Final Year BPT

Community Based Rehabilitation

PRACTICAL LABORATORY MANUAL

Objective of the manual

This manual was created to provide a hands-on resource to support teaching and
learning goals for Community based rehabilitation course. The purpose is to
inculcate and expertise in implementing the techniques accurately through close
monitoring and individual attention towards skill learning.

The student will be allowed to practice and demonstrate the procedure of

experiments only when the theoretical knowledge is found to be satisfactory;
precautions been taken during experiment will be observed.

The student will be expected to interpret the findings correctly and will also be
expected to prepare a report and submit to the faculty.

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 Table of contents

Sl. No. Name of topics Page no.

1. Lab attendance Guidelines 4

2. Lab report Guidelines 5-6

3. International Classification of Functioning, Disability and 9-10

Health (ICF)

4. Wheel chair 11-15

5. Information Education and Communication (IEC) 16-20

6. Home Safety Check List 21-22

7. Design of Public Buildings (Access Audit) 23-38

8. Assistive Technology Fabrication 39-43

9. Timed up and Go Test 44-47

10. Tinetti Test- POMA 48-52

11. Geriatric Fitness filed test 53-59

12. Kegels Exercise 60-67

13. REBA, RULA and ROSA 63-69

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14. WHODAS2.0 70-71

15. Energy Expenditure Index/ Physiological Cots Of Index 72-74

16. Wheel chair Prescription 76

17. Wheel chair Propulsion 77

18. Safe Falling 78-79

19. Otago Exercise Program 80-81

20.C Car Transfer 82-83

21. Home Modification 84

22. Interdisciplinary Plan Of Care 85-86

23. Therapeutic Recreation 87-88

24.P Patient Documentation 89-91

25. Work Conditioning and Work Hardening 92-93

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Lab Attendance guidelines

 Read about the given technique/ equipment

 Lab attire has to be adhered
 Should have tool kit

Experiment guidelines

 Greeting and education about the technique/ equipment

 Demonstration
 Evaluation (stations)
 Management
 Winding up

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Lab report/Record

Guidelines Goal

The goal of the laboratory assignments is to provide an environment to enhance the

learning experience by teaching through demonstration and to choose appropriate
equipment and analysis the need and outcome of the equipment or tool. The
students need to work in the groups in the lab to gain experience in implementing
the techniques, data collection, analysis, interpretation and presentation

CBR Lab

 Lab work will be done in groups of 2-5 depending on the type of the lab work.
 All lab reports will be due on Saturday, unless otherwise stated.
 Labs will be conducted in the scheduled practical hour. Attendance in
practical hour is calculated as per University attendance policy.

Lab Reports

Lab reports are to be submitted as formal written reports by the lab

group. Your lab should have as a minimum the following headings:

 Cover Page

 Introduction

 Purpose of Lab equipment or technique

 Methodology for lab

 Subject information

 Equipment utilized

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 Techniques performed

 Process of data collection

 Analysis

 Results

 Discussion/Conclusions

 Interpretation of the lab findings and its application in real life situations.

 Reference in Vancouver format

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ASSESSMENT

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 MODULE 1- ASSESSMENT

Learning objectives: The student will acquire knowledge, practice, and

demonstrate the technique/ procedure of the given component of assessment and
interpret the findings.

Theoretical knowledge required (give topics and page numbers from relevant
textbook)

Assessment of theoretical knowledge (MCQ)

Eligible for practical class Yes No

Practical objective: Student will be able to demonstrate the procedure of each

component in assessment and analyze the results of the experiment.

Procedure to be followed:

1. Student should select appropriate equipment

2. Ensure proper working condition of equipment

3. Introduction and explanation of the procedure to the model

4. Follow the principles-proper positioning of model and handling of equipment

5. Demonstration of the experiment and interpretation of findings.

6. Winding up procedure

ICF (International Classification of Functioning, Disability and Health)

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ICF model: International Classification of Functioning and health, ICF (WHO,
2001) a universal model which can be applied to all peoples that provides a
comprehensive, universally accepted taxonomy for describing functioning. In ICF
there is an integration of both biopsychosocial model of functioning and disability.

Learning Objective:

At the end of the session the student should be able to integrate the
definition of functioning and disability and the respective components within the
integrative bio psycho social model and identify and name the components on a
case example.

Theoretical knowledge required:

 Bio psychosocial model of disability.

 ICF Components: Functioning and disability, Contextual Factors.

Assessment of the theoretical Knowledge:

 What is functioning and disability?

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  Define body function, Body structure and activity limitation
and participation restrictions as per ICF model?
 Mention with an example the difference between performance and capacity?

Eligible for practical class: YES NO

Practical class objective: Student will be able to apply ICF evaluation on the
condition specified.

1. Mr. ABC, a 30 year old unmarried farmer by profession living with his aged
illiterate parents in a remote village sustained incomplete Motor ‘C’, Spinal
cord injury at the level of D10. Who underwent surgery and now referred for
rehabilitation. ABC wants to go back to his farm within 1 month and should
be able to work independently. Currently he is out of spinal shock and has
no muscle power in his lower limbs down to his hip which can work against
gravity. He is dependent for lower body dressing, bathing (Lower part of the
body) and transfers. All other daily skills he is independent. Plan a ICF
model of evaluation for the patient.

Health condition: Incomplete Motor C Spinal cord injury at the level of D10

Body functions: No muscle power in his lower limbs down to his hip against gravity

Activities: dependent for lower body dressing, bathing(lower part of the body) and
transfers.

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Participation: Person can’t go back to work due to his present health condition.

Environmental factors: unmarried farmer living with his aged parents

Personal factors: Spinal cord injury at D10 level, 30 years old, male, underwent
surgery

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WHEEL CHAIR

What is a wheel chair: It is a device providing wheeled mobility and seating support
for a person with difficulty in walking or moving around. wheelchair is one of the
most commonly used assistive devices for enhancing personality, which is a
precondition for enjoying human rights and living in dignity and assists people
with disabilities to become more productive members of their communities (WHO)

An appropriate wheel chair should meet the user’s needs and environment
conditions; Provide proper fit and postural support; is safe and durable; available in
the country; can be obtained and maintained and services sustained in the country
at the most economical and affordable prices.

What is the use of giving the wheel chair…?

By providing a wheel chair the person who has limited mobility will be able to be
mobile, be independent and remain healthy and participate fully in home and
community.

Types of wheel chair:

As the users of the wheel chair and the physical needs are different there is no
single model or size of the wheel chair which can meet all the needs of the users.

1. Manual wheel chairs

a. Manual wheel chair by style
i. Transport wheel chairs
ii. Folding frame wheel chairs
iii. Rigid frame manual wheel chairs
b. Manual wheel chair by weight
i. Light weight manual wheel chairs

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 ii. Standard weight manual wheelchairs
iii. Heavy duty manual wheelchairs
2. Powered wheelchairs.
3. Hybrid wheel chairs
4. Positioning wheelchairs
5. Sports wheelchairs
6. Mobility scooters
7. Standing wheel chairs

Manual Transport wheel

Chairs

Folding Frame wheel

Chairs

Powered wheel chairs

Positioning wheel chairs

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 Sports wheel chair

Standing wheel chair

Learning objective
At the end of the session the student should be able
to
 Describe the steps for appropriate wheel chair
provision, plan thorough assessment and
education based on the individual, needs,
environment and activities.

 Plan a wheelchair skills training session based

upon an individual portrayed.

Requirement prior to the practical class

The student must submit the Physiopedia course completion
certificate on the following areas.

 Introduction to wheel chair service provision

 Steps to appropriate wheel chair provision

 Wheel chair fitting skills and maintainace

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Wheel chair - Practical

1. Need description: used for indoor and outdoor locomotion. Used in hospital to
transfer patient from one place to another. In conditions like spinal cord injury, CP,
Stroke, Developmental disabilities, fractures, sprains etc.

