[checklist name="Physical Therapist Skills Checklist" mailto="credentialing@teemagroup.com" templatedoc="1OUc15TbFrtOHcwpOOBIpJtsYYsEaTa73FBWLy2z9NbY" templatedrive="1LG9WAg21_L3L-ZkZEChBzrYRhBOjpmcc" savedrive="15FFQjDXxe9nC9FkAAcuxbswGy1hq4sWm" sheetid="1xJkggLvktsyYL6zuIhdO-OURJhJTkWdDKunR11agspw"] [checklistHeading title="Physical Therapist Skills Checklist"] Please rate your experience / frequency (within the last year) using the scale (check the appropriate boxes below) 0 = No theory and/or experience 1 = Limited experience/need supervision and/or support 2 = Experienced/minimal support needed to perform 3 = Proficient/can perform independently 4 = Expert/very experienced in the field [/checklistHeading] [checklistInputGroup name="Recruiter Information"] [checklistInput type="date" default="none"]Submit Date[/checklistInput] [checklistInput type="text"]Recruiter TEEMA email[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Personal Information"] [checklistInput type="text"]Full Name[/checklistInput] [checklistInput type="email"]Your Email[/checklistInput] [checklistInput type="text"]Your phone number[/checklistInput] [checklistInput type="text"]Last 4 of Social Security Number[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Skills Orthopedics"] [checklistInput type="scale"]Neck Injury[/checklistInput] [checklistInput type="scale"]Back Syndromes[/checklistInput] [checklistInput type="scale"]Hand Injury[/checklistInput] [checklistInput type="scale"]Arthritis Programs[/checklistInput] [checklistInput type="scale"]Total hip/knee replacement[/checklistInput] [checklistInput type="scale"]Total joint replacement/upper extremities[/checklistInput] [checklistInput type="scale"]Hip Fractures[/checklistInput] [checklistInput type="scale"]Transmandibular joint dysfunction[/checklistInput] [checklistInput type="scale"]Mobilization techniques[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Skills Neurological"] [checklistInput type="scale"]Stroke rehabilitation[/checklistInput] [checklistInput type="scale"]Adaptive Equipment[/checklistInput] [checklistInput type="scale"]Functional splinting[/checklistInput] [checklistInput type="scale"]Head Trauma[/checklistInput] [checklistInput type="scale"]Neurosurgery[/checklistInput] [checklistInput type="scale"]Spinal Cord Injury[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Skills Sports Medicine"] [checklistInput type="scale"]Bracing/joint immobilization[/checklistInput] [checklistInput type="scale"]Biodex[/checklistInput] [checklistInput type="scale"]Cybex[/checklistInput] [checklistInput type="scale"]LIDO[/checklistInput] [checklistInput type="scale"]Orthotron[/checklistInput] [checklistInput type="scale"]Nautilus/Eagle[/checklistInput] [checklistInput type="scale"]Taping/Strapping[/checklistInput] [checklistInput type="scale"]Strength and endurance training[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Modalities / Manual Skills"] [checklistInput type="scale"]Acuscope[/checklistInput] [checklistInput type="scale"]Biofeedback[/checklistInput] [checklistInput type="scale"]Continuous passive motion machine[/checklistInput] [checklistInput type="scale"]Cryotherapy[/checklistInput] [checklistInput type="scale"]Diathermy[/checklistInput] [checklistInput type="scale"]Craniosacral therapy[/checklistInput] [checklistInput type="scale"]Electro-acupuncture[/checklistInput] [checklistInput type="scale"]Extremity mobilization[/checklistInput] [checklistInput type="scale"]Fluidotherapy[/checklistInput] [checklistInput type="scale"]Hot/Cold packs[/checklistInput] [checklistInput type="scale"]Hydrotherapy[/checklistInput] [checklistInput type="scale"]Hubbard Tank[/checklistInput] [checklistInput type="scale"]Therapeutic pool[/checklistInput] [checklistInput type="scale"]Whirlpool[/checklistInput] [checklistInput type="scale"]Massage[/checklistInput] [checklistInput type="scale"]Muscle Energy Techniques[/checklistInput] [checklistInput type="scale"]Muscle Stimulation[/checklistInput] [checklistInput type="scale"]Myofascial release