GENERAL INFORMATION

Note: * Denotes a required field.

Please enter your full name as it appears on your Social Security Card: First Name   Middle Name   Last Name  * Please enter the Last Four digits of your Social Security Number:  -   -   *       Please check here if you do not hold a valid social security card. Please provide your contact information: Phone Number  * E-mail Address  * Confirm E-mail Address  * Type your e-mail address again above.

This profile is for use by healthcare professionals in the Physical Therapist discipline and specialty. It will not be a determining factor for the program.

CHECKLIST INSTRUCTIONS

Please mark your level of experience      1. No theory and/or experience      2. Limited experience/need supervision and/or support      3. Experienced/minimal support needed to perform      4. Proficient/can perform independently

Orthopedic

1

2

3

4

Back syndromes

Hand injury

Arthritis programs

Hip fractures

Mobilization techniques

Neck injuries

Total hip/knee replacement

Total joint replacement/upper extremities

Transmandibular joint dysfunction

Neurologic

1

2

3

4

Neurosurgery

Spinal cord injury

Functional splinting

Head trauma

Stroke rehabilitation

Adaptive equipment

Sports Medicine

1

2

3

4

Bracing/joint immobilization

Biodex

Cybex

LIDO

Orthotron

Strength and endurance training

Taping/strapping

Nautilus/Eagle

Modalities/Manual Skills

1

2

3

4

Biofeedback

Acuscope

Continuous passive motion machine

Craniosacral therapy

Diathermy

Electro-acupunture

Extremity mobilization

Fluidotherapy

Hot/coldpacks

Hydrotherapy

Hubbard tank

Therapeutic pool

Whirlpool

Massage

Muscle energy techniques

Muscle stimulation

Myofascial release techniques

Neuro probe

Spinal mobilization

TENS

Therapeutic exercise/home programs

Traction

Cervical

Lumbar

Ultrasound

Vasopneumatic devices

Wound dressing

Strain/counter strain techniques

Paraffin

Prosthetics/Orthotics

1

2

3

4

Above knee prosthetics

Ankle foot orthosis

Below knee prosthetics

Dynamic splints

Gait analysis

Orthoplast/aquaplast

Serial/inhibitory casting

Static splints

Upper extremity prosthetics

Pediatrics

1

2

3

4

Cerebralpalsy

Early intervention

Equipment assessment

Activities of daily living

Adaptive

Gross motor assessment tools

Learning disabled

Mental retardation

Neurodevelopmental treatment

Orthotics

Spina bifida

Computerized Testing

1

2

3

4

Fatigue-characteristics

Fiber-type

Functional strength

Net muscular torque

ROM

Work-capacity

Other

1

2

3

4

Burn management

Cardiac rehabilitation

Chest physiotherapy

Computerized charting

Geriatrics

Inservice education

Wheelchair/equipment assessment

Work capacity evaluation

AGE SPECIFIC PRACTICE

1

2

3

4

Newborn/Neonate (birth - 30 days)

Infant (30 days - 1 year)

Toddler (1 - 3 years)

Preschooler (3 - 5 years)

School age children (5 - 12 years)

Adolescents (12 - 18 years)

Young adults (18 - 39 years)

Middle adults (39 - 64 years)

Older adults (64+)

Certification

BCLS

CPR

Computerized Charting System

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