2. Identifications of parts
Basic manual wheelchair- Push handle,
Armrest,
Back rest
Cushion
Seat
frame
calf strap
footplate
castor
anti-tip bar
rear wheel
brake
push ring
Powered wheel chair- Back upholstery
Hand grip
Arm
Joystick
Integral controller
Seat cushion
Seat upholstery
Front rigging
Leg strap
Foot plate
Castor
Cross brace
Rare wheel
Motor, battery box and tray
Wheel lock

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3. Measurements:
Seat height:- 19.5-20.5 inches
Seat depth:- 16 inches
Seat width:- 18 inches
Back height:- 16-16.5 inches
Arm rest height- 9 inches above chair seat

4. Safety features

 Do not force the wheelchair down or upstairs, slopes and inclines.

 Adjust and program your motorized wheelchair settings so that you are
comfortable with the speed.
 Do not go out n the rainy weather, wheelchairs are more prone to lose
traction and controls of the motorized wheelchair can get wet.
 Avoid having heavy bag or items on the back of the wheelchair, this can
cause the wheelchair to tip backwards during transferring.
 Lift up or adjust the footrest and arm rest if needed before transferring.
 Lock the brakes before getting out or into the wheelchair. The power should
be turned off for motorized wheelchairs before transferring

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5. Remarks

6. Skills
Turning in place, moving sideways
Slopes- inclination and declination
Stairs and accelerator uses
Pushing forward and backward

7. Assessment of wheel chair

1. Identifying the Presence, Risk of or History of Pressure Areas-risk of

developing a pressure area-

 decreased sensation
 decreased mobility and/or paralysis;
 moisture from sweat, water or incontinence;
 poor posture;
 previous or current pressure sore;
 poor diet and not drinking enough water;
 aging;
 Weight (underweight or overweight).

2. Identifying Method of Propulsion; It is important to find out what

method of propulsion the wheelchair user will use to push, as this
can affect the choice of wheelchair and the way it is set up.

3. Assessment of Sitting Balance.

patient‘s postural alignment at head, shoulder, trunk, pelvis and
lower extremities using the visual observation and palpation
skills.

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 Observation of sitting posture without support;
 Completion of a pelvis and hip posture screen, which will
identify how any problems around the pelvis or hips may
affect the wheelchair user’s sitting posture; and
 Carrying out hand simulation to ‘simulate’ the support
that a wheelchair and additional postural supports may
provide the wheelchair user;

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 IEC

Information, education and Communication (IEC) is an approach which

attempts to change or reinforce a set of behavior in a target audience regarding
a specific problem in a predefined period of time. IEC strategy was originated
from health education framework. IEC material attempt to give information
whose focus to increase peoples knowledge about and issue and have them use
it as a basis for decisions/change.

Learning Objective: At the end of the session the student should be able to
understand the situation or scenario (student can choose two situation or
scenario) and make an effective IEC material in any of the following ways.
a. Printed materials
b. Community discussion
c. Radio spot
d. Drama

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Prerequisites:

The student must have the knowledge about the community and should perform a
community assessment, to understand the existing knowledge, skills and attitude of
the community towards particular issue or given situation.

Scenario 1.

Mr. Ramesh is a spinal cord injury patient. He lives in a small village. He is

uneducated and health is not his priority. He is unaware of health benefits
available from the government. Make a printed education material to educate
him as well as the community about this situation.

1. Patient history:- Patient is diagnosed as spinal cord injury and is unaware of his health
benefits.

2. Examination findings
 Reduced or absent sensations
 Incomplete or complete loss of motor function
 Reduced coordination
 Impaired balance
 Reduced hand movements

3. Body structure deficits

 Muscles of the back
 Abdominal muscles
 Spinal cord, nerves and plexus

4. Functional Impairments
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  Strength and endurance is reduced

5. Activity limitation
 Sitting
 Standing
 Kneeling
 Walking is reduced

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 6. Participation restriction
 Unable to attend functions
 Unable to move around
 Unable to meet friends
 Unable to work in his village

7. Contextual factors
 Ramesh-spinal cord injury
 Unaware of his health benefits
 Uneducated
 Lives In a small village

Scenario 2.

Mr. varun is a teacher. He is working since 30 years. His chief complaint is pain in
the bilateral knees since 6 years. As he is a teacher, he involved in activities which
require prolonged standing. He is obese in nature. There are many people with
similar condition in his village. Design and conduct a community discussion
programme in order to educate people with similar problem.

1. Patient history: Patient is having pain in his bilateral knees since 6 years

2. Examination findings:
 Pain, NPRS:- 8/10
 Reduced mobility
 Reduced flexibility
 Reduced range of motion
 Presence of swelling

3. Body structure deficits

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  Muscles-Quadriceps, Hamstring, Calf muscles
 Cardiovascular function and blood vessels

4. Functional Impairments
 Endurance is reduced
 Knee joint range is reduced
 Cardiovascular system is reduced

5. Activity limitation
 Sitting
 Standing
 Walking is reduced
 Prolonged standing
 Prolonged sitting

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 6. Participation restriction
 Unable to attend school
 Unable to meet friend, neighbor
 Unable to attend any family function

7. Contextual factors
 Varun is a teacher
 30 year old
 Obese in nature
 Lives in the village

Scenario 3

Ms. Manju is a working lady and she is pregnant. Now she is in her second
trimester she has back pain from the starting of her pregnancy. Prepare a prenatal
education to educate pregnant women regarding the importantance of exercise
during pregnancy in the form of a radio announcement.

1. Patient history:- Patient has pain from the starting of her pregnancy. She is a
working lady

2. Examination findings:-
 Pain(NPRS)-7/10
 Muscle tightness present
 Joint ROM-reduced hip, knee, ankle joint, ankle swelling
 Reduced flexibility
 MMT(Reduced muscle strength)

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3. Body structure deficits
 Muscle tightness(back muscles)
 Ligament sprain

4. Functional Impairments
 Pain the back region, radiating pain in the leg

5. Activity limitation
 Sitting down
 Lifting objects
 Prolonged sitting
 Standing
 Unable to do the household activities

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6. Participation restriction
 Unable to work
 Unable to perform ADLs
 Unable to attend family functions

7. Contextual factors
 Barrier:-Gender, fear, pain behavior, income(financial status)
 Facilitator:- Education,family support,medications

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 HOME SAFETY CHECK LIST

What is home safety check list

When a person with impairment, Disability or elderly people live in their own
home, safety considerations need to be addressed in order to improve or maintain
their mobility and independence.

By doing a home safety check information and awareness can be given to the
recipient regarding any potential issues by which an accidental fall or injury can be
prevented.

Learning Objective
At the end of the session the student should be able to

1. List the safety issues in the patients home and need to describe the patient
and family members how it can affect patients safety
2. Should give the suggestions on Modification of the threats which were
identified and discussion with family members and patients to be done.
3. Should be able to analyze the impact of the modification done

Theoretical Knowledge required

1. People with disability and fall risk

2. Falls in elderly
3. Intrinsic and extrinsic factors for fall

Prerequisite for attending Practical Class

Prior to the practical class student should submit the following Physiopedia course
certificates

1. Fall prevention through exercise

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 2. Introduction to frailty

Eligible for practical class YES NO

Practical

Students will be given three videos of the patient home evaluation on the
given videos safety checklist has to be done
Condition:- Parkinson’s disease
Address:- Devanur

1. Description of the house on given videos.

- Slope of around 34 degree inclined at the entrance of the house, Presence of
gate in front of the house that consists of latch on both sides.
-There are 2 steps at the entrance measuring 4 inches each, height of the
front door – 72 cm, length= 12cm
-Type of inside flooring –red oxide cemented floor, smooth surface
-Furniture:- arm rest chair, armless chair 3,
-Lights-3 bulbs with 5 watts.
-Kitchen entrance:- 1.5 inches, width – 24.5 inches
-Indian toilet

2. Barriers noted
- Indian toilet
- Less number of Lights(dull)
- Uneven surface at entrance
- High steps at front door

3. Types of individuals at risk

- Geriatric person
- Patient with Parkinson disease
- Patient having Balance and gait abnormalities
- Cerebral palsy patient

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4. Remarks: lighting should be increased, change in type of toilet (western toilet)

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 DESIGN OF PUBLIC BUILDINGS (ACCESS AUDITING)

What is access audit: Access auditing is an assessment of a building, an

environment or a service against best-practice standards to benchmark its
accessibility to disabled people.