techniques[/checklistInput] [checklistInput type="scale"]Neuro Probe[/checklistInput] [checklistInput type="scale"]Paraffin[/checklistInput] [checklistInput type="scale"]Spinal Mobilization[/checklistInput] [checklistInput type="scale"]Strain/counter strain techniques[/checklistInput] [checklistInput type="scale"]TENS[/checklistInput] [checklistInput type="scale"]Therapeutic exercise/home programs[/checklistInput] [checklistInput type="scale"]Traction[/checklistInput] [checklistInput type="scale"]Cervical[/checklistInput] [checklistInput type="scale"]Lumbar[/checklistInput] [checklistInput type="scale"]Ultrasound[/checklistInput] [checklistInput type="scale"]Wound Dressing[/checklistInput] [checklistInput type="scale"]Vasopneumatic devices[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Prosthetics/Orthodics"] [checklistInput type="scale"]Above knee prosthetics[/checklistInput] [checklistInput type="scale"]Below knee prosthetics[/checklistInput] [checklistInput type="scale"]Upper extremity prosthetics[/checklistInput] [checklistInput type="scale"]Ankle foot orthosis[/checklistInput] [checklistInput type="scale"]Dynamic Splints[/checklistInput] [checklistInput type="scale"]Static Splints[/checklistInput] [checklistInput type="scale"]Gait analysis[/checklistInput] [checklistInput type="scale"]Resting Splints[/checklistInput] [checklistInput type="scale"]Orthoplast/aquaplast[/checklistInput] [checklistInput type="scale"]Serial/inhibitory casting[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Computerized Testing"] [checklistInput type="scale"]Fatigue-characteristics[/checklistInput] [checklistInput type="scale"]Fiber-type[/checklistInput] [checklistInput type="scale"]Functional strength[/checklistInput] [checklistInput type="scale"]Net muscular torque[/checklistInput] [checklistInput type="scale"]ROM[/checklistInput] [checklistInput type="scale"]Work-Capacity[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Other Skills"] [checklistInput type="scale"]Burn Management[/checklistInput] [checklistInput type="scale"]Chest physiotherapy[/checklistInput] [checklistInput type="scale"]Cardiac Rehabilitation[/checklistInput] [checklistInput type="scale"]Functional capacity evaluation[/checklistInput] [checklistInput type="scale"]Geriatrics[/checklistInput] [checklistInput type="scale"]Inservice Education[/checklistInput] [checklistInput type="scale"]Wheelchair/equipment assessment[/checklistInput] [checklistInput type="scale"]Work capacity evaluation[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Pediatrics"] [checklistInput type="scale"]Early intervention[/checklistInput] [checklistInput type="scale"]Cerebral Palsy[/checklistInput] [checklistInput type="scale"]Equipment assessment[/checklistInput] [checklistInput type="scale"]Activities of daily living[/checklistInput] [checklistInput type="scale"]Adaptive[/checklistInput] [checklistInput type="scale"]Gross motor assessment tools[/checklistInput] [checklistInput type="scale"]Learning Disabled[/checklistInput] [checklistInput type="scale"]Mental retardation[/checklistInput] [checklistInput type="scale"]Neurodevelopmental treatment[/checklistInput] [checklistInput type="scale"]Orthotics[/checklistInput] [checklistInput type="scale"]Spina bifida[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Age-Appropriate Care of"] [checklistInput type="scale"]Newborn (birth - 30 days)[/checklistInput] [checklistInput type="scale"]Infant (31 days - 1 year)[/checklistInput] [checklistInput type="scale"]Toddler (1 - 3 years)[/checklistInput] [checklistInput type="scale"]Preschooler (3 - 5 years)[/checklistInput] [checklistInput type="scale"]School Age (5 - 12 years)[/checklistInput] [checklistInput type="scale"]Adolescents (12 - 18 years)[/checklistInput] [checklistInput type="scale"]Young Adults (18 - 39 years)[/checklistInput] [checklistInput type="scale"]Middle Adults (39 - 64 years)[/checklistInput] [checklistInput type="scale"]Older Adults (64+ years)[/checklistInput] [/checklistInputGroup] [checklistFooter] [/checklistFooter] [/checklist]