
• Safe patient handling

Optional Topics

• Body-weight-supported treadmill training
• Functional electrical stimulation in gait
• Wheelchair mobility training
• Standardized outcome measures
• Caregiver training scenarios
• Practical examination 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 stroke and limb loss education materials usable directly with patients and families.
• A practice partner willing to simulate impairment honestly — the most important resource in this course.

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

⚠⚠ The hemiplegic shoulder — a preventable injury clinicians cause

• A flaccid or weak shoulder after stroke is vulnerable to subluxation and soft tissue injury, and a great deal of that injury is caused by handling.
• Never pull on the affected arm. Not to assist a transfer, not to reposition, not to help someone sit up. This is the single most important handling rule in stroke rehabilitation.
• Support the arm during transfers and positioning, and educate every caregiver and family member who will handle the patient.
• Position deliberately in bed and in the chair — supported, with the scapula protracted where indicated, and without the arm hanging unsupported.
• Avoid overhead pulley exercises in the presence of subluxation or impaired scapulohumeral rhythm; they are a documented cause of impingement injury in this population.
• Check for subluxation and report changes.
• Shoulder pain after stroke substantially impedes rehabilitation — a painful shoulder limits participation in everything else, which is why prevention matters so much.
• Teach the family. Most handling happens when you are not there.

⚠ Prosthetic and orthotic checks — fit problems present as gait deviations

• A prosthetic gait deviation is frequently a fit or alignment problem rather than a patient impairment, and treating it as the latter means training a compensation around a fixable device issue.
• Inspect the residual limb before and after every session. Redness that does not resolve within a defined period, blistering, or breakdown means stop and report — and the patient may not be able to feel it.
• Check the socket fit, sock ply, and suspension. Limb volume changes through the day and across weeks, particularly early after amputation.
• Residual limb wrapping and shrinker use shape the limb for prosthetic fit, and incorrect wrapping produces a shape that cannot be fitted.
• Contracture prevention is urgent early. Positioning after amputation prevents hip and knee flexion contractures that make prosthetic use difficult or impossible.
• Orthoses require the same discipline — check the fit, check the skin beneath, and know the wear schedule.
• Report device problems to the supervising PT and the prosthetist or orthotist. Adjusting a device is not within the PTA scope.
• Progress systematically — parallel bars, then a walker or crutches, then a cane, then community surfaces and stairs.

⚠ How to use the final laboratory well

• This is the last supervised practice before clinical rotations, and clinical instructors will assess these exact skills in your first week.
• Practise with partners simulating real impairment — hemiplegia with genuine non-use of one side, a partner who follows only simple commands, a partner who cannot see the affected side. A cooperative classmate teaches nothing about a patient who cannot cooperate.
• Practise the whole session, not the technique in isolation — screening, vital signs, transfer, intervention, gait training, documentation, and the handover.
• Rehearse the emergencies. A patient who becomes dizzy, who begins to fall, or who reports chest pain — knowing what you would do before it happens is what makes the response automatic.
• Practise the family education conversation. Teaching a caregiver to transfer safely is a real clinical task and it is frequently assessed.
• Ask for the difficult scenarios. Students who volunteer for the hard cases learn faster and arrive at clinicals more confident.
• Use open lab. Sixty scheduled hours is a floor.
• Take handling corrections seriously — an instructor adjusting your guarding is preventing a patient injury and protecting your own back.

⚠⚠ 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.

PHT2235L is 2 credits and approximately 60 contact hours, with a $9 lab fee, offered fall alongside PHT2235. It is the final laboratory of the PTA programme, immediately preceding the terminal clinical rotations.

Expect skills competency assessment and clinical readiness evaluation. See this repository's PHT2804, PHT2810, and PHT2820 guides for the clinical practicum sequence that follows.