Why access audit is required: The purpose of an access audit is to establish how
good a particular building or environment performs in terms of access and ease of
use by a wide range of potential users, including people with disabilities and to
recommend access improvements

Learning objective

At the end of the session students should visit designated places recognized by the
department of CBR in Mysore and should be able to fulfill the following objectives

 The current accessibility of the building/property/site;

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 Areas for improvement (e.g. no accessible car spaces in the car park or the
door in the accessible toilet on the ground floor is incorrectly located and
therefore the Wheel chair is inaccessible);

 Good/bad practice in relation to facilities management that an organization has

in place; positive accessibility features (e.g. counter loop at reception, good
use of lighting and color throughout building, signage);

Equipment required

Must Carry Items

 Disability Access audit check list

 Note Book with Pen

 A measuring tape (to measure door width, risers, landings etc.);

 A digital camera or Mobile camera

Good to Have
 A Grad level or gradient measuring device (to measure slopes);

 A door pressure gauge;

 An induction loop tester;

 A sound meter;

 A temperature recording device (hot water).

Prerequisites
Student should have the
 Theoretical knowledge about disability act(1995)
(http://disabilityaffairs.gov.in/content/page/acts.php)

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  Understanding about Disability Law and access to Rights
 Understanding Of RCI act
 National Trust Act
 Accessible India Campaign (Sugamya Bharat Abhiyaan)
 Access audit Process
o Pre audit Preparation
o Audit process
o Post audit reporting and follow up

Assessment Of theoretical knowledge

1. What are the steps involved in pre audit preparation?

2. Who are the members in the audit team?
3. How will be the impact of access audit will be analyzed?

Eligible for practical class: YES NO

Practical

Student will be given an a audited organization (Government/Private) and they

should do an access audit and report the same

Sample audit check List (Annexure)

Date of audit:29/9/2021
Name of the Audited organization : Government school, devanur
t Auditing Officer name:
Sahana,Chaitra,soundarya
Address: Devanur, Nanjangud

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Government or Private organization: Government

Name of the team Leader and signature:

soundarya, chaitra, sahana
A ENTRANCE
1 Before main entrance
Are these steps? Yes/No*. If yes, how many
Does the steps having railings? Yes/No*. If yes, one/both sides
Is there a ramp? Does the ramp have
railings? *Yes/No
Does the ramp have an edge protection? *Yes/No*. If yes, one/both sides
*Yes/No*. If yes, height of edge Protection:

2 Main Entrance
Is the width of the entrance greater than
Yes/No*. Width:980mm
or equal to 900 mm?
Type of door Automatic/Swing/Sliding*
Type of door handle (if applicable) Lever/knob*

Is the height of door handle between Yes/No*. Height of kerb:980mm

900 mm - 1100 mm?
Is there a kerb at entrance? Yes/No*. Gradient:
Is there a kerb ramp? Yes/No*.
Is there the International Symbol of
Yes/No*.
Access (Disabled Logo) displayed?
3 Side Entrance
Location (e.g. along Haig Road) (if
Yes/No*. If yes, location at
there is more than one location, please
specify all)

4 Side Entrance
Is the width of the entrance greater than Yes/No*. Width:980mm
or equal to 900 mm?
Type of door Automatic/Swing/Sliding*

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 Type of door handle (if applicable) Lever/knob*
Is the height of door handle between Yes/No*. Height of kerb:980mm
900 mm - 1100 mm?

Is there a kerb at entrance? Yes/No*. Gradient:

Is there a kerb ramp? Yes/No*.
Is there the International Symbol of
Yes/No*.
Access (Disabled Logo) displayed?
5 Is side entrance accessible to the Yes/No*. If no, give details:
wheelchair-users?(Please use section
A2 as a guideline).
6 Is the accessible entrance clearly Yes/No*. If no, give details:
identifiable?
7 Is the entrance wide enough? Yes/No*. If no, give details:
8 Is the door a push-open door? Yes/No*. If no, give details: It was not present
9 In multi-storey buildings, does
Yes/No*. If no, give details: The school was in
theaccessible entrance permit access ground floor
to
a conveniently located elevator?

10 Is the entrance landing area sufficient? Yes/No*. If no, give details:

Is the entrance landing easily
11 identifiable? Yes/No*. If no, give details:

Are there tactile landing areas free of
12 obstacles?
Is the entrance landing area free of
13 obstacles?
Yes/No*. If no, give details: The area as filled with
stones and uneven surfaces
Yes/No*. If no, give details: uneven surface

14 Are emergency exits easily identifiable? Yes/No*. If no, give details: Not present
15 Are emergency exits easily accessible? Yes/No*. If no, give details: emergency exit is not
present
B CAR PARKING
1 Is there a parking lot for the NO
disabled person within the building?
Are there accessible parking facilities? Yes/No*
Are indoor paring spaces located closest
Yes/No* There is no elevators
to accessible elevators?

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 Are accessible parking spaces within 50
meters of building entrances? Yes/No*

2 If yes, how many are there and state Yes/No*. If yes, location at
location where these can be found (e.g.
Basement 1, lot#112, near lift)
3 Is there the International Symbol of
Yes/No*.Size of logo:Yes/No*.If yes, describe oard
Access (Disabled Logo) printed on the
signb
parking lot
used:
Is there a vertical and visible signboard Yes/No*.Size of logo:Yes/No*.If yes, describe oard
indicating that the lot is for the disabled signb
driver?
used:

4 Are there directional signs within the Yes/No*.

parking lot to indicated the location of
the parking lot for the disabled person?

5 Size of parking lot.(Min. Size: 4800 Dimension: More than 8000 mm

mm x 3600 mm)

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6
Please provide information on
accessibility from the parking lot to the
Please tick on the box and delete accordingly
lift lobby/building entrance.
For the following

There is kerb/no kerb at the Entrance of the

lobby.

There is a kerb ramp at the Entrance of the lift

lobby. Gradient: no kerb

There is a swing/automatic/ Manual* door leading

to the main building

Width of door entrance is at least 900 mm wide

Width: yes 980mm

Corridor width is at least 1200 mm wide Width: 1

Width of lift door is at least 900 mm wide

Width: State the type of flooring used: No lift

C TAXI STAND

1 Is there a taxi stand at the building? Yes/No*.

If yes, please state the location (e.g. at Location:
the main entrance)

2 Is there a kerb at the taxi stand? Yes/No*.

3 Are these one/two kerb ramps for One/Two* Kerb
boarding and alighting the taxi? RamosRamp for Boarding. Yes/No*.
Ramp for Alighting. Yes/No*.
D LIFT
1 Is the lift accessible to every floor? Yes/No*. No lift
Is there an accessible path leading to the
If no, please specify which floor(s) the lift stops on: no
elevator?
elevator

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 Is the elevator door easy to identify?
If no, please specify which floor(s) the lift stops
on:
No elevator

2 Is the clearr door opening width more Yes/No*. No lift

than 900 mm? Width:

3 Is the height of the call button (outside

the lift) between 900 mm-1100 mm? ------

Is the space inside the elevator enough? Yes/No*. No lift

Height between:
4 Is there an audio system installed Yes/No*. No lift
(talking lift) for the lift?
5 Are there Braille/raised (for the visually Yes/No*. No lift
impaired persons) numbers usedon the Height
control panel? between:
6 Is the control panel placed at a height of Yes/No*. No lift
between 900 mm - 1200 mm from the Height between:
floor level
7 Are there grab bars inside the lift? Slides: Yes/No*. No lift
Are the doors and handrails of the Slides: One/Both*
elevator of contrasting colour? Rear: Yes/No*. No lift

8 Are the grab bars placed ata height of Yes/No*. No lift

900 mm from the floor? Height:
9 Is the emergency intercom usable Yes/No*. No lift
without voice comunication?
10 Is the door opening/closing interval Yes/No*. No lift
long enough?
11 Is the floor of the elevator non-slippery Yes/No*. No lift
E PUBLIC TELEPHONE

1 Are there public telephones for the Yes/

disabled person.If yes, provide location
No*.
(e.g. level 1,2) Location
:

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2 Is the height of the operable parts Yes/No*. No telephone
(highest and lowest) of the public Actual height between:
Phone between 800 mm-1200mm
3 Is there a clear knee space of more than Yes/No*.
680 mm Actual clear knee space:
4 Is there at least one telephone equipeed No telephone
with hearing aids?
5 Are the numerals on the telephone No telephone
raised to allow identification by touch?

6 Is the coin slot mounted at an No telephone

appropriate height?

7 Are accessible facilities identification? No

F COUNTERS
1 Is the counter easily identifiable? Yes

2 Is the level of the counter accessible? Yes

Is the staff able to communicate with Yes

3 people with visual, hearing and speech
impairment?
Is the staff supportive to mentally- Yes
4 challenged clients?
G PUBLIC TOILETS

1 Are there separate toilets for the

disabled person?
Is the accessible toilet identified by a Yes/No*.
sign?

Is the entrance to the public toilet Yes/No*.

accessible to people with disabilities?
Is the width of the door wide enough? Yes/No*.
Is there enough manoeuvering space in Yes/No*.
the toilet?

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 Are the toilets for the disabled perspn Yes/No*. If no, specify on which floor they are
2 available on every floor?
Available No floors
3 What type of toilets is provided? Individual/Compartment/Both*
4 Are the measurements of the toilet Yes/No*.
for the disabled person the same (if
there
are more than one toilet?

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5 State location of toilet checked: near the classes
If the toilets for the disabled persons
are different from one another, please
complete separate copies for each
toilet surveyed
Sketch toilet surveyed (include
door, water closet, wash basin, door
and grab bars)
No water basin present
Please tick on the box and delete accordingly for the
following
Individual washroom/compartment* Individual
washroom: Have clear dimensions between opposite
walls of not less than 1750 mm.
Actual dimension:
1200mm x 1250mm
Water Closet Compartment Have clear dimensions of
not less than 1500 mm by 1750 mm
Actual dimension: mm x mm
Door width more than 900 mm Actual width:
No kerb/kerb ramp* at the Entrance to the toilet. If
there Is a kerb ramp, the gradient is:
Door handles are located: Inside/Outside/Both sides*
Door opens outwards / inwards*
Door is a swing / folding / sliding* door
One horizontal grab bar is mounted at a height of
between 280 mm and 300 mm from the tope of the
water closet seat and one horizontal grab bar is
mounted on the side wall closet to the water extending
from the rear wall to at least 450 mm-in-front of the
water closet seat.
Actual height:
Water basin has a clear knee Space of at least 750
mm wide by 200 mm deep by 680 m high with an
additional toe space of at least 750 mm wide by 230
mm
Deep by 230mm high.
Actual clear knee space:
(W)x(D) (H)
Water closet is located between 460 mm - 480 mm
from the centerline of the water closet to adjacent wall.
Actual distance:
Clear dimension of 750 mm from the front edge of the
toilet bowl to the rear wall
Actual distance:
Page 33 of 94
 The passage way leading to the cubicle is at least
900 mm.
Actual width: 960mm

6 Is there at least one accessible shower? No

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7 Are grab bars installed in bathtubs and No grab bars
showers at an appropriate height?

8 Are accessible showers equipped with No showers

shower seats?
9 Are the grab bars slip resistant? No grab bars

10 Can grab bars withstand load? No

11 Is the mirror at an appropriate height? No mirror
12 Is the rest room equipped with an No
alarm system accessible to people with
different disabilities?
13 Are flushing arrangements, toilet paper No
and other dispensers mounted at an
appropriate height?
14 Are flushing mechanisms easy to No
operate?
15 Are the doors lockable from inside and No
released from outside in emergency
situations?
DRINKING WATER FACILITY
1 Is the water tap easily accessible? Yes

Can it be easily manoeuvred by a Yes

2 person with poor hand function?

3 Is the area dry? Yes

4 Are glasses provided? Yes

CAFETERIA

Is there an eating outlet located Yes/

1 within the building? No*.
Location
:
2 Is the eating outlet generally accessible Yes/No*.
to the disabled?

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3 Is there a circulation path/passage way Yes/No*.
of atleast 900 mm wide to allow the
wheelchair user to move around the
eating outlet and order their food?

4 Is there a table reserved for

the disabled?
Yes/No*. If no, give details of seating arrangement s:-
Height of table-top not higher than 800 mm with a
minimum clear knee of 700 mm x 480 mm deep
if no, provide Measurement: Table-top: clear knee
space: x Table with fixed stools/chairs Table
without fixed stools/chairs

5 Are there directional signs to lead the Yes/No*.

disabled person to the reserved table?

6 Is there enough leg clearance space Yes/No*.

below the table?

7 Is the height of the table appropriate? Yes/No*.

8 Is the height of the cash counter Yes/No*.

appropriate?
Is there a menu card available in
9 Braille? Yes/No*.

Is there a facility for a person with

10 speech impairment to be able to pace an Yes/No*.
order?
11 Do the tables have straight legs? Yes/No*.
H STAIRCASE
1
Applies to flights of steps Check the State where the staircase is located: yes it is
following: present near the principle office

2 Are there handrails Yes/No*. If yes, one/both sides

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3 Height of hand rails between 800and Yes/No*.Actual height:
900 mm from the floor
4 Are the handrails continuous Yes/No*.
5 Is there a leveled platform at the top Leveled platform:
and bottom step extending not less
than 300 mm (with railing) Yes/No*. Extended railing:
Yes/No*.

Uniform riser: Yes/No*.Open Riser: Yes/No*.

6 Steps specifications Height of risers: Protruding nosing: Yes/No*.
Is the minimum width of the stairs Yes it was enough
7 enough?

8 Is the landing space at the top and No

bottom of the stairs enough?
9 Are the stair nosings slip-resistant? yes

10 Is the location of the stairs clearly Yes

identifiable?
11 Is a handrail installed? yes

12 Do the stairs have guide strips? NO

I SLOP RAMPS
Applies to slope ramps Check the
State where the slope ramps are located: Near
following:
classroom
1 Are there handrails Yes/No*. If yes, one/both sides
2 Height of hand rails between 800 and Yes/No*.Actual height:
900 mm from the floor
3 Are the handrails continuous Yes/No*.
4 Is there a leveled platform at the top Leveled platform: Yes/No*.Leveled railing: *.
and bottom ramp extending not less Yes/No
than 300 mm (with railing)
Is the width of the ramp at least
5 1200 mm Yes/No*.Actual width: 8500mm

6 Ramp landings are provided at regular Yes/No*.Length of horizontal run:

intervals of not more than 9000 mm of
every horizontal run

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 7 Is an edge protection available Yes/No*.
8 Type of flooring used Specify:Redox
9 Describe the condition of the flooring e.g. leveled, tiles popping up, uneven surfaces
10 Are grafting found in the open area Yes /No*
11 Are the gratings covered? Yes/No*
12 Are grating placed across the dominant Yes/No*
placed across the dominant of travel
13 Is the width of spaces found between Width: 10mm
the grating strips less than 12 mm
1
General description of accessibility Paths to various locations of Attractions are easy d
within the premises an
Accessible. yes
Quite accessible but there are Steps (manageable). yes
Not quite accessible, there are Many obstacles such as
Inaccessible in most areas. No

(please specify)

CORRIDORS

Is the minimum unobstructed width of Yes, it was enough for wheel chair
the corridor wide enough for
wheelchair users?
Does the corridor width alow No
manoruvring through doors located
along its length
Does the corridor have guide strips? No
Is the corridor pathway obstruction- Yes
free?
Any other comments:

Name of Facilitator(s):
Name of Surveyor(s):
Reference: http://www.disabilityindia.co.in/Access-India/accessSurvey.php

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 ASSISTIVE TECHNOLOGY FABRICATION
For most people, technology makes things easier. For people with disabilities, technology makes things possible.
—Mary Pat Radabaugh

Assistive technology: Assistive devices are a set of devices which will assist
the person with limited functional activity to fulfill his functional demands by
which he can be active and productive in his life. As the production of the
equipment is limited and it requires a skilled person to design a low cost
material an insight regarding the fabrication of the material is needed.

Classification of assistive device: Assistive devices can be classified into

Mobility devices :
Eg; Crutches, walking sticks, wheel chairs

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  Positioning device: Eg; chairs, seats

Daily living devices

Eg; Adapted spoon, Adapted Comb, Adapted Tumbler holder

 Vision devices: Eg; Magnifiers, audio devices, Large print books

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  Communication devices
 Cognitive devices: Eg; List, Diaries, schedule

Learning Objective of the session: At the end of the session the student should
be able to

1. Identify the types of assistive devises required, its functionality and

suitability for various disabilities.
2. Disseminate the knowledge regarding the need of assistive device and its
impact on patient to patient and their family members.
3. Follow-up to ensure that the given assistive device is having an effect on the
person with disability.
4. Should be able to identify various barriers in making an assistive device.

Theoretical Knowledge required:

1. Should know the nature and progress of the given condition

(Musculoskeletal, Neurological or any others) and its effect on functional
status of the individual
2. Rights of persons with Disability Act 2016
3. International classification of functioning disability and health

Prerequisite required prior to attend the practical class:

Students should complete e learning course on SWAYAM on “Development of

assistive technology for persons with disabilities”

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Is student eligible for Practical Class YES NO

Practical class

Scenario 1: Mr Shivprakash who sustained TSCI (Traumatic Spinal cord injury) at

the level of C8, (Motor Impairment, Incomplete) who has difficulty in eating himself
with his hand. He complains that he requires lot of time and effort and at times
need of help of his family members to feed himself. Plan an Assistive technology
evaluation for him for the same.

a. Needs assessment:

b. Patient goals:
 Ability to eat himself with his hands
 Ability to perform basic ADLs using his hands

c. Choice of AT rationale

d. Measurement

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e. Fabrication procedure:

f. Follow-up evaluation

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 TIMED UP AND GO TEST

What is the purpose of the doing this test: Timed Up and Go (TUG) Test is a
Measure to assess mobility, balance, and walking ability and fall risk in geriatric
population. The area of assessment is Balance (Non vestibular), Functional Mobility,
Gait which is an observer assessment type

Who Is The Target Population: This test is validated for a population with
older adults and geriatric care, Osteoarthritis, Parkinson’s disease, Stroke,
Brain injury, Spinal injuries.

Materials needed for the test

 One chair with armrest

 Stopwatch
 Tape (to mark 3 meters)

METHODS

General Information

 The patient should sit on a standard armchair, placing his/her back against
the chair and resting his/her arms chair’s arms. Any assistive device used for
walking should be nearby.

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  Regular footwear and customary walking aids should be used.
 The patient should walk to a line that is 3 meters (9.8 feet) away, turn
around at the line, walk back to the chair, and sit down.
 The test ends when the patient’s buttocks touch the seat.
 Patients should be instructed to use a comfortable and safe walking speed.
 A stopwatch should be used to time the test (in seconds).

Setup:

 Measure and mark a 3 meter (9.8 feet) walkway

 Place a standard height chair (seat height 46cm, arm height 67cm) at the
beginning of the walkway.

Patient instructions

 Instruct the patient to sit on the chair and place his/her back against the chair
and rest his/her arms chair’s arms.
 The upper extremities should not be on the assistive device (if used for
walking), but it should be nearby.
 Demonstrate the test to the patient.
 When the patient is ready, say “Go”
 The stopwatch should start when you say go, and should be stopped with the
patient’s buttocks touch the seat.

INTERPRETATION

An older adult who takes ≥12 seconds to complete the TUG is at risk for
falling.

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Cut of scores indicating risk of falls by Population (in seconds)

 Community dwelling adults - 13.5

 Older stroke patients – 14
 Frail elderly - 32.6
 LE amputees – 19
 PD - 11.5
 Hip OA - 10
 Vestibular disorders - 11.1

LEARNING OBJECTIVES

Students should be able to determine fall risk and measure the progress
of balance sit to stand and walking on a model

Practical:

Student should do the TUG test on peers and record time in seconds:

Model 1.
Trial1=5.5 secs
Name of model: Lavanya Trial2=6 secs
Trial3=6.5secs
Time in seconds: 6 secs Average=18/3=6

Model 2.

Name of model: Soundarya Trial1=8 secs

Trial2=7.5 secs
Trial3=8.5 secs
Time in seconds:8secs Average=24/3=8

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Model 3.
Trial1=4.5 secs
Name of model: Sahana Trial2=5 secs
Trial3=5.5 secs
Average=15/3=5
Time in seconds: 5secs

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 TINETTI TEST- POMA

What is this test: The Tinetti Performance oriented Mobility Assessment

(POMA) test assess the gait and balance in older adults and also it will
assess the perception of balance and stability during activities of daily
living. It is a performance measure type of assessment test which will
assess the balance (Vestibular and non-vestibular) and gait and indicates
the risk of fall in an individual.

Theoretical Knowledge required: Students need to know about

1. Physiology of balance
2. Physiology of ageing
3. Intrinsic and extrinsic factors for fall in elderly.

Prerequisite prior to attending practical class

Student should successfully complete the following course in Physiopedia

1. The postural control system

2. Vestibular anatomy and neurophysiology

Is the student eligible for attending Practical? YES NO

Practical

Equipment required: Hard armless chair, Stopwatch or wrist watch, 15ft

(4.57 meter walk way), Gait belt.

Scoring: Three point ordinal scales, ranging from 0-2 will be used for
grading the patient. “0” indicates the highest level of impairment and
“2”indicates the individual’s independence.
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Procedure: The test has two parts one will assess balance abilities in a chair and
another will assess balance abilities during gait.

Tinetti POMA- Balance tests

Initial instructions: Subject is seated in hard, armless chair. The following

maneuvers are tested.

1. Sitting Balance Leans or slides in chair

=0 Steady, safe =1

2. Arises Unable without help =0

Able, uses arms to help
=1
Able without using arms =2

3. Attempts to Arise Unable without help =0

Able, requires > 1 attempt
=1
Able to rise, 1 attempt =2

4. Immediate Standing Balance (first 5 seconds)

Unsteady (swaggers, moves feet, trunk sway)

Steady but uses walker or other support =1
Steady without walker or other support =2

5. Standing Balance Unsteady =0

Steady but wide stance( medial heals > 4 inches
apart) and uses cane or other support =1
Narrow stance without support =2

6. Nudged (subject at maximum position with feet as close together as possible,

examiner pushes lightly on subject’s sternum with palm of hand 3 times)
Begins to fall =0
Staggers, grabs, catches self
=1 Steady =2

7. Eyes Closed (at maximum position of item 6)

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Unsteady =0
Steady =1

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8. Turing 360 Degrees Discontinuous steps =0
Continuous steps =1
Unsteady (grabs, staggers)
=0 Steady =1

9. Sitting Down Unsafe (misjudged distance, falls into chair) =0

Uses arms or not a smooth motion =1
Safe, smooth motion =2

BALANCE SCORE: /16

Tinetti POMA- Gait tests

Initial instructions: Subject stands with examiner, walks down hallway or across
room, first at “usual” pace, then back at “rapid, but safe” pace (using usual walking
aids)

10. Initiation of Gait (immediately after told to “go”)

any hesitancy or multiple attempts to start
=0 No hesitancy =1

26. Step Length and

Height Right swing foot

Does not pass left stance foot with step

=0 Passes left stance foot =1
Right foot does not clear floor completely With step
=0 Right foot completely clears floor =1 _
Left swing foot Does not pass right stance foot with step
=0 Passes right stance foot =1
Left foot does not clear floor completely With step
=0 Left foot completely clears floor =1

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 27. Step Symmetry

Right and left step length not equal (estimate) =0

Right and left step length appear equal =1 _

28. Step Continuity

Stopping or discontinuity between steps
=0 Steps appear continuous =1
29. Path (estimated in relation to floor tiles, 12-inch diameter; observe
excursion of 1 foot over about 10 ft. of the course)

Marked deviation =0
Mild/moderate deviation or uses walking aid
=1 Straight without walking aid =2

15. Trunk
Marked sway or uses walking aid =0

No sway but flexion of knees or back or Spreads arms out while walking =1
No sway, no flexion, no use of arms, and no Use of walking aid =2

16. Walking Stance

Heels apart =0
Heels almost touching while walking =1
GAIT SCORE = /12

Total score: (Gait score+ Balance score)= - /28

Interpretation: If the total score is < 19: high fall risk,

19-24 :medium fall
risk, 25-28 : low fall
risk
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Student should do the Tinetti POMA test on minimum three peers and record the
total score of gait and balance:

Model 1.

Name of model: Chaitra

Balance score:-16/16
Total Gait score:- 12/12
score:ba Total score:- 28/28 indicating low fall risk
bbb
Model 2.

Name of model: Lavanya

Balance score:-16/16
Total score: Gait score:- 12/12
Total score:- 28/28 indicating low fall risk

Model 3.

Name of model: Soundarya

Total score: Balance score:-16/16

Gait score:- 12/12
Total score:- 28/28 indicating low fall risk

Page 53 of 94
 GERIATRIC FITNESS FIELD TESTS

Why there is need for functional fitness test in geriatric population

A comprehensive functional fitness test will give specific information about

patient’s strength and weaknesses which are associated with daily functional
tasks and activities. By obtaining this information a therapist can identify the risk
of loss of functional ability and also can plan effectively a tailored made exercise
program or physical activity

Why to use Rikli and Jones battery: This battery holds good psychometric
properties and is also easy and fast to administer with minimal requirements for
equipment. Also it is safe to use for wide range of physical abilities.

Theoretical Knowledge required: Students should know about

1. Principles of physical fitness.

2. Exercise physiology – Muscles, energy production and cardio
respiratory function
3. Screening test prior to evaluation of fitness.
4. Matching age group needs and ability to each type of fitness.

Learning objective: At the end of the session the student should be able to

1. Apply the functional theoretical concepts of fitness in geriatrics and should

integrate the theoretical knowledge for evaluation of geriatric individual.
2. Should analyze the outcome of the test and its impact on the individuals

Prerequisite required: The student should complete the course in Physiopedia

“Comprehensive geriatric assessment and role of a physiotherapist”

Page 54 of 94
Is the student eligible for practical class: YES NO

Practical work

List of the equipment required: The Following are the list of the
equipment required by the students.

A chair without arms

Stopwatch
5 pound weight and 8 pound weight for women and men
String or cord 30’”in length
Visible, bright color tape.
A ruler
Measuring tape
One cone
Paper and pencil

TESTS

1. 30 second chair stand test

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 In this test the subject should do full stands from chair in 30 seconds with
arms folded across the test

Risk zone: Less than 8 unassisted stand for men and women.
2. Arm Curl :

In this test the number of Biceps curls that can be completed in 30 seconds
holding a hand weight of 5 and 8 pounds for men and women should be
done
Risk Zone: Less than 11 curl using correct form for men and women

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3.6 Minute walk test:

In this test the person has to walk 6 minutes for 50 yards (45.7meter) course.
Risk Zone; less than 350 yards for men and women.
3. 2 Minute step test:

In this test the subject will be informed to raise each knee to a point
midway between knee cap (Patella) and to hip bone (Iliac Crest) and
number of steps completed in 2 minutes will be calculated.

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 Risk Zone: Less than 65 steps for men and women.
4. Chair sit and reach test:

In the test the subject will be told to sit in the chair with the leg extended and
hands reaching towards toes. The number of inches (cm) between extended
fingers and tip of toe will be calculated
Risk Zone; Men minus 4 inches or more, Women minus 2 inches or more.
5. Back scratch Test:

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 In this test the subject will be told to stand and with one hand he/she should
reach over the shoulder and one up the middle of the back. The number of
inches between the extended middle fingers will be calculated.
Risk Zone: Men minus 4 inches or more and women minus 2 inches or
more.
6. 8 foot up and go:

In this test the subject is asked to get up from the seated position and walk 8 feet
then turn and walk back to the starting position and should sit the chair. The time
taken to complete this test will be noted.

Risk zone: if the subject takes more than 9 seconds

Student should do the Rickley and Jones battery on minimum three peers and
record the individual score on each test

Sl no Test - score Model -1 Model -2 Model -3

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1 30 second
12 times in 30secs 10 times in 30 20 times in 30 sec
chair stand secs
2 Arm curl 13 curls 15 curls 12 curls
3 6 minute 400 yards 500 yards 550 yards
walk test
4 2 minute step 66 steps 76 steps 70 steps
test
5 Chair sit and 6 inches-women 5 inches-women 5 inches-women
reach test
6 Back scratch 3 inches-women 2 inches-women 2 inches-women
test
7 8 foot up and 5 secs 8 secs 4 secs
go test

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KEGELS EXERCISES

What are pelvic floor muscles: These are a network of muscles that provide support
as a floor for the abdominal viscera and also provide continence mechanism for
urinary and anal orifices. The pelvic floor muscles comprise urogenital and pelvic
diaphragm and these muscles will keep the pelvic organs-bladder, uterus and
bowel
in correct
position.

What is kegels exercise: These are the exercises which are done by isometric
contraction of pelvic floor muscles which was proposed by Dr Arnold Legal to
strengthen the pelvic floor muscles. By application of this exercise it will help in
controlling urinary and fecal incontinence.

Learning objective: At the end of the session student should be able to

Ensure that she/he is contracting correctly the pelvic floor muscles and
should give the feedback of the performance to the patients effectively.
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Theoretical knowledge required: Students should know about

Pelvic floor anatomy and applied physiology for men and women

Prerequisite prior completion of the course: Students should complete the

following course on Physiopedia.

1. Functional anatomy of male pelvic floor.

2. Prostate cancer programme.

Is the student eligible for practical: YES NO

Practicals

Step 1: The success of the kegels exercise will depend upon how good the muscles
are isolated and trained so the first step is to isolate the right muscles

There are two ways that can be done to isolate the pelvic floor muscles,

Option 1

1. Imagine you are sitting on the toilet and peeing

2. Now, imagine stopping the flow of your urine midstream. The muscles you
used to stop the flow of urine are the pelvic floor muscles.

Option 2

1. Use a mirror to look at the area between your vagina and anus.
2. Tighten the muscles around your anus. It should feel like you are preventing
the release of gas. You should see the area between your vagina and anus lift
up and in towards your body. These are your pelvic floor muscles.

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Step 2: After locating the pelvic floor muscles, it should be done as if you are passing
urine or holding the bowel movement

1. Tighten and hold the pelvic floor muscles for five seconds ( count 1 one
thousand, 2 one thousand, 3 one thousand, 4 one thousand, 5 one thousand)
2. And then relax your muscles
3. This technique has to be mastered and progression in the time should be done

Note: While doing this exercise the subject has to be told

1. Not to do when the bladder or bowel is full

2. Not to do during defecation or urination
3. Not to hold the breath
4. Not to tighten the muscles of back, stomach or thighs a
5. And should relax pelvic floor muscle after each squeeze

Practical work: Student should do the Kegel exercise on self and Minimum of
three subjects.

1. Model 1

2. Model 2

3. Model 3

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 REBA, RULA and ROSA

REBA

The Rapid Entire Body Assessment (REBA) was developed to “rapidly”

evaluate risk of musculoskeletal disorders (MSD) associated with certain job
tasks. The Rapid Entire Body Assessment tool uses a systematic process to
evaluate both upper and lower parts of the musculoskeletal system for
biomechanical and MSD risks associated with the job task being evaluated.

Intended people: It is used for survey Investigations in the workplace where

people complain of work related musculoskeletal disorder.

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 RULA

Rapid Office Strain Assessment (RULA) is an ergonomic assessment tool

which is designed to provide a quantification of risk related to computer usage
at computer workstation. This will provide the risk associated with the work
involved. The ROSA scores range from 1 to 10 higher the score indicate
greater the risk related to musculoskeletal disorders.

LEARNING OBJECTIVES
At the end of the session students should be able to perform REBA and RULA
on a model and should be able to to provide a simple postural analysis
system sensitive to musculoskeletal risks in a variety of tasks and also

 To divide the body into segments to evaluate individually with reference

to postures and movement planes.
 To provide a scoring system for muscle activity caused by static,
dynamic, rapid changing or unstable postures.

PREREQUISITE REQUIRED

Student should complete online certificate course from Physiopedia

“Assessment of Fitness for Return to work” and submit the course
completion certificate

PRACTICAL WORK

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 Students should perform REBA and RULA on Three separate students and
should document the scores

Model 1: NIKITA- TABLE WORKER

REBA
A. NECK,TRUNK AND LEG ANALYSIS
Step 1:- +2
Step 2:- +2
Step 3:- +3
Step 4:- 5
Step 5:- 5(no load/force)
Step 6:- score A= 5
B. ARM AND WRIST ANALYSIS
Step 7:- +2
Step 8:- +2
Step 9:- +1
Step 10:- 2
Step 11:- 2+0=2
Step 12:- Score B=2
TABLE C=4
D.4+1(activity)=5 (TOTAL REBA SCORE) indicating medium risk, changes soon

RULA
A.ARM AND WRIST ANALYSIS
Step 1:- +2
Step 2:- +2
Step 3:- +2
Step 4:- +1
Step 5:- 3 Score A
Step 6:-+6
Step 7:- +0
Step 8:- 3+6+0=9( arm and wrist score)
B.NECK, TRUNK AND LEG ANALYSIS
Step 9:- +2
Step 10:- +2
Step 11:- +1
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 Step 12:- 2 (Score B)
Step 13:- +1
Step 14:- 0
Step 15:- 2+1+0=3(Neck, trunk, leg score)
Final RULA Score is 6 indicating further investigation, changes soon

REFERENCE

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REBA

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RULA

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ROSA

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Page 71 of 94
 WHODAS 2.0

Why Disability measurement is needed..?

Disability measurement is useful for health care and policy decision in terms of
identifying needs, matching treatments and interventions, measuring outcomes and
effectiveness, setting priorities and allocating resources.

What is WHODAS 2.0..?

WHODAS 2.0 (World Health Organization Disability Assessment

Schedule) is a practical generic assessment instrument that can measure health and
disability at population level or in Clinical Practice

Measuring Health And Disabality ;Manual For WHODAS

Why To Use WHODS2.0

The unique feature of WHODS 2.0 is that

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 1. It has a direct link to the International Classification Of Functioning
, Disability and Health
2. Has good Cross cultural Comparability
3. Good psychometric properties
4. Easy to use and availability

Prerequisite Knowledge student should possess

Students should be familiar with the concept of International classification Of

Functioning, disability and health.

Practical Work

Students have to perform WHODAS disability assessment on a model based on

the scenario. Case scenario will be given at the time of practice.

1)understanding and communication

Disability1.1 1
Disability1.2 1
Disability1.3 1
Disability 1.4 1
Disability1.5 1
Disability1.6 1

2)Getting dressed
Disability2.1 1
Disability2.2 1
Disability2.3 1
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 Disability 2.4 1
Disability2.5 1

3)Self care
Disability3.1 1
Disability3.2 1
Disability3.3 1
Disability 3.4 1

4)Getting along with people

Disability4.1 1
Disability4.2 1
Disability4.3 1
Disability 4.4 1
Disability4.5 1

5)Life activities
Disability5.1 1
Disability5.2 1
Disability5.3 1
Disability 5.4 1
Disability5.5 1
Disability5.6 1

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ENERGY EXPENDITURE INDEX – WHEEL CHAIR

What is energy expenditure index?

The Energy Expenditure Index (EEI) has been advocated as a means of

using the HR response to assess energy cost during ambulation by relating changes
in HR to velocity.

Why it is needed in wheel chair Users?

By using the EEI measurement it will provide functional efficiency of the

user, locomotor efficiency of the wheel chair and potential benefit of the
propulsion system.

How it is calculated?

The EEI which was termed as Physiological cost of index (beats/m) s

calculated as net heart rate (working heart rate - resting heart rate)/ speed of
ambulation (distance in meter/ time in minutes), thus yielding a PCI in net beats
per meter.

Learning Objective

At the end of the session students should be able to interpret the PCI scores and
discuss the benefits and drawback of the obtained scores.

Theoretical Knowledge required

1. Energy metabolism

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 2. Physical activity in wheel chair users
3. Types ,parts of wheel chair and basic propulsion techniques

Practical Work

Equipment required: One wheel chair, Stop watch, 4 cones, 25 meter

pathway for wheel chair propulsion, Polar heart rate monitor, measuring tape.
Paper and pen

Members in the group : 6

Procedure

A standard wheel chair should be used on which the subject will be seated with a
cloth belt tied at the level of ASIS to prevent him/her sliding from the seat.

Another cloth belt should be tied horizontally just above the foot rest in order
to prevent the legs from slipping from the foot rest during wheelchair propulsion.

Patients should be given 5 minutes rest at the starting line in order to attain a steady
resting heart rate.

It should be measured by Polar heart rate monitor. The Subject should be

instructed to propel the wheel chair at their normal propulsion speed on a standard
leveled corridor (which had a walkway of 25 m) for a minimum duration of 5
minutes to attain a steady physiological heart rate.

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At the end of 5 minutes, they should be instructed to stop and immediately
the steady propulsion heart rate should be measured by the palpation of the radial
pulse polar heart rate monitor.

The distance traveled by the patient should be measured by calculating the number
of rounds covered by the patient multiplied by 25 meters (walk way distance) and
the extra distance was measured using an inch tape.

Students should do the procedure on three different subjects and should

interpret the PCI values

Sl No Name Heart rate Distance PCI value

Pre Post travelled
1
2
3

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INTERVENTION

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 WHEEL CHAIR PRESCRIPTION

Student should be able to check the following and prescribe the wheel chair

 Condition of the patient: Below knee(L) and above knee amputation(R)

 Patient name:- Lakshmi
 Type of wheel chair:
o Reclining wheel chair
o Foldable wheel chair
 Wheel chair Cushion
o Seat
o Back
 Need of lap tray : Yes No
 Need of seat belt: Yes No
 Need of foot strap: Yes No
 Brake are working: Yes No
 Height of arm rest:-above 9 inches
 Height of back rest:-16-16.5 inches
 Ant tippers are present : Yes No
 Condition of caster wheels-good
 Condition of rear wheels-good

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 WHEEL CHAIR PROPULSION

Student should demonstrate the following basic wheel chair propulsion

techniques.

Equipment’s required: Wheel chair, 25 meter walk area

Techniques:

1. Hand Grip

2. 10-2 position Wheel chair stroke pattern 90 Degree turn

3. 180 degree turn

4. 360 degree turn

5. Ascending the ramps

6. Descending the ramps

7. Stop and turn in ramps

8. Negotiating the curbs

9. Change in the

direction 10.Wheelie

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SAFE FALLING

What is safe falling: Safe falling is a technique where an individual falls safe on
the floor with minimizing the risk 0f injury

Why it is needed to be taught: When a patient who has lost mobility skills due to
the disease or in elderly population due to change in the physiological system the
normal ambulation will be challenged. Under these situations while training there
is a risk of fall due to which the secondary complications like fracture, dislocation,
head injury or death can happen. To prevent this, the patient needs to learn safe
falling technique

Students should demonstrate the following safe falling

steps Fall forwards

1. Are the elbows bent to 90 degrees: Yes NO

2. Are the hands opened : Yes NO
3. Are the hands kept in front of the face: Yes NO
4. Is the hands is first to come in contact : Yes NO
5. Is he rolling to the side of his body: Yes NO

Fall sideways

1. Is he/she falling away from the direction of the fall: Yes NO

2. Is there a contact directly on hip : Yes NO
3. Is he/she changing the fall direction towards the fall: Yes NO
4. Is the lower body turning with upper body : Yes NO

Fall backwards

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 1. Is he/she locking the knees: Yes NO
2. Is he/ she reaching up with the hands: Yes NO
3. Is he/she Reaching back with the hands: Yes NO
4. Is he /she holding the things near by : Yes NO
5. Is he/she leaning back with the head: Yes NO
6. Is he/she sit himself or herself on the floor while falling : Yes NO
7. Is he/she bringing the hands down while falling : Yes NO

Injury Checklist

1. Are you able to stretch your back Yes NO

2. Are you able to move your ankles: Yes NO
3. Are you able move your hip and knees: Yes NO
4. Are you able to move your wrist: Yes NO
5. Are you able to move your elbows: Yes NO
6. Are you able to move your shoulders Yes NO
7. Are you able to move your neck Yes NO

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 OTAGO EXERCISE PROGRAM

What is an Otago exercise program

It is evidence based individually tailored strength and balance retraining program

designed for older adults.

This program consists of 5 strengthening exercise and 12 balance exercises.

Participants are instructed to perform these exercises three times a week

Theoretical Knowledge required: Students should know about

1. Ageing and exercise

2. Falls in elderly
3. Falls and exercise
4. Physical activity in ageing

Practical work

Students should demonstrate each steps of the Otago exercise program

Sl Exercise steps Able to do

No
Yes No

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1 Knee extensor strength exercise YES
2 Knee flexor strength exercise YES
3 Hip adductor strength exercise YES
4 Ankle plantar flexors YES
5 Ankle dorsiflexors YES
6 Knee bends exercise YES
7 Backwards walking YES
8 Walking and turning around YES
9 Sideways walking YES
10 Tandem stance YES
11 One leg stand YES
12 Heel walking YES
13 Toe walk YES
14 Heel to toe walking backwards YES
15 Sit to stand YES
16 Stair climbing YES

Patient details:- Maramma

Condition:- Knee pain both sides
Place:- Devanur,Nanjangud

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CAR TRANSFER

Need of car transfer

The ultimate goal for any rehabilitation is to be independent in all daily and
functional activities. As a person need to transfer from his place to other he need to
be taught car transfer independently so as he will be able to commute easier and
effectively

Theoretical knowledge required: Students should have the knowledge on

1. Types of wheel chair

2. Parts of the wheel chair
3. Technique of transfer with transfer board

Items required for car transfer: Car, wheel chair and transfer board

Students should be able to do the following procedure independently

Procedure

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 Position the wheelchair directly next to the surface (car). A slight angle of
30- 45 degrees is helpful but not absolutely necessary.
 Open the passenger side door and recline the car seat
 Place the car cushion in the car seat
 Lock the wheelchair brakes and move the footrests out of the way of the
feet. The armrest on the side you will be transferring to car also be moved
out of the way.
 Always talk to the person being transferred so that assistance is being given
at the appropriate time, allowing for coordination of efforts.
 Gait/transfer belt should be placed securely.
 Move person's bottom to the front of the surface they are sitting on so that
the feet are in firm contact with the floor.
 A person assistance can be given from the other side of the car- From Inside
 Subject is advised to use the hand bar of the car to swing himself inside the
car .
 To complete the transfer, the person should lean forward over their feet, use
their hands to push from the surface they are sitting on, swing their bottom
around to the adjacent surface and slowly sit back down
 Place the wheel chair inside the car

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HOME MODIFICATION

What is home modification: These are the structural changes made to the
homes of the people living with a disability or older people to reduce the risk of
injury.

Why Home modification is needed: After a person is injured and is disabled

home modifications are done to support a person’s ability to live independently at
home. This change in home can improve the quality of life of the individual and
reduce the level of disability and healthcare cost.

Practical work

Videos will be given at the time of practice. Students have to watch the entire
videos and identify the following factors

Patient name:- Putananjappa

Condition: Parkinson’s disease

1. Facilitators
-Family and friends support
-Lights and bulbs in the hall and kitchen
-Rails
-Good space and ventilation

2. Barriers
-Toilet outside the home (Indian toilet)
-Uneven surface
-Age
-At door high steps are present
-Financial issues

3. Type of individual at risk

-Cerebral palsy
-Gait and balance issues
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 -Parkinson disease
-geriatric patient

4. Recommended modifications
-Even surface should be made at home entrance
-Western toilet
-Canes/walkers recommended

5. Rationale

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INTERDISCIPLINARY PLAN OF CARE

What is interdisciplinary Plan of care

It is a strategy which is developed by the group of disciplines to establish a

protocol or therapy as per the goals set and need for the specific patient. The
objective of this care plan is to ensure that each discipline involved in the care of
the patient must participate in patient assessment, and propose a joint approach
toward achieving the goals and interventions set for the patient.

What is the use of interdisciplinary plan of care?

A plan of care set by interdisciplinary team will ensure that optimal outcomes for
the patient are met during the hospitalization and can provide measurable benefits.

By using interdisciplinary plan of care it will increase communication effectively

and build a sense of collaboration and team work

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Theoretical Knowledge required: Students should be able to

1. Identify the members of the interdisciplinary team and know

the responsibility of each of them
2. Should be able to modify the patient stated goals to SMART goals.
3. Should be able to set the goals in a SMART way

Practical

1. Case scenario:

2. Case scenario:

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THERAPEUTIC RECREATION

Recreational therapy, also known as therapeutic recreation, is a systematic

process that utilizes recreation and other activity-based interventions to
address the assessed needs of individuals with illnesses and/or disabling
conditions, as a means to psychological and physical health, recovery and
well-being.

Why Therapy recreation is needed: After the disability there are limitations
in individuals Physical, cognitive, emotional, social and leisure areas of their
lives by doing recreational therapy it will assist the patients in developing
skills, knowledge and behaviors for daily living and community involvement

Prerequisite knowledge for therapy recreation

LEARNING OBJECTIVES
At the end of the session students should get an idea regarding therapeutic
recreation and able to identify suitable recreational activities for different
patients using a variety of techniques including crafts, sports, games, and
dance and community outings.

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Practical work

Description of patient Recommended mode Rationale and

condition of recreation expected outcome

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 PATIENT DOCUMENTATION

All patients who come into contact with a healthcare professional will have
details of that contact documented in their clinical record (also called
the medical record). These details are usually in the form of notes on the
assessment, treatment, progress and ultimate plan for the patient and can be
summarized in the SOAP format. Patient identification in the form of name, date
of birth (DOB) and folder number on every sheet in the record is vital, as well as
numbering each page consecutively.

Documentation should be clear and accurate for the following reasons:

 It promotes optimum patient care by providing a record of the baseline condition,

treatments and progress.
 It ensures continuity of care.
 It allows communication between members of the Multidisciplinary team
(MDT).
 It is a legal document that is admissible as evidence in court.
 It provides evidence of the care provided and decisions made.

Principles of documentation

 Write in chronological order.

 Record only factual information, not your opinion.
 Write legibly, printing if necessary.
 Use black pen, or print in black if the record is digital.
 Put patient quotes in quotation marks.
 Date all entries.
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 Time all entries using the 24 hour clock (i.e. 18:00, not 6:00).
 Chart every intervention as soon as possible after the event.
 Chart notes should be neat and tidy.
 Sign each entry with a signature and position / role (e.g. Senior physiotherapist)
 Give the full name and title of all personnel mentioned in the record.
 Use only official Outcome measure
 Test results must be signed and fixed to the proper mount sheet in the correct
date order

PREREQUISITES

Students should read about the following content https://physiopedia.com/SOAP_Notes?

utm_source=physiopedia&utm_medium
=related_articles&utm_campaign=ongoing_internal

https://en.wikipedia.org/w/index.php?title=Electronic_medical_record&oldid=2
61006644

LEARNING OBJECTIVES

Students should be able to do documentation procedure of given scenarios

adequately

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Page 95 of 94
 WORK CONDITIONING

Work conditioning is a rigorous conditioning program designed to help patients

regain their systemic, neurological, cardiopulmonary and musculoskeletal
functions. This includes strength, mobility, power, endurance, motor control and
functional abilities. Work conditioning provides a middle step in the process of
returning to work. The goals of a work conditioning program are to restore the
patient’s physical capacity and functional abilities, to prevent the recurrence of the
same injury, and to decrease their fear of returning to work.

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 WORK HARDENING

Work hardening is an individualized, highly-structured program designed to help

patients return to their pre-injury work level in a safe and timely manner. It aims
to help patients regain their biomechanical, cardiovascular, metabolic,
neuromuscular and psychosocial functions in conjunction with their work tasks.

Work hardening is multidisciplinary, using a physical therapist, occupational

therapist, psychologist and vocational specialist. It includes strengthening and
flexibility exercises, cardiovascular conditioning, spine and joint stabilization
exercises and job task training (i.e. pushing, pulling, crouching, lifting, bending,
sitting, or twisting).

Links to read:

https://www.researchgate.net/publication/10944771_Work_conditioning_
work_hardening_and_functional_restoration_for_workers_with_back_and_
neck_pain_Review

https://www.researchgate.net/publication/10944771_Work_conditioning_
work_hardening_and_functional_restoration_for_workers_with_back_and
_neck_pain_Review

Practical work

Ramu a 50 year old mechanic by profession has low back pain since 9 months
which made him irregular at his work. Currently he has fear and also slight pain
in the low back when he lifts weight and during the activity. Perform a functional
capacity evaluation and form a work hardening program which will make him to
go back to work regularly and efficiently.

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